Healthy Eating during Ramadan

Sabrina Bitar, MS, clinical dietitian and center manager at Diet Watchers^TM in Saudi Arabia, guest blogs about tips for maintaining a healthy diet during Ramadan.

Ramadan is the holiest month of the year for Muslims, but the restrictions on eating can be tricky for people who are trying to lose weight or maintain a healthy diet. With careful planning, thoughtful food choices and self-control, you can stay on track with your weight loss goals during the month of Ramadan.

During Ramadan, Muslims abstain from eating and drinking from dawn till dusk. Although the tradition goes against typical dietary recommendations for small, frequent healthy meals throughout the day, there are ways to sustain your healthy diet during Ramadan.

To maintain a healthy diet during the month of Ramadan, it is important to provide your body sufficient healthy nutrients during the non-fasting hours. That means having your first meal (Sahur) before the fast starts at dawn, an evening break-the-fast snack after dusk (Iftar) and dinner as the last meal of the day.

This guide can help you stay on track with your weight loss goals during Ramadan:

Pre-dawn Meal (Sahur):

The pre-dawn meal or Sahur is essential to jumpstarting your day, so make sure to eat a wholesome, balanced and moderate-sized meal.

A healthy morning meal gives you energy by the providing the nutrients you need to get through the fasting hours. It also reduces unpleasant signs of hunger throughout the rest of the day, including hunger pangs, headaches and sleepiness.

Stick to high-fiber foods and complex carbohydrates, such as grains. It takes longer to digest and absorb these foods, so they help you stay full throughout the day.

A healthy morning meal can include:

• Whole wheat bread with cheese or labneh
• High-fiber cereal with low-fat milk
• Fresh or dried fruit, including bananas and dates
• Unsalted nuts

Breaking the fast meal (Iftar):

Iftar presents the biggest obstacle to maintaining a healthy diet. The best way to approach breaking the fast is to treat Iftar as a light snack to hold you over until dinner instead of as a reward for fasting. That mindset can help you avoid indulging in the rich traditional desserts that are loaded with fat and sugar.

A healthy break-the-fast meal can include:

• Three dates
• Cup of water or low-calorie juice
• Bowl of vegetable soup

Dates and water are traditional Iftar foods and they also have nutritional properties to replenish the body after a long fast. Dates help regulate blood sugar and provide a much needed boost of energy. If dates are not available, you can substitute them with any other fruit. Water rehydrates your body and helps reduce hunger.
 
Dinner:
During Ramadan, dinner is the best chance to get most of your important daily nutrients, so make sure to have a balanced meal that covers all of the major food groups. Plan to eat dinner after the evening prayer or Maghrib to allow sufficient time to digest your food from Iftar.

A healthy dinner can include:

• Soup and salad
• Grilled chicken, fish or lean meat
• Grain such as brown rice, whole wheat bread or whole wheat pasta
• Low-fat yogurt
• Fruit – fruit is a much healthier substitute for the high-fat, syrup-sweetened treats that are common during Ramadan. You can also have fruit as a snack before bed.

Make sure to pace your consumption throughout dinner. It takes 20 minutes for the stomach to tell the brain that it is full, which means you have to allow adequate time for your stomach to send those signals. Try slowing down your eating by taking smaller bites, chewing well and savoring the taste of each bite to avoid overeating.

Most importantly, remember that resisting the temptation to overindulge not only helps achieve your weight loss goals, but also focuses attention on empathizing with the poor and needy, the centerpiece of Ramadan.

- Sabrina Bitar, MS

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Bariatric Surgery Better Than Medication for Diabetes

A new study says people with type-2 diabetes may have more success in managing their diabetes with bariatric surgery rather than traditional medical therapies.

The study, published this week in the New England Journal of Medicine compared the standard treatment of medication, diet and exercise to weight-loss surgery, also known as bariatric surgery, for the treatment of type-2 diabetes.

“Research has already shown that gastric bypass surgery improves or resolves type-2 diabetes in days or weeks following surgery,” says Noel Williams, MD, director of the Penn Metabolic and Bariatric Surgery Program. “This new study shows that in addition to gastric bypass, sleeve gastrectomy has the same positive impact on type-2 diabetes and is more effective than medical management alone.”

During a sleeve gastrectomy, a sleeve-shaped tube is created from a small portion of the stomach and the majority of the stomach is removed. Food passes through the new stomach tube directly into the intestines. Nutrients and calories are absorbed from food normally, but patients feel full sooner and longer.

“It is important that patients choose an experienced physician to perform their weight-loss surgery,” says Dr. Williams. “The Penn Metabolic and Bariatric Surgery program performs more than 500 procedures every year and more sleeve gastrectomies than any program in the Philadelphia region.”

Type-2 diabetes is a chronic disease in which the body cannot or does not produce enough insulin to manage blood sugar levels. Type-2 diabetes is often associated with obesity, though people of average weight may also develop the disease.

“Research is proving that weight-loss surgery reduces the co-morbidities associated with obesity,” says Dr. Williams. “Following surgery some patients quickly see their blood sugar level return to normal and they are able to stop taking insulin and other medications.”

The study also found bariatric surgery helped people lower their blood pressure and cholesterol.

Read more about the study here.

