Tuesday, December 22, 2009

Christmas in Umbria

This is the first year that I am spending Christmas in my adopted country, Italy. Last year, 2008, I was in Santa Rosa, California working on my extended visa with the Italian consulate in San Francisco, and had Christmas with my sons, their wives and my two grand children.

A lot has changed in my life this year. Elizabeth and I are nearing our second anniversary in March. I am working with her catering group as a cook, and doing some instruction in the cooking classes. I continue, slowly, learning Italian each week and that is getting a bit better. My scientific life has been put on hold though I do read a lot and follow the current scientific thinking and trends.

On a personal level, my weight has remained at 165 pounds since flattening out in June 2009. I have found that I can eat and enjoy lots of different kinds of food without discomfort. That includes an occasional glass of wine, or spirits. In a recent discussion on line I found that after weight loss surgery, alcohol reacts more quickly on the system and some say that one drink may be the equivalent of four, so if you are going to imbibe, do it carefully and be aware of the effects it may have on you. This is not to say don’t drink, but early in the post-surgical healing, the alcohol may irritate the surgical site, so slowly, slowly. A little at a time.

So this Christmas I will write about the experience of being and eating in Italy during the holidays.

Natale con i tuoi; Pasqua con chi vuoi. Christmas with your family; Easter with whomever you like.

The Christmas holidays in Italy are an extended time, running from Christmas Eve until the 6th of January. It is a time for family gatherings, traditional foods, and celebrations. These are predominantly religious holidays, but over the years the religious nature has been diluted somewhat by the secular.

Christmas Eve, La Vigilia di Natale, is a major family event. Entire small towns become quiet as the people leave and return to family homes elsewhere. The big cities are quiet and it is safe to cross the street. It is a time of gathering. It is multi-generational, and much of the cooking is done by the older women, using classic recipes, and historic methods. Children are running amuck as children do at Christmas everywhere. The kitchen is warm with the smells of bread and cookies baking, and meats are roasting or simmering. Pasta is being rolled out, sauces being prepared and sweets are either purchased from the bakery or baked at home. The Christmas Eve meal is traditionally dominated by fish and seafoods, throughout much of Italy. There are certainly regional and even city level difference in the choices of fish for the meal, but if it swims and extracts oxygen from an aqueous medium, it is a potential food source. Sardines, anchovies, squid, shrimp, octopus, fish of all types, baccalà (salt cod) and especially the freshwater eel (Anguilla) are all present in the various Christmas Eve dishes. It is traditional that seven or more fish dishes be served on Christmas Eve and eel is considered one of the most important. Its snake-like body represents a continuity between the past and the future, and is eaten grilled as spiedini (skewered) interspersed with sage leaves as served in Bologna, or in a braise, or just grilled over an open fire in the fireplace. Its consumption is often the centerpiece of the dinner.

This Christmas Eve, we will be hosting a party for between 12 and 15 friends here at Casa Ruspante. The house has been decorated with our new presepe (crèche) I bought for Elizabeth at the local Christmas market in Umbertide. It is composed of clay figures, painted in great colors and was hand made in Peru. It makes a nice addition to the Christmas sideboard. Hand-painted ornaments are placed around, with a gold garland of tinsel. A ceramic Christmas tree adds some green to the display and an added festive touch. Candles are set up, to be lit before dinner. Gifts for friends are all wrapped and placed on the sideboard to hand out on Christmas Eve. They are small gifts, more tokens of affection than anything else. They are often things like kitchen towels and implements, various marmalattas I have put up, and in at least one case, cash. Our stockings (le calzi) are hung from the mantle.

