Healthy Food & Healthy Living by Dr. Ayala

Battle of the diets: Which is best for your heart?

Misinformation is a common problem when it comes to diet advice – it spreads through diet books, blogs and social media outlets such as TikTok, Instagram and Twitter. According to Christopher D. Gardner, the director of nutrition studies at the Stanford Prevention Research Center, misinformation has reached critical levels, leading to widespread confusion about what we should eat to prevent disease and promote health.

To help us make sense of the barrage of diet messages we receive, a team of scientists, cardiologists, health experts and dietitians headed by Gardner evaluated common diet plans to determine how they comply with evidence-based guidelines for promoting heart health. Their findings appear in the journal Circulation.

So let’s start with what we know promotes heart and metabolic health: We should eat plenty of vegetables and fruit, prefer whole to refined grains, choose healthy proteins, mostly from plants, but also from fish and seafood, and if consuming meat and poultry avoid processed and fatty forms, prefer plant oils to animal and tropical oils, limit ultra processed foods, minimize sugary drinks and foods with added sugars, and moderate alcohol intake.

The best and the worst

The panel identified 10 popular diet plans. These include (1)  DASH  (Dietary  Approaches  to  Stop  Hypertension)-style, (2) Mediterranean-style, (3) pescetarian,  (4)  ovo/lacto-vegetarian,  (5)  vegan,  (6)  low-fat,  (7)  very low-fat, (8) low-carbohydrate (including Zone, South Beach, low glycemic), (9) Paleolithic (Paleo), and (10) very low-carbohydrate/ketogenic patterns (which includes Atkins and the ketogenic diet). For the several vegetarian style diets the researchers considered optimal versions of the diets – chips and soda are vegan, yet don’t represent a plant-based diet, as eating more plants is a central tenet of this food philosophy. Same applies to the other diet plans.

They then compared these popular diets to the ideal diet as defined by the American Heart Association’s dietary guidelines. Diets were ranked using a 0-100 point system.

And the results: 

The best diets are Mediterranean, DASH-Style, pescetarian, and ovo/lacto-vegetarian diets. They score high (above 85 points) because they emphasize vegetables, fruit, whole grain, healthy oils and moderate alcohol intake. They are also flexible, providing a wide range of choices. They also score high on sustainability, and have a lower environmental impact.

The lowest scoring diets: Paleo diets and very low carb/ketogenic diets with a score of under 55 points. Following these diets doesn’t align as well with dietary guidelines. These diets are promoted for weight loss and the notion that carbs are bad is widespread, but painting carbs with a broad brush eliminates healthy carbs, such as fruits, vegetables, legumes and whole grains, the cornerstone of a healthy diet. So although the Atkins and keto diet restrict some foods that should be limited, such as added sugar and refined grains, they miss the point on many other healthy, whole, fiber-rich plant based carbs, and introduce lots of animal products and fatty meats.

Taking the long view

Although the ketogenic and low carb diet may curb appetite and lead to short term weight loss, they’re not a good long-term plan. These diets often increase “bad” cholesterol levels, which can elevate the risk of heart disease, they impose a strain on the kidneys, and they’re difficult to maintain long term due to their restrictiveness. “A diet that’s effective at helping an individual maintain weight loss goals, from a practical perspective, needs to be sustainable,” says Gardner.

The Keto and paleo diets not only have a lower dietary quality, they also have a higher carbon footprint according to a recent study in the American Journal of Clinical Nutrition. The keto diet, which is a high-fat low-carb diet, is estimated to produce almost 3 kg of carbon dioxide for every 1,000 calories of food. The paleo diet, which prioritizes meats, nuts and vegetables, emits 2.6 kg of carbon dioxide for every 1,000 calories. A vegan diet, on the other hand, generates 0.7 kg of carbon dioxide per 1,000 calories – less than a fourth of a keto diet.

Common sense would suggest that it’s moderation that’s key to a sustainable, healthy diet. 

The sensible, practical, socially acceptable diet plan you can keep long term is the most promising plan for weight control and for wellness. 

Dr. Ayala

 

The diet that keeps you young

Age’s just a number, goes the saying, years since birth don’t accurately predict ability, health or how much time’s left. 

Lifestyle often does. Eating well and being active are linked with lower incidence and later-in-life occurrence of chronic diseases such as heart disease, cancer, diabetes and stroke, and with greater likelihood of survival into old age.

How does food increase longevity? There are many mechanisms in which your diet can affect disease, as certain foods affect lipid profiles, sugar metabolism and inflammation, for instance, and all these play a role in disease onset and progression. 

Genetic makeup also predicts disease and lifespan.

