Maintaining a Healthy Lifestyle 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 lifestyle during Ramadan.

The keys to healthy eating during Ramadan are planning and self-control. After fasting from dawn to dusk, your hunger and delirium make it easy to overeat. That’s why you have to plan ahead of time to get the nutrients your body needs during the non-fasting hours and control your impulse to indulge in unhealthy Ramadan foods that are in high in fat, calories and sugar.

With a focus on empathizing with the poor and needy, Ramadan can even be the perfect time of year to kick-start a new healthy way of eating and living.

Follow these tips to start or maintain a healthy lifestyle during Ramadan.

Drink lots of water
It is important to drink large quantities of water between dusk and dawn to remain hydrated, prevent constipation and headaches and aid in digestion

Consume foods that are high in fiber
High fiber foods are essential because they provide a steady release of energy during the fasting hours. Fiber also helps prevent constipation and makes you feel full for longer periods of time. High-fiber foods include whole grains, vegetables and fruit.

Limit your intake of sugary foods
This includes Ramadan desserts, which can be loaded with sugar.

Avoid spicy and salty foods
Make sure to avoid spicy and salty foods, especially during Sahur, because they make you thirsty for the rest of the day.

Avoid caffeine
Stay away from caffeinated drinks such as cola, coffee or tea. Caffeine is a diuretic, which can lead to dehydration

Avoid frying
Stick to baking and grilling instead of frying your food to keep your calorie and fat intake in check.

Get moving
Incorporate light exercise into your day such as stretching or walking. Exercise is essential for a healthier you.

- Sabrina Bitar, MS

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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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Are You Getting Enough Water?

When it comes to healthy eating and drinking, nothing beats a tall glass of water.

Staying hydrated is important because every system in your body needs it to perform at its best. Water flushes toxins out of your body, keeps cells hydrated and provides a sense of satiety or fullness.

In fact, if find yourself hungry, you might want to ask if, instead, you are thirsty.

How much water do you need every day?

So, how much water does your body need to perform at its best? It all depends. If you are a man, it’s recommended that you drink about 13 cups of liquid a day. If you are a woman, that number dips to nine cups.

But there are other factors that play into hydration.

If you exercise or engage in any activity that makes you sweat, you lose a lot of water. Exercise lasting for more than an hour, for example, requires a lot more fluid than if you are engaging in a quick workout. And if you are doing yard work in the hot sun, you probably need more water to perform at your peak.

Your environment also plays a big part in hydration. In the summer, the heat of the outdoors can zap hydration from your body’s stores. In the winter, the dry air associated with heating systems can cause your skin to lose moisture. And where you live makes a difference, too. Higher altitudes may cause you to become dehydrated quicker.

Breastfeeding or pregnant women especially need to make sure they drink enough liquid. That’s because their bodies are working overtime preparing a baby for birth, or feeding that baby for growth.

What liquids to choose?

You have heard the advice “don’t drink your calories.” Calories that come from juices or sodas are considered “empty” and have no real nutritional value.

Beverages such as coffee and teas do have a diuretic affect, which make you urinate more and lose water. These types of beverages should not make up a big portion of what you drink each day.

The best bet for staying hydrated is water. It’s calorie free, and you can get it just about everywhere.

Bottom line: Reach for water with and in between meals and before, during and after exercise. 

How much water do you drink every day?

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Tips for Healthy Holiday Eating After Weight Loss Surgery

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for managing your post-surgical diet during the holidays.

There is no getting around it. Food is a central part of the holiday season. Whether you’re enjoying holiday food with friends and family or inundated with unhealthy treats at the office, it is hard to maintain your healthy eating goals over the holiday season, but it is possible.

These tips can help you stay on track with your post-surgical diet and lifestyle changes while still allowing you to enjoy the holiday festivities.

Don’t skip meals
Always make time for breakfast, lunch and dinner. Going long stretches without eating can lead to eating too much or too quickly and cause nausea or vomiting in people who have had weight loss surgery. It can also result in unhealthy food choices due to overwhelming hunger.

Be selective about food choice
Resist the temptation to try foods that are high in sugar and fat. After gastric bypass surgery, fatty and sugary foods can cause “dumping syndrome,” resulting in severe abdominal pain and cramping, diarrhea, nausea and vomiting. Instead, choose low-calorie party foods such as raw vegetables, fruit with yogurt dip or boiled shrimp with lemon or cocktail sauce.

