I watched the Today Show last week and saw Carnie Wilson (of Wilson Phillips) discussing her need for a second WLS. In 2001 she had a gastric bypass and lost about 150 pounds. Due to a weight gain of almost 50% of what she had originally lost, she decided to have a second surgery this last January. That surgery entailed the placement of a Lap Band probably around the pouch attached to the intestine created during the previous surgery. I consulted with my surgeon and he was not particularly optimistic about the value for the additional surgery. I have previously discussed the surgical options available and also their limitations. I have also discussed the role of the individual changing their lifestyles and their eating habits in order to maintain their weight loss.
What it really comes down to is that it is your responsibility to ensure that you have taken all of the steps necessary to lose the weight and keep it of to the greatest extent possible. If you are a compulsive overeater or compensate for stress in your life by eating to excess, you will not have the success that you anticipate after WLS. Your surgeon can give you most of the physical tools to lose the weight and you will initially lose weight. But if you back slide into your old eating habits the weight will return. I have seen it in patients who start out with the best intentions, and who know they have to save their own life. They have the surgery and then in the years following, slowly (or sometimes rapidly) regain the weight. You simply cannot make a soup out of cheesecake in the blender and wash it down with a milkshake and still expect to maintain your weight loss.
The stories about weight gain after surgery are common and are one of the reasons that insurance companies are reluctant to pay for the surgery. Even though the data supports the effective control of diabetes and other health related problems post-surgery, the frequent result of the weight gain holds back the insurability of the procedures. So what has to happen? Frankly it is time that we as the post-surgical patient stop expecting someone else to solve our weight problem.
We have to honestly look at ourselves and ask:
1) Were we ready to have the surgery?;
2) Did we reconciled why we are heavy and really understand and agree to actively do something about it? ; and
3) Do we have the institutional tools as well as the courage to allow us to succeed with the weight loss as well as to know how to keep it off?
My surgeon told me that he could create inside of me the physical conditions to help me lose weight, but he added that it would be my responsibility to ensure that I kept it off. While I have not been as successful as I expected, I know what I have to do. I need to exercise more and watch my food habits. I am not eating to excess and I still eat about eight bites per meal. I have not lost the enthusiasm for that amazing change in my body and my health. I simply have gotten sloppy.
So back to Carnie Wilson. Her second surgery may or may not help her. From her words, she has a hard time controlling her diet. Eating seems a bit compulsive for her. I wish her well but I feel that her success (or failure) will depend more upon a psychological change in her behavior and not so much on the second surgical "magic bullet". I wish her well but frankly I am not overly optimistic. Change has to occur in her head as well as in her abdomen.
Wednesday, April 11, 2012
Tuesday, February 7, 2012
Smaller servings and balanced meals.
In a recent study published in the American Journal of Clinical Nutrition (December 2011) the researchers found that feeding preschoolers smaller portions of the main dish at lunchtime meant that they would eat more fruit and vegetables on the side and fewer total calories. The hypothesis of the study was to see if the portion size of the main food serving (in this case macaroni and cheese) affected the consumption of the healthier side dishes of vegetables (green beans) and fruit (applesauce). The children were presented with varying amounts of macaroni and cheese (from less than ½ cup to 1 ½ cups) as well as plenty of green beans and unsweetened applesauce, plus a whole grain roll and milk. The results indicated that the children ate the main dish first, and if they were full would eat the vegetables and fruit last or not at all.
Jennifer Savage (a nutritional researcher) at Pennsylvania State University in University Park and her colleagues found that the bigger the serving size of the macaroni and cheese; smaller amounts of the healthy side dishes were eaten. The preschoolers finished almost all of their smallest portion of mac and cheese, for an average of about 145 calories. But they still ate the majority of the much bigger portions, and put away 390 calories worth of the main course when they started with the most on their plate. When they were served the smallest amount of mac and cheese, kids ate almost half of their healthy side dishes, including fruits and veggies, compared to only a quarter when they were served the biggest mac and cheese portion.
Eating is always a matter of choices. If you give the child an option for a large portion of an entrée food that they really like, they will eat that more and they'll fill up. They'll reach their satiety point and they'll just stop eating thus reducing the nutritional quality of their meal.
So what does this mean to those of us who have a weight problem and have had or are thinking of having WLS? When we were heavy we could choose anything we wanted and eat as much as we wanted. Balancing our nutrition with good food choices was not always high on our agenda. However when you decide to diet or have WLS the concept of nutritional requirements needs to be one of your foremost areas of concern. After weight loss surgery we often find that our restrictive diets often do not allow the inclusion of the balanced nutrition that our body needs. Since we can only eat “Eight Bites” we often look at the main course as all we are going to eat. With so little available room in our stomachs post-surgery we often eat the things we like to eat and leave the “side dishes” alone. That is sort of like the kids who when given a large amount of the dish they prefer will eat it to satiety and then ignore or minimize the ingestion as well as the nutritional value of vegetables and fruit.
As was seen in the research discussed earlier, the kids ate a lower calorie and a more balanced diet when the “main course” was provided at a lower level along with the fruits and vegetables. One of the biggest concerns in the post-WLS eating world is to get sufficient amounts of protein. But how much do we need? The rule of thumb is about 60-70 grams of protein per day. In that light, 3 ounces of beef, pork and chicken all vary generally between 20 to 30 grams of protein; an egg is about 6 grams of protein. Spinach and other cooked greens are about 10-14 grams per cup .
So there are two issues to deal with. The first is to eat the nominal amount of protein necessary to ensure that we remain in balance during our weight loss and weight maintenance; and the second is to ensure that we do vary our diets with vegetables and fruits to get adequate vitamins and minerals. That is a balancing act. Since we can only eat eight bites or thereabouts per meal, how do we ensure that we get the balance we need between protein and vegetables?
I have found that while the largest component of my meals is protein (meats, eggs, cheese) I do add some vegetables and fruit to the meal just to enhance the dining experience. At a restaurant I might order a steak with a baked potato and spinach au gratin. I will cut about 2-3 ounces of the steak up and then I will alternate bites of meat with the vegetables. Eating slowly helps, but at the end of the meal I will need to ask the waiter to bring a take-home box for the remaining steak, potatoes and spinach. I will have consumed about 25 grams of meat protein. If I had a tablespoon of sour cream on my potato that is another gram or so and then the spinach would provide another 3-4 grams of protein. My dinner resulted in the consumption of about half your daily requirement for protein and was balanced nutritionally. It is important that you do not totally focus on the meat portion of your diet but also to provide yourself with a balanced diet.
