Healthy Food & Healthy Living by Dr. Ayala

Spice up the new year

We’re cooking at home more – a positive development health-wise, despite its sad cause. Months of homemade meals day in and day out make us yearn for something new, different, better. 

How do you make the same raw ingredients rich and exciting?

Julia Child taught us an easy trick: “With enough butter, anything is good.” Likewise, some more salt, and added sweetness make food taste better. Alas, these easy fixes, if repeated often, make food less healthy, adding extra calories, extra salt and too much sugar to a diet already excessive in all of these.

There’s a better way: the spice way. 

Spices add a full palette of flavors, bring other worlds and cultures to the table, and most of them aren’t spicy, as in hot. Spices have antioxidant and anti-inflammatory properties, and can help ease several ailments; ginger is a proven remedy for nausea and vomiting and several studies suggest that cinnamon may improve glucose control in diabetics. Studies have shown cancer prevention activity of compounds that are present in spices in cell and animal models – the most promising compound is curcumin, abundant in turmeric.

Hot peppers to the rescue

And then, there’s the chilli pepper in all its varieties. New research presented at the latest American Heart Association’s Scientific Sessions reviewed thousands of studies that had data about  people who include hot peppers in their routine and those who avoid it. Overall, the study involved 570,000 people from around the world. People who ate hot peppers had 26 percent less cardiovascular deaths, 23 percent cancer deaths and 25 percent all-cause mortality.

These types of studies don’t prove causality – more research is clearly needed.

Spiciness, however, is clearly a nice add-on for flavor and variety. Spiciness can also help reduce the use of salt and lower blood pressure. There’s some research showing hot peppers can aid in weight loss and burn a few extra calories – warning: it’s very few calories, so don’t get over excited. A small study published in the American Journal of Clinical Nutrition showed that exposure to capsinoids – similar to the capsaicin in hot pepper – activated calorie-burning brown fat in men. A small randomized study in Appetite found that adding red chilli peppers to meals increases satiety and fullness after meals, and reduces the desire to eat after dinner.

A few tips on how to spice up the dish without a backlash: If you’re just starting out, go slow. Add just a little bit in your cooking, enough to create a pleasurable tingling, and bear in mind that spiciness is an acquired taste; you don’t want to scare your family members off. I place a hot pepper flake shaker on the table and sprinkle a hefty shake on many dishes: from curries, to pizza, pasta and soup. Likewise, I think that hot sauce (natural, with no added sugars) is a nice way to customize the meal to the spiciness level each diner prefers.

This is a holiday season like no other. We’re going to have to expand and divert from our traditions this winter, so why not replace some of the salt and sugar with spice in the next new year?

Dr. Ayala

 

Does food affect susceptibility to Covid-19?

Six months into the Covid-19 pandemic, and the astonishing variability in disease severity remains an enigma. The same virus causes an infection so mild in some that it passes without notice, yet in others it manifests catastrophically. While older age clearly increases the risk for severe disease and death, at times younger people also need intensive care, and a whole host of underlying conditions are presumptive risk factors.

According to the WHO, the CDC and other leading health agencies, conditions that make a person more likely to suffer severe Covid-19 include cardiovascular disease, diabetes, lung disease such as asthma and COPD, hypertension, obesity and history of smoking, among others.

Unfortunately, underlying health conditions are common. According to modeling recently presented in the Lancet about one in five people worldwide are at increased risk of severe Covid-19, due to underlying health conditions, and 4 percent of those infected worldwide would require hospitalization. The situation in the US is even more concerning: 60 percent of Americans have an underlying condition. Even young adults ­– late teens to late twenties – in the US are more vulnerable than one might imagine. A new study by UCSF researchers, in the Journal of Adolescent Health predicts that 32 percent of young adults are at risk of severe Covid-19 based on risk factors.

But although time goes in only one direction, and not every underlying disease can be reversed, many risk factors are highly modifiable. And since it looks like we’re in for a long battle it’s time to step up our efforts.

Eating to support immunity and measured inflammation

Our knowledge of Covid-19 is evolving, but it’s safe to assume that a sound nutritional status supports immunity, and lowers the chance of severe, out-of-control inflammation.

More importantly, many of the chronic diseases, which put us at risk of severe Covid-19, can be mitigated by a healthy diet. A healthy diet supplies us with all the essential nutrients – malnutrition causes immune deficiency – and also promotes health, reduces undue inflammation, and lowers the risk of chronic diseases.

There are many ways to eat healthy. There’s one particular diet pattern, however, that’s clearly not good, and it’s unfortunately popular, inexpensive and prevalent. The Western diet, characterized by excessive consumption of highly processed, sugary and fatty foods, refined grains and cured and red meats, and low intake of fruits and vegetables, is associated with impaired blood sugar and insulin, metabolic disease and obesity. It’s linked with inflammation and many chronic diseases, including diabetes and heart disease, even in people with normal weight.

