Ready To Go Nuts? 6 Tips for Adding Nuts to a Healthy Diet

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the health benefits of nuts and provides tips for incorporating them in a healthy diet. 

They say good things come in small packages and nuts are no exception. Filled with protein, fiber, phytonutrients and antioxidants, nuts pack lots of good things into a small, convenient and healthy package. They keep you satisfied, help curb unintended grazing and have powerful cancer-fighting properties.

Previously shunned by healthy dieters because of their high fat content, it turns out that nuts actually contain heart-healthy mono- and poly-unsaturated fat, which has been shown to lower LDL or “bad” cholesterol levels.

In addition to being healthy, nuts are inexpensive and have a long shelf-life, which makes them perfect for throwing in your purse or briefcase when you’re on the go.

Before going nuts with nuts, check out the following tips to incorporating them into a healthy diet:

Control portions
Nuts are high in calories, so moderation is key. Limit serving size to one to two ounces per day. 

Use nuts as a substitute
Instead of simply adding nuts to your diet, use them to replace foods that are high in saturated fats like meat, or contain empty calories.

Always read the nutrition label
Look for items with nutrition labels that say “dry-roasted” or “raw” and avoid those that just say “roasted.” Roasted nuts often contain added oils. Also, choose unsalted nut varieties.

Love the nutty flavor? Try nut butters
There are a variety of nut butter options available today including peanut, almond and cashew. Before making your purchase, make sure the nut butter does not include added ingredients like sugar or hydrogenated fat.

Store properly 
If you’re buying a large bag of nuts, store them in the freezer for maximum freshness and to aid in portion control.

Chop or grind nuts as an add-in or topping
Add nuts to yogurt, oatmeal, salad or stir-fry to infuse them with the nutty flavor while keeping portions in check. You can also mix nuts with herbs to use as a crunchy coating for fish or chicken. Sound good? Check out this healthy recipe for almond encrusted tilapia.


- Cara Stewart, RD, LDN

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Study Shows Weight Loss Supplements Are No Magic Pill for Weight Loss

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a recent study about the safety and effectiveness of weight loss supplements.

Supplements that promise quick, easy and permanent weight loss can be tempting, but a new study published in the International Journal of Sport Nutrition and Exercise Metabolism proves the old adage: “If it sounds too good to be true, it probably is.” It turns out that weight loss supplements are no exception.

A recent study showed that there is no evidence of a link between supplements and significant weight loss. In fact, some products produce detrimental side effects, such as increasing the risk of stroke or heart problems.

Led by researchers at Oregon State University, the study looked at hundreds of weight loss supplements, including chitosan, caffeine, conjugated linoleic acid and soluble fiber. They found no direct link between these products and significant weight loss. They did find that a few products, including green tea, fiber and low-fat dairy supplements, showed modest weight loss of three to four pounds, but only when combined with a reduced-calorie diet.

The bottom line is that there is no magic pill for successful and sustained weight loss. If you have had weight loss surgery, and even of you haven’t, the key to losing weight and keeping it off is a healthy diet and regular exercise program.

- Cara Stewart, RD, LDN

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Sleep Less, Eat More

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a recent study that suggests a link between sleep deprivation and calorie consumption.

Approximately 20 percent of Americans get six or less hours of sleep a night, according to the National Sleep Foundation. That figure raises concern given new research that sheds more light on the major toll sleep deprivation can take on your health.

A recent study showed that people who slept less ate more, suggesting a link between sleep deprivation and obesity. The study, conducted by researchers at the Mayo Clinic, followed sleep and eating patterns of 17 healthy young men and women for 11 days.

For the first three days, researchers measured calorie consumption and energy expenditure to establish a baseline. For the remaining eight days, half of the participants slept normally while the others got just two-thirds of their normal sleep. Eating habits remained unchanged in both groups. The findings revealed that those in the sleep-deprived group consumed an average of 549 more calories a day.

Although the study was small, it supports earlier research that linked chronic sleep deprivation with a variety of adverse health effects and illnesses, including cardiovascular disease, diabetes and obesity.  Larger scale studies are needed to confirm these findings and better understand exactly why sleep deprivation leads to increased calorie consumption.

