Tips for bringing your diet on vacation

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, offers tips for maintaining your post-surgical diet during your vacation.



Following the recommended post-operative diet after bariatric surgery is always a challenge, but it is especially difficult when traveling. By planning ahead, you can maintain good eating habits and continue to meet your nutritional goals – even on vacation.



If you are traveling by car, here are tips for healthy eating on the road:

• Pack plenty of water. If you are traveling by car, pack an insulated cooler filled with water, sugar-free beverages and protein drinks.
• Bring high-protein foods. Light yogurt, cheese, cottage cheese singles, hard-cooked eggs and individual packets of tuna or lean deli meats can be kept in the insulated cooler with ice packs or frozen water bottles to keep them cool.
• Always keep healthy snacks on-hand. Protein bars, nuts and soy crisps are easy, nutritional snack choices that also are high in protein. Fresh fruit, light fruit cups, vegetable medleys and cherry tomatoes make excellent are also great choices.
• Read the nutrition facts. Before making any purchases on the road, use the nutrition label to guide your selection and portion size to make sure you stay on track with your diet. Highway rest stops carry a variety of calorie-free beverages, but their healthy snack options are often much more limited.
• Stick to plain or simply prepared foods. When purchasing meals on the road, simple is usually best. If you have any questions about sugar content, ingredients or method of preparation, ask the restaurant for clarification. Many restaurants have brochures with nutrition information available upon request.
  
  
• Find a nearby grocery store. Once you reach your final destination find a local grocery where you can replenish your beverages and diet essentials.
• Request an in-room refrigerator. It it easier to eat healthy if you have a place to keep your healthy beverages and snacks. Also, take advantage of the complimentary ice machine to fill your beverage container or cooler when you pack up to leave.
  
  

If you are traveling by plane, here are tips for healthy eating in the air:

• Buy a calorie-free beverage after you are through the security checkpoint. The Transportation Security Administration (TSA) requires that all carry-on liquids fit inside a 3.4-ounce or smaller container that is stored in a quart-sized, clear, plastic, zip-top bag. Each passenger is limited to one zip-top bag of liquids. Purchase calorie-free beverages to bring on the flight after you have been cleared by security.
• Pack protein powder in your carry-on bag. Dense foods items like peanut butter and sugar-free preserves should be packed in your checked luggage, but carry a quick protein fix in your carry-on. Just remember to leave time for any additional screening.
• Order special in-flight meals in advance. Many airlines offer meal accommodations for passengers with specific dietary needs on long or international flights, including low-fat and sugar-free meals. Special meals need to be ordered at least 24 hours before your flight.
  
  

Regardless of your means of traveling, keeping a food diary is a foolproof way of ensuring that you meet your nutritional needs no matter how far you are from home.



It may take extra planning on your part, but it is possible to stay on-track with your diet on vacation.



Safe travels!



- Karen Buzby, RD, LDN

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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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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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Greek Yogurt: Energizing, Healthy and It Tastes Good, Too!

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the health benefits of Greek yogurt.

Greek yogurt is all the rage lately – and for good reason. Although it has been a part of Mediterranean and Middle Eastern diets for centuries, Greek yogurt has only recently gained popularity in the U.S.

Strained of most of its whey content (the liquid portion of yogurt), Greek yogurt has a thicker and creamier texture than regular yogurt. It is also higher in protein, which is why Greek yogurt is a mainstay of many people’s diets before and after bariatric surgery. Ounce for ounce, it contains up to twice as much protein as regular yogurt.

As with any packaged food, it is important to read the food label. Beware of the fat and sugar content in some varieties. Full-fat versions can contain up to 20 grams of fat per serving while fruit-flavored versions may contain significant amounts of added sugar.

Stick to the nonfat, plain varieties with no added sugar. Non-added sugar listed on the label is from lactose, a natural milk sugar. Add fresh or frozen fruit or a no-calorie sweetener like Splenda^® to give Greek yogurt a healthy and flavorful boost without adding excess sugar or fat. Greek yogurt can also be a delicious ingredient in other recipes, including fruit smoothies.

See below for comparisons between regular and Greek yogurts.








- Cara Stewart, RD, LDN

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Get Moving! Tips for Exercising – Safely!

Sarah Krebs, DPT, and Pamela Welsh, PTA, members of the Penn Metabolic and Bariatric Surgery team, provide tips for starting an exercise program.

Are you interested in starting an exercise program? Congratulations! Making the decision to start exercising is half the battle. Avoiding injury and staying committed – that’s the other half.

Exercise is an important part of your weight-loss program. But before you jump right in, make sure to take the proper steps to ensure your safety and long-term exercise success. Taking precautions maximizes the efficacy of your workouts while helping you stay healthy and well, which means you can stay on track to your fitness goals.

Follow these tips to expedite your journey to tip-top shape:

1. Clear your workout with your doctor before starting resistive training.
2. Wear proper footwear (i.e. rubber sole sneakers).
3. Set realistic goals.
4. Start slowly.
5. Maintain proper form. Remember to seek quality, not quantity.
6. Warm up and cool down before and after every workout.
7. Stretch after every workout.
8. Focus on breathing techniques. Exhale on exertion and inhale on relaxation.
9. Monitor your heart rate and stay within target heart rate zone.

