Is the Med Diet a Dead Diet? No – Despite Retractions

But the Mediterranean diet did get a kick in the keester. The New England Journal of Medicine just published a retraction of the 2013 PREDIMED study because of flaws discovered in the randomization methodology. Basically, it found that about a fifth of the 7447 trial subjects weren’t randomized properly, which could have allowed bias to creep into the data.

PREDIMED was a study on the Mediterranean diet and its impact on cardiovascular disease, specifically heart attack, stroke, and cardiovascular-related death. The study was intended to go on for 7 years but was stopped after about 4 years because the results were so dramatic that it was considered unethical to prevent the participants on the control diet from benefitting from the Med diet.

Subjects were supposed to have been randomly assigned to one of three groups:

• Instruction on the Med diet and provided free extra-virgin olive oil (EVOO);

• Instruction on the Med diet and provided free nuts (about 30 grams daily of a mix of almonds, hazelnuts, and walnuts);

• General advice on a low-fat diet. After 3 years, this group would also have additional dietary instruction.

Where did things go awry?

For about a fifth of the 7447 participants, randomization didn’t happen. They point out several ways the randomization failed for these participants, and these failures didn’t seem intentional or malicious. Probably due to site technicians who were poorly trained, poorly supervised, or sites that just weren’t run efficiently.

The authors completely re-analyzed the results of the study and published them here.

Did the corrected analysis change the results?

Yes. The results are still good, but not as dramatic. The Med Diet with either nuts or EVOO showed benefits only for reducing the risk of stroke, but not heart attack or other cardiovascular event.

We shouldn’t dismiss the Med diet though.  Although the PREDIMED study had flaws, other Med diet studies have shown positive results.

What holds true about the Med diet

• It’s simple and sustainable.

• It uses easily obtainable foods.

• It doesn’t require major dietary changes, yet still has at least some cardiovascular benefits.

As a clinician who has spent years helping people change their eating behaviors, a diet with these attributes hits the tri-fecta.

Where the Med diet could improve

A 14-item questionnaire was used in the PREDIMED study to determine a “MedDiet Score” of adherence to the diet. Some of the questions are a bit odd, if not troubling:

• Why are homemade pastries OK but “commercial bakery” items discouraged?

• Why are “red and processed meats” grouped together? More to the point, why is lean red meat in the same category as fatty, salty sausage?

• There is absolutely no mention at all of dairy foods, milk, yogurt, or cheese, either low-fat or regular? Yogurt and cheese are nutrient-rich and present in a Med Diet, even if not adequately so.

Solution: A “MediterDASHean Diet”

It combines the best of the Med Diet with the DASH (Dietary Approaches to Stop Hypertension) diet. Both emphasize lots of fruits, vegetables, legumes, but DASH makes up for what’s missing from the Med Diet and the diets of most people: dairy nutrition.

The Med Diet, for all it’s advantages, is low in calcium. Even the 2015 US Dietary Guidelines for Americans, which praises the Med Diet, acknowledges the likely lack of adequate calcium in the Med Diet.

A calcium supplement alone cannot replace the nutrition-rich package in dairy foods.  With a MediterDASHean Diet, you just do the Med diet but include at least 2 servings of dairy foods daily – full-fat, low-fat, or non-fat, whatever your calorie needs allow. Personally, I get three servings and happily so.

The Med diet discourages “red and processed meat” but it’s not clear why. It’s even less clear with a new dynamite study that looks at what happens when a Med Diet swaps out lean poultry for lean beef and pork. It’s my next post, so watch this space!

Photo credits: Penne: Petar Milošević – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=59899700  Caprese salad: Jessica Rossi, https://www.flickr.com/photos/jesswebb/3797226962

Can You Be Fit and Fat?

And can you reduce your risk of a heart attack? That’s what a new study asked, and the results were recently presented at the annual meeting of the American Academy of Sports Medicine (abstract 366, specifically).

