Blog Posts by Dr. Ayala

  • Why do liquid calories in sugary drinks matter so much?

    Many experts see sugary drinks as a major contributor to overweight and obesity. Large, well-preformed studies such as Harvard's Nurses' Health Study, which followed more than 50,000 women, have shown a correlation between consumption of sugary drinks and expanding waistlines.

    Is this just a correlation, or is there a clear cause-and-effect relationship between the two? Is there something special about sweet beverages that sets them apart from other low-nutritional-value foods, and justifies "blaming" them for a disproportionate contribution to the obesity epidemic?

    The science community generally agrees that when it comes to weight control a calorie is a calorie is a calorie, and weight gain is a result of consuming more calories than what one spends no matter where the calories came from. Calories from fats or carbs, junk food or gourmet meals all add up in the same way, and weight gain is just a matter of energy imbalance, in which the extra energy accumulates as fat.

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  • Calorie posting laws spread—healthier choices follow

    Last year, the Philadelphia City Council passed a measure requiring chain restaurants with more than 15 outlets to disclose calories on menu boards beginning on Jan. 1, 2010. My home town, Philadelphia-famous for the Philly cheese steak, all 900 calories of it-now joins New York City, several counties, and the state of California in passing such a measure.

    Why is calorie posting such a good idea?

    1) Knowing what you're eating is the first step to eating sensibly.

    I believe people will think twice about ordering menu items such as Arby's Sausage Gravy Biscuit -(at 960 calories), or McDonald's Vanilla Triple Thick Shake (at 1100 calories), products that supply half the daily caloric allowance in one meal item.

    Until now we could live in ignorant bliss, because unless we went through the trouble of going to the company's website or asking for nutrition charts, we wouldn't know the numbers.

    Will consumers lighten up their selections when presented with calorie

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  • Who’s shaping decisions about the school lunch program?

    This is the last time I'll be writing about the school lunch program for a while, I promise. I know it's not the most cheerful of subjects, but it's an important topic and, as you'll see, a timely one: the School Lunch Program is up for renewal, and that's why now's the time to review and hopefully improve it.

    I wanted to share with you Steven Greenstreet's provocative video, "The Food Lobby Goes to School," produced by the The American News Project. The video is of a hearing on school lunch nutrition regulations assembled at the Institute of Medicine. The institute will later this year advise the U.S. Department of Agriculture (USDA) on revisions to the School Lunch Program nutrition requirements.

    I think that if videos of barfing people get hundreds of thousands of views on YouTube, this video should be viewed by at least as many, just to prove there are thinking people out there too, so please pass this video on!

    There are many people weighing in on the subject of

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  • Sugary drink consumption still on the rise

    With seemingly everyone drinking tap, filtered, sparkling, domestic, imported or bottled water, it may be surprising that consumption of sugar-sweetened beverages continues to rise.

    A recent study published in the American Journal of Clinical Nutrition shows that the number of adults consuming sugar-sweetened beverages has increased dramatically in the past two decades. Two-thirds of adults now consume sugar-sweetened beverages, with an average daily intake of almost 300 calories, or 15% of the 2,000 calories/day recommended for the typical diet.

    Sugar-sweetened beverage consumption was highest among young adults, and particularly among young African Americans followed by young Mexican Americans, and was highest in populations at highest risk of obesity and diabetes.

    The study analyzed the 24-hour dietary recall data of more than 15,000 people collected in the National Health and Nutrition Examination Survey (NHANES) for the period 1988 to 1994 and compared it to the

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  • Not a healthy choice: junk foods vs. the school lunch program

    I devoted a recent post to the school lunch program, a federally sponsored and regulated program, which complies with some (if not altogether satisfactory) nutrition standards for nutrient content and portion size. I was grousing about the sorry state of the food our young ones are served under the guise of an "improved" lunch program.

    But to get the full picture of the school food environment, we need to also look at the competitive foods sold in schools-foods that are expressly marketed to our kids-which make up a big part of what kids actually eat while they're in school.

    What are competitive foods? They're anything sold, served or given to the kids that isn't part of the school subsidized lunch. They are comprised of foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events. The lunch money parents give their kids may very well be spent on these offerings, rather than on the school lunch.