Our dinner menu will be dominated by fish and seafood. Antipasti will be crostini (bruschetta) with braised cavolo nero (black cabbage, a winter vegetable) and anchovies, a spicy shrimp (gamberetti) dish, a baccalà pate to be spread on crostini or cucumbers, and a plate of sliced pecorino and Cacciota cheeses with chutney recently made here. The primo piatti (first course) will be freshly made tagliatelle with smoked salmon and fresh peas in a light bechamel sauce. The secondo (second course) will be grilled or lightly fried fish with a lemon mostarda (that I made two weeks ago) and garnished with lemon slices. I will make some pickled onions to go along with the fish. A friend is bringing artichokes alla romana. We will be preparing a baked pumpkin topped with gruyere cheese as a vegetable course. It is dish my wife is quite fond of. She learned to cook it in Provence, brought the seeds from France, and the pumpkin was grown by a good friend.  Dessert will be a persimmon cake with a brandy hard sauce and possibly a mince pie. That makes five fish or seafood dishes. Not quite the expected seven, but frankly it will be as much as I can handle for that many people. Wine will be poured and consumed and the mood I am sure will be festive.

Crostini (bruschetta) with braised cavolo nero and anchovies

Cavolo nero is a “chard-like” leafy vegetable that has a hard bitter stem and less bitter leaves. It requires a lengthy cooking in boiling salted water. I trim the ends of the stems off, and then strip the leaves from the stems.  I chop up the stems and put them in a pot of boiling water and cook them for at least 20-30 minutes. I then add the leaves that have been chopped and cook the vegetables until they are well done. They will not be mushy as these are tough vegetables. Drain them well and allow to cool. Then squeeze out as much moisture as you can. When ready to serve, chop the vegetables into a fine dice. Saute 5-8 anchovy fillets in a bit of olive oil in a saute pan until they dissolve. Add some minced garlic, allow to color slightly (do not let them burn) and then add the cavolo nero and saute. Add a bit more olive oil if it appears tobe drying out. However the mixture should be quite dry to serve.

I make my bruschetta in a grill pan on the stove during the winter. Grill the bread slices until slightly crisp and well marked with the grill marks. Remove them to a rack, and rub each slice with a garlic clove. Brush on a good measure of high quality olive oil, and sprinkle with seasoned salt or just plain salt. Cut the bruschetta into 3-4 pieces each and place a small mound of the cavolo nero on top. Sprinkle with Parmigiano-Reggiano and serve warm.

Spicy shrimp

The spicy shrimp is based upon a sweet and sour sauce and uses the locally available small gamberetti (shrimp) sold frozen in packages. They are already cooked and only need to be defrosted under running cold water in a colander and then reheated in the sauce. The sweet and sour sauce is simply made using pineapple juice, vinegar, sugar, ketchup, green peppers, and onions. In a sauce pan put the juice from a can of pineapple or use pineapple juice directly. Add about 2 tablespoons of sugar, ½ cup of ketchup, and ½ cup of apple cider vinegar to taste. Dice a green pepper and an onion and add to the sauce. Cook for about 5 to 10 minutes to thicken it. Taste this one. The flavor is very personal and if you need to add more sugar or vinegar, or pineapple or ketchup do so. To make it a bit hotter, add a couple of good splashes of Tabasco sauce or an oriental hot sauce. Again taste to make it yours. When you have the taste you want add the shrimp. Allow the mixture to warm and serve in a warm bowl. Provide small dishes for individual servings.

Baccalà pate

This is a dish I am trying for the first time and I hope it comes off well. It will combine baccalà (salt cod) which has been soaked for two days to remove the preserving salts and then poached, with fresh butter, some capers, a couple of anchovy fillets, chopped parsley, and some lemon juice. No additional salt is needed (hopefully) but generous grinds of black pepper are called for. The fish (about ½ to 1 pounds) is poached in a court bouillon with onions and black pepper until the fish is cooked and flakes easily. Allow the fish to cool on a plate and then flake it checking for bones. Put the fish in a food processor with a steel blade. Add 100 grams (a cube) of butter, a good tablespoon of drained pickled capers, two anchovy fillets, 1 /2 cup of parsley and a tablespoon of lemon juice. Process until smooth. Then taste and add pepper as needed. This pate will be served either on cucumber rounds (if good cucumbers are available right now) or on toasted crostini made with my quick bread (see the recipe for beer bread in an earlier post) seasoned with fennel seeds.