Learn more about weight-loss surgery at Penn, and how it may help you control your diabetes by attending a free informational session about weight-loss surgery. 

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Drinking Alcohol after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate alcohol in a healthy diet after weight loss surgery.

People considering weight loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications. Here’s why:
       
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.

Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.

Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.

If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.

Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain. 

Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.

Guidelines for drinking:
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight loss surgery:

• Avoid alcohol for the first six months after bariatric surgery.
• When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. 
• Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar. 
• Never drink and drive, even after consuming only minimal alcohol. 
• Only drink with meals or while eating to help slow absorption of alcohol. 
• Be aware of the calorie content of alcohol.
• If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.

- Cara Stewart

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Eat More to Lose More: Healthy Snacks for Weight Loss

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the benefits of healthy snacking.

Don't overlook the benefits of snacking when trying to lose weight. Snacking helps you fuel up between meals and can prevent you from overeating and making unhealthy food choices. The healthiest snacks include a mix of complex carbohydrates and protein to keep you feeling full throughout the day.

In fact, many nutrition experts suggest shifting away from the traditional three-meals-a-day diet. Instead, they recommend eating small, nutritious meals every three hours or eating five to six times a day. Although it may seem counter-intuitive to weight loss, eating smaller, more frequent meals helps you maintain consistent blood sugar levels throughout the day, and prevents ravenous hunger that often leads to overeating and poor food choices.

If you are tired of your usual snacks or looking for healthier alternatives, here are a few ideas to liven up your healthy snack options:

• Celery sticks spread with one to two tablespoons of almond or peanut butter
• Fresh vegetables (i.e. carrot sticks, cherry tomatoes or fresh green beans) with two tablespoons of hummus
• One serving of whole grain crackers topped with one ounce of reduced-fat cheese and sliced green grapes
• One small apple, sliced with one tablespoon of peanut butter for dipping
• Half a cinnamon raisin, whole-grain English muffin topped with low-fat cottage cheese, no-calorie sweetener (i.e. Splenda^®, Truvia or Pure Via™) and cinnamon
• One serving Greek yogurt with fresh fruit
• One cup homemade vegetable soup
• One brown rice cake with pesto, canned salmon and diced tomatoes
• Three handfuls of air-popped popcorn seasoned with spray butter and herbs
• One brown rice cake topped with a sliced hard-boiled egg, light mayo and fresh herbs
  

- Cara Stewart, RD, LDN

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Low-calorie but not a Freebie: Get the Scoop on Sugar Alcohol

Sugar alcohols, or polyols, are carbohydrates that get their name from their chemical structure. Adding sweetness and texture to foods like sugar-free candy, gum and desserts, sugar alcohols contain fewer calories than regular sugar -- 2.6 calories versus 4 calories per gram – and do not contribute to tooth decay.

The body absorbs sugar alcohols slowly and incompletely, reducing their effect on blood sugar. This can be helpful for people with diabetes or those who are limiting caloric intake. Sugar alcohols do not cause dumping syndrome for people with gastric bypass, although their abnormal absorption can cause cramping, bloating and diarrhea when consumed in large quantities. Studies indicate that people can tolerate 10 to 15 grams of sugar alcohols per day without gastrointestinal distress, although some individuals can experience side effects from less.

It is important to remember that sugar alcohols are typically used in foods that have little nutritional benefit but still contain calories, such as desserts and snacks. Therefore, portion control remains very important for long-term, sustained weight loss.

Products containing sugar alcohols list the grams per serving on the nutrition fact label. The sugar alcohol content can also be found by looking for ingredients ending in “-tol,” such as sorbitol, mannitol and xylitol.

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Weight-Loss Surgery Can Help Control Diabetes

Cara Stewart, RD, LDN, a member of the Penn Metabolic & Bariatric Surgery team, explains the importance of diabetes management and the impact of bariatric surgery on blood sugar control.

November is American Diabetes Month as designated by the American Diabetes Association. It is a time to raise awareness about diabetes, its potentially serious complications and effective management strategies.

For people with diabetes, it is important to keep blood sugar levels within a healthy range to prevent damage to blood vessels and nerves. Properly managing blood sugar levels involves making healthful food choices, being physically active, and using medications as prescribed. For people with diabetes and obesity, bariatric surgery may be an option to improve and potentially cure diabetes.

A recent meta-analysis of data published in The American Journal of Medicine reveals the significant impact of bariatric surgery on type 2 diabetes. According to the data, type 2 diabetes was resolved in 84 percent of patients who underwent gastric bypass surgery. For these patients, blood sugar often normalized within days or weeks after surgery, even before they lost significant amounts of weight. Type 2 diabetes was resolved in 48 percent of patients who underwent adjustable gastric banding surgery. For these patients, their type 2 diabetes resolved following post-operative weight loss.

A team of researchers at Penn Medicine is currently conducting a National Institutes of Health funded-study to determine if bariatric surgery, either gastric bypass or adjustable gastric banding surgery, is more effective than lifestyle modification at reducing weight and ultimately treating type 2 diabetes.

To learn more about the Penn Metabolic & Bariatric Surgery Program, please visit www.PennMedicine.org/bariatrics.

- Cara Stewart, RD, LDN

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