Dr. Ayala's Open Salon Blog

Caffeine, coffee and type 2 diabetes

Wed, 28 Nov 2012 07:11:03 -0500

A new study of caffeinated drinks and type 2 diabetes caught my eye. I’m always on the lookout for studies on coffee, because – let’s admit it – I love coffee, and like many other coffee aficionados, I fear that someday this adored pleasure will be found a guilty one. And then what shall we do? Decide it’s worth the risk? Or convince ourselves we never really cared for this delicious, thought brightening, history-defining drink?

For coffee lovers most research news has been reassuring. Years of investigation have shown that coffee in moderation poses no threat to healthy adults – those worries about heart disease and cancer risks end up being unwarranted. What’s more, the coffee habit has even been shown to confer health benefits, and is associated with protection from Alzheimer’s and Parkinson’s disease, stoke, gallstones and liver disease.

Caffeine and diabetes

The new study, published in the American Journal of Clinical Nutrition (online ahead of press), observed a very large population of about 75,000 women and 40,000 men for more than two decades, trying to see if there’s an association between the caffeinated and caffeine-free drinks they consume and the development of type 2 diabetes.

The study looked at all types of typically caffeinated drinks: coffee, tea, sugary drinks and artificially sweetened drinks.

Over the years more than 10,000 of the people developed type 2 diabetes. There are many factors known to increase the risk of developing type 2 diabetes, such as obesity, family history of diabetes, hypertension and smoking. After controlling for those, the researchers set about to see whether caffeinated drinks made a difference.

Here’s what they found:

Coffee, caffeinated or decaf, was associated with a lower risk of type 2 diabetes.
Caffeinated tea was associated with a lower risk of type 2 diabetes.
Sugary drinks, both caffeinated and caffeine free, were associated with a significantly higher risk of type 2 diabetes.

Are coffee and tea protective?

It’s impossible to conclude cause and effect from these kinds of studies. The authors describe a few plausible protective mechanisms in which coffee and tea can affect diabetes: both are rich in flavonoid antioxidants, which may help in reducing inflammation. It’s likely that it’s one of the multitude of compounds in coffee and tea – or several of them acting together -- that have positive health effects, and caffeine, which we treasure for its stimulating properties, has nothing to do with the other benefits.

On the other hand, the association between sugary drinks and diabetes is very suggestive of a direct biologic effect: sugar and high fructose corn syrup are quickly absorbed and cause spikes in blood sugar and insulin. Several studies have shown that sugary drinks are linked with diabetes independently of the weight gain associated with these drinks.

What this study shows quite well is that it’s the sugars that are associated with the development of type 2 diabetes, not the caffeine. The caffeine content of soda seems irrelevant to the risk of diabetes.

So hurray for coffee – and tea – but before you go on a coffee binge, a few words of caution: most studies showing coffee’s benefits and lack of harm looked at people drinking coffee in moderation. Coffee in moderation is fine, but that doesn’t mean that coffee in large amounts is even better – quite the opposite!

That also doesn’t mean that caffeinated drinks are healthy – it seems that energy drinks can be quite unsafe.

And it doesn't attest to caffeine’s safety for kids. These coffee and caffeine safety studies were done with adults only, and kids’ physiology is quite different.

Dr. Ayala

Image: The shrub on the right, Coffea Arabica, carries coffee berries. On the left: the familiar roasted coffee beans, which are the seeds of the plant.

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

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13 lies dieters tell themselves

Wed, 21 Nov 2012 08:11:43 -0500

The worst lies are the ones we tell ourselves. Before the holiday season eating extravaganza is upon us here are a few common diet lies -- and how your better angel would react if he were awake.

Feel free to add your own in the comment section.

Olive oil is good for you

(it is; it also has 120 calories per tablespoon)

This pack’s only 100 calories

(that’s when you eat just 1, not 4)

It’s only 140 calories

(per serving! There were 3 serving in the pack – all gone!)

I’ll sweat this dessert off

(speed-walk for an hour, and it won’t make a dent)

It’s fat-free

(yeah, but did you look at the sugar?)

It’s sugar-free

(did you look at the fat?)

It says no added sugar

(just evaporated cane juice and fruit juice concentrate. Who are you kidding?)

I found this miracle diet

(there are no miracle diets, silly)

Chocolate is good for your brain and can help you win a Nobel Prize

(brain candy is still candy. BTW, who pays for these studies?)

Wine is good for your heart

(it’s also bad for your liver, and has 120 calories a glass)

It was a small portion

(smaller than a mountain, for sure)

After this, I’ll eat nothing ‘till tomorrow

(it’s 2pm!)

But I skipped breakfast!

(skipping breakfast awards no prizes)

Final thought:

The scale and your old clothes won’t lie, and on the other hand, some feasts are well worth their caloric price.

Have a happy and healthy Thanksgiving.

Dr. Ayala

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Day-after-the-elections soup

Wed, 7 Nov 2012 09:11:24 -0500

After Superstorm Sandy (I hope you all have power, and are safe and warm!) and a stormy election season, I thought it would be nice to share a comforting, earthy soup.