So this Christmas Eve we will eat fish and celebrate la vigilia di natale with friends and neighbors.

On Christmas Day (Natale) we have been invited to a dear friends for an early dinner and what we will be consuming is not known. What is known is that a goodly amount of wine will be offered and poured and a warm Yule log will be burning in the fireplace.

The 26th of December is call Santo Stefano and we will be attending a chorale in the main piazza in Umbertide.

New Years Eve (capo d’ anno) this year will be one of catering a festive dinner for five which includes a birthday cake for one of the celebrants. We will grill some marinated lamb; have some tagliatelle with a tomato and meat sauce, mixed roasted winter vegetables, and a salad with mixed greens and an acacia honey vinaigrette. I will make a Zuccota or domed cake as a birthday cake, sprinkled with rum, and filled with chocolate ganache, cherry gelato and chocolate gelato. It is quite spectacular and is always a hit.

Tuesday, December 15, 2009

Primo piatti - First plate sauces

Primo piatti means the "first plate" in Italian. After you have eaten a bit of the antipasti and had a bit of wine in the living room, you move to the dining room table and sit down. The first plate is about to arrive. More often than not, the first plate is a pasta dish and is almost always of modest size and minimally sauced. You must eat the pasta when it is hot an immediately after being served. In our catering service we don't call the diners to the table until we are ready to serve the pasta.

Pasta in its thousands of various forms, is institutionalized in the Italian diet. They use either fresh (more likely northern Italians) or dried (generally southern Italians). Regardless of how it is served or what its basic form, the Italian does not over sauce their pasta.

The Italians do not drown their pasta in sauce but almost use it as a condiment, to enhance the flavor of the pasta rather than overwhelm it. In my post "What about pasta?" I discuss how pasta is made and served. In this post I will be giving you some interesting sauces to use as well as serving information. The picture was taken by Kathy Simon in 2009. Thanks, Kathy.

Pasta is not a great addition to the bariatric menu but it can be quite satisfying in small doses. These recipes are designed to feed a group, so don’t feel that you have to eat all of the pasta yourself. Remember that Eight Bites can be used up by a few bites of pasta or by a piece of meat. Take the bites of pasta occasionally (sharing a plate of pasta with a friend can be terrific) and enjoy the great flavors.

Basil Pesto Sauce

This is a classic sauce that is often served with gnocchi (potato dumpling pasta). It is very rich and creamy and a little goes a long ways. You can make up a large batch and freeze a portion. If you do freeze it, do not add the cheese before freezing. Line an ice cube tray with plastic wrap, and fill each pocket with the pesto. Freeze and then remove from the ice tray and store the cubes in a freezer bag. When you want to use the pesto, remove a few cubes (as much as you need) and defrost and then add in the grated Parmigiano-Reggiano or Pecorino Romano. Pesto can also be used as a topping for crostini. You might wish to add some of finely chopped walnuts to the pesto when served as crostini.

3 cups fresh basil leaves
3/4 cup good olive oil
1/4 cup pine nuts
3 garlic cloves
1/4 teaspoon salt
1/2 cup finely grated Parmigiano-Reggiano or Pecorino Romano cheese

Place basil leaves, olive oil, pine nuts, garlic and salt in a blender. I like to add the olive oil in a stream during the processing, because I think it makes a better emulsion. Process until smooth. Pour out into a bowl. If the sauce is to be used immediately, mix in the grated cheese. Heat gently in a small pan when ready to use. Pesto can also be made in a marble mortar with a wooden pestle, but make it easy on yourself and use the blender. Other herbs can be used instead of basil. You might like to try sorrel, rucola, or fresh young grape leaves (stay away from pesticide-sprayed vineyards).