It’s the question everyone wants answered, given that nearly 2 out of 3 people in the US are overweight or obese. (The photos on this post are of military personnel. Even they struggle with weight and fitness!) The idea being, do we have to be focused on weight if we’re willing to do our aerobic thing, or strength training, or just leading an active lifestyle, with things like regular biking, tennis, and recreational sports and activities?

New Findings

This research, known as Tromsø Study, was carried out over 34 years, from 1979 through 2013. When you look at heart attack risk, long-term data studies are preferred, but by their nature, it takes a oong time to learn the results. That’s what makes this study more significant. Participants were grouped based on the activity levels they reported:

Low activity – walking, gardening, etc. less than 4 hours per week.
Moderate activity: walking or gardening at least 4 hours per week.
High activity: running, biking or similar things that get the heart rate up, at least 4 hours per week.
Vigorous activity: engaging in competitive sports regularly.

Being active at any weight helps

This is the good news. Highly active people at any weight cut their risk of heart attack by about 12% versus those in the low-activity group.

Those engaging in regular “vigorous activity” cut their risk by 37% overall. Among those who were overweight or obese, the more active they were, the lower their risk of a heart attack.

Being overweight or obese mattered more

Even after adjusting for age, gender, smoking, and activity level, the overweight and obese people had much higher risk for a heart attack than normal weight people. Even active obese people were more than twice as likely as inactive normal weight participants to have a heart attack.

HOLD ON! – This Study Wasn’t Perfect

No study is, and the researchers call out this study’s weaknesses and limitations:

• Heart attack was the only health issue studied. Being active DOES benefit other chronic conditions like hypertension and type 2 diabetes, to name only two, but these weren’t addressed by this study.

• Activity levels were self-reported. Sorry – but people are known to report higher levels of activity than they really engage in.

• Body composition wasn’t studied. The researchers used the body mass index (BMI) to classify people as normal weight, overweight, or obese. It’s possible to be overweight but not overfat, especially if you engage in lots of strength training and are thus very muscular, although this is not as common as you might think. Flipping this around – you can be normal weight and still have too much body fat.

Cut-to-the-Chase Advice

1. Do what you can do. Being active at any weight is better than being inactive. Check with your doctor to see what activities are right for you. Running and high-impact stuff just isn’t right for everyone.

2. Consistency is everything. Aim to be active every day in some capacity – even if you’re normal weight.

3. Forget trying to be a “perfect” weight. Pick a weight you can maintain. Work on holding it there for a few months, then re-evaluate. Maybe that’s where you’ll stay, maybe you’ll take it down a bit. If you do go for less weight, take it five pounds at a time.

4. For activity: DO WHAT YOU LOVE. Then love that you can do it. I’ve worked for many years with people who have physical disabilities. They’d give anything to have the option to take the stairs or just go for a walk. Embrace the gift of your abilities.

YOU’LL BE “CRUCIFER-IED” FOR EATING THESE FOODS!

“I can’t stand cabbage but I only have to eat it once a year, on St. Patrick’s Day.”

Cabbage gets a bad rap because it’s so often boiled with corned beef. While corned beef needs to be boiled for a long time, cabbage just loses flavor the longer past al dente it cooks. If your only other exposure to cabbage is that poorly made deli-style coleslaw the above sentiment is justified, as it would be for most veggies eaten that way.

If St. Patrick’s Day is the only time you ever eat cabbage (save perhaps for the mayonnaise-laden coleslaw at the deli or maybe some super-salty sauerkraut on a hot dog) then it might be worth another look at this incredible food.

Not a cabbage fan?

No big.  Mother Nature provides many ways “up the mountain”. Cabbage is just one in a family of “cruciferous” vegetables, which research has shown to have cancer-fighting compounds called “glucosinolates”. These are the sulphur compounds that give the veggies much of their distinct taste and “aroma” but these veggies are loaded with other antioxidants, as well as vitamins and minerals. There are lots of delicious options to cabbage:

• Broccoli                                   • Collard greens
• Brussels sprouts                    • Mustard greens
• Bok choy                                 • Radishes
• Cauliflower                             • Turnips/turnip greens
• Chinese & napa cabbages    • Watercress

How tastes change

Never in my wildest days did I ever think Brussels sprouts (also a “cruciferous” veggie) would be an “in” food. Ditto kale. Indeed, kale got so “in” it’s now almost out (but the nutrition stays). Of course, like cabbage, if you’ve always associated Brussels sprouts with boiled-to-death soggy spheres, you’ll hate them. Tossed with olive oil and roasted however, maybe with some walnuts or pine nuts at the end, makes them a whole other ball game. Even better for kids, sliced or “shaved” disguises them completely and turns them into a great stir-fry with onions and any other veggie.