One example of a healthy diet – one I’m especially fond of due to its flavor and ease of preparation – is the Mediterranean diet. It’s characterized by high intake fresh whole foods, fruits and veggies, fiber and only moderate intake of other foods; it’s associated with lower incidence of chronic diseases. Any diet that emphasizes fresh plant-based foods such as vegetables and fruits, whole grains, legumes, and nuts may improve the inflammatory response, fight insulin resistance and metabolic disorders.

An interesting new paper in ACS Chemical Neuroscience looks at the correlation between herb and spice consumption and Covid-19 cases, deaths and recovery in 163 countries. It found that countries with lower consumption of spices per capita had a higher number of deaths per million citizens as a result of Covid-19, and more importantly, that the recovery rate was higher in nations with higher consumption of spices. Could ginger, turmeric, garlic, clove and thyme help fight infections? The authors cite studies that support the notion that “herbs and spices are well-known to boost immunity,” perhaps due to their antiviral, antioxidant and anti-inflammatory actions.

Or perhaps, people from countries that utilize large amounts of spices simply cook more from scratch, rely less on highly processed foods, and therefore just have better diets.

Now, more than ever, healthy eating habits should be a top priority; they may reduce our susceptibility to severe Covid-19 and its complications. Now, more than ever, is the time for cooking simple meals from scratch, and filling half the plate with veggies. Spices and herbs will enhance the flavor of the dish, add to its nutritional value, and maybe even help with fighting illness.

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

Want kids to eat their veggies? Try herbs and spices

Vegetables shouldn’t be such a hard sell. They’re colorful, pretty, crunchy, and in my personal opinion, quite delicious even in their raw, unadorned state.

But despite lots of urging from every health authority and mom, people don’t eat enough of them. Eating veggies has never been as important: Veggies, with their abundance of fiber, phytonutrients, antioxidants, vitamins and minerals, not only reduce the risk of several chronic diseases – such as heart disease and diabetes – eating them can replace other foods, and there is no other food group with fewer calories and more filling capacity. They’re the food that societies facing rising rates of obesity should turn to and delight in – a carrot, after all, is much tastier than the “stick” of food avoidance.

Shockingly, only about 2 percent of American teens eat the recommended amount of vegetables daily.

Multiple strategies have been employed to change this sorry statistic – education campaigns have been quite successful in making people aware of the benefits of 5-a-day, but they have not moved the needle enough – and one of the promising ones is adding flavor and interest to vegetables.

A pinch of flavor

A new study, published in Food Quality and Preference tests how the addition of herbs and spices may affect teens’ fondness of vegetable dishes.

The study was conducted in a rural Pennsylvania school, among teens aged 14-18. Surveys taken before the study showed that about 75 percent of students reported that the main reason they don’t eat more veggies at school is their taste. The kids also had very little familiarity with herbs and spices.

Nevertheless, when vegetables such as carrots, green beans, cauliflower and broccoli were prepared with herbs and spices, students liked and selected them more, and preferred them over the plain versions. The kids favored the seasoned dishes even when the spices and herbs were unfamiliar to them – dill-seasoned broccoli and cauliflower with coriander got better ratings than plain broccoli and cauliflower, even though dill and coriander were unfamiliar to the kids.

And since meals – both at school and at home – strive to reduce added salt and oil, recipes with healthy spices and herbs could make vegetables more desirable.

Another recent study in Appetite tested vegetable consumption in a university cafeteria, comparing the selection of seasoned vegetables to steamed ones. The researchers tested several different vegetables – carrots, broccoli, and green beans – steaming and seasoning them with things like garlic, parsley, dill, cinnamon and black pepper, as well as some oil and salt, as opposed to just steaming them with vegetable oil and salt. Given the choice, students preferred the seasoned vegetable, and even people who otherwise wouldn’t have selected a vegetable side were 1.6 times more likely to pick one if it was seasoned.

Dare to flavor

Processed food is very high in flavor – much of it comes from sugar and salt, with other flavorings, not all of them natural, added to the mix. Regardless, the profile of most of these craveable foods is the polar opposite of bland.

Yet when parents and cafeterias prepare vegetables they often add very little flavor to them. Serving veggies raw and plain can work if they’re at the height of ripeness, freshness and flavor, and if people already love that particular veggie.

For other vegetables, especially those with a hint of bitterness, seasoning could make a huge difference, and a little effort and attention could elevate veggies' desirability and consumption among kids.