Sugo do pomodori e verdure

The next recipe is for what could be considered a classic tomato-vegetable sauce that is a sauce common in Sardinia. The aroma (vegetable mix) is often sold in a single package in the grocery so you just have to chop up the vegetables and start cooking.

1/4 cup good olive oil
2 stalks celery, chopped into medium dice
1 yellow onion (often a red onion is added to the pre made aromi package)
4 large carrots, grated and are normally just washed and not peeled
A handful of flat-leafed Italian parsley
2 cloves garlic, crushed
1/4 tsp. peperoncino (hot pepper flakes), optional
2 lbs fresh cherry tomatoes
1 tablespoon coarse salt
1-2 liters passata di pomodori (or a quart of tomato purée)
1 cup water
1 cup white wine
1 cup grated pecorino Romano cheese (to be added at the end)

Use a 11-12” large heavy stainless steel frying pan with 3-4” high sides.
Pour enough olive oil to coat the bottom and bring it to a medium temperature.
Chop the celery and onion coarsely; mince the parsley and garlic together; grate the carrot, unpeeled, on the largest holes of a grater.
Add these to the heated oil.
Wash the tomatoes and remove the stem, leaving whole.
Place the tomatoes on top of the other vegetables and sprinkle in a tablespoon of salt.
Cover the pan and place over medium heat
When the vegetables have cooked down a bit, add the wine and stir for another 15 minutes.
Add the tomato puree, and rinse out the containers with water and add the water to the mix, and stir.
Continue to cook, covered over medium heat, for another half hour.
Stir regularly to ensure that the sauce is not sticking to the bottom. .
When the sauce is thick and no longer watery, remove from the heat and set aside, covered. Reheat just before you are ready to add to the pasta.

Sugo di Cinghiale (Sauce of Wild Boar, Herbs, Olives, Juniper Berries and Wine)

This sauce is often served in the fall and winter during the hunting season for wild boar. These big creatures are heavily hunted in Umbria and Tuscany and provide a large amount of meat. The population of these boar seems to be increasing each year and they have become significant agricultural pests. The hunts are large scale hunting club affairs with men dressed in camouflage clothing, with dogs. Some of these hunts can sound like a war zone. Some of the boar meat is kept by the hunters, and the rest is often sold to commercial meat packers for sausage or salame. If wild boar meat is not available in your area, try using a good shoulder roast of pork. Try to find a well-marbled piece to get the added flavor of the fat into the sauce.

1 pound wild boar shoulder, cut into bite-sized pieces
1 cup good olive oil
Flat-leafed Italian parsley (chopped)
1-2 onions (coarsely chopped)
2 carrots (washed and grated)
2 celery stalks washed and coarsely chopped
1 small branch of rosemary, 5-6 inches long
2 cloves garlic, peeled and chopped
1/2 cup black olives, with or without pits (remember to let people know which kind you added)
3 fresh bay leaves
6-7 juniper berries
4-5 capers preserved in vinegar
1 liter passata di pomodori (or one large can of tomato puree)
1 cup dry white wine

Saute the vegetables, stirring until the onions are golden. Add the remainder of the ingredients except for the tomatoes and wine. Cook and stir for another 5 minutes over medium heat. Add the tomatoes and wine and cover and cook over low to medium heat for 1/2 hour, stirring regularly. Add more wine if necessary to keep the sauce from sticking to the bottom of the pan. This is classically served with hot polenta (easy to make up at home), but can also be served with penne, pappardelle (wide egg noodles), or rigatoni. Larger pasta holds onto the thick sauce a bit better, but do remember to minimally sauce the pasta. You don’t want the pasta to be swimming in the sauce.

Sugo all'amatriciana

This is a fairly simple tomato based recipe from the area of Amatrice (in the region of Abruzzi, near Rome). In its original form it was made with guanciale and pecorino cheese, no tomatoes. As tomatoes were introduced into Italy the dish was altered to include the new vegetables.