All those great healthy compounds in cruciferous veggies are also a source of flavor. They just need some herbs and spices to complement them. Stir-fries have done wonders to awaken people to the flavor of cruciferous veggies.  Here’s my recipe for my fool-proof “Quick, Colorful, Cruciferous Stir-Fry Medley”.  Delicious, fast, and super-healthy.

Roasting cruciferous veggies, like Brussels sprouts, cauliflower, and broccoli makes them almost irresistible, and they take added herbs and spices like garlic, oregano, and cardamom very nicely. Of course, there’s always my go-to addition, grated parmesan or pecorino. Even just a teaspoon amps up the umami quotient.

Kids love finger food, and roasted veggies make great finger food.  Get them eating these veggies with their fingers, then deal with etiquette issues later.

Bonus: What’s St. Patrick’s Day without soda bread?  Get “My Mistake Brown Irish Soda Bread” recipe that I tweaked from Cook’s Illustrated’s version.

DRINK BEER, LIVE LONGER, MORE OR LESS

But maybe a little less than you thought.  Lots of people see holidays like St. Patrick’s Day as the a day when getting drunk doesn’t seem so awful, because:

a) it’s tradition to do it,
b) people almost EXPECT to do it, and
c) you feel almost left out if you DON’T do it.

I had a patient once who recalled his family’s St. Patrick’s Day tradition, “it’s a rule: you go to the parade, then you come home and abuse yourself.” A case of beer PER PERSON (that’s four 6-packs or 24 cans) during the course of the day was not unusual, “and that wasn’t the only stuff we drank, either.”

Moderate drinking seems to be fine (see below) but there’s no way this kind of drinking is moderate and certainly not healthy, even if it’s “typical” for some St. Patrick’s Day.

What’s “moderate drinking”? There really are definite numbers here. The feds describe “moderate drinking” as: 2 drinks for a man, one for a woman. What’s “one drink”?

• 12-ounce can or bottle of beer
• 5-ounce glass of wine
• 1.5 ounces of distilled spirits

So that case of beer should have last about 12 days for a man, and 3-1/2 weeks for a woman. That’s the bad news for beer drinkers. For wine drinkers, you may want to check your pour. Five ounces is likely less than you think – it means 5 drinks per average bottle or white or red.

Booze: The good news

Moderate drinking, as defined above, seems to be associated with a longer life. The 90+ study was initiated in 2003 to study the common factors about people who live to be 90 years and older. There’s reason for this study – the nonagenarians are a fast-growing group. Baby boomers will likely contribute to their expansion in the years to come.

The 90+ year-old folks who have one or two drinks per day tended to live longer than those who abstained. Ditto for moderate coffee drinking, which has been defined as two to three cups daily. As for why moderate drinkers live longer, that’s till up for grabs.

This is an “association” study – it cannot show that moderated drinking of booze or coffee CAUSE you to live longer. Studies like these can only generate a hypothesis. Still, at least drinking moderately isn’t associated with negatives like earlier death.

It could be that people who drink moderately also aren’t taking take medication that is incompatible with alcohol. Therefore, the alcohol consumption acts as a screener or “marker” of people who are healthier to start. Same with coffee drinking. If you have high blood pressure, you may be told to stay away from caffeine, associating abstainers with poorer health.

“Beer-Bank”? It’s No-Deposit, No Return 

With booze, unfortunately there is no “banking” your beers ahead of time so you can enjoy a big blast on St. Patrick’s Day – or on any random Friday night. It’s two drinks per day, use them or lose them. If you know you’re going to drink more than that, keep it to no more than one drink per hour. The liver just can’t metabolize alcohol more quickly than that. Even at that rate, you may still not pass a breathalyzer, so don’t drink and drive. Period.  And please, holiday or not, legal drinking only, not for kids.