“I like to start off with something they are familiar with, like Italian seasoning,” says registered dietitian and chef Julie Harrington. “Most children are familiar with the Italian seasoning that is on their pizza or in their pasta sauce.”

Kids’ cooking teacher Katie Kimball likes to combine the novel with the familiar: “When I use a spice like turmeric, for example, I like to call the veggies "mustard veggies" because all my kids adore mustard. That explains the yellow color and reduces their skepticism. We add smoked paprika to veggies in a breakfast hash, a very strong flavor that many might think is too much for kids - but along with oregano, it helps veggies taste a little like pizza. And of course, pumpkin pie spice makes numerous recipes including squash or sweet potatoes go right down the hatch!”

Registered dietitian Jennifer Glockner offers these tips:

Spices and herbs may have a powerful flavor so just a tiny amount may go a long way. Pureed or finely chopped herbs work well for kids.

Cinnamon or nutmeg can pair well with sweet vegetables such as sweet potatoes and carrots.

Dill or chive works well with cruciferous vegetables like cabbage or cauliflower.

Mint and/or citrus (juice, zest, slices) adds brightness to salads (tomatoes, cucumber, bell peppers).

Paprika is a fun spice that adds smokiness and color to vegetables.

Jennifer also reminds us that we should “try, try, try again. It can take up to 12 tries to like a new food including vegetables and seasonings.”

Let’s celebrate the last days of National Nutrition Month and “Go Further With Food” by breathing new flavors with spices and herbs. These wonderful natural, healthy flavorings from nature unlock veggies’ potential and can make them exciting to both kids and adults.

Dr. Ayala

The lifelong benefits of spices

Hillary Clinton credits her stamina to hot sauce. She reportedly picked up her spice habit in 1992, after reading that hot chilies help the immune system.

I, too, am one of those people who carry hot pepper flakes in my bag – such is my fear of bland food.

Spices for healing are an old belief with a modern incarnation. Hippocrates, the father of medicine, famously said: “Let thy food be thy medicine and thy medicine be thy food,” and used spices and herbs he collected in the Greek hills for healing. A spiced wine recipe containing cinnamon, cloves, allspice and honey – sounds delicious – is attributed to him, and was allegedly prescribed for many common ills. Mulled wine is an ancient remedy for the broken heart and aching body.

Current research is providing evidence of the benefits of spices. Spices have antioxidant and anti-inflammatory properties, have been shown to affect fat metabolism, and have been found to aid in several conditions; ginger is a proven remedy for nausea and vomiting and several small studies suggest that cinnamon may improve glucose control in diabetics. Studies have shown anti-cancer activity of compounds that are present in spices in cell and animal models – the most promising compound is curcumin, abundant in turmeric.

A new study in PLOS one, that I’m sure will please hot sauce fans, looked to see if people who eat hot peppers live longer.

Hot pepper and mortality

The researchers, Mustafa Chopan and Benjamin Littenberg, included more than 16,000 Americans, whose hot pepper consumption was assessed through a food frequency questionnaire, and who were followed for about 19 years. During the follow up, almost 5000 of these people died.

Participants who reported eating hot peppers on a regular basis died 13 percent less than the people who didn’t eat spicy. The more hot peppers people ate, the less the risk of their dying from all causes, and these findings were adjusted to minimize known confounders such as obesity, income, exercise, education, marital status, smoking and dietary habits such as eating meat and vegetables.

This is of course an association. It doesn’t prove that hot peppers affect longevity.

The researchers remind us, though, that this association was demonstrated in another population: A recent study from 2015 including more than 500,000(!) Chinese people found a 14 percent risk-of-death reduction in spicy food eaters. They also suggest several mechanisms, which might explain the connection, among them, that capsaicin, the main substance that causes the tingling hotness in peppers, has antimicrobial properties. These might affect the bacteria in the gut, and cause the microbiome of individuals to be colonized by more healthful bacteria. The microbiome, a hot research topic, we are discovering, is linked to many diseases -- from diabetes to obesity and heart disease.

While I don’t think Sriracha will help you cheat death, and the magic properties of hot peppers are far from conclusively proven, one thing’s for sure: When food is properly seasoned it’s tastier and more appealing.

Season healthy food well, and it’ll help you eat healthy.

Spices also add a whole host of antioxidants and nutrients to your dish and reduce the need for salt, sugar and fat.

Spices are old. They have been valued for their ability to bring other worlds and cultures to our table, to make food delicious, interesting and beautiful well before the advent of these recent discoveries. Every sprinkle might also add a little health bonus.

Dr. Ayala

Black lentil, sweet potato and carrot soup

I love green lentils, and use red ones a lot too, but once you try the black variety I think you'll never look back. Black lentils soften quite quickly, but remain intact after cooking, dotting this satisfying, nutritious soup with dark contrasting-colored bits of delicious beauty.

