Eating out... Guilt-free!

The most common question I get asked by patients at my clinic is “What about eating out?”

Everyone wants to lose weight. However, no one wants to sacrifice their social life in order to get there. And I totally understand that. In this country, we have all the choices as to restaurants but not too many activities are available. And until we change that, we have to cope with reality.

So let’s see how one can eat out with friends and still keep a healthy lifestyle.

Plan your outing

Eating out is OK.

Eating out every day or every other day is NOT!

You can go for lunch or dinner once or twice per week. The rest of the days should include other activities or just coffee or tea.

It is also important to plan your calories. In fact, when you know you’re eating out, the other big meal should be lighter than usual. Now I know that sometimes these outings are spontaneous. Nothing wrong with that! You can balance your meals on a weekly basis and not necessarily on a daily basis. Ask you dietitian to include restaurant meals in your diet.

Choosing the right restaurant is a key to a healthy diet. A patient once told me “But there was nothing light at that burger joint!!” My answer was simple “Why did you go there?” Some places just have a limited menu. Avoid them! Consider your dining options before heading to a certain restaurant.

The final step should be to increase your physical activity whether the same day or the one after in order to compensate for the extra calories.

Make the right choices

“I’m blowing the diet by eating here so… what the hell! I’m gonna go all the way!” WRONG!

You can make safe choices that go along with your diet as long as you take control of what you’re eating and how much you’re eating.

QUALITY OF FOOD

When browsing the menu, there are words you should stay away from: pan fried, deep fried, crispy, buttered, breaded, creamy, extra, etc. these indicate a higher content in fat. The word extra, for example, is extremely dangerous. It’s like saying “Please add more calories to my already-high-fat meal!” So avoid the extra toppings on pizzas, the extra bacon or cheese in your burger or the extra parmesan and sauce to your pasta.

In contrast, there are words that should guide your choices: grilled, light, low fat, breast, filet, baked, steamed, boiled, etc. I was at a diner once with my friends and one of them asked me “Nadine, would this burger be a good choice?” I looked at the ingredients and answered instantly “When you read the word grilled 4 times in the same sentence, you are safe!”

Luckily, nowadays, there are healthy options in a lot of restaurants. So, look for the “healthy sign” in some menus or even the light section in others.

One thing that would increase your calorie intake without you noticing it would be the pre-meal options: bread and butter, nuts, chex-mix, appetizers, etc.

Stay away from refillable regular sodas and ice tea. They can increase your sugar intake excessively. Go for water or diet products.

Beware of sauces. They would make a huge difference between a high fat and a light sandwich. Go for ketchup and mustard or even any light sauce instead of mayo.

Finally, and most importantly, eat mindfully. Give your body and mind the time to realize that you are full and stop as soon as you are. I have a personal problem. If the food is still sitting on the table, I would keep eating even if my mind has realized that I’m full. Well, it’s very easy. Now I just ask the waiter to remove my platter as soon as that signal goes to my head!

QUANTITY OF FOOD

When you’re ordering, it’s very important to know the size of the portion you’re ordering. Sometimes a pizza can be shared and sometimes it’s just too small.

Choose the small portions. You don’t have to eat the 220 burgers. The regular one should be enough. If you’re absolutely craving those fries, get a side order instead of an entire basket. Don’t upsize even though it’s economically better. Small fries at that fast food restaurant give you 220 calories, medium 360 calories and large 560 calories. Upsizing in this case doubles your calorie intake!

Ask for sauces on the side so you can control the quantity you’re having.

Finally, beware of salad bars. They are very tricky because you think you’re just having a salad but you tend to overeat to get your money’s worth.

Eating out is possible when on a diet. However one should do it responsibly and be in full control because the temptation is simply a killer!

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Obesity In Lebanon: The Shocking Truth!

The problem of obesity is “not a simple and discrete” one, just like Michelle Obama once stated. There is no specific cause but many. And the consequences are bigger than a single individual would imagine.

As dietitians, we try to solve this epidemic one person at a time. However, we will need hundreds of years to do so! Researchers and community nutritionists try to attack a mass of people so that the hundreds of years would become decades.