By the way, plenty of other factors were also associated with longer life, including daily exercise and working on hobbies of interest. Sounds like those who are enjoying themselves more also tend to live longer.

Silver lining for moderate drinkers/teetotalers

Keep your drinking sensible and instead of kissing the Blarney Stone, you’ll kiss hangovers good-bye and feel great the next day.  Cheers!

IF YOU FORGOT TO BUY CHOCOLATE, YOU MAY NEED TO EAT MORE!

If your significant other likes chocolate, you probably give it on Valentine’s day, but some science says eating it every day might help your brain function better. Chocolate and its components have been studied a fair amount in recent years, from its effects on blood flow through arteries to performance on cognitive tests.

What exactly does chocolate do to our brains?

This scientific review looked at studies on chocolate’s effects on our mood and found “very reliable effects of chocolate and chocolate components” on lessening mental fatigue and negative moods. Even better: the best effects came from eating “whole chocolate” rather than in pill form or in a supplement-type drink.
The review also looked at studies that showed acute effects of chocolate on brain function. Performance on cognitive tests that measured factors like working memory, attention, and reaction time were improved after giving test subjects single doses of “cocoa flavanols” – the antioxidants in chocolate. Not all studies showed such benefits, and to be fair, most studies used a fairly high dose of cocoa flavanols.

There is also a host of population studies that show “associations” between chocolate consumption and better health, less heart disease, diabetes, hypertension, etc., but these are non-specific and just serve to generate clinical trials.

How does chocolate do all that?

The exact mechanism is still unclear. What we DO know is that eating flavanol-rich chocolate and cocoa improves things like blood flow, blood pressure, and insulin sensitivity. Cocoa flavanols also have been shown to stimulate areas of the brain that deal with working memory, so they appear to be biologically active, and positively so.
It’s also possible that the caffeine and theobromines in chocolate are involved. Although caffeine can increase blood pressure, but theobromine seems to overcome this effect, helping reduce blood pressure.

Cocoa flavanols have long been known to improve blood flow. Better blood flow to the brain may be responsible for the cognitive effects. Improved circulation may also contribute to improved insulin sensitivity, among other benefits. Still, there’s a lot more we need to know before saying anything conclusive, but it’s good to know chocolate has some good things going for it besides taste.

What chocolate has the most antioxidants?

Definitely it’s plain, unsweetened cocoa powder, and not the type that the label says was “processed with alkali” or “Dutched”. That process pretty much destroys the antioxidants. Cocoa powder has almost no fat in it, either, so it’s also pretty low in calories. I use it in my homemade hot chocolate (I use about double what’s called for in most recipes!). Aside from it’s use in baked goods, you can add it to smoothies and try adding a tablespoon of add cocoa powder to chili (intensifies the flavor and I highly recommend it!).

As for solid chocolate, the darker the chocolate, the higher the antioxidant level – usually. Not all 70% chocolate will have the same amount of flavonoids, but again, the darker the better.

The presence of milk seems to reduce the absorption of the antioxidants. This study found that having a glass of milk when eating dark chocolate reduced the antioxidant absorption by 46%. Eating milk chocolate alone? The plasma antioxidants were reduced by a full 69%.

Cut-to-the-chase advice on chocolate

If you like chocolate, have it! Yes, it has calories, about 160-170 in an ounce, but with a cup of coffee or tea it makes a better snack or dessert than most. All those antioxidants make getting your cocoa on a good thing. Having milk with it cuts your absorption of the antioxidants, but it’s so loaded you’ll still get a good dose.

Me? Oh, I’m in.

BEST DIETS: THESE 2 TIED FOR GOLD

It’s January, and that means US News has issued its “Best Diets” rankings. Out of the 40 diets ranked, both the DASH diet and the Mediterranean Diet tied for first place – again.