Ingredients:

• 2 sweet onions
• 2 tablespoons olive oil
• 5 carrots, cut into large cubes
• 2-3 sweet potatoes, cut into large cubes
• 1 tablespoon paprika
• dash of cayenne pepper
• 1/2 teaspoon tumeric
• Salt and pepper to taste
• 6 cups water
• 2 tablespoons miso paste (I prefer the white mellow)
• 1 cup washed black lentils
• 2 cups spinach leaves, chopped
• ½ cup dill, finely chopped
• Garnish: fresh dill or cilantro, chopped

Preparation:

• In a large pot, on medium-high heat, sauté the onions in olive oil until soft and golden. Add the carrots, sweet potatoes, paprika, cayenne pepper, turmeric, salt and pepper, and sauté for about 15 minutes, until sweet potatoes are quite soft. Add a little water if the the pot seems too dry
• Add the water, bring to a boil, simmer until the vegetables are soft but still tender
• Remove from heat, add the miso paste to the pot, and with an immersion blender process until smooth
• Wash the lentils in a sieve with plenty of cold water. Add to the pot, bring to a boil, lower to a simmer, and cook about 20-30 minutes, until the lentils are soft, turn off heat
• Add the spinach and the dill (heat's already off, but the soup is still very hot, so spinach will wilt nicely)
• Taste and correct seasoning.
• Garnish with a spinkle of herbs and serve with a nice loaf of bread. 

Enjoy!

Dr. Ayala

A pleasurable way to cut salt

There are many good reasons to add spices and herbs to your life. They add flavor, aroma, color and healthfulness; they bring with them the memories and atmosphere of faraway places.

Here’s another reason to make use of your spice rack: they can help reduce salt intake.

In a new study in the American Journal of Clinical Nutrition a group of men and women from Baltimore – all of whom were at high risk and were advised to eat no more that 1500 mg of sodium daily – were started on 4-week low sodium diet in which all food and drink was supplied.

To figure out how much sodium each person consumed, rather than rely on self-reports, which are especially difficult in the case of salt, urinary sodium excretion over a day was measured, as we know the what’s found in the urine represents what’s in the food quite well.

And this indeed worked. Adhering to a supplied diet the participants showed a remarkable drop in the collected sodium – from about 3500mg/day to 1650mg/day.

Maintaining a low sodium diet in the real world, in which prepared food already contain an abundance of salt, is much harder, and that’s what the second phase of the study was all about. The group was divided randomly into two: in one group the participants received individual and group counseling, and were advised about the use of spices and herbs as a way to curb salt intake, and in the other participants were just given general advice about salt reduction.

Although overall the salt intake increased above the level achieved in phase 1 in both groups the first group did much better: the group receiving the behavioral intervention consumed remarkably less salt (and its urinary sodium was about 1000 mg/day less).

Interestingly, the participants were given a blinded taste of chicken broth with 8 differing concentrations of salt – from 0 to 1.5 percent salt – before and after the low salt diet. After just 4 weeks on a low-salt diet the participants tasted significantly more salt in the 0 percent broth, suggesting that it doesn’t take long to become sensitized to the taste of salt.

Spice it up

While the authors say they placed “particular emphasis on the use of spices and herbs”, since the treatment group received several behavioral interventions, we can’t give spices all the credit.

We do know that positive messaging (eat more fruit) usually feels better than hearing about what we shouldn’t be doing (candy will make you fat and rot your teeth) and may be more effective.

So instead of advising people to eat less salt – which sounds bland and boring – maybe the better message is: Spice it up.

Dr. Ayala

 

Roasted herb and spice chickpeas

Chickpeas, also called garbanzo beans, are healthy and fun to nibble on, and this recipe makes them spicy, delicious, crispy and super snackable. Serve warm, straight out of the oven, or store in an airtight container.

Ingredients 

• 1 ½ cups dried chickpeas soaked overnight in cold water, or 2 (15oz) cans of chickpeas, drained and rinsed
• 2 tablespoons olive oil
• 1 tablespoon paprika
• ½ teaspoon cayenne pepper
  2 tablespoons dried dill weed
• ¼ teaspoon salt

Preparation

• Place chickpeas in a large pot with plenty of water – water should cover the chickpeas by a few inches. Bring to a boil, lower to a simmer, and cook until soft, about 60 minutes. Drain thoroughly. Skip this step if using canned chickpeas.
• Heat oven to 400 °F.
• Toss chickpeas with the rest of the ingredients.
• Bake until crisp and crunchy, 20-30 minutes.

Enjoy,

Dr. Ayala