Avoid Food-Borne Illness When Traveling Abroad

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for avoiding food-borne illness while traveling.

Trying new foods and local cuisine is often the highlight of a vacation abroad, but unfortunately that also puts travelers at risk for food-borne illness. Food-borne illness can be contracted through bacteria, parasites or viruses. In addition, food safety practices in other countries are often not as strictly regulated as they are in the United States, which means travelers are particularly susceptible to these illnesses.


Before your jet off to your next destination, do some research ahead of time and follow these tips to keep your trip illness-free:

1. Do not drink tap water or put ice in beverages - In areas where water may contain bacteria, parasites or viruses, only drink water from sealed bottles. Make sure the bottle is securely sealed before taking a sip.
2. Avoid fountain drinks – Fountain drinks are made from syrup, carbon dioxide and water, which can be contaminated. Drink tea or coffee made with boiled water instead of fountain drinks. 
3. Peel your own fruits and vegetables - If fruits and vegetables have already been peeled, they may have been washed with contaminated tap water. Stick to only fruits and vegetables that you or your family peeled yourselves. 
4. Do not eat food from street vendors - Food from street vendors may not be stored at safe temperatures or handled in a sanitary manner, so although it may be tempting, it is best to avoid. 
5. Only consume pasteurized dairy products - Make sure food is thoroughly cooked. Avoid eating raw meat and seafood, including steak tartar, Carpaccio, sushi, sashimi and ceviche. 
6. Familiarize yourself with local dietary customs - It is important to learn about local diets and customs ahead of time so you do not unknowingly eat an item that you otherwise would not.   
7. Remember good hand hygiene – Before eating, use antibacterial hand wipes or alcohol-based hand sanitizers that contain at least 60 percent alcohol. 
8. Ask the hotel for recommendations - Hotel employees are usually familiar with local restaurants. Ask for recommendations of restaurants with high standards of cleanliness. 
9. Talk to your health care team - While preparing for your trip, inform your health care team of your plans. They can help make sure you are healthy enough to travel and your vaccinations are up-to-date.

For more information on international travel tips, visit the Center for Disease Control and Prevention Traveler’s Health website.

Safe and healthy travels!

- Karen Buzby, RD, LDN

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Eat Right When Eating Out

Karen Buzby, RD, LDN, and Cara Stewart, RD, LDN, members of the Penn Metabolic and Bariatric Surgery team, offer these tips for eating healthy when dining out.

Dining out can be a challenge for anyone trying to follow a healthy eating plan, but it is especially difficult if you have had weight loss surgery. Restaurant portions are notoriously large and the meals are often packed with sodium and hidden calories from fats, sugars and sauces. Before weight loss surgery, larger portions may have tempted you to eat more than you wanted or needed. After weight loss surgery, the food may go to waste or cause discomfort. 

The following tips can help you enjoy your meal out while sticking to your diet plan.

Limit calories:

• Be conservative with food selection, especially during the first few months after surgery. Stick with simple prepared foods.
• Before ordering, ask yourself: “Is this food pouch worthy?” Make sure you order foods that are a good source of protein and fiber.
• Look for heart-healthy, low-fat or light options. U.S. Food and Drug Administration (FDA) regulations require restaurants to back up their health claims. Feel free to ask for nutrition information if it is not already provided.
• Stay away from the bread and chip baskets as well as dessert and alcohol menus. Ask the server not bring out the dessert cart. If you choose to eat bread, opt for a small, plain yeast roll and avoid items with added fat like garlic bread, cornbread, croissants and muffins.  
• Salad dressings are often high in calories and fat. Always order dressing on the side and ask for low-fat dressing, a lemon wedge or flavored vinegar instead of the full fat and calorie version. 
• Don’t drink your calories. Quench your thirst with calorie-free drinks like water or unsweetened iced tea. Limit or avoid alcoholic beverages.
• If your job requires socializing or doing business over meals, call ahead or go online to learn about your options in advance. Inform the restaurant manager of your dietary restrictions and make special requests ahead of time if necessary.
• Savor each bite of food, enjoy the company and take your time. Allow at least 20 to 30 minutes for each meal. Remember, conversation is calorie-free!

Control portion sizes:

• Watch your portion size. People who have had bariatric surgery receive a “restaurant card” to request smaller portions when dining out. Use it to make sure your meals are an appropriate size.
• Share a meal or order a smaller portion. This reduces portion size and the expense as well.  
• Order from the lunch menu if it is available. Often the lunch menu offers smaller and less expensive entrees.
• Order from the children’s menu if there are healthy selections available.
• Order an appetizer as a main entrée. The portions of appetizers are usually two to four ounces, which is the ideal meal size after weight loss surgery. 
• Ask the waiter to split the main dish and box half before serving it. You can also request a “doggie bag” as soon as you feel satisfied to avoid the temptation of overeating. 
• Try a tapas restaurant, which serves snack-sized appetizers and entrées.  

Manage leftovers:

• When you take home leftovers, remember to refrigerate the food promptly to avoid food-borne illness. Food left out for more than two hours may not be safe to eat.
• Write the date of purchase or preparation on leftovers and remember to discard the food after three to five days. Always follow the mantra: “When in doubt, throw it out.” Plus, you don’t want your refrigerator to turn into a jungle of leftover containers. 
• Reheat food thoroughly.

- Karen Buzby, RD, LDN and Cara Stewart, RD, LDN

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The Essential Kitchen Tools, Utensils and Appliances for Successful Weight Loss

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses kitchen tools that can help you eat healthier and lose weight.
Whether you’re trying to lose weight or recovering from weight loss surgery, healthy meal preparation is critical for weight loss.  Follow these recommendations to make sure your kitchen is set up with the right appliances and utensils to help you successfully shed the pounds.