If we take the children’s study to heart, we would reduce the entrée portion (even though it is already reduced) and add some vegetables and fruits. We would get better overall nutrition, probably lower total calories, and a more varied diet. That is a good thing. You can keep your portion control in check and have the nutrition you need. Remember its only eight bites.
Jennifer Savage (a nutritional researcher) at Pennsylvania State University in University Park and her colleagues found that the bigger the serving size of the macaroni and cheese; smaller amounts of the healthy side dishes were eaten. The preschoolers finished almost all of their smallest portion of mac and cheese, for an average of about 145 calories. But they still ate the majority of the much bigger portions, and put away 390 calories worth of the main course when they started with the most on their plate. When they were served the smallest amount of mac and cheese, kids ate almost half of their healthy side dishes, including fruits and veggies, compared to only a quarter when they were served the biggest mac and cheese portion.
Eating is always a matter of choices. If you give the child an option for a large portion of an entrée food that they really like, they will eat that more and they'll fill up. They'll reach their satiety point and they'll just stop eating thus reducing the nutritional quality of their meal.
So what does this mean to those of us who have a weight problem and have had or are thinking of having WLS? When we were heavy we could choose anything we wanted and eat as much as we wanted. Balancing our nutrition with good food choices was not always high on our agenda. However when you decide to diet or have WLS the concept of nutritional requirements needs to be one of your foremost areas of concern. After weight loss surgery we often find that our restrictive diets often do not allow the inclusion of the balanced nutrition that our body needs. Since we can only eat “Eight Bites” we often look at the main course as all we are going to eat. With so little available room in our stomachs post-surgery we often eat the things we like to eat and leave the “side dishes” alone. That is sort of like the kids who when given a large amount of the dish they prefer will eat it to satiety and then ignore or minimize the ingestion as well as the nutritional value of vegetables and fruit.
As was seen in the research discussed earlier, the kids ate a lower calorie and a more balanced diet when the “main course” was provided at a lower level along with the fruits and vegetables. One of the biggest concerns in the post-WLS eating world is to get sufficient amounts of protein. But how much do we need? The rule of thumb is about 60-70 grams of protein per day. In that light, 3 ounces of beef, pork and chicken all vary generally between 20 to 30 grams of protein; an egg is about 6 grams of protein. Spinach and other cooked greens are about 10-14 grams per cup .
So there are two issues to deal with. The first is to eat the nominal amount of protein necessary to ensure that we remain in balance during our weight loss and weight maintenance; and the second is to ensure that we do vary our diets with vegetables and fruits to get adequate vitamins and minerals. That is a balancing act. Since we can only eat eight bites or thereabouts per meal, how do we ensure that we get the balance we need between protein and vegetables?
I have found that while the largest component of my meals is protein (meats, eggs, cheese) I do add some vegetables and fruit to the meal just to enhance the dining experience. At a restaurant I might order a steak with a baked potato and spinach au gratin. I will cut about 2-3 ounces of the steak up and then I will alternate bites of meat with the vegetables. Eating slowly helps, but at the end of the meal I will need to ask the waiter to bring a take-home box for the remaining steak, potatoes and spinach. I will have consumed about 25 grams of meat protein. If I had a tablespoon of sour cream on my potato that is another gram or so and then the spinach would provide another 3-4 grams of protein. My dinner resulted in the consumption of about half your daily requirement for protein and was balanced nutritionally. It is important that you do not totally focus on the meat portion of your diet but also to provide yourself with a balanced diet.
If we take the children’s study to heart, we would reduce the entrée portion (even though it is already reduced) and add some vegetables and fruits. We would get better overall nutrition, probably lower total calories, and a more varied diet. That is a good thing. You can keep your portion control in check and have the nutrition you need. Remember its only eight bites.
Monday, December 26, 2011
Family Traditions
The holidays are generally a time of traditions. Many of them are simple and represent a continuation of the past. Others are painful and diminishing. Each life is a history lesson written against the background of traditions. So many of our life’s important traditions revolve around the time period between Thanksgiving and Christmas. I spent the Christmas weekend with a family that reminded me of some of the traditions that have been my life.
I grew up in a large family. I was the oldest boy of six boys and four sisters. My father was a school principal and my mother kept the house and the kids fed, and safe as possible and secure. Thanksgiving and Christmas were good times in the family. At Thanksgiving we all would pile in the station wagon and drive to San Francisco. There we would visit my father’s sister and her daughter Joyce. Joyce was one of my best friends. We would spend an hour or two there and then head down the San Francisco peninsula to my grandmother’s house. Early images were from a house near Candlestick park. Several stories tall, it was an old row house with a dark and scary basement and a small backyard. I remember the stairs, and the kitchen. Many of my memories were about the food. My grandfather would sit at the table and drink a cup of coffee made in a percolator pot on the stove. He would always spill some into his saucer and would finish by drinking the spilled coffee out of the saucer. At Thanksgiving, the smell of the turkey roasting was overwhelming. My grandmother would be bustling around in the kitchen and the kitchen table would be laden with food. There was always a Jell-o salad mold with celery, nuts and apples in it. Pies: pumpkin and mincemeat. One aunt always brought some pasta like a lasagna. The cousins would all arrive, increasing in number until by 1963 there were 27 first cousins. My aunts and uncles would greet each other with hugs and kisses and the kids would run off to play. In the late 1950’s my grandfather bought a new house in Burlingame and with all the room and yard and the canyon behind it, Thanksgiving was a time of exploration. The weather was usually nice. It was time for eating and laughing and watching the uncles play poker and the aunts sit and gossip. The cousins fended for themselves.