Can food change our genes? Diet of course doesn’t change our coded DNA sequence, but diet can modify genes’ expression: which genes are more active and which are suppressed. This fascinating field of study is called epigenetics. Gene expression can be controlled through chemical changes such as methylation, the addition of a methyl group to the DNA chain in an area that doesn’t code for the gene itself. Methylation can occur in many places, and thousands of these sites are known to be correlated with aging, acting like “clocks”, which predict biological age, chronic diseases and mortality. People whose epigenetic age is older than their chronological age are thought to be biologically older and at greater risk of disease, while those with young epigenetic ages are at lower risk.

Diet and lifespan

A new study in the American Journal of Clinical Nutrition looks at the diet and at the methylation patterns of almost 2700 women. Diet quality was assessed in reference to four recommended healthy diet indexes, such as the DASH (Dietary Approaches to Stop Hypertension) and the Alternative Mediterranean Diet.

And the results: Higher diet quality was strongly inversely linked with two widely recognized epigenetic clocks that predict mortality – better diets predicting long lives and younger biological age. The authors conclude: “In summary, we found that healthy eating patterns are associated with some methylation-based measures of biological age. The benefits of healthy eating appear to accrue particularly in women reporting lower levels of physical activity. These findings support the hypothesis that a higher diet quality may slow aging and lower disease and mortality risks.”

Another recent study, including 2000 people, also looked at the overall diet quality using a DASH score, and at methylation profiles using 3 different verified epigenetic aging measures. The DASH score evaluates the intake of dietary components giving high scores for consuming more vegetables, fruit, nuts, legumes, whole grains and low-fat dairy, and for consuming less red and processed meat, sugary drinks, sweets and salt. The study demonstrated that higher diet quality was associated with slower aging according to the methylation epigenetic scores. What’s more, during the 10-year follow up in this study 297 participants died, and both a lower DASH score and the three epigenetic age acceleration measures were significantly associated with all-cause mortality. 

Several other studies look at how certain foods change methylation patterns, suggesting that high intake of plant-based foods slows the clock, that high intake of poultry predicts an accelerated aging, as does red meat. A study of 120 people aged 65-79 year showed slower epigenetic aging when people ate a Mediterranean-style diet for a year.

Anti-aging from within

Anti-aging skin care routines promise young looking skin (the most proven anti aging skin treatment however is ultraviolet radiation avoidance and blocking) and longevity supplements promise death defying miracles – without much evidential support.

But we actually know that certain habits are linked with delayed aging, disease and death. Chief among them are eating well, exercising, avoiding smoking and nurturing social ties. It’s not as  easy as taking a pill or a potion, and you need to stick to it long term.

What does eating well mean? There are very many ways to eat healthfully, and all of them center on emphasizing whole plant-based foods (vegetables, fruits, nuts, legumes, whole grains) and minimizing highly processed foods (fast-food, processed meats, sugary drinks). 

Dr. Ayala

Two proven ways to halt aging and disease

A milestone birthday, a forehead wrinkle and a temporary bout of morning stiffness lead many to seek all kinds of creams, supplements and regimens in search of lasting youth. Less hopeful individuals sigh and accept these as a sign of inevitable decline.

There’s no sound scientific support for those youth-in-a-bottle miracles.

There is, however, plenty of evidence that the decline and disease associated with age can be dramatically altered.

Several metabolic risk factors are known to lead to type 2 diabetes, heart disease and cognitive decline: abdominal obesity, high blood pressure, abnormal lipid profile, insulin resistance and high blood sugar. The clustering of three of these metabolic risk factors (abdominal obesity measured by waist circumference, elevated blood glucose at fasting, high blood pressure, unfavorable cholesterol and high triglycerides) is defined as the metabolic syndrome. And these risk factors, when present in people’s thirties, forties and fifties, can lead to deteriorating health later in life.

Age-associated diseases are lifestyle dependent

These risk factors, however, are highly amenable to lifestyle choices. Diet and exercise are super important. Many studies show that adhering to a healthy diet lowers the risk of the metabolic risk factors of disease mentioned above. Many studies prove that exercising regularly, and avoiding a sedentary lifestyle help prevent this myriad of metabolic risks. 

And now, a new study in the Journal of the American Heart Association looks at the effect of each modality, and, more importantly, at the protection they offer when combined.

The researchers followed almost 2400 people aged 18 and up from the Framingham Study, looking at their adherence to diet and exercise recommendations. Physical activity was assessed by wearing an accelerometer for eight representative days, to assess moderate and vigorous physical activity. Diet was assessed by questionnaires, and compared to the recommended Dietary Guidelines for Americans.

Among the participants, only 28 percent followed both diet and exercise, while almost half followed just one of them, diet or exercise.

When the participants achieved the desired minimum of 150 minutes of moderate to vigorous activity per week, the risk of metabolic syndrome was reduced by half. 

When the participants adhered to the dietary guidelines, the risk of metabolic syndrome was reduced by a third.

Metabolic syndrome risk was 65 percent lower in people who adhered to both fitness and diet recommendations!