Why? They have the most research behind them and they’re both great for your health. The DASH diet (Dietary Approaches to Stop Hypertension) was created to reduce high blood pressure and the Med diet is intended for heart health – two very common health conditions.

Both diets emphasize plenty of fruits and vegetables. The main difference is that DASH also emphasizes at least 2 to 3 servings of low-fat dairy foods daily. The Med diet is strong on heart-healthy fats like olive oil, nuts, and fish, like salmon, because of its high omega-3 fat content. The Med diet can be a bit low on calcium, due to the modest intake of dairy foods.

“Flexibility” Gets a Bronze!

The Flexitarian Diet approaches vegetarianism but not obsessively so. I like this approach. It takes the best from the vegetarian diets but the only thing it banishes is the absoluteness. You don’t have to choose a camp here. For many people, veg is fine – but not all the time. This diet , and so supports this thinking, and so do I. Plus, it’s actually very healthful.
What I love about the DASH, Mediterranean, and Flexitarian diets is that they’re basically eating styles. You can lose weight on them, but they can be a way of eating for the whole family, even the kids. This is ideal for families where one person is trying to lose weight, but doesn’t want to make, or eat, different food from the rest of the family. These diets are all about healthy (and tasty) eating. They also take no special work, don’t require exotic food, and have enough options for everyone.

>>>Cut-to-the-Chase Eating Style: A “MediterDASHean Diet”<<<
Here’s my short-order combo of the DASH and Med diets:
• All fruits and veggies – and 5 portions of them (at least!) daily.
• Low-fat dairy foods of the DASH diet Aim for 3 servings but at least 2 (that’s still an improvement for most).
• Extra-virgin olive oil, fatty fish, nuts, and sure, a glass of wine (if you drink).
Basically a Med diet with more low-fat dairy foods. More inclusive, flexible, less limiting – IOMO.
Up next: The Worst Diets (NOTE: this could get ugly)

COULD “REVERSE RECESS” IMPROVE BOTH TEST SCORES & DIETS?

I’ve said forever that kids who eat breakfast do better in school. A growing pile of research also suggests that “reverse recess”, that is, having some physical activity before – not after – lunch, may also contribute to better test scores.  This reverse recess also seems to help0 kids want to eat more of what they need.

The latest study  included 1350 students in Texas elementary schools and looked at the differences in intake and test scores when schools scheduled recess before or after lunch.

Simple changes, big results

I love research like this. It’s simple and shows real results.

When students (third, fourth, and fifth grade students) had recess before lunch, they scored higher on the “3Rs” – reading, writing, and arithmetic. Not all grades scored higher on all measures, but the results were enough to impress school principals enough to consider changing the school’s recess schedule for next year.

There were nutritional implications here, too. In the schools with recess before lunch, students ate more of all lunch components: the entrée, fruit, milk, and even the veggies. Two things may be happening here to produce the results:

• The kids were hungrier after being active, so they had a better appetite for their lunch
• Having just actively “let off steam”, they were a bit more calm and more ready to eat, and with play time done for a while, they could devote more time to eating and socializing.

Another thing I love about his study is that it looked at “plate waste”. This is messy research, because it requires the investigators to look at how much food was actually eaten. It’s a dirty job, but I’m glad they did it, because the results are more informative than some other studies that look only at how much food is chosen, not necessarily eaten. That’s significant, because it’s not nutritious until they eat it.

More than nutrition: BEHAVIOR benefits, too?

A 2014 study done in an Oregon community however, found that the students having recess before lunch drank significantly more milk and were 20% more likely to drink the entire 8-oz. carton of milk than were the students having recess after lunch.

Even better: the teachers reported that having recess before lunch resulted in better classroom behavior and greater readiness to concentrate on academics after the lunch period.

What I love about these studies is that they really didn’t change the curriculum or even the offerings of the school lunch program. Only the scheduling changed, so that kids were given more activity right before they sat down to lunch. Easy fixes for nearly all schools, and most certainly worth a try, especially because virtually none of the schools offering recess before lunch noted any misgivings or negatives.