Christmas on the other hand was quite different. Christmas was celebrated in our house. Decorations went up both inside and out. There was a wire strung from the living room to the dining room near the ceiling. My mother hung old family ornaments from the wire from one end of the room to the other. Plywood Christmas figures were attached to the roof. In the early 1950’s my father would carve linoleum blocks into our Christmas card and print them on a hand press. I remember the smell of the ink. We always bought a Christmas tree smelling of pine and Christmas and decorated it with hand-made ornaments; construction paper chains glued together, strings of popcorn, glass balls and little angels, and lots of lights. Some of the lights were long skinny ones that when they warmed up bubbled sort of like a Lava-lamp which came much later. The biggest tree we could put in that place of honor in the front room was about 6 feet tall. But the final tree topper almost always touched the ceiling.
Our tradition on Christmas Eve was to go out to dinner at the Riverview Restaurant sitting on a wharf overlooking the San Joaquin River Delta. While we ate, boats would pass with lights strung on the masts and we would eat seafood. Sometimes if it was Friday I would get to eat Cioppino (a seafood stew like bouillabaisse), in a large wooden bowl, sopping up the soup with great sourdough French bread. It was only served on Fridays. After dinner we would drive around Antioch looking at the Christmas light displays. And eventually we would end up at the home of one of my Father’s teachers. She was Greek, lived with her parents and her mother made the most amazing cookies I have ever tasted. Food memories.
We would head home and to bed so Santa could come and leave the presents under the tree. I sometimes tried to stay awake to catch him, but that only resulted in me falling asleep in the clothes hamper or some other strange place. Expectations were always modest regarding presents but there were always enough to make us happy and rarely did we feel that we didn’t get what we wanted. Sometimes my Dad would make pancakes, or fried corn meal mush with syrup. It was always a nice morning. Then we would be off to San Francisco again. Dressed in our Christmas clothes we would again visit my father’s sister and Joyce. Then head for my grandmother’s house for another visit with the cousins and a big feast. It was Thanksgiving all over again only this time we all got presents from my grandparents.
These traditions sort of ended for me when I graduated from high school and went into the Coast Guard in 1963. Dinners at my grandmother’s house still went on for ten more years but the cousins were growing older and starting to have other interests. Age was taking its toll. My Grandfather was killed in an auto accident in 1967. And it really ended in 1976 when my grandmother past away.
However since I had experienced traditions I was ready to create some of my own. Married in 1966, our first Christmas tree was a juniper branch cut from a neighbor’s tree, decorated with aluminum foil ornaments. From that point forward, we always had a real tree at Christmas. That first Christmas eve we went out in a snowstorm to a Greek restaurant for dinner. I had my first glass of Ouzo. And as the storm intensified we found a cab to take us back to the apartment. It was a good Christmas with not much in the way of presents but a great deal of family.
Traditions. In 1972 our first son was born in December and that was year we started another tradition. On the tree went an ornament engraved with Galen’s name and the date 1972. Each year we would get a new ornament to add to the tree. When our second son Garth was born in 1974 on New Year’s Eve, we added another. We brought our children up with Christmas being a magical time and not just about presents. We would go out and see the Christmas lights like I used to as a child. From the late 1970’s through the early 1990’s I played Santa Claus for friends and others. I have written about that experience before. But it was one of my most significant traditions.
As the years went by, the actual physical events at the holidays changed a little. We ate Thanksgiving at our house. On Christmas Eve we exchanged ornaments with each other and added these to our collections and hung them on the tree. On Christmas morning, I would make beignets and coffee, and we would let the kids open their presents. After the exchange of gifts, we would get dressed and drive to my mother’s house for Christmas gift giving and a meal not unlike what my grandmother used to create. My mother always gave us cookies. Hundreds of cookies. Sometimes the entire family would be there; sometimes not. As the years went by the sometimes not was a more frequent scenario.
So those are some of my holiday traditions and what they meant to me. In the last few years I have lost some of these family events that were such a large part of my life. My wife of 39 years was diagnosed with pancreatic cancer at Christmas in 2004, and died shortly thereafter. Christmas after that was quite a bit different. The kids still came over for their gifts bringing their families with them. Beignets were still fried and covered with powdered sugar. Ornaments were still exchanged on Christmas Eve. But it seemed that the traditions I had grown up with were disappearing as the kids developed their own. Maybe that is how it should be.
It is sad that so many people grow up with few, if any holiday traditions. Christmas is NOT just another day. It is a day that should be joyful, not ignored. It is a day of giving and being with family and not just one where the TV is on. It is not just any other day. The tree is lit all day, and there is candy on the coffee table. The Christmas dinner is being prepared by those who do it out of love not out of duty. It is family, and colored lights, and the smell of roasting turkey, and cinnamon. It is warmth and security and yes, traditions.
This Christmas I remembered that there were traditions in my life. And I still appreciated them. Merry Christmas everyone.
Here are a couple of recipes to enliven the Christmas season.
Prosciutto Rolls
Ingredients
2 tbs Olive oil
2 tsp grated lemon peel
1 Tbs Lemon juice
6 oz Goat cheese (room temperature)
2-3 cloves of fresh garlic
12 slices prosciutto (thicker) cut in half
½ C fig preserves
Rucola (Arugola)
Directions
Mix oil, lemon zest, and lemon juice and set aside. Mix goat cheese and minced garlic in a small bowl and set aside.
On a ½ slice of prosciutto, spread a layer of goat cheese, then a thin layer of fig preserves, then a couple of leaves of rucola. Drizzle with a bit of the lemon vinaigrette and season to taste with pepper. Roll the prosciutto around the filling and place on a serving platter. Garnish with chopped parsley.
Artichoke Crostini
Ingredients
8 1/2"-thick slices good French or Italian artisan bread
Extra-virgin olive oil
1 garlic clove
1/2 cup mascarpone
1 6 1/2oz. jar marinated artichoke hearts
2 tbsp. finely chopped chives
2 oz. Parmigiano-Reggiano, shaved thin with a peeler
Freshly ground black pepper, to taste
Prepare a medium-hot charcoal fire in a grill or using a stove-top grill set to medium-high. Grill bread slices until both sides are golden brown with slightly charred crusts, 4–5 minutes. While hot, rub bread with garlic. Drizzle the bread with oil.
Slather 1 tbsp. of the mascarpone on top of each toasted slice. Top mascarpone with artichoke hearts, chives, parmesan, and pepper. Drizzle with more oil, if you like.
Check for seasoning on the artichoke hearts. Add a bit of vinegar or possibly some salt. They are often a bit bland in the jars.