And for all these lifestyle choices, there's a dose response link: the more people exercise and the better they eat, the better the outcome.

Bear in mind that this study doesn’t define adherence to a healthy lifestyle too ambitiously. Two and a half hours of moderate to vigorous activity per week and eating according to the American Dietary Guidelines – which are no more than a sensible dietary pattern that emphasizes nutritious choices, while allowing moderate amounts of pretty much everything else – isn’t a tall order.

While according to this study you don’t need to be a health fanatic to reduce your risk of disease, we know that sadly, very few American’s eat well and exercise, and metabolic health is pretty rare in the US. According to a recent study of 9000 Americans whose metabolic health was assessed by measuring five parameters (blood pressure, waist circumference, fasting blood glucose, triglycerides and cholesterol) only 1 in 8 people had optimal levels of all five.

Joyful prevention 

We’ve been focusing on lowering our disease risk at considerable sacrifice this year – preventing Covid-19 spread kept us to ourselves and six feet apart for more than a year.

Now that we’ve been practicing preventive measures to improve our health, here’s some good news: The measures needed for keeping our arteries and brain supple don’t involve the type of deprivation we engage in to prevent Covid-19 spread. They don’t involve isolation; quite the contrary! Most exercise activities can be social, and usually keep you social with the sort of people that will keep you young. And eating healthfully can be super delicious – look at the Mediterranean Diet with all its mouthwatering fresh delights, look at the colorful bounty of the markets.

Dr. Ayala

What’s more important, ideal weight or eating right?

Obesity and a poor diet are both established risk factors for a long list of chronic diseases and for early death. Obviously, it’s recommended to maintain a normal body weight and to eat a healthy diet. 

But if you had to choose one over the other, which is more important?

Here’s why the question is relevant: Losing weight and keeping that weight off are a very difficult task, one that only ten percent of dieters manage to stick to long-term, no matter how strong their will power. Does a healthy diet compensate for the adverse effects of the extra weight? 

And here’s the other reason why this question is pertinent: People often dismiss advice to improve diet quality since they think that their normal weight status protects them from heart disease and other ailments. They believe that unhealthy diets increase risk only through obesity. Is an unhealthy diet indeed compensated for if you’re sufficiently thin?

To address this question, a new study in PLOS Medicine looked at the longevity of a large cohort of about 80,000 representative Swedish people, aged 45-83 years, for a mean of 17 years. The participants’ diet was scored against a modified Mediterranean diet, which looks at eight components: fruit and vegetables, legumes (such as peas, lentils and beans) nuts, unrefined or high-fiber grains (such as whole-wheat bread, oatmeal), fermented dairy products (such as yogurt, and cheese), fish, red and processed meat, olive or rapeseed oil, and alcohol intake.

Thin isn’t everything

And the results: People with obesity, who adhered to a Mediterranean diet, did not have a higher overall mortality rate usually associated with a high BMI. On the other hand, a normal BMI did not protect those eating lower on the Mediterranean-like diet from early death.

The authors claim that theirs is the first study to look at the combined effect of BMI and a Mediterranean-like diet on mortality rates. The correlation between obesity and premature death was, however, shown in other studies, and the link between a Mediterranean style eating pattern and good health and longevity is also quite established.

The author’s conclusion: “Obese individuals adhering to a Mediterranean diet did not have an increased mortality in comparison to more lean individuals. In contrast, a lean BMI did not offset a poor diet.”

Obesity rates in the US are sky high – 40 percent of adults and almost a fifth of our kids are obese. For the sake of weight loss, people often select foods they know do not promote health – low-calorie highly-processed foods and drinks for instance. This may not be a wise choice.

Improving diet quality should be a more achievable and worthy goal, even as we also try to reverse our worrying obesity rates.

So rather than obsessing over the number on the scale, first focus on what you eat and how you feel. A healthy diet is an independent factor – much like exercise – that protects at any weight level, while an unhealthy one ads to your risk even if you’re not overweight.

Dr. Ayala

 

A tasty addition may help fight inflammation, even when you indulge

Immunity’s on our minds as we’ve altered our lives to deal with the Covid-19 pandemic. Inflammation is critical to the immune response to this virus, but we’re also hearing about cytokine storms and exaggerated immune reactions. We’re learning that sometimes an overactive immune reaction causes severe illness – that can be even worse than the virus itself. Inflammation is both friend and foe.

Inflammation isn’t just at the center of our reaction to infectious diseases though. Chronic low-grade inflammation can happen when we’re not attacked by invaders, and it recruits chemicals and cells that damage arteries and build plaque; it’s a likely major mechanism of many chronic diseases including heart disease, cancer, depression, Alzheimer’s, arthritis, and it can age you prematurely.