Finally, remember that kids like to eat stuff that tastes good, but we adults can stand to learn a thing or two about what we assume kids will eat. The kids in the 2014 Oregon school study ate the most fruit when pineapple and cottage cheese was served. Wake-up call here!

MEAT AND TYPE 2 DIABETES? CALM DOWN — LET’S BOIL IT DOWN

Just when people are at feeling (justifiably) entitled to feel OK about eating meat again, out comes a study that “associates” consumption of meat with type 2 diabetes.  It was published in the American Journal of Epidemiology and was part of the Singapore Chinese Health Study.  Here’s the gist:

Over 63,000 Chinese adults, ages 45-74 years

There were two interviews during follow-up of just under 11 years to determine type 2 diabetes

Dietary pattern determined only once – at the start, by a food-frequency questionnaire

The variables: intake of poultry, red meat, seafood and incidence of type 2 diabetes upon follow-up.

They divided the subjects into four groups based on intake of shellfish, poultry, and red meat.  Then they compared the groups with the lowest intake of meat/poultry/shellfish with groups that had the highest intakes.

Here’s where things get interesting, but first:

Iron 101

There are two ways iron exists in food.  Iron is either part of hemoglobin (called “heme iron”), as in the case of animals, or it’s bound to other compounds (called “non-heme iron”), as with plants.  Compounds like phytates in plants bind to iron to make it less absorbable.  Eating plant iron with an acid, like having spinach with a vinaigrette dressing, will help liberate some of the iron, but in general, heme iron is more available to the body.

How much iron do we need each day?  Adults need 12 mg/day and women of child-bearing age need 18 mg/day, because they lose iron each month they menstruate.

The study data are “noisy”

This means the study has limitations that prevent drawing strong conclusions. To be fair, he study’s authors were pretty responsible in pointing out some of the limitations of their study. Most notably:

  • Dietary pattern was taken at the beginning and never again. So, what you had for dinner on a  Tuesday night 11 years ago predicts your health now?  You might be able to get statistics from this data, but drawing any realistic conclusions is making a Grand Canyon leap.  People’s diets change over 11 years!
  • Activity patterns were also assessed only once, at the beginning of the study.
  • Those who ate the most red meat ate averaged only about 53 grams daily – less than two ounces! And they still ate more seafood than meat.
  • Those who ate the most seafood also averaged about 33 grams of red meat daily — a little over an ounce! So differences between the HIGHEST and LOWEST consumption of red meat was only 20 grams – about 2/3 of an ounce.
  • Different meat types were assessed (beef, pork, lamb, etc.), but not cuts of meat, or parts of poultry (legs have more heme iron than breast) or dietary fat.  Pork belly has lots more fat than pork loin, for instance.

With the difference between the highest fish-eaters and the highest meat eaters being only 20 grams of meat, the difference may be statistically significant but not clinically (“real life”) significant.  The “associations” these studies talk about don’t mean “cause-and-effect” but consumers don’t often understand that. and the headlines don’t help much. To get the facts you usually have to read beyond headlines.

My take-away from this study? Not a whole lot.    

And the authors pretty much agree with me, noting, “We do not perceive any reason for meat intake to be related to the likelihood of disease diagnosis in our study population.”  Simply put, this study failed to connect meat intake with type 2 diabetes.  Game over.

Seafood absolutely is great food, but meat and poultry are also nutrient-rich.  Some tips for eating meat and poultry well:

  • Go leaner whenever possible.
  • Keep portions real. Even 4 ounces of lean meat is going to be loaded with enough protein for your meal.
  • Keep half your plate veggies and fruits.
  • Include a whole grain or a starchy vegetable.
  • Keep added fat reasonable. Olive oil or canola are good choices, rather than butter or coconut oil.

 

FAMILY MEALS: ESSENTIAL TO FAMILY HEALTH

September is National Family Meals Month, and it couldn’t come at a more appropriate time than right now, when kids are back at school, yet for many families affected by weather, a family meal can be the most comforting thing ever.  For all families, re-committing to having family meals together is one of the most beneficial things parents can do for their kids and for family life.