Use the right utensils

• Measuring spoons: The tablespoon is useful for portion control and the ¼-, ½- and 1-teaspoon measurements are commonly used in recipes.
• Measuring cups: The ¼-, ⅓-, ½-, and 1-cup measurements are frequently used for solids, and an 8-ounce glass or clear plastic measuring cup works best for liquids.
• Food scale: A scale is helpful to weight meat, poultry and fish for portion control

Slow the pace of eating

• Mini or baby spoon and fork: The small surface area of small utensils reduces consumption by making bites smaller.
• Tea cup saucer: The bigger the plate, the bigger the serving. A smaller plate size often means eating less. 
• Cup warmer: Place a cup warmer under a ceramic plate to keep food hot so you don’t feel rushed when you eat.
• Egg or kitchen timer: Use the timer to slow down the pace your meals and to remind you to drink plenty of water.  

Use storage items to keep healthy meals on hand and promote small portions

• Insulated, reusable water bottle and brush: A portable beverage container allows you to keep your protein drink or beverage with you at all times. The brush is useful for cleaning your container.
• Small non-stick frying pan and ceramic baking container: The small size helps you regulate portion size.
• Extra small, reusable, plastic storage containers: Use the environment-friendly containers to store lunches and on-the-go snacks in the refrigerator and freezer.

Handy kitchen gadgets and countertop appliances make healthy meal preparation easier

• Meat thermometer: The thermometer allows you to ensure that entrées are cooked appropriately to help avoid food-borne illness.
• Vegetable peeler: A peeler removes tough skin from produce such as potatoes.
• Blender: Helpful for making protein drinks and low-calorie smoothies, you can choose a counter-top blender, hand-held stick blender, wire whisk or shaker.
• Food processor: A food processor is a kitchen essential during the pureed food phase of the post-surgical diet.

- Karen Buzby, RD, LDN

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Avoiding Food-borne Illness after Weight Loss Surgery: What You Need to Know

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses the importance of prevention and fast recovery from food-borne illness, especially after bariatric surgery. 


Contracting a food-borne illness, or food poisoning, is distressing for anyone, but it is particularly dangerous after bariatric surgery. When recovering from bariatric surgery, the pace of drinking and eating is often limited and makes rehydration difficult. For people who had the adjustable gastric band procedure, there is also an increased risk for the gastric band to slip out of position if vomiting is severe or prolonged.

Food-borne illnesses are caused by bacteria, viruses or parasites in food. They are the result of mishandling during processing or preparation, failure to cook items to the recommended temperature or improper storage. Foods from animals and unpasteurized milk are particularly at risk for food poising. This includes raw or undercooked meat, poultry, fish, shellfish and eggs. Although less common, fresh fruits and vegetables can also contain harmful bacteria from contaminated water or soil.

Food poisoning causes flu-like symptoms, including nausea, vomiting, diarrhea and fever. Symptoms usually appear four to 48 hours after eating and pass after one or two days. However, some cases of food-borne illness can be severe and even life-threatening. It is important to seek immediate medical attention if you experience any of the following symptoms:

• Light-headedness when standing
• Persistent vomiting
• Fever higher than 101 degrees Fahrenheit
• Blood in bowel movements
• Diarrhea for more than three days

Keep in mind that after bariatric surgery, food intolerance and dumping syndrome cause similar symptoms to food poisoning, such as nausea and vomiting. The difference is that symptoms from food intolerance and dumping syndrome typically occur immediately or soon after eating and resolve within several hours. Symptoms from food poisoning tend to have delayed onset and longer duration.

To prevent contracting food-borne illness, take the following precautions:

• Wash your hands. Make sure to wash your hands with soap and water before preparing or eating food. If you are unable to wash your hands, use an alcohol-based hand gel that is at least 60 percent alcohol.
• Cook meat, poultry, fish and eggs thoroughly and serve hot. If a restaurant serves an undercooked item, send it back and request a new plate.
• Meat and poultry: Cook to an internal temperature of 160 degrees Fahrenheit. Make sure the meat is no longer pink inside and the juices are clear.
• A whole chicken or turkey should be cooked to an internal temperature of 180 degrees Fahrenheit. Make sure the poultry joints move easily.
• Poultry breasts and roasts can be cooked to 170 degrees Fahrenheit.
• Egg: Yolks and white should be firm, not runny. Avoid food with raw egg, including salad dressing, sauces, homemade ice cream, uncooked cake batter or cookie dough.
• Fish: Cook fish until the internal temperature is 145 degrees Fahrenheit. Make sure the fish is opaque and easily flakes with a fork.
• Only drink pasteurized dairy products. Avoid foods made from unpasteurized milk.
• Refrigerate perishable food promptly. Food that is left out for more than two hours may not be safe to eat. Store perishable foods in a refrigerator that is below 40 degrees Fahrenheit. In the summer, when the temperature can be over 90 degrees, do not leave food out for more than an hour.
• Wash fruits and vegetables before eating.

If you do fall victim to a food-borne illness, follow these tips for a quick recovery:

• Hydrate with water or low-calorie fluids. Clear broths, diluted juice, weak tea, diet gelatin or sugar-free ice pops are good sources of hydration. Start with small sips and gradually increase the pace of drinking.
• Reintroduce food slowly. Start with bland foods that are easy to chew and digest.
• Separate drinking and eating by 30 minutes. Take several days to progress to your regular bariatric diet.
• Talk to your doctor. Tell your provider about your symptoms to avoid a long-term impact on your health.

- Karen Buzby, RD, LDN

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