BellaRosa
This is a thick luscious dessert that has never failed to get raves from guests. Use various liquors to achieve different flavors. The amount of cheese dictates the size of the dessert. Keeps well for several days in the refrigerator.
Ingredients
Mascarpone cheese (Italian cream cheese) 8-16 ounces
Cream cheese 8-16 ounces
Cream 1 pint
Sugar ½ cup
Lemon zest ½ tsp
Liquor: Use about 2 oz (Grand Marnier, brandy, coffee liquor, Amaretto, Limoncello, chocolate liquor)
Chocolate: bittersweet 70%, 2-4 oz chopped medium
Almond biscotti: 2 cups crushed
Directions
Place cream cheese and mascarpone in a bowl and mix with either a stand mixer or a hand mixer for 4-5 minutes until it is very smooth. Add 2 oz of the liquor of choice (I normally use Grand Marnier and chocolate liquors). Try to use complementing flavors and try not to use too much. Add 1/2 cup of sugar and the lemon zest and continue to mix. In another bowl beat the cream with a couple tablespoons of sugar and a teaspoon of vanilla extract until it reaches a medium stiff peak. Add half of the cream to the cheese mixture and mix thoroughly. Continue to whip cream to stiff peaks. Take the cheese mixture off the mixer and fold in the remaining cream gently.
Prepare the serving dish: Using a 13x9 inch casserole dish, place the crushed biscotti in the bottom of the dish (reserve about ¼ cup for the top). Sprinkle a bit of Grand Marnier or another liquor over the biscotti if you wish. Pour the cheese mixture onto the biscotti and smooth the top. Sprinkle with the chopped chocolate and the reserved crushed biscotti. Cover with plastic wrap and place in the refrigerator overnight. Serve in 3-4” squares.
I grew up in a large family. I was the oldest boy of six boys and four sisters. My father was a school principal and my mother kept the house and the kids fed, and safe as possible and secure. Thanksgiving and Christmas were good times in the family. At Thanksgiving we all would pile in the station wagon and drive to San Francisco. There we would visit my father’s sister and her daughter Joyce. Joyce was one of my best friends. We would spend an hour or two there and then head down the San Francisco peninsula to my grandmother’s house. Early images were from a house near Candlestick park. Several stories tall, it was an old row house with a dark and scary basement and a small backyard. I remember the stairs, and the kitchen. Many of my memories were about the food. My grandfather would sit at the table and drink a cup of coffee made in a percolator pot on the stove. He would always spill some into his saucer and would finish by drinking the spilled coffee out of the saucer. At Thanksgiving, the smell of the turkey roasting was overwhelming. My grandmother would be bustling around in the kitchen and the kitchen table would be laden with food. There was always a Jell-o salad mold with celery, nuts and apples in it. Pies: pumpkin and mincemeat. One aunt always brought some pasta like a lasagna. The cousins would all arrive, increasing in number until by 1963 there were 27 first cousins. My aunts and uncles would greet each other with hugs and kisses and the kids would run off to play. In the late 1950’s my grandfather bought a new house in Burlingame and with all the room and yard and the canyon behind it, Thanksgiving was a time of exploration. The weather was usually nice. It was time for eating and laughing and watching the uncles play poker and the aunts sit and gossip. The cousins fended for themselves.
Christmas on the other hand was quite different. Christmas was celebrated in our house. Decorations went up both inside and out. There was a wire strung from the living room to the dining room near the ceiling. My mother hung old family ornaments from the wire from one end of the room to the other. Plywood Christmas figures were attached to the roof. In the early 1950’s my father would carve linoleum blocks into our Christmas card and print them on a hand press. I remember the smell of the ink. We always bought a Christmas tree smelling of pine and Christmas and decorated it with hand-made ornaments; construction paper chains glued together, strings of popcorn, glass balls and little angels, and lots of lights. Some of the lights were long skinny ones that when they warmed up bubbled sort of like a Lava-lamp which came much later. The biggest tree we could put in that place of honor in the front room was about 6 feet tall. But the final tree topper almost always touched the ceiling.
Our tradition on Christmas Eve was to go out to dinner at the Riverview Restaurant sitting on a wharf overlooking the San Joaquin River Delta. While we ate, boats would pass with lights strung on the masts and we would eat seafood. Sometimes if it was Friday I would get to eat Cioppino (a seafood stew like bouillabaisse), in a large wooden bowl, sopping up the soup with great sourdough French bread. It was only served on Fridays. After dinner we would drive around Antioch looking at the Christmas light displays. And eventually we would end up at the home of one of my Father’s teachers. She was Greek, lived with her parents and her mother made the most amazing cookies I have ever tasted. Food memories.
We would head home and to bed so Santa could come and leave the presents under the tree. I sometimes tried to stay awake to catch him, but that only resulted in me falling asleep in the clothes hamper or some other strange place. Expectations were always modest regarding presents but there were always enough to make us happy and rarely did we feel that we didn’t get what we wanted. Sometimes my Dad would make pancakes, or fried corn meal mush with syrup. It was always a nice morning. Then we would be off to San Francisco again. Dressed in our Christmas clothes we would again visit my father’s sister and Joyce. Then head for my grandmother’s house for another visit with the cousins and a big feast. It was Thanksgiving all over again only this time we all got presents from my grandparents.
These traditions sort of ended for me when I graduated from high school and went into the Coast Guard in 1963. Dinners at my grandmother’s house still went on for ten more years but the cousins were growing older and starting to have other interests. Age was taking its toll. My Grandfather was killed in an auto accident in 1967. And it really ended in 1976 when my grandmother past away.
However since I had experienced traditions I was ready to create some of my own. Married in 1966, our first Christmas tree was a juniper branch cut from a neighbor’s tree, decorated with aluminum foil ornaments. From that point forward, we always had a real tree at Christmas. That first Christmas eve we went out in a snowstorm to a Greek restaurant for dinner. I had my first glass of Ouzo. And as the storm intensified we found a cab to take us back to the apartment. It was a good Christmas with not much in the way of presents but a great deal of family.