One of the ways you can help your body mediate inflammation is through your food choices. An anti-inflammatory diet resembles a classic Mediterranean diet – it’s rich in fruits, vegetables, spices and herbs, whole grains, legumes, garlic, onion, olive oil and fish, it’s low in red meat, refined grains, highly processed foods and sugary drinks. Metabolically healthy people can deal with nutritional indiscretion quite well, but people at risk of metabolic syndrome are already prone to chronic inflammation, and eating a pro-inflammatory meal exacerbates the situation. Unfortunately, metabolic health isn’t common – just 12 percent of US ­adults are in optimal metabolic health.

So what if you still want that occasional burger with French fries? Can you make it less inflammatory by adding anti-inflammatory foods to the pro-inflammatory ones is the meal?

Improving an inflammatory meal

A new randomized controlled study from Penn State University, published in the Journal of Nutrition, tests this idea.

The study recruited twelve men aged 40-65 years who were overweight or obese, and had at least one risk factor for heart disease. The participants ate three versions of 1000 calorie meals of coconut chicken curry, a corn muffin, and a cinnamon biscuit for three days and in a random order: one had no spices and herbs added, one had two grams of the spices and herbs, and the third meal had 6 grams, amounting to 1-2 teaspoons of the blend. Blood was drawn before the meal, and hourly in the 4 hours after the meal, and tested for inflammatory cytokines. (Cytokines mediate our immune reactions, recruiting inflammatory cells, stimulating the movement of cells towards sites of inflammation, and changing the behavior of blood vessels.)

The spices and herbs blend contained basil, bay leaf, black pepper, cinnamon, coriander, cumin, ginger, oregano, parsley, red pepper, rosemary, thyme, and turmeric.

White blood cells were also cultured and stimulated to respond to an inflammatory stimulus, resembling what could happen if the body’s attacked by a pathogen such as a virus.

And the results: Inflammatory cytokines were significantly reduced with the addition of 6 grams of herbs and spices.

This is a small study, but the antioxidant and anti-inflammatory activities of certain spices and herbs have been shown before, for instance: A study of turmeric in adults with obesity reduced the cytokines IL-1β and IL-4, and ginger has been shown to reduce circulating inflammatory markers in people with type 2 diabetes. Additional studies will help test this hypothesis.

But we already have excellent reasons to add herbs and spices to our food: they add flavor (without adding calories, sugar, fat and salt), make food more interesting, and transport us to faraway places – at least in our mind. 

Dr. Ayala

For 2020, take an upgrade

It’s a new year, a good time to improve upon old habits. We humans are amazing in our endless desire to work towards a better self and a better future, but most resolutions are hard to keep, because resolve is in short supply. Instead, I suggest picking a goal that will enhance your life and elevate your sense of wellbeing almost straightaway.

A few suggestions:

Do some yoga

Yoga is great practice for your body and your mind, and although I don’t think everyone needs yoga in their lives, I think that it can enhance the life of anyone who gets into it. Seriously.

The reason I’m mentioning yoga now is because I have a low-cost/almost free plan for you ­– I know, access to a yoga studio and time for full sessions is a luxury not everyone has, and the pre-recorded TV sessions are repetitive and hard to follow in my humble opinion.

I finally found the app that makes yoga practice easy to start, easy to follow (you can place your phone where you can see it), customizable, and extremely variable in both practice and music – you get a new sequence and playlist practically every session. It’s called Down Dog and it's available for all devices. The app is free to download and is free of ads; subscriptions are $34.99 year when bought through the website, there’s a new year's sale going on now: $19.99 / year, (60% off the in-app price.) They also offer financial aid; send a note to [email protected] explaining your circumstances and the good people at Down Dog may give you a long free trial.

Eat less meat

Although the Golden Globes 2020 served a totally animal-products free meal, the world isn’t going vegan, not anytime soon, and I’m not suggesting you giving up foods you love as an upgrade.

What I do think we can all do with little sacrifice is eat less meat. It’s absolutely clear that our current food system is a major contributor to climate change. A UN climate-change report, compiled by 100 experts from around the world, includes dire predictions, and a policy recommendation to reduce meat consumption. It’s also quite clear that eating a more plant-based diet can improve your health.

Eating less meat has become much easier, and it’s super fashionable.

And the best way to go about it is to focus on what you can eat more of, because as you clear some space on your plate you’re going to load it with colorful veggies, whole grains, pulses and beans, nuts and seeds, aromatic spices and herbs and sweet fruit.

Perhaps a better name for this goal is Eat More Plants. And while you’re at it, remember that there’s plenty of vegan junk food out there. The benefits of plant-based diets are seen with whole plant-based foods, not with highly processed animal-product-free ones.

Give eating a (short) rest

Another current trend for weight loss and fitness is Intermittent Fasting, which at its severe end can’t be any fun. 

Time restricted eating – the practice of consuming daily meals within a limited time window that can range anything from 3 to 14 hours – is often lumped together with Intermittent Fasting. When the window narrows to just 3 hours it does resemble intermittent fasting, but when the window is 10-14 hours it actually resembles what life used to be like for most of humanity until just recently.