As the recipe spread, variants were introduced depending on local availability of certain ingredients, and are still commonly used. While some have become accepted, other variations are considered corruptive and are frowned upon by locals and especially opposed by people from Amatrice, who are understandably protective of the traditional standard recipe. For example, the addition of garlic sautéed in olive oil ("soffritto") before adding guanciale is widely accepted, whereas the use of onion in its place is strongly discouraged. The substitution of local pecorino cheese with the more easily available pecorino Romano is widely accepted, while replacing guanciale with the more common (and less expensive) pancetta is not considered acceptable. However in many parts of the world, guanciale (smoked pork cheeks) are not commonly available and a perfectly suitable replacement would be well-smoked, thickly sliced bacon. The addition of black pepper or peperoncino is considered a matter of personal taste.

Peel, seed, and slice 2 pounds of tomatoes
Cut 1/2 pound of guanciale (or bacon) into thick cubes and fry them with a bit of oil and pinch of dried chili flakes.
Cook on a high flame for a few minutes till the meat becomes lightly browned.
Add a ½ cup of little wine and cook down until no liquid is left.
Remove guanciale cubes, set them aside and keep them warm.
Cook the slices of tomato in the hot pan with a bit of salt, for a few minutes
Then add the browned guanciale back into the pan
Continue cooking for 5-10 minutes to thicken the sauce
Grate 1 cup of pecorino cheese

To serve: boil the pasta " al dente" and put it in a heated bowl; put on it half of the grated pecorino, add all the tomato sauce, stir it again, then top with the remaining pecorino cheese and serve immediately.

Sugo alla Puttanesca

The etiology of the name for this sauce is a bit murky but it does have a colorful past. According to one story, sugo alla Puttanesca was invented in the 1950s by the owner of a famous Ischian restaurant. When near closing one evening the owner found a group of hungry friends sitting at one of the tables. He was low on ingredients and told them he didn't have enough to make them a meal. They complained that it was late and they were hungry. "Facci una puttanata qualsiasi" or “make any kind of garbage,” they insisted. (In this usage, puttanata is a noun meaning garbage or something worthless even though it derives from the Italian word for whore, puttana.) The owner only had tomatoes, olives and capers; basic ingredients for the sugo. And those are still the primary ingredients for the sauce.

Made of ingredients found in most Italian larders, this dish is also known as sugo alla buona donna - or 'good woman's sauce’. It was also said that it was a quick, cheap meal that prostitutes could prepare between customers. So the story goes. But the sauce is terrific.

3 tablespoons extra virgin olive oil
1 onion, finely chopped
2 cloves garlic, finely chopped
4 anchovy fillets, chopped
1 small fresh red chili, seeded and chopped
2 teaspoons salted capers, rinsed and drained
8 pitted black olives, quartered
14 oz (420g) canned tomatoes, coarsely chopped
½ teaspoon sea salt
¼ teaspoon freshly ground black pepper
1 tablespoon finely chopped fresh flat-leaf parsley

Heat the oil in a frying pan over medium heat and cook the onion for 6 minutes, stirring occasionally.
Add the garlic and anchovies and cook for another minute, stirring to break up the anchovies. Add the chili, capers, olives, and tomatoes, salt and pepper, and bring to the boil.
Reduce the heat to medium-low and simmer uncovered, for 10 minutes, stirring occasionally. Cook your pasta of choice then drain the pasta and stir into the heated sauce.
Top with chopped parsley and the reserved tablespoon of olive oil, and toss together gently to combine.

Bechamel sauce and variations

The last sauce is for a white sauce or bechamel sauce that can be flavored with a variety of ingredients to enhance the particular pasta dish being served. It is particularly good with lighter ravioli, tortellini, or other filled pastas. We serve pumpkin ravioli with a version of this sauce that incorporated walnuts and a bit of Marsala wine.

The basic bechamel sauce is very simple but needs to be watched to ensure that it doesn’t scorch or thicken too much.