Traditions. In 1972 our first son was born in December and that was year we started another tradition. On the tree went an ornament engraved with Galen’s name and the date 1972. Each year we would get a new ornament to add to the tree. When our second son Garth was born in 1974 on New Year’s Eve, we added another. We brought our children up with Christmas being a magical time and not just about presents. We would go out and see the Christmas lights like I used to as a child. From the late 1970’s through the early 1990’s I played Santa Claus for friends and others. I have written about that experience before. But it was one of my most significant traditions.
As the years went by, the actual physical events at the holidays changed a little. We ate Thanksgiving at our house. On Christmas Eve we exchanged ornaments with each other and added these to our collections and hung them on the tree. On Christmas morning, I would make beignets and coffee, and we would let the kids open their presents. After the exchange of gifts, we would get dressed and drive to my mother’s house for Christmas gift giving and a meal not unlike what my grandmother used to create. My mother always gave us cookies. Hundreds of cookies. Sometimes the entire family would be there; sometimes not. As the years went by the sometimes not was a more frequent scenario.
So those are some of my holiday traditions and what they meant to me. In the last few years I have lost some of these family events that were such a large part of my life. My wife of 39 years was diagnosed with pancreatic cancer at Christmas in 2004, and died shortly thereafter. Christmas after that was quite a bit different. The kids still came over for their gifts bringing their families with them. Beignets were still fried and covered with powdered sugar. Ornaments were still exchanged on Christmas Eve. But it seemed that the traditions I had grown up with were disappearing as the kids developed their own. Maybe that is how it should be.
It is sad that so many people grow up with few, if any holiday traditions. Christmas is NOT just another day. It is a day that should be joyful, not ignored. It is a day of giving and being with family and not just one where the TV is on. It is not just any other day. The tree is lit all day, and there is candy on the coffee table. The Christmas dinner is being prepared by those who do it out of love not out of duty. It is family, and colored lights, and the smell of roasting turkey, and cinnamon. It is warmth and security and yes, traditions.
This Christmas I remembered that there were traditions in my life. And I still appreciated them. Merry Christmas everyone.
Here are a couple of recipes to enliven the Christmas season.
Prosciutto Rolls
Ingredients
2 tbs Olive oil
2 tsp grated lemon peel
1 Tbs Lemon juice
6 oz Goat cheese (room temperature)
2-3 cloves of fresh garlic
12 slices prosciutto (thicker) cut in half
½ C fig preserves
Rucola (Arugola)
Directions
Mix oil, lemon zest, and lemon juice and set aside. Mix goat cheese and minced garlic in a small bowl and set aside.
On a ½ slice of prosciutto, spread a layer of goat cheese, then a thin layer of fig preserves, then a couple of leaves of rucola. Drizzle with a bit of the lemon vinaigrette and season to taste with pepper. Roll the prosciutto around the filling and place on a serving platter. Garnish with chopped parsley.
Artichoke Crostini
Ingredients
8 1/2"-thick slices good French or Italian artisan bread
Extra-virgin olive oil
1 garlic clove
1/2 cup mascarpone
1 6 1/2oz. jar marinated artichoke hearts
2 tbsp. finely chopped chives
2 oz. Parmigiano-Reggiano, shaved thin with a peeler
Freshly ground black pepper, to taste
Prepare a medium-hot charcoal fire in a grill or using a stove-top grill set to medium-high. Grill bread slices until both sides are golden brown with slightly charred crusts, 4–5 minutes. While hot, rub bread with garlic. Drizzle the bread with oil.
Slather 1 tbsp. of the mascarpone on top of each toasted slice. Top mascarpone with artichoke hearts, chives, parmesan, and pepper. Drizzle with more oil, if you like.
Check for seasoning on the artichoke hearts. Add a bit of vinegar or possibly some salt. They are often a bit bland in the jars.
BellaRosa
This is a thick luscious dessert that has never failed to get raves from guests. Use various liquors to achieve different flavors. The amount of cheese dictates the size of the dessert. Keeps well for several days in the refrigerator.
Ingredients
Mascarpone cheese (Italian cream cheese) 8-16 ounces
Cream cheese 8-16 ounces
Cream 1 pint
Sugar ½ cup
Lemon zest ½ tsp
Liquor: Use about 2 oz (Grand Marnier, brandy, coffee liquor, Amaretto, Limoncello, chocolate liquor)
Chocolate: bittersweet 70%, 2-4 oz chopped medium
Almond biscotti: 2 cups crushed
Directions
Place cream cheese and mascarpone in a bowl and mix with either a stand mixer or a hand mixer for 4-5 minutes until it is very smooth. Add 2 oz of the liquor of choice (I normally use Grand Marnier and chocolate liquors). Try to use complementing flavors and try not to use too much. Add 1/2 cup of sugar and the lemon zest and continue to mix. In another bowl beat the cream with a couple tablespoons of sugar and a teaspoon of vanilla extract until it reaches a medium stiff peak. Add half of the cream to the cheese mixture and mix thoroughly. Continue to whip cream to stiff peaks. Take the cheese mixture off the mixer and fold in the remaining cream gently.
Prepare the serving dish: Using a 13x9 inch casserole dish, place the crushed biscotti in the bottom of the dish (reserve about ¼ cup for the top). Sprinkle a bit of Grand Marnier or another liquor over the biscotti if you wish. Pour the cheese mixture onto the biscotti and smooth the top. Sprinkle with the chopped chocolate and the reserved crushed biscotti. Cover with plastic wrap and place in the refrigerator overnight. Serve in 3-4” squares.
Monday, August 8, 2011
Three years out
In 2008 on the 4th of June, I checked into California Pacific Hospital in San Francicso, California to have my vertical sleeve gastrectomy performed by Dr. Jossart. I had lost about 8 pound in the month between my initial meeting with him in May and my weight was 292 pounds. I had a BMI of about 45. At about 2PM that afternoon I went into surgery and then next time I knew what time it was, it was 530PM and I was back in my room. On June 5th, a bit after noon, my son picked me up and I returned to my home in Santa Rosa, California. For those first few weeks I took it easy with a liquid protein diet, riding the stationary bike and walking. I followed the “book” I had been given by Dr. Jossart to the letter. I knew I was losing weight because my clothes were starting to get very loose. Elastic pants worked the best.