Studies show that longer nighttime food abstinence, with meals spread to 10-12 hours of the day, lead to an involuntary and effortless cut in calories and to weight loss.

Try for a 10-14 hour window with no food overnight. Brush your teeth after dinner – that seals the day’s meals, and if you’re like me, sheer laziness about brushing shuts my appetite – see what happens.

Go outside

I believe we need contact with nature for our wellbeing. Every child and every dog demands a steady dose of this powerful elixir, yet too many people deny themselves this essential pleasure. I know this to be true, and there’s also plenty of evidence that greener living circumstances are associated with better health: It lowers the risk of heart disease, obesity, diabetes, asthma, anxiety and early death. It’s even been shown that fewer kids need corrective glasses when there are more green open spaces in the neighborhood.

Find your green spaces and visit them, frequently.

Drink less sugar

Sweet drinks pack lots of calories, and tend to go uncounted and unnoticed.  Choose water, sparkling water, or other non-caloric non-sweet drinks. Sugary drinks should be a rare special occasion treat. This little tweak will shave your added sugar tally and will benefit your health.

Have a peaceful and healthy 2020!

Dr. Ayala

Not all plant-based is created equal

Whether you’re seated in a restaurant, scrolling social media feeds, or walking the supermarket aisles, the term “plant-based” will hit you soon enough. It’s everywhere.

Health professionals have been recommending a plant-based or a plant-forward eating pattern – foods that comes mostly from plants – for many decades. The recent plant-based trend explosion, however, is fueled by the meatless burger revolution. Demand for Beyond Meat and Impossible Burger patties has skyrocketed, and Beyond Meat’s IPO was incredibly successful. These products look and taste like meat, and enable people to eat a vegan burger with little sacrifice.

Which is good news for animals, as fewer cows will be factory farmed and slaughtered. It’s also very good news for the environment – raising cattle is a huge drain on land and energy resources, and destroys the ecosystem.

Now that plant-based hamburgers have become mainstream and can be found in fast-food joints and college campuses, are we also going to see a boon to public health?

Plant-based for health

Recommendations for plant-based diets are based on large studies– very many of them – that find that plant-centered and Mediterranean style eating patterns correlate with good health. Vegetarian and Mediterranean eating patterns are associated with reduced risk of heart disease, type 2 diabetes, hypertension and certain cancers, and also with lower rates of obesity and a longer life.

These eating patterns have a wide range of adherence and animal-product avoidance, but generally they focus on fruits, vegetables, nuts, seeds, whole grains, beans, and legumes. When health professionals recommend a plant-centered diet what they’re talking about is a healthy plant based eating pattern, or a whole-foods plant-based diet.

Because not all foods of plant origin are healthy: Potato chips and soda are perfectly vegan, and obviously not good for you.

And since meat avoidance, in and of itself, doesn’t tell us enough about what people actually eat, we need to look at studies that grade plant-based diets according to their healthfulness.

A new study in the American Journal of Clinical Nutrition looks at data from large cohorts such as the Nurses Health Study and the Health Professionals Follow-up, including almost 130,000 people, to see if plant-based diets affect weight gain. Overweight and obesity are important risk factors for many chronic ailments, therefore the link between plant-based diets and weight is an important health measure.

The researchers look at three indexes of plant-based diets. The first is an overall plant-based index, in which plant-based foods receive a positive score, and animal foods receive a negative one. The other two are subcategories of the first one: healthful plant based (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) receive positive scores, less healthy plant foods (sweetened beverages, refined grains, potatoes, sweets/desserts) and animal foods received reverse scores, and unhealthful plant-based (sugary beverages, refined grains, potatoes and desserts receive positive scores and healthy plant-foods and animal foods receive negative ones).

The cohorts were followed for over 20 years, during which participants gained on average 2 to 4.5 pounds every 4 years. Diets that were more plant-based ameliorated weight gain. But not all plant-foods and meat avoidance are the same – weight gain differed greatly among the subgroups. People who ate a more healthy plant based diet gained 1.5 pounds less. People who ate an unhealthy plant-based diet gained about 1 pound more.

The same group of researchers previously reported similar findings when studying type 2 diabetes: Overall high plant-based diets and especially healthy plant-based diets were linked with lower the risk of diabetes. Unhealthy plant-based diets, however, were actually associated with higher rates of type 2 diabetes.

What about heart disease? Again, although, overall, sticking to a more plant-based diet seems to be protective, when you look at subgroups of plant-based patterns the picture is different: Healthier plant-based diets are linked with lower heart disease risk, and unhealthy plant-based foods with higher risk.

Far from the tree

Meat manufacturers argue that meatless burgers shouldn’t be called meat; wholesome plant-based diet advocates could argue that they’re hardly a plant, either.