    Kids love the vending

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  • How to make healthy whole-wheat pita bread and the mystery of the pita pocket

    Making pita bread at home is really easy and fun. It's really a beginner baker's project, and a wonderful first bread recipe to make with kids. The entire process of making pitas takes only about two hours (most of it rising time) and pita bread bakes in minutes. Kids are fascinated when they see the pita balloon in the oven and form its pocket.

    Freshness makes all the difference, therefore your own pitas are going to be better than anything you ever bought in a supermarket.

    Once you've mastered the dough preparation you'll be able to experiment with baking pitas over any very hot surface. While I usually use an oven with a baking stone, pitas can be made in any oven, on a grill, on a stovetop in a pan and even on hot pebbles!


    3 cups flour. (Use 1 ½ cups whole wheat flour and 1 ½ cups all purpose flour or bread flour for starters. You can then experiment with increasing the proportion of whole to regular flour)

    1 package active dry yeast

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  • Why you should not sneak vegetables into kids’ food

    Two recently published cookbooks guide parents through the art of sneaking puréed vegetables into their kids' food.

    While I agree that getting your kids to eat well is important, and vegetable and fruit consumption is linked to lower risks of obesity and certain chronic diseases and cancers, I think that teaching them to eat well is even more important.

    From the beginning of time the key to offspring's survival was learning where to get safe foods, and how to avoid dangerous ones. That was very apparent when our ancestors were gathering food, and a mistaken identity of a plant could lead to disease or death. I would argue, that in our times, in which there is an overabundance of things to eat, our roles as parents are just as important, because choosing the right food has become very difficult, especially since kids are exposed to so much advertising and marketing, pushing all the wrong foods.

    The best way to get children eating more fruit and vegetables is that they

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  • Hardly a healthy lunch: The sorry state of the school lunch program

    The third School Nutrition Dietary Assessment Study, which evaluates the school meal program, came out recently. The Journal of the American Dietetic Association devoted over 130 pages in a special supplement this month to its findings. There's much to read and think about in its data.

    I'd like to devote this post to just one topic covered by the study, and talk about what our kids get served, and what they actually eat while in the school cafeteria for lunch. I, for one, am quite concerened.

    A short introduction to the school meal program:

    In 1946 the National School Lunch Act created the National School Lunch Program (NSLP) with a dual purpose-to feed kids and prevent dietary deficiency and to provide an outlet for surplus agricultural commodities. The school lunch program operates in all public schools and in many private schools too.

    The School Breakfast Program was established in 1975 to help meet the nutritional needs of children from low-income families and is

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  • The power of the health journalist’s pen

    Where do you get your health and medical news? How do you know whom to trust? Should you act on news you read about health and nutrition?

    The Health Correspondent Susan Dentzer recently wrote a perspective piece in the New England Journal of Medicine in which she argues that when journalists ignore complexities, or fail to provide context, the public health messages they convey are inevitably inadequate or distorted. While many seasoned reporters do a responsible, thoughtful job, she says, others-due to ignorance, an inability to interpret and convey the nuanced results of clinical studies, or a desire to hype a story to draw attention to it-deliver misleading or wrong information.

    Dentzer writes:

    "In my view, we in the news media have a responsibility to hold ourselves to higher standards if there is any chance that doctors and patients will act on the basis of our reporting. We are not clinicians, but we must be more than carnival barkers; we must be credible
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  • Do fruit and vegetables explain the “French Paradox”?

    For years I've been watching with jealousy our French friends across the ocean, who indulge in meats, butter, rich pastries, full-fat cheese and other foods high in saturated fat (the classic repas français), yet are thinner and enjoy lower rates of heart disease and diabetes than us Americans.

    There's been a lot of interest in the "French Paradox" and plenty of controversy about it. (Some even doubt its existence.) We'd all love to draw practical lessons from the French. Red wine was suggested as one protective food the French consume in plenty. But there are many other differences between the average American diet and the French one: the French eat smaller portions, consume less added sugar and more fish, indulge in less prepared and snack food, drink less sugary beverages and snack less between meals. All of these dietary differences may be part of the explanation of why the French have less heart disease.

    The bad news is that the French people aren't as thin as they used

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