And that’s exactly what the team at AUB, USJ and USEK tried to prepare for in the last 2 years. Along with the ARU (Associate Research Unit) and the CNRS (National Council for Scientific Research), they conducted a study that would include representative samples of Lebanon. Lots of interesting and probably also shocking results were exposed by the team in a seminar entitled “Undernutrition and Obesity in Lebanon” on Friday, January 20^th 2012 at the AUB campus, under the patronage of the Minister of Health, Ali Hassan Khalil.

The study included around 3500 people from all over the country. The male/female ratio was chosen according to the area and was representative of this area.

Results of the Study

Thankfully, the rates of underweight in our country were very minimal. That problem is crossed off the list!

However, they discovered that 1 in 3 children or adolescents were either overweight or obese. 36% of adults were overweight and 26% were obese. In comparison with results from 1997, this study showed an increase of childhood obesity of 1.6; a doubled adolescent obesity and an increase of adult obesity of 1.5.

The team wasn’t only interested in weight but also whether the population is getting a good quality of food. Through blood tests, they were able to determine status of certain micronutrients: Vitamin D, Zinc, Copper, Magnesium and Selenium. They found that:

7.1% of males and 31.6% of females were deficient in Vitamin D.

25% of the population was deficient in Zinc.

7.9% lacked Copper.

8.1% had Magnesium deficiency.

21.7% of the population lacked Selenium.

More research showed that almost 100% of the population had inadequate intake of Vitamin D.

These results are quite disturbing. There was a need to find out why and how we can change that.

Causes for Obesity and Overweight

Ok! So we have an obesity problem. But where does it come from?

The precipitating factors of obesity and overweight were different for children and adults.

Children	Adults
Age	Age
Gender (males were more affected than females)	Marital status for men (It seems that married men were more likely to be obese than single ones. Now they will hold it against us forever!)
Family history	Non educated women (They seem to have a higher level of obesity. Education is a protective factor in this case.)
Living in Beirut	Lack of physical activity
Sedentary time (the more the time they spent in front of the TV or computer the more obese they were)	Family History
Lack of regular breakfast consumption	Energy intake (more than 2000 cal/d for women and more than 2600 cal/d for men)
Educated mothers (weirdly enough, the mother’s education increased risk of obesity for girls)	High intake of fats and oils
Low intake of carbs and fibers	Low intake of legumes and pulses (hboub)

Besides that, 4 dietary patterns were compared in order to evaluate which ones were more likely to cause obesity. There was the:

- Western diet (fast food)

- Traditional Lebanese (based on fruits and vegetables, olive oil, etc.)

- Prudent (low fat, low sugar, etc.)

- Fish and alcohol

While some people may think Lebanese food is very high in fat and could induce obesity, it turned out to be very protective. The only pattern that was proven to be very fattening was the western one.

Action Plan

Based on those findings, this team of professionals decided to put an action plan to try to reduce the obesity and overweight rate.

They created Food Based Dietary Guidelines (FBDG) for adults. For children, they started an intervention in schools, public ones, to create awareness for healthy eating.

The FBDG are still a draft to be reviewed by several ministries such as the Ministry of health before being exposed to the public. We will mention a few such as more fruits and vegetables, more legumes and cereals, less saturated fat, less alcohol, more physical activity, etc. They are very well adapted to the Lebanese cuisine and tradition.

We will hopefully be the first to publish them when they’re finally out. Until then, keep reading this blog for nutrition and health advice ;) 

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All you need to know about... SALT

Some like it, others don’t. Some add it to their plates without even tasting the food first. Others fear it because of its bad reputation. It is the infamous “Salt”. I’m sure many of you have questions regarding this seasoning item so I’ve tried as much as possible to answer all potential ones. But of course if you have some more, I’d be more than happy to include them…

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Why do I need salt?

Sodium is the main constituent of table salt (40%). It is considered as a very important mineral to the body. It helps maintain body fluid and electrolyte balance. In fact, it is used to preserve the volume of fluids outside the cells. It is also essential to muscle contraction and nerve transmission.

