Dr. Ann’s Blog

1. Flavored yogurt products: Although these “healthy favorites” provide some of calcium, B vitamins, and essential amino acids, they are loaded with added sugar - in many cases more than is typically found in a standard dessert.  “Yogurt” products, through slick packaging and clever marketing have very successfully garnered  what is referred to as the ”health halo effect” - meaning consumers naturally assume any product with “yogurt” on its label is wholesome and good for you.  The only truly healthy yogurt is low-fat plain.  If you prefer it sweetened, combine with some berries or cut up fruit or add a teaspoon or two of maple syrup or honey.
2. Pretzels:  Standard pretzel packages scream “fat-free and natural,” but don’t be dooped. This popular snack food is nothing more than 100% refined white flour (the exact same thing as sugar in your body) combined with a whopping dose of sodium.  Instead, choose from the growing selection of whole grain or multigrain, crunchy snacks like Stacy’s multigrain pita chips or my personal favorite, Food Should Taste Good whole grain tortilla chips.  Even regular potato chips (trans fat free of course) would be a better choice, as they provide significantly more fiber and nutrients, and will not spike your blood glucose level like the infamous white flour (naked starch) that pretzels are made from.
3. Bran muffins:  Unless you make your own, forget these no-icing cupcakes.  The standard store-bought (or Starbucks) bran muffin is loaded with white flour, sugar, vegetable oil, additives difficult to pronounce with a touch of added bran.  Don’t let that wholesome, rich, brown color fool you.  Like colas, it typically comes from added caramel coloring.
4. Meal replacement/energy bars:  Although some are a bit more wholesome than others (15 vs. 40 or so ingredients) these popular, modern day favorite are the ultimate in 100% pure factory made, processed foods.  In my book, they are not food, but food-like artifacts that are generally high in sugar and/or unhealthy fats.  Have a handful of nuts and a piece of fruit as a real, healthy alternative.  (If you must - Kashi, Nature’s Path, Luna, or Pria are your best options.)
5. Infused waters:  Like yogurt, “water” has the health-halo effect and the beverage industry is currently exploiting it to the max.  Water infused with all sorts of supposedly healthy extras, like vitamins, minerals, antioxidants, and herbs are the fastest growing beverage products.  Most of them are nothing more than sugar-fortified drinks like their first cousins, soda with a smidge of a few added vitamins.  There is zero evidence that extracting nutrients from their native context (foods) and adding them to water has any health benefit.  If you use these products, you are paying 100x more than you would for tap water (which is more rigorously monitored than bottled water). By the way, pure water is the only beverage that provides 100% of what we need and why we have to drink to stay alive - namely H20.

 Fatigue is epidemic and is second only to low back pain as the most costly condition to the bottom line of American businesses.  A novel study from the University of Georgia provides strong evidence that the anecdote may be as quick and simple as a 20 minute leisurely stroll.  Investigators divided 36 sedentary adults plagued with chronic fatigue into 3 groups.  During this 6 week study, one did no exercise, the second did 20 minutes of exercise at a moderately intense pace 3 times a week, and the third group did 20 minutes of activity at a leisurely pace, like relaxed walking 3 times a week.  Both groups of exercisers experienced a significant boost in energy and reduction in fatigue.  Curiously, the relaxed pace exercise group reported the greatest reduction in fatigue - an impressive 65% decrease! (Psychotherapy and Psychosomatics, February 200

 This study adds to what is honestly already a scientific diction - namely, the human body is incapable of producing energy unless it also expends energy, and there is a direct, positive relationship between the two.  Basic human physiology dictates that the more energy you expend, the more energy you are capable of producing.  So please do not expect to have any energy (and certainly don’t complain about it) unless you are willing to expend it too!