Stay well hydrated
Stay hydrated by drinking water and low-calorie beverages. Avoid alcoholic beverages and try to separate eating and drinking by 30 minutes.

Keep a food diary
Research* shows that recording what you eat helps you stay on track during the holidays. It also helps you meet your protein and fluid goals. Take a minute each night to record your food and fluid intake for the day.

Click here for more healthy eating tips for you and your family.

- Karen Buzby, RD, LDN


*Cornett R, Akers J, Salva J, Zoellner J, Davy B. Daily self-monitoring during the winter holiday period: a feasible strategy for holiday weight maintenance. SCAN’s PULSE. Fall 2011, Vol 5, No 4: 1 – 6.

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Bottled Water: Is It Worth It?

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the benefits of drinking tap water instead of bottled water.

Water is the best beverage for staying hydrated and avoiding extra calories, but it’s not necessary to buy it in a plastic bottle. The bottled water industry promotes bottled water as being healthier, yet the reality is that bottled water is less regulated for quality than tap water. Plus it is more expensive and can be environmentally unfriendly, too.

Before buying bottled water, consider these facts:

• Bottled water can cost nearly 2,000 times as much as tap water.
• Environmental Protection Agency (EPA) guidelines for regulating municipal tap water are far more rigorous in terms of control, disinfection and monitoring than those used by the U.S. Food and Drug Administration (FDA) to oversee bottled water. In fact, a National Resource Defense Council (NRDC) study of the bottled water industry, tested over 1,000 bottles of water, and concluded that bottled water is not guaranteed to be any cleaner or safer than tap water. The study found that approximately 25 percent of bottled water was tap water packaged in a bottle and 22 percent of the samples contained chemical contaminants above the strict state limits on municipal tap water.  
• Bottled water companies are not required to disclose information about their products. A recent report released by the Environmental Working Group (EWG) indicates that more than half of the bottled water products surveyed failed EWG's transparency test. According to the report, 18 percent of the companies failed to reveal the source of the water and another 32 percent did not disclose any information about the treatment or purity of the water.
• Studies have also shown that chemicals called phthalates, which disrupt testosterone and other hormones, can leach into bottled water over time.  Although there are regulatory standards limiting phthalates in tap water, there are no legal limits for phthalates in bottled water.  
• Although plastic bottles are recyclable, nearly 90 percent of them end up as litter or garbage contributing more than 2 million tons of plastic to landfills each year. 

A comprehensive list of the tap-water contaminants in your area is available on the EPA website. If you are concerned about the quality or flavor of your tap water, purchase a water filter to put on your tap. It is both easier on your wallet and on the environment. To keep filtered water accessible to drink when you’re on the go, put it in your own reusable bottle to carry with you throughout the day.  

• Complete guide to purchasing a water filter 
• More details on the NRDC study results

- Cara Stewart, 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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Coping with Constipation after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for achieving bowel regularity after weight loss surgery.

It may not be an appropriate topic of conversation in many circles, but constipation is relatively common among people who have had weight loss surgery, especially immediately following their surgery. Irregularity can be caused by a lot of things:

• Decreased fluid and fiber intake
• Reduced physical activity
• Narcotic painkillers
• Iron or calcium supplements
  

Many people report only having a bowel movement every two or three days following weight loss surgery. This can lead to constipation. It is important to keep track of your bowel habits and try to have a bowel movement every day.

To relieve constipation:

If it has been more than three days since your last bowel movement, you can take one dose of milk of magnesia or two Dulcolax^® tablets. Repeat every four to six hours. If you do not have results within 24 hours, you should call your bariatric nursing team to discuss.

To prevent constipation and promote bowel regularity:

• Stay hydrated. Drink adequate fluids to help soften your stool. You should drink at least 48 ounces per day.
• Exercise. Take frequent short walks throughout the day, as tolerated.
• Consume adequate fiber. Because your eating is primarily focused on high-protein foods following bariatric surgery, your consumption of high-fiber food is limited. Take fiber supplements as needed to help you get at least 15 grams of fiber per day.
• Use laxatives when necessary. Stick with Metamucil^® and other bulk-forming laxatives based on whole psyllium. Make sure to follow the mixing instructions for optimal results.
  

- Cara Stewart, RD, LDN

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