I lost weight virtually continuously for the next year. On June 4th 2009 I weighed 170 pounds and had dropped 12 inches in my waist and gone from a jacket size of 54 to a 44. I was having no significant problems and could eat almost anything I wished. Tomato sauces and red wine did cause me some pain so I restricted my intake of those items. Ground beef (fast food hamburgers) also created significant pain so they also were avoided. Since I was in Italy and cooking with the AmoreSapore cooking program I could control what and how I ate to some degree. As time went past, I continued to slowly lose a few more pounds and ultimately reached 161 pounds. Dr. Jossart had given me a target weight of 154 when I first visited him and I had laughed at the thought of that. But there I was in 2010 at 96% of that goal. That by itself was actually hard to comprehend. I had not been that weight since I was 15 years old and a sophomore in high school. I was 64 years old with heart disease and I had gone back to the weight I was in high school. I thought that all was well in my life.
I bought new clothes, smaller clothes. I studiously avoided anything that had the insidious label on it of Extra large! I promised myself I would NEVER go back to that excess weight again. And for another year I maintained that weight at 165. I was cooking as part of the AmoreSapore team and a lot of people wanted to know how I could be a cook and still stay thin. I said it was always a matter of taste. Eight Bites were all I needed to satisfy me, from both a nutritional and an emotional level. I tasted things as I prepared them, and I was satisfied with the bits and morsels allowing me to eat a wide variety of foods, satisfy my nutritional demand and still create meals of substance for the guests.
I returned to California at the end of September 2010 and began trying to establish a cooking career. Over time while I cooked fairly frequently, it was not enough work to meet my financial obligations and I began seriously looking for a job back in the environmental industry where I had an almost 40 year career. In those stressful times I noticed that while I didn’t seem to be eating more, my weight began creeping upwards. First to 170, then to 175. My waist increased to 35 inches and my jackets went from 42R to 44R. When I went to the doctor and weighed on their scales, I was heavier than on my scale at home. I began evalating my diet, lifestyle, stressors, etc to see if I could get a clue as to the weight gain. I have written previously about some of the issues and increased calories. My doctor felt that I was reestablishing my satisfactory weight, but that didn’t help me button my jackets that were now 1” too tight.
So here I am in the summer of 2011. I am at 190 pounds, my waist has not increased and my jackets remain where they were at 44R. I feel OK and I am now working full time for a couple of environmental laboratories in the Los Angeles area. Work has been going well and while I am staying in residential hotels, I am able to control my food consumption and stay away from the fast food gauntlet on every thoroughfare in the Los Angeles area.
In the last few months I have had to have a stent put in an blocked artery in my heart and have learned to live with the realities that I have heart disease from a lifetime of excess weightr and my weight loss, while helping, has not diminished the heart disease. I will be held responsible for that and my life will undoubtedly be shortened by that issue. But I will continue to walk the path that I am on. I can only do what I can do right now to make myself healthier. One of those things is to exercise more and try to drop 4-5 pounds. That will not make me healthier but will make me a bit happier with myself.
The take away lesson here is that if you do this weight loss process do it because it will make you healthier. It will likely make you happier with who you are and how you look. But it will not make you a different person than you were pre-surgery. Pre-existing illnesses, health effects and other issues will still be there. I guess I have done what I could. Now I have to maintain it for as long as I can. Stay tuned. One thing for sure is that I will never go back to the weight I was before the surgery.
Tuesday, May 24, 2011
Braised meats
Moles are typical chile sauces made in Mexico and central America and provide a complex flavor to the dishes where they are used. There are hundreds of recipes for moles, and they often include many different types of chiles, bitter chocolate and lots of different spices. They are often very complex but well worth trying. Mexican and Central American markets will often have the primary ingredients. This mole is pretty simple and provides a nice spicy counterpoint to the chicken.
1 whole chicken (3–4-lb), cut into 8 pieces
1/2 cup chopped cilantro stems
2 tbsp. kosher salt
1 tsp. whole black peppercorns
2 cloves garlic, chopped
1 large yellow onion, chopped
1 bay leaf
Green chili mole
8 oz. tomatillos, peeled and chopped
2 jalapeños, stemmed and chopped
1/2 cup cilantro leaves
2 tbsp. kosher salt, plus more to taste
2 cloves garlic, chopped
2 8″ flour tortillas, toasted
3 tbsp. canola oilChicken Stewed in Coconut Milk
Coconut milk is used in chicken stews from Southeast Asia to Africa, from which this fragrant dish hails. It makes a very delicious braising liquid, imparting an exotic flavor to the meat. This is a highly spiced dish requiring some spices that may not be common on your pantry shelves. If the turmeric has been in the cabinet for so long you forgot it was there, it would probably be best to toss it and get a new bottle. The same holds true for lots of ground spices like cardamom, cloves, cinnamon, and cumin. Whole spices can last for a long time, if you toast them gently then grind them for each use. Ground spices are probably good for about a year, and then become relatively tasteless. Depending upon the number of chilies used this dish can be from moderately spicy to very hot. Thai chiles can be found at oriental groceries or small red chiles can substitute. Use your palate’s judgment as well as some restraint, when you cook this for the first time. This dish will serve 6-8 people.
1⁄4 cup canola oil
4 cloves garlic, minced
4 green or red Thai chiles, stemmed, seeded, and minced
4 plum tomatoes, cored and minced
1 medium red onion, minced
4 skinless bone-in chicken legs and thighs, separated
1⁄4 cup fresh lime juice (don’t use bottled lime juice here)
2 14-oz. cans coconut milk
Kosher salt and freshly ground black pepper, to taste
4 cups cooked rice, for serving
Finely chopped fresh cilantro, for garnish
Directions: Heat the oil in a 6-qt. pot over medium-high heat. Add the turmeric, garlic, chiles, tomatoes, and onions and cook, stirring often, until the onions are caramelized, 20–25 minutes. Add chicken to pot along with lime juice and coconut milk. Bring mixture to a boil and reduce heat to medium-low; simmer, stirring occasionally, until chicken is tender, about 30 minutes. Season with salt and pepper. To serve, put rice into 4 serving bowls and spoon chicken and sauce over rice. Garnish with cilantro and season with more black pepper.
Chicken “Osso Bucco”
This is a nice variation on the classic Italian veal shank dish. Serve it with a classic gremolata (finely minced mixture of parsley, lemon peel, and garlic).