 On the subject of moving, a new study from the journal Epidemiology (March 200 provides further evidence that regular physical activity can provide significant breast cancer protection.  Researchers compared the lifelong activity levels of 2,176 women with breast cancer and 2,346 healthy subjects.  The women with the greatest levels of physical activity over their lives were 20% less likely to develop breast cancer versus those who were the least active.   Researchers noted that although activity was protective, no matter what the women’s size or age, women in their 50’s who spent more time engaging in moderate to vigorous exercise relative to when they were in their 20’s to 40’s were 34% less likely to get breast cancer.  Those in their 50’s that increased their activity the most experienced a 41% risk reduction.  These finding are consistent with what we now know in general about the benefits of physical activity in relation to age.  The older you are the greater the efficacy of physical activity, i.e. an 80 year old that engages in moderate physical activity 30 minutes a day benefits significantly more than a 30 year old doing the same.  

 My 72 year old mother is a shining example of this reality.  Although she was active throughout her life (raised 7 kids), she never engaged in regular, formal exercise until her early 60’s.  At that time, she took up competitive running and has been at it ever since.  She competes frequently in 5Ks, 10Ks, and even half marathons and almost always wins her age group or places in the top 3.  She takes no prescription drugs, has boundless energy, and enjoys the functionality of someone in their 40’s. Go Mom!

Make exercise a priority throughout your life, but be especially vigilant as you enter the golden years!

According to a powerful new study – the largest such study ever, middle aged to elderly men can slash their risk of premature death from all causes in half simply by taking a brisk, 30 minute walk at least 4 to 6 days a week.  The investigators calculated the fitness levels of over 15,000 adult males through treadmill exercise testing sometime between 1983-2006 and assigned them depending on their results from “low fit” to “very high fit.”  By tracking fatalities through June 2007, the scientists found that a study subject’s fitness level was more predictive of their future risk of death than blood pressure, body weight, or age.  The most fit study subjects cut their risk of early death by a whopping 70%! (Circulation, February 2007)

A second compelling study, unique in that it included the effects of physical activity for several subgroups of the general population reported similarly remarkable findings.  This study involved over 252,000 men and women ages 50 to 71 and found the risk of death was reduced by 50% in people who engaged in moderate activity (like brisk walking) 30 minutes at least five days a week or vigorous activity (enough to break a sweat) 20 minutes at least 3 times a week.  Even those that did a little bit of moderate activity during the week were 19% less likely to die than those who were sedentary – in other words, some is always better than none at all (Archives of Internal Medicine, December 2007). 

These two new studies are further confirmation of one of my favorite wellness soundbites – namely, “exercise is the magic bullet!” There is simply nothing else available to you – not nuts, not berries, or any combination of foods, nor prescription drugs, nor meditation, that can provide to your body what regular physical activity can.  And it’s free (yet priceless). So as they say in the Nike ads – just do it!

There is perhaps no other food that has received more spin than soy!  Here are the facts based on my understanding of the science:

 Whole soy foods have an exemplary nutritional profile, i.e. they are very, very nutritious.

o       Provide high quality, (“complete”) inexpensive vegetable protein that is naturally low in saturated fat and cholesterol-free.

o       Rich in vitamins and minerals, including B vitamins like folate, vitamin E, calcium, magnesium, iron, potassium and selenium.

o       High in soluble fiber (the type of fiber that reduces cholesterol and stabilizes blood sugar).

o       Provide heart-healthy polyunsaturated fats to include the superstar omega-3 fats.

o       Provide a broad array of phytochemicals felt to have specific disease-fighting capabilities, i.e. isoflavones, saponins, phytosterols and protease inhibitors.

o       Please note that only whole soy foods – soy milk, tofu, tempeh, soy nuts, miso and edamame, provide this wonderful bounty of nutrients, not isolated soy components or soy supplements.

The most well-documented health benefit of soy foods is reducing cardiovascular risk.  There is solid, demonstrable evidence that whole soy foods can lower total and LDL (bad) cholesterol levels.  The specific cholesterol-lowering effects of soy foods are due to its protein fraction.  To obtain maximal heart benefits, one should strive to consume 2 separate servings of soy foods daily.  For example – soymilk in your breakfast cereal or smoothie and a handful of soy nuts as a mid-afternoon snack.

It’s particularly beneficial to work towards substituting soy foods, i.e. soy burger for red meat that is high in saturated fats and often contain hormonal residues along with other harmful chemicals.  This way, you get the nutritional benefits of soy while simultaneously displacing unhealthy fat calories from your diet.