Calling these products plant-based takes advantage of the health halo attached to this term, and applying it to what's actually a highly processed food product, one whose plant origins are pretty distant.

Don’t get me wrong, I welcome these meat alternatives, I’m thrilled by their success; their benefit to animal welfare and the environment is reason enough to support them.

But to actually reap the benefits of a plant-based diet you’ll need to do more than replace your burger with a meatless alternative.

Dr. Ayala

Can healthy food improve your mental health?

Depression is a common and serious disorder, and while its causes are multiple and complex, diet may also play a role.

Inflammation has been implicated in many diseases, depression among them. Inflammation is the body’s beneficial defense from injury and infection by invaders such as bacteria and viruses. On the other hand, chronic low-grade inflammation in the absence of attack or threat is harmful and can lead to serious trouble – it has been linked with heart disease, cancer, Alzheimer’s, arthritis, premature aging and also depression.

The inflammation-depression connection is a fascinating discovery that is gaining ground. Previous research has shown that inflammatory cytokines – substances such as interferon and interleukin that are secreted from immune system cells when those are activated or when they are used as drugs – can trigger major depression. There have been several studies that show improvement of depression symptoms when inflammation is controlled, either with drugs or with and an anti-inflammatory diet. A recent large prospective study published in the Journal of Nutrition found that an anti-inflammatory diet lowered the risk of depression, especially in men.

Can you modify the risk of depression by changing your diet?

A new meta-analysis in Public Health Nutrition gathered the findings of four studies, including about 50,000 people, to see if the inflammatory potential of their diet is linked with developing depression.

The tool used in this and in most research of pro- and anti-inflammatory foods is the Dietary Inflammatory Index. The index is based on thousands of scientific articles, which enabled scoring of every food and nutrient.

The researchers found that a pro-inflammatory diet was associated with a higher incidence of depression, and that people eating diets with the highest inflammatory score had a 23 percent higher risk of developing depression.

Foods that protect mood

The anti-inflammatory diet shows promise. So should we get a copy of the Dietary Inflammatory Index and post it on the fridge? Here’s what the index tells us:

Foods and nutrients that have strong anti-inflammatory activity include certain spices and seasonings: turmeric, fiber, tea, wine, ginger; phytochemichals in plant-foods – flavones, flavonols, flavonones, anthocyanidins, isoflavones. They also include vitamins such A, E, D, C, and many from the B family, magnesium, mono and poly unsaturated fats, and omega-3 fats.

Foods and nutrients with pro-inflammatory activity include total fat, saturated fat, trans-fat, protein, refined carbs and iron.

This list, you’ll agree, is not particularly practical and doesn’t sound like a fun way to eat. Luckily, the index is pretty easy to internalize since it pretty much follows a pattern that you may find familiar.

The personification of a pro-inflammatory diet is a stereotypical American diet – low on fruits and veggies, high on highly processed food, meat, refined grain, desserts and sugary drinks.

The epitome of an anti-inflammatory diet would be a classic Mediterranean diet – a diet that highlights vegetables, fruit, spices and herbs, whole grains, garlic, onion, olive oil, fish and wine.

Another way to look at it: A healthy diet – which happens to also score as a low inflammatory diet – might protect from depression and ease its symptoms.

Again, depression is a complex and a very serious disease, its treatment usually requires many modalities, concurrently, and these studies are quite preliminary.

But since we already know that a healthy diet mitigates the risk of so many diseases, a low-inflammatory diet is already worth trying even without conclusive proof. It may also help fight depression. To do so, crowd your plate with foods that fight inflammation: veggies, fruits, whole grains, spices, herbs, nuts. Enjoy these, and there’ll be less room for pro-inflammatory foods such as soda, refined carbs, fried foods, red and processed meat.

Dr. Ayala

A useful trick for eating healthier

What’s the perfect diet? We’ll probably never agree on that, nor is it likely that there’s just one optimal eating pattern, or that it fits everybody.

But there’s little doubt about this: A shift towards eating more plants and less meat will benefit your personal health and is more sustainable for the planet.

The Western diet – high in animal protein and low in plant-based food – is linked with chronic diseases: Obesity, type 2 diabetes, heart disease and cancer. Feeding plant crops directly to people is far more efficient, and the meat industry is a major contributor to greenhouse gasses, land deforestation, water contamination and environmental degradation.

Although interest in plant-based diets is rising, few people actually choose to adopt a vegetarian diet – just 5 percent of Americans avoid meat altogether. But if more people would shift a little towards plants and little away from meat it could make a big difference for both public health and preserving our environment.

One way to replace meat with plant-based protein is the booming market of plant based meat substitutes. Companies like Beyond Meat make products that imitate meat’s flavor and texture.

Another option is to simply replace part of the meat with legumes and vegetables in their original state. Dishes and recipes that combine meat with other ingredients are common to many cuisines, and shifting the proportions of meat to veggies might be a practical way to achieve this goal.