In the meantime, it seems safe to conclude that sleep is an important part of your healthy lifestyle. Just by getting in bed on time, you can cut calories without even trying. Now that’s a diet that is hard to beat!

To learn how to improve your sleep habits, click here.

- Cara Stewart, RD, LDN

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Flavorful, Healthy Almond-Crusted Tilapia

Tilapia is a good source of lean protein. In fact, the 2010 Dietary Guidelines for Americans recommend eating eight ounces of fish each week to help prevent cardiovascular disease. The best part? This rich, nutty-flavored recipe tastes delicious and its three easy steps takes just minutes to prepare.

Ingredients:

• 1/4 cup whole natural almonds
• 2 tablespoons dry breadcrumbs
• 1 teaspoon salt-free garlic and herb seasoning blend (such as Mrs. Dash)
• 1/8 teaspoon freshly ground black pepper
• 1 tablespoon canola oil
• 1 tablespoon Dijon mustard
• 2 (6-ounce) tilapia fillets
• Chopped fresh parsley (optional)

Preparation:

1. Place first four ingredients in a blender or food processor; process 45 seconds or until finely ground. Transfer crumb mixture into a shallow dish.
2. Heat oil in a large nonstick skillet over medium heat. Brush mustard over both sides of fillets; dredge in crumb mixture. 
3. Add fish to pan; cook for three minutes on each side or until fish flakes easily when tested with a fork. Sprinkle with parsley if desired.

Nutritional Information
Amount per serving

• Calories: 367
• Calories from fat: 47 percent
• Fat: 19 g
• Saturated fat: 2.1 g
• Monounsaturated fat: 10.6 g
• Polyunsaturated fat: 4.8 g
• Protein: 38.9 g
• Carbohydrate: 9.9 g
• Fiber: 2.5 g Cholesterol: 85 mg
• Iron: 1.3 mg
• Sodium: 321 mg
• Calcium: 28 mg

Total preparation and cooking time is 11 minutes.

This recipe is courtesy of Cooking Light Fresh Food Fast, Oxmoor House (2009).

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Weight Loss Surgery Reduces Cardiovascular Risk

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses recent study findings, which reveal the cardiovascular benefits of weight loss surgery and identify diabetes, not BMI, as the best indicator of cardiovascular risk.

Obesity is a well-known risk factor for a host of cardiovascular problems, including heart attack, stroke and heart disease, but a recently published study in the Journal of the American Medical Association suggests that weight loss surgery can significantly reduce that risk.

Researchers found that bariatric surgery lowered the risk of heart attack and stroke by 33 percent and the risk of death from heart-related causes by nearly 53 percent. The results are based on a Swedish study of over 4,000 obese adults that compared the outcomes of people who had bariatric surgery with those that did not.

The study showed that diabetes and risk factors for diabetes, including high blood sugar, were significant indicators of post-surgical cardiovascular benefit. Body mass index (BMI) before surgery and weight loss after surgery were not associated with reduced incidence of cardiovascular events, based on the study results.

Currently, candidates for bariatric surgery must have either a BMI over 40 or a BMI over 35 with one or more obesity-related condition, such as diabetes, high blood pressure or sleep apnea.  The findings of this study highlight the importance of considering diabetes, in addition to BMI, when deciding whether bariatric surgery is the best treatment option.

- Cara Stewart, RD, LDN

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What exactly is “moderate-intensity” aerobic exercise?

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains what “moderate-intensity” aerobic exercise is and the activities you can do to achieve it.

Exercise improves overall health and physical fitness, reduces the risk of many chronic diseases and is an essential component of any weight loss plan.  For healthy adults, the Physical Activity Guidelines for Americans recommends at least 150 minutes every week of moderate-intensity aerobic activity and at least two days per week of muscle-strengthening activities. 

For overweight or obese adults trying to lose weight, the Penn Metabolic and Bariatric Surgery Program recommends at least 200 to 300 minutes a week of moderate-intensity aerobic activity as well as the standard two days of muscle-strengthening work.