 Other reported benefits of soy foods include: 

Cancer protection – especially for the hormonally sensitive tissues of the breast, prostate and uterus.  Soy foods are the richest, dietary source of phytochemicals called isoflavones.  Isoflavones function in the body as weak estrogens and are thought to block the actions of the more potent biologic estrogens that can promote tumor growth.  Most of the evidence for soy’s cancer-protective properties are from population studies.  For example, Asian populations whose traditional diets are high in soy have much less of these cancers relative to Western populations who consume less soy.  Unfortunately, when you examine all of the available science – results are mixed.  Some studies show protection while others don’t.  We simply need more studies to know the definitive answer.  My “personal hunch” is that regular consumption of whole soy foods over one’s lifetime does reduce cancer risk.

A recent review of 18 epidemiologic studies looking at soy consumption and breast cancer reported a small (14%) reduction in breast cancer risk among women who had a high soy intake (April 5, 2006, Journal of the National Cancer Institute).

Reduction in Menopausal Symptoms – Soy isoflavones, again, through their estrogen properties, may provide relief of menopausal symptoms in women.  Like the studies with soy and cancer, results here are also mixed.  Based on my reviews of the science – some women benefit while others don’t.

Protection from Osteoporosis – The isoflavones, calcium, magnesium and “bone-friendly” vegetable protein found in soy foods appear to promote bone heatlh.  A large study from China recently published in the Archives of Internal Medicine (Sept. 12, 2005) found a significant reduction in fracture risk in women with high soy consumption.

Further studies are needed for conclusive proof of this reported benefit.

 Summary of potential benefits of whole soy foods:

1.      Everyone (men, women, children) can benefit from its healthy package of nutrients. FACT.

2.      Men and women (esp. women as they are at greater risk of osteoporosis) may benefit from the package of bone-protective nutrients and phytochemicals it provides.  LIKELY.

3.      Older women may experience a reduction in menopausal symptoms.  POSSIBLE.

4.      Men may receive protection from prostate cancer.  POSSIBLE.

5.      Everyone can benefit from its cholesterol-lowering properties.  FACT.

6.      Lactose-intolerant individuals (African Americans, Asians, etc.) can use soy milk as a lactose-free alternative to cow’s milk.  FACT.

7.      Women may receive protection from breast cancer.  POSSIBLE.

In regards to children – serving children whole soy foods as part of a balanced diet is safe, nutritious and consistent with health promotion.  I regularly serve my 4 children soy milk, soy nuts, tempeh and edamame (please see below for controversy on soy formula for infants).

This is the area where some controversy exists with soy foods.  The most noted is the effect of soy foods on patients with diagnosed breast cancer and whether the soy isoflavones stimulate or reduce tumor growth.  Although promotion of tumor growth is a theoretical concern, I suggest women with breast cancer discuss the potential risks/benefits with their health care provider to make an informed, personal decision. 

In regard to thyroid function – some animal studies show a link between soy isoflavones and possible thyroid disorders.  This appears to be highly controversial.  One of the arguments against this possibility is the observation that Asian populations that consume lots of soy foods do not have a higher incidence of thyroid disease.  I am comfortable with my thyroid patients consuming soy foods unless they have personally observed exacerbation in their condition as a result.

Recent concerns have emerged with soy infant formulas and the high concentration of isoflavones infants receive when virtually all of their nourishment is provided by soy (I consider this topic outside of the context of your article, but provide it to be complete.  Further studies are needed here).

The healthiest soy products are clearly the “whole” soy foods (soymilk, tofu, tempeh, soy nuts, edamame, miso).  They all have a similar nutritional profile and are very nutritious. 

I recommend that people try them all – and regularly include those that suit their palate best.  In my experience, most everyone (including kids!) find edamame and roasted soy nuts delicious.  Tempeh and tofu are bland and tasteless on their own, but conveniently adopt the flavor of whatever you add to them, i.e. tofu in barbeque sauce.