A new study in the journal Appetite tested students’ reception of lower-meat, more-plant dishes in a college setting. The research, led by Molly Spencer, included 150 California students.

Taking away two thirds of the meat

The students were tested three separate times, and were served three different burrito bowls, while not knowing which sample they were eating. The “control” burrito bowl had 60 percent meat (beef), 20 percent legumes, and 20 percent veggies, and was accompanied with mild salsa and layered on a bed of flour tortillas. The test bowls both had lower meat: 20 percent meat, 40 percent legumes, and 40 percent veggies. One of the lower meat bowls had mild salsa, and the other one had spicy salsa, and both were served with the same flour tortillas as the control. Both low meat bowls had a healthier nutrition profile: fewer calories, less salt and saturated fat, more fiber, potassium and vitamin C. The researchers studied student’s acceptance and opinion of the three dishes.

And the results: The students liked all three versions. The low meat bowls were just as appealing in texture and flavor, and just as satiating and filling. The students said they were equally likely to select any of the three preparations.

Interestingly, there were more complaints of “too much” about the legumes (beans) than the veggies in the lower meat dishes, and similarly, in the high meat dish, more people complained about “too little” of the veggies, rather than the beans. Veggies were more popular than beans, and this isn’t the first study to show that.

And what about spiciness? The spicier dish was perceived as a little saltier, a little more complex.

Shifting towards plant foods

Many healthy cuisines are plant-rich without avoiding animal products. The typical Mediterranean diet contains meat, but the meat is more of a flavoring, a condiment, than the majority presence on the plate. The Mediterranean traditional eating pattern is characterized by high consumption of fruit, vegetables, herbs, spices, legumes and complex carbs, moderate consumption of fish, and low consumption of meat and full fat dairy.

Likewise, the current Dietary Recommendations for American’s visualize in My Plate a dish half full with fruits and veggies. My Plate’s protein, which includes protein from all sources, including meat, poultry, eggs pulses, beans, nuts, seeds etc. represents just about a quarter of that plate.

This new study concludes that “a shift from meat-centric dishes to plant-forward dishes without the strictness of vegetarianism or veganism, is feasible,” and I think that places like schools, college cafeterias and health care facilities might be the great place to introduce people to this easy, gradual shift.

As would be the family meal.

Dr. Ayala

Is the Mediterranean diet eco friendly?

The Mediterranean diet is respected for its health benefits. Eating Mediterranean style is associated with lower incidence of chronic disease and obesity.

It’s appreciated also for its flavor and for its practicality: Cooking Mediterranean is relatively easy, and relies on good raw ingredients simply prepared, rather than on complicated or drawn-out techniques.

Good for heath, easy on the palate and practical to prepare, but in this day and age ecological consequences are also important. Food production at the massive scale needed to supply the human population is a huge burden on the environment. Food production is a leading cause of deforestation, water pollution and loss of biodiversity. Food production uses lots of water, and generates greenhouse gases ­– about one third of global greenhouse gas emissions come from agriculture, much of it from livestock.

A new study in Public Health Nutrition evaluated the Mediterranean diet’s environmental impact.

The study involved some 20,000 Spanish participants, who reported on their food intake. The foods consumed were categorized on a sliding scale as adhering more or less to a Mediterranean diet pattern. A Mediterranean diet typically emphasizes vegetables, grains, (mostly whole/unrefined) legumes, nuts and olive oil. Fish and dairy products are eaten in moderation, as are meat and meat products; some wine is typically enjoyed. The impact of each food item on water, land and energy consumption and on greenhouse gas emission was assessed.

The researchers found that the better the adherence to the Mediterranean diet, the lower the environmental cost – natural resource use and emissions went down with Mediterranean adherence. Meat – especially beef meat – eggs, and dairy consumption had the highest detrimental impact on the environment. The results are quite impressive: Water requirements for food production for a person adhering to a Mediterranean diet is 60 percent less than what it is for someone who doesn’t, land use is 70 percent less, you need 90 percent less energy, and Mediterranean style diets produce 70 percent less greenhouse gasses.

The researchers, led by Ujué Fresán conclude:“As diet influences positively not only our health but also the environment, a nutritionist giving dietary advice may take the environmental impact of diet into account, and enhanced adherence to a MedDiet is likely to be an important target to be fostered in our society.”

Do people care about food’s sustainability and environmental impact? 

When people make their food choices they consider convenience, cost, taste, health, and availability; but do they care about sustainability and environmental impact?

“The environmental costs tend to be a tertiary discussion for most and fall well behind, ‘How do I lose weight and get off my meds?’” says Nutrition, Health & Wellness coach Scott Putnam. “People are first looking for ways to feel better and drop weight, but then get excited to learn that by eating more plant-foods, they're not only helping themselves, they are doing their part to save animal lives and the planet. It's really a Win-Win-Win situation!”