So you see why it is indispensable and why we can’t completely eliminate it from our diet.

Why does salt have such a bad reputation?

As we explained, sodium draws water out of the cell. So, when in excess, it will draw too much water into your arteries and cause your blood pressure to rise. On the long run, this will lead to an increased risk of a disease called Arterial Hypertension (AHT). With high blood pressure, the heart becomes damaged and risk of death from stroke and heart disease climbs.

Please note that hypertension is not only due to sodium intake but other factors can contribute to it (genetics, other cardiovascular diseases, etc.).

Is it possible for me to be deficient in salt?

Blood sodium might drop in many cases. In fact, overly strict low-sodium diets in treatment of hypertension, kidney disease and heart disease can deplete the body of needed sodium. Vomiting and diarrhea can also be responsible for the latter. And finally, deficiency can be due to heavy sweating.

In order to prevent this lack of sodium, it is very important to consume sufficient amounts of salt in your diet; also, you should increase your intake when you’re experiencing either vomiting or diarrhea. And finally, during high intensity sports activities, you should drink lots of water and sports drinks that will replenish your body with the right minerals.

Does excess salt make me fat?

Excess salt makes you gain water weight. In fact, there’s always a sodium-water ratio that is maintained by the body.

Notice how every time you eat something salty, you feel thirsty right after. Well, when there’s an excess of sodium in your body, a series of events trigger thirst. After you drink, the excess salt and water will be removed by the kidneys and the ratio is restored. Water is needed in order to carry the sodium out of your body.

So normally, this water weight gained will be immediately excreted by your body. You don’t need to worry about getting fat from salt!

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What’s the relationship between sodium and potassium?

You may have heard of this or it may be new to you. Potassium has the exact opposite function in the body than sodium. It draws water into the cell. Some studies show that people can modify their salt response by consuming potassium rich foods such as fruits and vegetables.

So basically, in order to reduce disease risk, one should lower their sodium intake and higher their potassium intake. It sounds familiar right? More fruits and vegetables, less salt and salty foods!

So besides salt, where can I find sodium?

The most apparent source of sodium is salt of course. However, there are hidden sources of sodium one should pay attention to.

- Canned food: sodium helps preserve these foods. It would be preferable to go for frozen ones when available.

- Condiments such as ketchup, mustard, mayonnaise, etc.

- Olives and pickles: they are marinated with salt. The latter can be removed from olives by submerging them in water for a few days. However, it’s nearly impossible to have salt-free pickles.

- Organ meats such as sausages

- Ham, turkey, mortadelle and especially the smoked ones.

- White cheeses: the extra salt can be removed the same way as olives. There are also versions low in salt to make your life easier!

- Quick and easy recipes: noodles, microwave popcorn, macaroni and cheese, etc.

- Seafood: it is naturally rich in sodium. You should limit its consumption to once every two weeks and focus more on fish.

- Baking soda

- Everything that contains MonoSodiumGlutamate (MSG). Check the food labels for this ingredient.

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Always remember moderation is the key to a healthy diet! 

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Hangover Myths Revealed... (Part II)

So we started listing the myths about hangovers and exposing the truth in Part I. Here's Part II to complete it...