- Sarah Krebs, DPT, and Pamela Welsh, PTA

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Provençal Cooking Minus the Cost of Airfare: Eggplant, Zucchini and Tomato Tian

Dreaming of a summer getaway to the South of France? Fantasizing about leisurely dinners in the warm, Mediterranean air? Keep dreaming, but in the meantime, try this Provençal recipe for eggplant, zucchini and tomato tian. Tian [TYAHN ] is a French word used throughout Provençe that refers both to a shallow cooking vessel and the food that is cooked in it.

The recipe gives you a taste of delicious Provençal cooking while taking advantage of summer’s bounty of ripe, nutritious and colorful vegetables. An 11 x 7-inch glass or ceramic baking dish works well for this recipe.

Ingredients:

• 1 pound Japanese eggplant, cut diagonally into ¼-inch thick slices
• 1 pound zucchini, cut diagonally into ¼-inch thick slices
• Cooking spray
• 1 pound large beefsteak tomatoes, peeled, seeded and cut into ¼-inch thick slices
• 1 ½ tablespoons extra-virgin olive oil, divided
• ¼ teaspoon salt, divided
• ¼ teaspoon freshly ground black pepper, divided
• 4 ounces French bread baguette
• 1 cup (4 ounces) grated fresh parmigiano-reggiano cheese
• 2 tablespoons fresh flat-leaf parsley, chopped
• 2 teaspoons fresh oregano, chopped
• 1 ½ teaspoons fresh thyme, chopped
• 2 garlic cloves, minced
• ¼ cup fat-free, low-sodium chicken broth

Preparation:

1. Preheat oven to 375 degrees.
2. Arrange eggplant and zucchini in a single layer on a baking sheet coated with cooking spray. Lightly coat vegetables with cooking spray. Bake at 375° for 15 minutes. Arrange half of eggplant in a single layer in an 11 x 7-inch glass or ceramic baking dish coated with cooking spray. Top with half of zucchini and half of tomato. Drizzle 2 ¼ teaspoons olive oil evenly over vegetables. Sprinkle vegetables evenly with 1/8 teaspoon salt and 1/8 teaspoon black pepper.
3. Place bread in a food processor; process until coarse crumbs measure 2 cups. Add cheese and next 4 ingredients (through garlic) to processor; process until combined. Sprinkle 1 ½ cups breadcrumb mixture evenly over tomato. Repeat layers with remaining eggplant, zucchini, tomatoes, oil, salt, pepper and breadcrumb mixture. Pour broth over top. Bake at 375° for 1 hour or until vegetables are tender and topping is browned.
4. Bon appetit!
   

Nutritional Information:

• Amount per serving
• Calories: 191
• Fat: 8.1 g
• Saturated fat: 3 g
• Monounsaturated fat: 3.7 g
• Polyunsaturated fat: 1 g
• Protein: 10 g
• Carbohydrate: 22.3 g
• Fiber: 4 g
• Cholesterol: 12 mg
• Iron: 1.6 mg
• Sodium: 459 mg
• Calcium: 178 mg

This recipe makes 6 servings. Serving size is approximately 1 cup.

The recipe is courtesy of Joanne Weir, Cooking Light (June 2010).

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Check Your Heart Rate During Exercise: How to measure it and why it’s important

Sarah Krebs, DPT, and Pamela Welsh, PTA, members of the Penn Metabolic and Bariatric Surgery team, explain how to monitor and optimize your heart rate during exercise.

Exercise is an important part of your weight-loss program. It is important to measure your heart rate before starting an exercise program to assess your initial fitness level and to continue monitoring as you progress through the program.

There are three simple steps to monitor heart rate:

1. Find your pulse by placing your pointer and middle finger on your neck or wrist.
2. Gently press to feel your pulse.
3. Count the number of pulses that you feel in ten seconds and multiply that figure by six. This number tells you how many times your heart beats per minute.
   

When exercising, monitor your heart rate throughout the workout to ensure that it remains within your target heart rate zone. Health care professionals have determined that a healthy, safe and effective target heart rate zone during physical exertion is 45 to 85 percent of your heart rate maximum. The heart rate maximum is the fastest your heart can safely beat during exertion.

Follow these steps to calculate your target heart rate zone:

1. Determine your maximum heart rate by subtracting your age from 220. (Example: If you are 45 years old, your heart rate maximum is 220 minus 45, or 175 beats per minute.)
2. Multiply your heart rate maximum by 0.45 to determine the lower end of your target heart rate zone. (Example: 175 x 0.45 = 78.75 beats per minute)
3. Multiple your heart rate maximum by 0.85 to determine the higher end of your target heart rate zone. (Example: 175 x 0.85 = 148.75 beats per minute)
   

The range between the minimum and maximum constitutes your target heart rate zone. If you are beginning an exercise program, or just seeking light activity, aim for a heart rate on the lower end. If you are more physically fit or seeking strenuous activity, aim for the higher end.

Using the example above, the target heart rate zone for someone 45 years old is 78.75 to 148.75

Please talk to your health care team before beginning an exercise routine for help determining your target heart rate zone and designing an appropriate, effective and safe fitness program. It is often helpful to monitor your heart rate before and after everyday activities prior to meeting with your health care team to provide insight into your current fitness level. Keep in mind that as your fitness improves, your heart rate slows down as a result of your heart’s increased efficiency. Lowering your heart rate is an important step in the journey to better heart health.

- Sarah Krebs, DPT and Pamela Welsh, PTA

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