My personal favorite is tempeh – a fermented soy product that has a firm, cheese-like texture.  I flavor it with a little olive oil, balsamic vinegar, salt and pepper and add it to salads or wraps.  My kids know it as “Asian cheese” and love it too!

I’m also a proponent of substituting organic, calcium fortified soy milk (Silk Enhanced is my favorite) for cow’s milk because of its nutritional profile is healthier.  Most adults’ taste buds can easily accommodate this transition in their morning cereal.

Whatever whole soy food one may choose – I always recommend organic, non GMO varieties.  A basic tenet of my personal nutritional philosophy is focusing on whole vs. processed foods.  As such, I am not as enthusiastic about processed soy foods (soy cheese, ice cream, meat analogs, etc.)  If someone insists on processed foods, however, soy products are generally healthier than their non-soy alternatives.

There were several new studies from the past few weeks supporting the importance of sleep for both general health and body weight.  According to a study in the Journal of Clinical Sleep Medicine (December, 2007), adults with chronic health problems like heart disease and diabetes that reported less than 7 hours of sleep each night were 3 times more likely to be obese than those who got 8 or 9 hours of sleep.  Prior studies have found that sleep deprivation boosts levels of the appetite-stimulating hormone ghrelin, while lowering levels of the appetite-suppressing hormone leptin, in addition to promoting a sluggish metabolism by decreasing insulin’s effectiveness.  A second, startling report from the Proceedings of The National Academy of Sciences (December, 2007) found that poor sleep quality in young adults, specifically failing to sleep deeply for just 3 nights in a row, had the same negative impact on the hormone insulin’s effectiveness as gaining 20 to 30 pounds! (Poor insulin activity a.k.a insulin resistance turns your fat cells into fat magnets while dramatically increasing your risk of heart disease and type 2 diabetes.)  Stated another way – 3 nights of disrupted sleep gave the young adults in this study the metabolism of people 3 times their age.  This was the first study to link poor sleep quality with an increased risk of diabetes and has huge implications for public health as sleep duration and quality are at an all-time reported low and, type 2 diabetes has become the proverbial “runaway train.”

Consistently, studies have found that 7-8 hours of sleep a night for adults is optimal.  Both too little and too much can boost your risk of death.  A recent Dutch study of 8000 adults ages 35-55 followed for several years found that those who reduced their nightly sleep below 6-8 hours per night from the start of the study experienced a 110% excess risk of cardiovascular-related death.  Those who increased their sleep duration beyond 7-8 hours from the start of the study had a 110% excess rate of non-cardiovascular death (Sleep, December 2007)

Kids are susceptible too when it comes to poor sleep and poor health.  The journal Pediatrics (November 2007) reported that 6^th graders who averaged less than 8.5 hours of sleep a night had a 2-fold greater obesity rate than their counterparts who slept more than 9.25 hours a night.  Investigators reporting in the journal Sleep (January 200 found that amongst 591 seven year olds, those who got the least sleep had a three fold higher risk of being overweight or obese in addition to more emotional volatility.  As in adults, adequate sleep is required for both a child’s physical and emotional health.  The American Academy of Sleep Medicine recommends that preschool children get 11-13 hours of sleep a night and that school-aged children get 10 to 11 hours per night.

 Eggs have always been a cheap, delicious and convenient source of high quality, low-fat protein along with B vitamins, vitamin E and iron. Thanks to modern food technology eggs are now healthier than ever.  Many egg producers now fortify their chicken feed with omega 3 fats (usually from fish meal) which means that this superstar fat gets incorporated into the egg yolk.  These “omega 3 eggs” are available at all grocery outlets.  You will pay a bit more, but it’s well worth it as these eggs are second only to seafood as the most plentiful food source of the long-chained omega 3 fats like DHA.  Simply look for “DHA or omega 3″ on the label.  Eggland’s Best (white carton) are a popular brand and have also been voted America’s “best-tasting” egg by the American Culinary Institute. On the subject of eggs and health — please know that there is not a shred of scientific evidence that eggs elevate the risk of cardiovascular disease in healthy subjects, so enjoy them and feel good about it too if you are a member of this healthy bunch!  There is some evidence however, that eggs can elevate cholesterol levels in a small minority of cholesterol patients (especially diabetics) so I recommend that these folks eat 6 or less a week.  Perhaps, one of eggs most important, but barely recognized health benefits relates to preservation of eyesight — Egg yolks provide the most biovailable form of lutein of any food, providing about 3 times higher blood levels than other food sources.  Lutein is a carotenoid phytochemical that is instrumental in protecting against age-related macular degeneration and cataracts by shielding the eyes from damaging ultraviolet radiation. 