Likewise, when people first seek organic foods their primary motivation is personal avoidance of pesticides and chemicals, but choosing organic for selfish reasons evolves into an environmental commitment. “There are fruits and vegetables for which choosing organic doesn't necessarily reduce exposure to pesticides much, because the chemicals remain in the peel and do not penetrate the edible part.  So, although choosing organic may not necessarily benefit my family's potential exposure directly, I may still choose organic because I know that this choice may support organic farmers and their surrounding communities,” notes Dr. Luz Claudio, professor of environmental medicine and public health at Mount Sinai School of Medicine. 

That’s why it’s important to find an eating pattern in which health, taste, practicality and sustainability are aligned, and the Mediterranean diet is a worthy candidate.

That olive oil as the main source of fat in the Mediterranean diet also avoids another ecologic pitfall: "A personal soapbox of mine is palm oil," notes Registered Dietician Nichole Dandrea. “The palm oil industry is linked to major environmental issues such as deforestation, habitat degradation, climate change, animal cruelty and indigenous peoples rights abuses. The World Wildlife Fund states that rainforest areas equivalent to 300 football fields are cleared every hour to make way for the palm oil industry.” She encourages avoiding palm oil unless it's Certified Sustainable Palm Oil (CSPO).

We can all take steps towards greater sustainability by eating more plants and less meat (this is the single most impactful decision), eating less processed foods, choosing organic when possible, preferring produce that's locally grown and in season, and avoiding waste.

Even the smallest steps count in a world with more than seven and a half billion people making food choices.

Dr. Ayala

The best diet to fight belly fat

People call a bulging abdomen a beer belly, but beer, clearly, isn’t the (only) culprit.

And finding the cause isn’t a silly blame game.

Abdominal fat isn’t merely an esthetic issue. Fat in and around abdominal organs is active metabolically, much more so than the fat under our skin, and it poses additional risk for diabetes, heart disease and stroke, above and beyond the risk seen with just having some extra weight. Fat around our internal organs acts like an endocrine gland, causing insulin resistance and interfering with fat metabolism.

A growing body of evidence suggests that what we eat certainly affects body shape and fat accumulation patterns – it isn’t just age and genetics. Dietary choices matter, and a more appropriate term of endearment for the rounded belly would be sugar belly.

Or perhaps soda belly, as research shows.

Drinking 25 percent of daily calories (which is quite a lot) in fructose for 10 weeks increased triglycerides and cholesterol, caused insulin resistance and belly fat accumulation, a study from the University of California at Davis showed.

Another study found that even moderate (1 can of soda a day for 3 weeks) consumption of sugary drinks led to increased belly fat, elevated glucose levels, higher inflammation markers, and worsened lipid profile.

A study in the journal Obesity, following 800 people, found sugary drinks were associated with significantly more belly fat and wider waistlines.

And a study in the American Journal of Clinical Nutrition assigned overweight people to drink cola, skim milk, diet cola or water for 6 months, with total calories staying constant. Liver fat and fat around abdominal organs and muscle increased significantly in the regular soda group, while it remained unchanged in the other study groups. Blood pressure and triglycerides also rose among the soda drinkers. 

These studies show that sugar -- especially in drinks -- increases fat accumulation in the worst possible locations of our anatomy. Similarly, saturated fat might also cause more weight to accumulate as fat in the liver and around internal organs.

But is there a weight-loss diet that can target these specific fat pools?

Losing that belly

A new study, led by Yftach Gepner and published in Circulation examines whether different weight-loss programs attack fat deposits preferentially. The 2 diets butted against each other were a low-fat one, and a Mediterranean diet – rich in unsaturated fat and low in simple carbs, with and without a moderate exercise regimen.

This was a unique, 278 participant, 18-month study, because besides the weight and waist circumference measurements, total body MRI was used to in order to measure fat quantities around all the internal organs.

The two groups lost about the same amount of weight.

The weight was loss pattern was, however, significantly different: the Mediterranean diet/low carb group lost more abdominal fat, more liver fat and fat around the heart and pancreas.

Exercise also helped shed abdominal fat preferentially.

And losing this liver and deep intra-abdominal fat helped to improve lipid profile and insulin sensitivity!

Making that belly fat the first to go

The take home message: When it comes to fat deposits it isn’t just how much we eat, but also what we eat.

Some foods – especially refined carbs – lead to fat storage in the worst-for-health places.

And the same is true for weight loss: You can preferentially target belly fat by eating a healthy Mediterranean diet with lots of fruits, veggies, nuts and unsaturated fats, and less sugar and carbs. It might work better than a low-fat weight-loss diet with the same number of calories.

Add to that all-important exercise and healthy hydration, and you’ve got yourself a good regimen that will help you avoid weight gain during the holidays – and a worthy plan if you need to lose some in the coming year.

Dr. Ayala