MYTH #5: “Hair of the dog that bit you” Some people say you should have a drink in the morning to relieve the symptoms. Well, the truth is, a hangover is the result of a withdrawal from alcohol. Having a drink can relieve the symptoms but only for a short period of time. This morning drink does nothing but postpone the hangover until later during the day. “Additional drinking will only enhance the existing toxicity of the alcohol consumed during the previous bout and may increase the likelihood of even further drinking.”, scientific reports claim.		MYTH #6: “Tylenol, a good night sleep and you’re good to go!” Taking any pill at night is useless because the effect of pain killers peaks in about 4 hours so it’ll be gone in the morning. Whatever you’re planning on taking, you should take as soon as you wake up for optimal results. Scientific results show that antacids such as Maalox, Tums or Eno can be good for the gastritis and nausea that come with the hangover. Aspirin and Ibuprofen reduce headaches and muscle aches. However they should be used with caution. So ask your pharmacist or doctor. It seems that Paracetamol (Panadol, Tylenol…) is to be avoided after a drunken night as the alcohol metabolism enhances the pill’s toxicity to the liver.
MYTH #7: “Coffee PLEASE!” Having coffee the morning after a drunken night is not really the best choice. In fact, it will make you even more dehydrated and aggravate the symptoms. You should focus on energy drinks and water to replace liquids and electrolytes lost especially if you vomited the night before.
MYTH #8: “I think I’ll have some pasta before going to bed tonight!” This is wrong for 2 simple reasons. First of all, in order to decrease alcohol absorption, food has to be in your stomach before drinking. Second of all, carbohydrates are not the best choice for decreasing alcohol absorption. You should go for something a little fatty such as a pizza or steak. Now I know that it’s not the healthiest choice but it’s the best way to avoid that terrible feeling of being hung over.		MYTH #9: “I’m definitely gonna need a cold shower” Wrong showering can be a great idea; however, you should alternate between hot and cold water. The first will relax your muscles and your overall body as well as remove some of the alcohol from your skin and the latter will help you wake up.

Recap: The recipe to avoid and/or cure hangovers

1. Have a good meal before going to the bar: Have a consistent dinner before drinking. 

2. Try to hold your liquor: control your alcohol consumption. Alternate between alcoholic and non alcoholic drinks such as juices and water. This will allow you to hydrate yourself and decrease your alcohol consumption.

3. Water, water and even more water: water will prevent you from getting dehydrated and experiencing those dreadful symptoms you have every single time! 

4. Don’t skip the next morning’s breakfast: you might be suffering from nausea. Still, you will need the energy. So, have some complex carbs and some proteins (e.g. eggs on toast).

5. Eating a banana before going to bed seems to be helpful. In fact it is rich in sugar (fructose) and potassium which are both very good after alcohol consumption.

6. Sleep: one of the best ways to cure a hangover is to get a good night sleep.

Don’t let the morning after ruin the memories of a great night. Follow these tips and most importantly always drink responsibly!

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Hangover Myths Revealed...

Nothing could kill last night’s fun except the good old hangover! The headache, dizziness, nausea and dryness make you regret every sip of that Jack and coke. And you tell yourself this is the last time you will allow for this to happen. Next time, you will make sure not to go overboard. But that resolution gets flushed down the toilet as soon as you hit the bar!

Watching your alcohol is the best way to ensure you won’t get hung over. But let’s face it! Sometimes you – and I – will slip. And we will need to know how to prevent a hangover after a night out.

Let’s check out the myths regarding hangovers and try to correct them. Meet AL. He had a party last night and woke up feeling not-so-good!

MYTH #1: A hangover is not THAT serious

A hangover is the consequence of alcohol poisoning. In fact, too much alcohol can - Dehydrate your body and your brain causing headaches, dry mouth and fatigue. - Decrease blood sugar. Glucose being the primary energy source of energy for the brain, this may disturb brain activity and cause fatigue, weakness, mood disturbances, depression, decreased attention and concentration. - Produce additional toxins and free radicals. - Cause an inflammation in the stomach lining resulting in abdominal pain, nausea and vomiting.

	MYTH #2: “I’m not THAT wasted to get a hangover.”
	While drinking an entire bottle of vodka will speed your way into the hangover, you don’t need to drink that much in order to get it. Depending on your body composition, a couple of drinks can generate symptoms. For example, people who have a higher percentage of water in their bodies will tolerate more alcohol. The severity of a hangover also depends on how rapidly you drink. Original Al

	MYTH #3: “Wine is a gentler choice.”
	It’s actually the contrary! Dark-colored liquor such as brandy, whiskey or red wine, is more likely to provoke a hangover. A wiser choice would be to have gin or vodka. red wine

	MYTH #4: “Maybe light cocktails would’ve been a good idea.”
	They’re a great idea for dieters but not-so-great for hangovers. In fact, studies show that the ingestion of sugar with alcohol can reduce the incidence of a hangover. So, go for a vodka seven up rather than a Jack with diet coke!

A lot more myths revealed in Part II... Don't forget to come back!

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