8 chicken drumsticks or thighs4 tsp. all-purpose flour
2 tbsp. extra-virgin olive oil, plus extra for pasta
1 carrot, peeled and diced
1 onion, diced
1 stalk celery, diced
1 red bell pepper, diced
8 cloves garlic, peeled and chopped
1 cup dry white wine
2 cups tomato sauce
4 cups chicken stock
Salt and freshly ground black pepper
1 sprig of fresh thyme and a bay leaf
1 1⁄2–2 cups penne pasta
1 tomato, diced
Chopped fresh parsley
Directions: Lightly coat drumsticks with flour. Heat olive oil in a large ovenproof skillet over medium heat. Add drumsticks and cook until golden brown, about 2 minutes per side. Transfer to a plate and keep warm.
Add carrots, onions, celery, peppers and garlic to skillet and cook over medium heat until lightly browned, about 3 minutes. Add wine and scrape up any browned bits. Add tomato sauce, chicken stock, zest, and juices. Season to taste with salt and pepper and add the thyme and the bay leaf. Continue cooking, uncovered, over medium-high heat until sauce thickens, 20–30 minutes.
Preheat oven to 325°. Return the chicken to pan and bake, covered, until chicken is cooked through, 20–30 minutes.
Cook the pasta in a large pot of salted water until al dente. Drain and toss with a little olive oil. To serve, spoon chicken and sauce over pasta and garnish with tomatoes and parsley or the gremolata.
Braised Cod with Kale and potatoes
Cod is a meaty, hearty fish that stands up to the dense and earthy flavor of kale. You can also substitute halibut for the cod. Serve this dish with French bread and a fresh green salad.
1 lb. leeks4 tbsp. extra-virgin olive oil
2 cloves garlic, peeled and minced
1 lb. new potatoes, washed and halved
1 lb. thick cod or halibut fillets cut into large pieces
3 packed cups washed, stemmed, and roughly chopped kale leaves
1 cup dry white wine or stock
Salt and freshly ground black pepper
Directions: Trim off and discard green tops of leeks. Roughly chop the white part, place in a colander, and wash thoroughly in running water to remove all sand. Drain and dry on paper towels. Heat 3 tbsp. of the olive oil in a large sauté pan over low heat. Add leeks and garlic and cook slowly until leeks are tender, about 20 minutes.
Dry potatoes well and add to the pan. Raise heat to medium-high and sauté until lightly browned, about 3–5 minutes. Add kale and stock or white wine. Cover, lower heat, and simmer until potatoes are tender and kale has cooked down, about 15 minutes.
Meanwhile, sear the fish in a lightly oiled nonstick pan over medium-high heat until golden, about 1 minute per side. Add fish to kale mixture and continue to simmer until fish is opaque, about another 5 minutes. Season to taste with salt and pepper and serve.
Wednesday, March 23, 2011
Crackers and cheese
Back to the issue of eating quickly or slowly. Dieters are counseled to eat slowly and chew their food many times, and put their fork down between bites. This enforced slowing of the consumptive process is theoretically intended to trick the body into sending messages to the brain that you are full and then this tells you to stop eating, before you eat too much. Fast eating may overwhelm the body’s intrinsic hormonal and psychological systems and allow you to eat more, because the message to the brain that you are full is delayed. I have also said that eating your Eight Bites slowly can be incorporated into a active social process which includes eating with friends and family who have not had bariatric surgery, may not be heavy, and may not be on a diet. So what do we do? Eat fast or eat slowly?
After WLS, your body processes eating inputs differently than before. Eating fast or slow was relevant to the information inputs from the stomach to the brain. After WLS when you are physically restricted from eating too much, a different set of conditions occurs. You are now responsible for how much food is put into your body (stomach or what is left of it). The hormonal and neural inputs have been altered and no longer function at the same level. After WLS, you have to learn to feel that you are full, or preferably one bite less than full and stop eating. Overeating after WLS has a variety of effects. It can be painful from over-distending the stomach or pouch; and it can in the early period immediately after surgery cause the surgical site to rupture causing a serious infection (peritonitis) that is often life-threatening. So after WLS you have to learn to know your body better than you did before. After WLS you have to feel and know when to stop eating.
This knowledge is a combination of stomach capacity and your own ability to look at what you are eating and say that is enough. Enough? That is probably the most difficult thing we have to understand after we have undergone the surgical procedures to lose the weight. How do we know what enough is? If you have lived your life never limiting your capacity to eat, this is a difficult thing to understand. First you have to know how much food you can physically put into that newly altered physical environment called your digestive storage system (previously known as your stomach). Your doctor’s instructions are very clear on how that early period post-surgery should be handled. You are likely drinking high protein liquids, which do not put excessive pressure on your surgical site and also provide you with the nutrition your body needs. It is actually pretty easy in those first weeks and months as you rapidly see yourself losing weight, and losing inches. It is easy to succeed when you are succeeding easily. When you switch to a more normal diet is when things get more difficult. Over time as the weight falls off you start to get back into a more “normal” mode of eating. Breakfast, lunch, dinner, and snacks all become part of your normal life. In a year or more post-surgery you will reach a point where you will not lose any more weight. If you are near your ultimate goal you may be satisfied. If you are not, it may be time to critically evaluate the factors in your nutritional world.
This is the time you need to look clearly at what you are eating, when you are eating, and how you are eating in this new environment. This is a time for total honesty with yourself. You went into this weight loss regimen for a reason. What was it? Was it for your health and the desire to increase the potential for a longer healthier life? An honest appraisal of your motives is critical at this point. It may make the difference between your successful weight loss and the potential to put weight back on.
In the last few months I have put approximately 12 pounds back on and I contacted my doctor. His response was because I had been having my heart issues in January and February, I had cut back on my exercise and also probably was retaining fluid as well. So I increased my exercise after the angioplasty. But I also started to examine what and when and how I was eating. After you have WLS you tend to think that calories don’t really count anymore because you can only eat a small amount of food. It can be a very slippery slope if you stop considering what caloric values foods have. And can be even more slippery, if you neglect the exercise so fundamental to the maintenance of the weight loss.