These forms of exercise are considered moderate-intensity physical activity:

• Walking two miles in 30 minutes
• Biking four miles in 15 minutes
• Going up and down stairs for 15 minutes
• Fast dancing for 30 minutes
• Doing water aerobics for 30 minutes
• Swimming laps for 20 minutes
• Gardening for 30 minutes
• Wheeling yourself in a wheelchair for 30 minutes
• Shooting baskets for 30 minutes
• Jumping rope for 15 minutes

If you are starting a new exercise program, remember to ease into activity gradually and consult your physician first. In fact, there are certain programs customized for beginning exercisers, including this walking program from the National Heart, Lung and Blood Institute.  There’s no day better than today to begin exercising in pursuit of a healthier lifestyle.

- Cara Stewart, RD, LDN

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Get the Facts about Healthy Fats: Omega-3 and Omega-6 Fatty Acids

Rachel Griehs, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the nutritional importance of essential fatty acids.


For years experts have been saying that all fats are bad, but it turns out that is not the case. Among the healthy fats are omega-3 and omega-6, which are considered essential fatty acids. Although the body needs them, it cannot produce them itself, which is why they must be incorporated into your diet.

There are three types of omega-3 fatty acids:
1.    Alpha-linoleic (ALA)
2.    Docosahexaenoic (DHA)
3.    Eicosapentaenoic (EPA)

ALA is found in plant foods and flaxseed is the richest source. EPA and DHA are found in similar foods, including seafood, algae and higher fat cold water fish, such as mackerel, albacore tuna, salmon, sardines, Atlantic herring, swordfish and lake trout. Enriched eggs are also a good source of omega-3 fatty acids because the egg-producing hens are fed a diet that includes flaxseed and algae. As a result, these eggs contain all three types of omega-3 fatty acids. 

Omega-6 fatty acids are made up of linoleic acid. They are found in nuts, seeds and vegetable oils, specifically soybean, safflower and corn oil. Experts recommend that 5 to 10 percent of your total caloric intake should come from omega-6 fatty acids.

How do these fatty acids benefit health?

Omega-3 fatty acids thin the blood, reducing the risk for blocked blood vessels, heart attacks and strokes. They also prevent hardening of the arteries, lower triglycerides and help reduce blood pressure.

Omega-6 fatty acids lower cardiovascular disease risk by decreasing total cholesterol, including “bad” cholesterol (LDL—low density lipoprotein). However, by reducing the total cholesterol, omega-6’s also lower “good” cholesterol (HDL—high density lipoprotein), which functions like a sponge and carries “bad” cholesterol and other lipids to the liver for excretion.

The American Heart Association recommends that people who do not have coronary heart disease (CHD) eat a variety of fish, specifically oily fish, at least twice a week. For those with CHD, they recommend one gram of EPA and DHA from oily fish a day. It can be hard to obtain sufficient omega-3 from your diet alone. If so, talk to your physician about adding a fish-oil supplement.

- Rachel Griehs, RD, LDN

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Enjoy this Fall Favorite: Fresh Apple Salsa

Apple salsa brings together the fresh flavor of delicious fall apples and healthy nutrients. Apples are packed with a soluble fiber called pectin and powerful antioxidants called polyphenols. These two key nutrients reduce blood cholesterol levels and prevent the formation of artery-clogging plaque.

Serve fresh apple salsa with roasted chicken or pork, black beans or with tortilla chips as a dip.

Ingredients:

• 2 cups diced peeled Fuji or Jonagold apple (about 3/4 pound)
• 1/2 cup diced red bell pepper
• 1/3 cup fresh lime juice
• 1/4 cup diced red onion
• 1/4 cup minced fresh cilantro
• 1 tablespoon honey
• 1/4 teaspoon salt
• 1/4 teaspoon freshly ground black pepper
• 1 jalapeño pepper, seeded and minced

Preparation:

1. Combine all ingredients, stirring well.

Nutritional Information:
Amount per serving

• Calories: 21
• Fat: 0.1g
• Saturated fat: 0.0g
• Monounsaturated fat: 0.0g
• Polyunsaturated fat: 0.0g
• Protein: 0.2g
• Carbohydrate: 5.7g
• Fiber: 0.8g
• Cholesterol: 0.0mg
• Iron: 0.1mg
• Sodium: 50mg
• Calcium: 4mg

The recipe makes 12 servings.