Root vegetables become magical when they meet the high heat of the oven. They develop caramelized and mellow flavors, and are so much richer. This soup is the perfect little meal on a cold day.

Ingredients:

2 sweet potatoes, diced
4 potatoes, diced
5 carrots, diced
2 parsnips, diced
3 tablespoons olive oil, divided
1 tablespoon honey (optional)
1 large yellow onion, diced
8 cups vegetable stock
1 teaspoon paprika
1 teaspoon dried dill
2 tablespoons tomato paste
1 cup pearled barley
Salt and pepper to taste
1 cup parsley, finely chopped

Preparation:

Preheat oven to 400°F (200°C)
In a large baking sheet, toss sweet potatoes, potatoes, carrots and parsnips with 2 tablespoons olive oil, honey, and some salt and pepper
Bake for 30-40 minutes, stirring the veggies occasionally, until the vegetables are soft but still chewy and slightly caramelized
In a large pot, over high heat sauté the onion and the 1 tablespoon of olive oil until golden
Add the roasted vegetables, vegetable stock, paprika, dill, tomato paste, pearled barley and some salt and pepper, cover the pot, and bring to a boil
Reduce heat to a simmer and continue cooking until the barley is soft (about 20-30 minutes)
Add the parsley and correct seasoning

This soup is now ready to serve, but will taste even better the day after, and will keep in the fridge for 5 days.

Yield: serves many (10-12 easy).

Enjoy,

Dr. Ayala

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Pediatricians advise on organic food

Wed, 31 Oct 2012 12:10:20 -0400

Do you consult your pediatrician about food? Nutrition evaluation is part of what doctors are supposed to cover in well-child visits, and I’m sure many pediatricians are asked for advice concerning food choices in general, and organic foods in particular.

To that end, the American Academy of Pediatrics gathered the relevant research comparing organic foods to conventionally produced ones, and prepared a report that’s published in the November issue of Pediatrics. There’s no new research here; the report analyses existing studies (many of which have been widely reported), weighs the evidence, and concludes with some advice.

I was glad to see that this report included environmental impacts in its analysis. Not only are environmental issues important in and of themselves, but also we’re kidding ourselves if we think that impacts on the environment will not end up affecting our health. There might be a long delay in that effect, but no insult on the environment goes scot-free.

Here’s what the report finds:

Organic food exposes eaters to fewer pesticides

There’s no doubt that pesticides are toxic. Acute poisoning from pesticides is reported among farm workers regularly, and several studies have shown that chronic exposure to pesticides is associated with health problems, such as breathing problems, skin disorders, neurologic deficits and cancer.

Kids who don’t work on a farm are exposed to pesticides mainly through their food. Organic food has consistently been shown to have fewer pesticides and to reduce exposure. The report cites a study that looked at kids that ate conventional produce, and showed that just 5 days on an organic diet reduced their urinary levels of pesticides to undetectable.

The report also informs that washing reduces some pesticides, but isn’t proven to decrease human exposure.

But can we undeniably prove that exposure to pesticides in small amounts is harmful? We can’t, and we definitely can’t prove it’s safe; I doubt excellent large prospective studies putting kids on a pesticide residue diet and a pesticide-free one will ever be performed.

Nutritional differences seem minimal

The report finds flaws in many of the studies comparing the nutrient content of conventional and organic produce, and declares the results conflicting. It concludes that although studies show more vitamin C and phosphorus in organic food, for now: “there does not appear to be convincing evidence of a substantial difference in nutritional quality of organic versus conventional produce.”

Meat

Conventional growers feed animals routinely with antibiotics. Of all antibiotics used in the US 40-80 percent goes in animal feed, and animal and human antibiotics are pretty much the same. This leads to antibiotic-resistant bacteria spread through people and food, which the report sees as a reason to prefer organic.

Milk

The report surprised many by declaring that they find no clinical difference between organic and conventional milk. Conventionaly raised cows are supplemented with growth hormones and estrogen, but the Academy claims the former breaks down and isn’t active, and the latter’s quantities are too small to matter.

Environmental impact

The report states that:

“Many believe that organic farming is less damaging to the environment because organic farms do not use or release synthetic pesticides into the environment, some of which have the potential to harm soil, water, and local terrestrial and aquatic wildlife.

In addition, it is thought that organic farms are better than conventional farms at sustaining diverse ecosystems, including populations of plants, insects, and animals, because of practices such as crop rotation.

When calculated either per unit area or per unit of yield, organic farms use less energy and produce less waste.

Organically managed soil has been demonstrated to be of higher quality and have higher water retention, which may increase yields for organic farms in drought years.”

What’s a parent to do?

The report is aimed for pediatricians, so it’s a little technical, but if you care to read through the sections describing the use of growth hormones and sex steroids in conventional agriculture you’ll be introduced to some of the common practices of conventional animal treatment. For example, animals are treated with a range of growth hormones and sex steroids (injected as estrogen pellets under the skin) to increase yields. The report reassures us through studies that the hormone levels found in our food are low, or irrelevant, but I doubt you’ll find it a reassuring read.