You need to examine what you are eating in light of both the volume and caloric values. I realize that you are eating much smaller amounts than you used to but it is time to examine the true nutritional value of the food you are eating. The first thing is to make a list of what you ate today. Include the estimated amounts in your list. I created spreadsheet that had one worksheet that was a list of foods, their caloric values per unit, and the total grams of proteins, fats and carbohydrates. A second sheet held a calculation sheet. To start I input the foods I ate the day I created the spread sheet, and I found out my day’s intake was 1600 calories instead of the 800-900 calories I thought I was eating. Wow! In my case I found I was snacking on too many crackers and cheese. Ten crackers were about 100 calories, an ounce of cheese is about 100-120 calories, and a tablespoon of butter is 100 calories. So snacking on crackers and cheese at intervals during the day can add 400-600 calories to your diet. That can take you from 900 calories per day to 1500 calories per day, and gradually put on a few of those unwelcome pounds again. If anyone wants a copy of my spreadsheet just email me at kfk125@yahoo.com and I will send it to you.
Now back to the original question that started this entry, should you eat fast or slow? A recent research study published by a group of Dutch scientists suggested that eating slowly doesn't make you eat less than if you eat more quickly. The researchers compared what happens to meal size and appetite by having a group of volunteers eat a leisurely two-hour lunch, and at another time, eat the same lunch in just 30 minutes. They found that the volunteers did indeed feel fuller after the leisurely meal, and were still satiated several hours later. But despite feeling full, when presented with an offering of traditional snacks several hours after lunch, the group who ate the slow meal snacked on as many calories as they did following their 30-minute meal. What this means is that regardless of whether they ate quickly or slowly, it did not translate into an unwillingness to snack on post lunch snacks. So in terms of dieting, snacking is a potentially big problem. As I have personally seen, eating typical post WLS meals is not a difficult proposition. However eating snacks between those meals can almost double the total caloric input for a day.
Reference: http://www.nytimes.com/2011/03/08/health/nutrition/08eat.html
What does this mean for those who have gone through the process of some version of weight loss surgery? The physical restrictions placed upon our eating habits at first keeps you satisfied as the pounds come off. Calories are irrelevant and unimportant. But when you get to the flattened out spot on your weight loss chart, the physical restrictions begin to play a less significant role. It then is up to you. You need to decide what you want to eat, and how often you want to eat. There are three directions you can go here: 1) You can remain at the weight you achieved by balancing the calories you consume with the calories you expend on a daily basis; 2) you can continue to lose weight by increasing your caloric output through exercise; and 3) you can gain weight back by consuming more calories that you expend. Thermodynamics rules this decision making. Snacking defeats the objective to maintain your weight unless you increase the calories expended (exercise). Your doctor can give the mechanism to lose weight, but it will be up to you to maintain that weight. The discipline necessary to effectively make it through this journey can be difficult. Sometimes you just have to sit down and give yourself a good talking to and realize that if your weight is to be what you have sought, it will be up to you. In my case I have given up eating so many crackers and cheese.
Sunday, March 6, 2011
Fried Potatoes and Eggs with Cinnamon Toast
To make the potatoes, I drain the potatoes well and chopped a medium onion into a coarse dice. Into a non-stick saute pan I put about ¼ cup of canola oil and brought it to a temperature of about 330 degrees. At that temperature the potatoes will cook relatively quickly and will not absorb too much oil. I then add the chopped onions and the potatoes and start to quickly saute the vegetables. As they begin to brown, I pour in about ½ cup of water and immediately put a lid on the pan. The water quickly steams the potatoes and when it is evaporated you will hear the potatoes starting to sizzle in the remaining oil. The onions should not burn when using this combination oil and water technique. The vegetables will cook nicely together. When the potatoes are golden and crisp, put them in the oven at 350 degrees to hold until you make the eggs.
Eggs are the salvation of the WLS diner. They are so versatile and nutritious that they should be an integral and important part of your high protein diet. They provide a very high quality protein source and can be served in hundreds of ways. In Larousse Gastronomique, an early compendium of French cooking methods and dishes, there are many pages of egg preparations ranging from the simple to the extraordinarily complicated.
My guest liked their eggs sunny side up and I like mine over easy. To cook a beautifully fried egg sunny-side up, you need to start with a non-stick saute pan set over medium-low heat. You really don’t want to overcook the eggs and want the whites set but the yolks still slightly runny.
Put a pat of good butter in the warm pan to provide rich flavor and break two eggs into a bowl. When the butter has melted and has stopped foaming, slide the eggs from the bowl into the pan and start to cook them gently. The whites will start to cook first and then you can add a pinch of pepper. When the whites are fully cooked but still a bit soft, give the pan a little shake to free the eggs from the pan and slide them out on to a warm plate. Over easy is a bit trickier but you start using the same technique. After you shake the pan to release the eggs you can gently flip the eggs in the pan so they cook for 20-30 seconds on the other side.
Plate the potatoes on a warm plate and place the eggs next to them to serve.
Now to the cinnamon toast. I like using a baguette sliced in half horizontally and opened up flat. Spread the bread with butter and sprinkle on a mixture of sugar (1/2 cup), cinnamon (1 teaspoon) and a small pinch of nutmeg. Place on a baking sheet and then into the oven with the potatoes. Allow the toast to get a light brown and the sugar topping is a bit melted.
Thinking in Eight Bite increments
This breakfast provides a good level of protein in the eggs, complementing flavors in the potatoes and onions, and then a little sweetness and crunch with the cinnamon toast. However you still have to think about the volume you should eat. My estimate of the breakfast portion size is the two eggs, about ½ cup of the potatoes, and a 3” piece of the cinnamon toast. This will give you the nutrition you are looking for as well as a sense of eating a nicely flavored breakfast. Don’t be afraid to indulge your tastes every once in awhile with things like cinnamon toast. There is just no need to eat to excess. Thomas Keller at the famous restaurant The French Laundry in Yountville, California says that he serves small portions because we really only remember the taste of that first bite or two. So tastes and those small bites are important.
Tomorrow I will make a couple of nice espressos, plate the eggs and potatoes, portion out the cinnamon toast and call my buddy to breakfast. It will be a nice way for me to start their day. And it will be the start of a good day for me as well. So invite your friends to visit and make a simple breakfast to start their day.
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