The practice of having family meals isn’t dead, but there are signs it’s ailing.   Families still eat together, but according to a Harris poll cited in a 2015 study on family meals, only 3 in 10 families eat together every night.  There’s room for improvement here and there are many reasons to make the effort.

Family Meals: It’s About the ACT As Much As the Meal

A quick research rundown on benefits of frequent family meals:

  • Kids are 12% LESS likely to be overweight
  • Kids are 24% MORE likely to eat healthier foods (and 20% LESS likely to eat unhealthy foods!)
  • Kids are 35% LESS likely to have eating disorders (e.g. have a healthier RELATIONSHIP with food)
  • A separate study found that eating home-cooked meals most often (even if using some frozen or packaged convenience foods) resulted in eating about 130 FEWER calories for the day, compared to people who cook at home less often or not at all. Those families also ate less fat and sugar.

The benefits go beyond nutrition.  Better mental health, social skills and even higher grades In addition to the dietary benefits, research has shown advantages to eating meals together that go beyond nutrients and nutrition but that are every bit as important:

  • A 2015 study: Kids who grow up having regular family meals are more likely to have more desirable social behaviors (such as sharing, respect, fairness) as adults.
  • A 2014 study: have fewer signs of depression, less likely to abuse drugs, less likely to engage in delinquent acts.
  • Strong association between family meals and higher grades, higher self-esteem, less risky behavior.

So…What’s the Barrier to Family Meals?

Check the “Life Happens” folder.  There’s more demanded of everyone today.  Jobs aren’t 9 to 5 anymore.  Technology allows (and encourages) us to check work-related messages outside of typical workday hours.  Pile on the demands of the kids, their academic, extracurricular, and social schedules, plus the demands of just running a household, and family meal seems like an unnecessary expenditure of time.

It’s necessary. As often as you can have it and really make it a priority.   It sends important messages to your kids:

  • A little time spent together every day is important, and
  • You kids are worth my time every day.
  • I want to know what’s happening with you, and

Is there a downside to family meals?  Only if the family relationship isn’t strong.  It’s also another reason to establish the family table early on as a totally neutral zone for parents and kids alike.

How To Enjoy, Not Endure, Family Meals

  • No technology.   If kids – or patents can’t disconnect for the 20-30 minutes it takes for the family meal, then family meals aren’t the problem, family standards are, and it’s time for a reset.  They’ll miss a few texts and posts and they’ll learn the world still spins.
  • Switzerland. The family meal table is a fully demilitarized zone.  No fights, no bickering, no lectures.  Keep it positive.  If social skills need some work, this is the place.  Give some guidance, but always with encouragement, not judgement.  And ALWAYS give some positive feedback.  Kids (and adults) love to be told they’re doing a good job.
  • Table it. Research has associated eating together around the family table, not in front of the TV or in other rooms, with lower body mass index (BMI – a measure of weight-for-height) for kids AND parents. Keep them engaged until everyone is finished – that’s also associated with lower BMIs.
  • Everyone’s an owner. Parents are hungry for prep help! No matter the menu, give age-appropriate tasks for prep and clean-up.  Everyone gets dinner sooner and enjoys it more because they have a personal stake in its prep.  Big note: tell the kids you appreciate their help.  Positive feedback is the ultimate motivator.

Fave Family Meal Story

My friend, Marylou, told me about her former next-door neighbor, a widow with six kids and a huge house to care for.  Marylou visited one Saturday morning to find the widow with a huge pile of laundry to do, yet she was prepping to take all her kids on a picnic.  Marylou was aghast and said, What about all this laundry?!”  The woman said, “I know, but in ten years they won’t remember the laundry.  They’ll remember the picnic we had.”

I love that mom.  And thanks to my own mom, for making great family meals — including breakfasts!

CAN COCOA & CHOCOLATE HELP METABOLIC SYNDROME?

 Cocoa flavanols – those phenom compounds in cocoa that seem to have great health benefits, such as improving blood flow and helping manage blood glucose levels, but some recent research pulls together just how they may be useful in metabolic syndrome.