This recipe is courtesy of Kathy Farrell-Kingsley, Cooking Light (October 2010).

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Considering bariatric surgery? Quit Smoking. Today.

Anyone who smokes knows they should kick the habit. But quitting smoking is especially important for people considering bariatric surgery. The guidelines for bariatric surgery require patients to quit smoking 60 days prior to surgery.

The health consequences of smoking are well known and well documented, but these dangers are amplified for people with obesity. Along with the associated higher risk for cancer, heart disease and stroke, smoking increases the risks associated with surgery, including anesthesia-related complications, infections, heart attack, stroke, pneumonia and death. It also slows down healing time by narrowing blood vessels, restricting blood flow to the surgical site.

Smoking after bariatric surgery puts patients at significantly higher risk for a host of complications, such as ulceration of the gastric pouch, gastritis, infection and increased shortness of breath.

It is never too late to quit and Penn has several options to help people break their smoking habit. The health benefits of smoking cessation occur almost immediately and have a long-lasting impact.

Effects of quitting smoking* after:

• 20 minutes: Heart rate and blood pressure drop.
• 12 hours: Carbon monoxide level in the blood drops to normal.
• 2 weeks to 3 months: Circulation improves and lung function increases.
• 1 to 9 months: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs and reduce the risk of infection.
• 1 year: Excess risk of coronary heart disease is half that of a smoker.
• 5 years: Risk for cancer of the mouth, throat, esophagus and bladder are cut in half; cervical cancer risk falls to that of a non-smoker; stroke risk can fall to that of a non-smoker after two to five years.
• 10 years: Risk of dying from lung cancer is about half that of a smoker; risk for cancer of the larynx and pancreas decreases.
• 15 years: Risk for coronary heart disease is that of a non-smoker's.
  

For smokers who are interested in bariatric surgery, enroll in a smoking cessation program to begin the quest to a healthy lifestyle.

Local resources:

• Penn’s Comprehensive Smoking Treatment Program: A multidisciplinary team of specialists offers state-of-the-art, individualized treatment to help smokers quit safely and comfortable.
• Quit Smoking Program at Pennsylvania Hospital: The respiratory care team offers a five week program with counseling and support to help smokers overcome their addiction.
  
• Pennsylvania’s Free Quitline: The Philadelphia Department of Public Health offers a variety of resources to help residents quit smoking, including a free one-month supply of nicotine patches through the PA Free Quitline telephone counseling program at 877-724-1090.
  

Additional resources:

• American Cancer Society, 800-ACS-2345
• American Lung Association, 800-586-4872
  

Get help to begin the journey to health - today!

*American Cancer Society, Guide to Quitting Smoking.

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Give Your Heart a Gift

February is American Heart Month: a time to raise awareness about cardiovascular disease, the number one cause of death in the United States. The risk of cardiovascular disease is increased for people with severe obesity. Obesity can cause structural changes in the heart including excess heart muscle and ventricle inflammation that can lead to heart failure.

It is no secret that weight loss reduces cardiovascular risks, but a recent study published in the Journal of the American College of Cardiology suggests that bariatric surgery can also help reduce the risk of heart disease.

Researchers found that gastric bypass surgery can lead to a “remodeling” of the heart as well as significant weight loss. The study compared a group of more than 400 severely obese people with gastric bypass surgery to a group of 300 severely obese people who did not have surgery.

Two years later, echocardiograms showed a reduction in left ventricular mass and right ventricular cavity area among the surgical patients. The improved cardiac function and appearance suggests less stress on the heart and reduced overall cardiovascular risk.

For more information on how bariatric surgery can reduce your cardiovascular risk, please contact the Penn Metabolic & Bariatric Surgery team at 800.789.PENN.

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