A massive, new, landmark review of the most definitive science to date provides confirmation that we, as individuals, have enormous control over whether or not we will develop cancer.  Titled Food, Nutrition, Physical Activity and the Prevention of Cancer:  a Global Perspective - the report was the most comprehensive ever undertaken to examine the impact of lifestyle choices on cancer risks.  Over a period of 5 years, hundreds of leading scientists from around the globe analyzed over 7000 large-scale studies to make their conclusions.  They summarized their findings by constructing the following “action plan” for cancer prevention.  Spread the word by forwarding this to all of your friends and love ones.   Please note that the first 3 are in order of importance following avoiding tobacco while 4-8 are in no particular order as they all appear on par with one another.

1. Be as lean as possible within the normal range of body weight.
2. Be physically active as part of everyday life.
3. Limit consumption of energy-dense foods.  Avoid sugary drinks.
4. Eat mostly foods of plant origin.
5. Limit intake of red meat and avoid processed meat.
6. Limit consumption of salt.  Avoid moldy cereals (grains) or pulses (legumes).
7. Limit alcoholic drinks.
8. Aim to meet nutritional needs through diet alone.

Special Population Recommendations

1. Mothers to breastfeed; children to be breastfed.
2. Cancer survivors to follow the recommendations above.

And always remember - do not smoke or chew tobacco. For more on cancer prevention go to www.preventcancer.org 

Heart attacks remain the leading killer of women – killing more women than the next 5 causes of death combined.  Additionally, heart attacks tend to be more deadly in women vs. men.  So it was especially good news and incredibly empowering that a provocative new study in the Archives of Internal Medicine (October 2007) reported that women could slash their risk  (up to 92%!) of having a first heart attack simply by eating the right foods, enjoying alcohol in moderation, staying physically active, maintaining a healthy weight and avoiding tobacco.  The study authors described the right diet as one rich in vegetables, fruits, whole grains, fish and legumes.  According to this analysis, the combined benefits of the 5 strategies noted above could prevent about 77% of all heart attacks in women. You can also order my Just Say Whoa! to Heart Disease Grocery List for a detailed listing of all the right foods.

Fish was featured prominently in this month’s nutrition science news.  According to 3 reports in the November issue of the American Journal of Clinical Nutrition, fish really is brain food! A Dutch study that included over 400 people, ages 50 to 70, found that those with the highest blood levels of omega 3 fats (the type of fat found in fish) had a slower decline in cognitive capacity over the 3 year study period vs. those with lower levels.  A second study of over 2400 people reported a robust and consistent relationship between blood levels of EPA (a type of omega 3 fat) and physical health.  A third study found that elderly folks who consumed more than 10 grams daily of fish had much higher test scores on cognitive ability than those who ate less than 10 grams daily.  Finally, French researchers reported in this month’s issue of the journal, Neurology, that older adults whose diets were high in omega 3 fats experienced less dementia than those whose diets were low in omega 3 fats. 

These studies lend strong support for current dietary recommendations to include at least 2 servings of fish a week, preferably the oily varieties like salmon, tuna, sardines, herring, and lake trout.  Everyone should strictly avoid the large, carnivorous fish because of its high concentrations of environmental toxins.  These include shark, marlin, sword fish, king mackerel, and tile fish. 

One of my very favorite new “convenience foods” is single-serving pouches of shelf-stable wild Alaskan salmon.  I top my lunch salad at least 3 times a week with this super-healthy protein package.  Each 3 oz serving provides 1000 mg of omega 3 fat, 13 grams of protein, and over 100% of the recommended daily amount of vitamin D - all for just 120 calories!