The report suggests pediatricians emphasize the importance of eating lots of fruits, vegetables and whole grains, and respond to the question of “should we go organic” with the facts presented by the report, and admit that in some areas evidence is lacking.

So this is the American Academy of Pediatrics’ advice. What’s yours?

Dr. Ayala

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A revised food label that isn’t a dream

Wed, 24 Oct 2012 10:10:56 -0400

In a recent opinion piece in the New York Times Mark Bittman dreams about an improved front-of-package food label. “Right now, the labels required on food give us loads of information, much of it useful. What they don’t do is tell us whether something is really beneficial, in every sense of the word,” he writes.

What Bittman proposes is an upgraded traffic light model (green: great choice, yellow: eat sometimes, red: eat sparingly or never), but his fantasy label takes into consideration not only dietary guidelines, but includes also grades for the way each particular food affects the earth, the farm workers, animals and the air we breathe.

Bittman’s proposed label has a 15-point scoring scale. The score is divided to 3 categories, and a food can score up to 5 points in each (see illustrations and examples here):

Nutrition: things such as trans-fat, saturated fat, sugar, vitamins and fiber affect this score

Foodness: assesses whether the food is real, or so processed it can hardly be called food

Welfare: scores how well the animals, factory and farm workers, the land, waterways and air are treated.

How realistic is the Bittman label?

The Institute of Medicine recommended in its 2011 report a single, standardized front of package symbol system that can be easily understood and that would appear on every product.

It's not easy: Getting food producers to agree on front-of-package guidance, guidance that would label many of their foods ‘red’, is a huge undertaking.

But adding a welfare key is a wild dream. Bittman admits it’s the trickiest part, and I think the problem isn’t just a logistical and resource one. Measuring carbon footprint is hard and expensive, and assessing pesticide and herbicide’s pollution of water and air is even harder, but trying to get to an agreement about what animal welfare standards should be is impossible. It is a personal-view kind of question, with moral, religious and subjective subtexts, and I think the Republicans and Democrats will unite on the role of government and abortion before vegetarians agree that organic, grass-fed veal gets a 5 for welfare.

Loads of information, but important information’s still missing

While the package’s guiding system continues to be debated, and Bittman’s dream label is a distant aspiration, there are two information pieces still surprisingly missing from the nutrition panel itself:

- Added sugar: Total sugar is listed in the nutrition panel, but there’s no distinction between the naturally occurring sugar present in, let’s say, fruit, and added sugar in its many forms (including sucrose, HFCS, dextrose, dehydrated cane sugar, fruit juice concentrate and a dozen others) put into so many products by food makers.

Current dietary recommendations call for limiting the amount of added sugar in our food. Scientific studies have shown that added sugar has negative health outcomes – such as heart disease and high level of triglycerides and cholesterol -- and leads to obesity.

So stating the amount of added sugar would be useful and is long overdue. But is such labeling feasible?

According to a recent paper by Jennifer Pomeranz in the American Journal of Public Health, providing the added sugar information is both important and doable. The manufacturers already know how much sugar they’re adding, and random sampling in order to check the accuracy of the manufacturers declaration is technically realistic because each sugar source has unique, traceable, sugar isotopes.

- Genetically Modified Organisms (GMO): While the debate about GMOs effect on agriculture, environment and health continues, many consumers believe they have a right to know if a food item contains them in order to make informed purchases.

GMO labeling is required in more than 60 countries, including Italy, Spain, France, Germany, the UK, Japan, China, Russia, Brazil, Mexico and Saudi Arabia.

The California Right to Know ballot initiative is up vote November 6^th, and if passed will mandate that all foods containing GMOs sold in California be labeled.

If this ballot initiative passes, this might be a precursor to mandatory labeling in other states, so the outcome of the vote goes well beyond California.

Understanding the label leads to better choices

I don’t think that reading the ingredient list is such an arduous task that we have to dumb down nutrition information to a traffic light system (although a clever, straightforward one could potentially help).

I believe that people need to have minimal nutrition knowledge in order to make the right decisions for themselves, based on their personal set of needs and values. Nutrition literacy is key to living in our obesogenic environment. Minimal medical literacy determines how well you’ll be able to care for yourself and to advocate for loved ones, and in much the same way nutrition basic knowledge promises you will be able to navigate your way to healthy food in an ocean of junk.

A de-cluttered front of package, free from misleading health claims and false promises, would give the average person a chance to turn the package around, and quickly read the ingredient list and nutrition facts. I’m always amazed at kids' deep knowledge of sports’ statistics, and the number of player's names they remember. Reading and understanding an ingredient list after a short introduction to food should be quite revealing, and exempting us from reading the label by the instant gratification of a traffic light code makes us less informed and more open to manipulation by food marketers.

And if you’re looking for a good packaged food grading system, based on nutrition facts and ingredient lists, try Fooducate’s (free) app.

Dr. Ayala

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