Let me get through the basics so we can talk about the good stuff.  Metabolic Syndrome constitutes a group of conditions:

  • High triglyceride levels
  • High fasting blood sugar
  • Large waist circumference
  • Low HDL cholesterol (the good type of cholesterol)
  • At least borderline high blood pressure

If you have any three of these, or if you’re taking medication to control three of these, you probably have metabolic syndrome.  You also have lots of company, since 1 in 3 Americans has it, too, according to a 2015 study, although many don’t know it.  Having even one of these conditions increases your risk for common but serious chronic diseases, such as heart disease, type 2 diabetes, and stroke.  These are impacted by diet, so having metabolic syndrome usually means your diet and eating style needs a closer look.  Sounds awful, but it isn’t, and you may get some help where you never expected any.

Cocoa flavanols to the rescue

Not everyone is aware that cocoa is one of the most, if not the most, concentrated sources of antioxidants in the diets.  We may get a larger quantity of antioxidants from other foods, like tea, coffee, fruits and vegetables, but that’s because we eat larger amounts of them and on a daily basis.

A recent review in the highly respected Journal of Nutritional Biochemistry looked at the ways cocoa may act to be healthful and it may be different than you thought (for those of us “chocolate-science nerds” who even thought about such things).   After looking at over 244 published papers, here’s what the authors concluded about cocoa flavanols and how they lessen metabolic syndrome:

  • Cocoa flavanols appear to slow down the action of digestive enzymes, delaying spikes in blood glucose levels, possibly by limiting or delaying the digestion of starches, and encouraging better insulin response. Nice news: a larger dose seems to be most effective, but it’s way too early to suggest any “more is better” recommendations.
  • Regular cocoa consumption seems to have “pre-biotic” effects, e.g. regularly exposing the gut environment to cocoa flavanols encourages growth of good bacteria that in turn helps the lining of the colon function more effectively. How so? It seems to reduce the absorption of endotoxins (the stuff that’s released when bacteria disintegrate).  Endotoxins that get absorbed into the bloodstream can cause things like plaque buildup and disruption of insulin regulation.  Less of these is better.
  • Cocoa flavanols also help insulin sensitivity in muscles and peripheral tissue. However, they’re not well absorbed. They get broken down by the gut bacteria, but the resulting metabolites (products of the breakdown) do get absorbed and are likely what is doing the good work in the peripheral tissues.

It’s not over

Metabolic syndrome, and especially type 2 diabetes, are associated with chronic low-grade inflammation.  Through a variety of mechanisms, the powerful antioxidant activity of cocoa flavanols may also help reduce this inflammation, and in an enjoyable way.

As a clinician, this is music to my ears: something my patients like hearing and that I like explaining.  Chocolate and cocoa flavanols are a win-win and make me love the power of food.

There’s still much more to know, however.  Many of the studies in humans were of short duration, so it’s not known if observed benefits fade after a few weeks or months.  Dark chocolate is where the flavanols reside, (aim for cocoa powder — the most concentrated source, or 70% bars) but specific doses of cocoa for each condition and best ways to administer cocoa for maximum effect are also unknown.

Cut-to-the-chase

  • There’s excellent news on potential benefits of cocoa and its flavanol compounds, and their potential impact on metabolic syndrome, diabetes, blood glucose control, and other chronic health risks.
  • We still need to remember that the ways in which we consume cocoa – bars, truffles, hot chocolate, etc. provide calories. Too many of those – from ANY source — will contribute to weight gain, one of the hallmark hazards of metabolic syndrome.
  • So it is with chocolate and cocoa as it is with alcohol: eat with your head, not over it. An ounce a day of the darker stuff, or a good scoop of cocoa powder in a drink, is just fine.  NOTE: If the ingredient label says the chocolate is “processed with alkali” or “Dutched”,  the flavanols have been removed. Skip this stuff if you want the benefits.

[Personal note to researchers: please try to avoid concluding that a pill is the best way to get cocoa flavanols!  We’re real people and would be far more likely to get recommended “doses” if they were in the form of edible chocolate and cocoa. Just saying.]