Put three tablespoons of butter in a frying pan over medium heat to melt.
When butter is melted but NOT brown, add three tablespoons of flour
With a whisk, stir the flour into the butter until it has combined and no raw flour is visible.
Cook for about two to three minutes over low heat to cook out the flour taste
Heat 1-2 cups of milk in a sauce pan and add one cup to the butter mixture and whisk in.
It will thicken quickly, add salt and ground white pepper to taste.
If the sauce is too thick add a bit more warm milk.

Don’t worry about it being too thin, It will get thicker.

To make a cheese sauce, add ½ to ¾ cup of grated cheese (combine Parmigiano-Reggiano and a meltable cheese) and stir until melted.

To make a walnut sauce, add 2 tablespoons of Marsala (optional) and ½ cup finely chopped walnuts. Add a 1/8 tsp of ground nutmeg. Stir and combine to thicken.

Another version of a cheese sauce is a simple mixture of melted butter (4 Tablespoons), 4 ounces of Gorgonzola cheese, cream, grated nutmeg and a good grind of black pepper. Add 1 cup of cream to the melted butter, add the cheese and the pepper and nutmeg. Stir until thickened and cheese has melted and serve over meat filled or cheese filled tortelloni or tortellini for one of the best “Mac and cheese” dishes of all time.

So there are some sauce recipes. Great flavors, seasonings and textures. Enjoy a bit of pasta occasionally with a group of friends. Your life will be better for it.  Mangia.

Friday, December 11, 2009

Being big and being Santa

This is a bit of an unusual post. I was writing an email to a friend about my experiences as Santa Claus during the holidays and as I considered what I wanted to say, I kept seeing myself as the big guy being the Santa in the stories. The problem was that I was the big guy in the stories. This was a time in my life when I didn't think about my weight as a handicap or as a detriment to my health. I was simply able to put on my Santa suit with no additional pillows or padding. The kids when they snuggled up to me just felt me under that suit and it made them feel closer to the real Santa. And it made me feel like the real Santa.

So here are a few of my stories on being Santa.

From 1979 to 1990 I was given the amazing responsibility of being Santa Claus during December. In the beginning, I had my Father’s old suit made of flannel with some actual wolf fur for trim. The beard and the wig were cheesy and the “boots” were just covers for black shoes. But I put it on and I became Santa. It was an amazing transforming experience each time I put on that and subsequent suits over the years. It was not a costume. To the children and many others, Santa was real, not a character like the Easter Bunny, or a Halloween character. You were transformed and you had to behave and act the way Santa would act.

Every year I would plan to visit the children of my co-workers in San Diego. We all had kids in the appropriate age range (4-8 years old) so I would show up at their houses, with a bag of presents provided by Mom and Dad. I would come in Ho Ho Ho-ing and then sit for a while with the kids so pictures could be taken. I then almost always sat down on the floor with the kids to look at their presents and spend a few minutes of bonding. I rarely was there more than 20 minutes. Kids kind of get into emotional overload with Santa, so I would come in, do the visit and get out. The years went on and the kids got bigger and they began to not believe any longer. That was a sad time but it was inevitable.

While those times were precious to me there were others that were magical.

After doing a Christmas party for a friend’s child, I went to find my wife who had been shopping at Toys R Us in San Diego. The one thing you never do is wear part of the costume. Either you are in it and Santa or you are out of it and not Santa. No in between. So I decided to walk into Toys R Us in full costume. It was amazing. I was looking for Sandi and was wandering up and down the aisles. Kids were pulling parents toward me and parents were pulling kids toward me. I would kneel down and give then each a hug and a candy cane and then walk on. I finally found Sandi and we finished shopping. She was having fun watching all the kids. As we went to check out, the checker in our line was frowning at me and said that I was disappointing a lot of children there. But I looked over into the next checkout aisle and there was this beautiful little girl about 5 years old sitting in the cart. She was staring at me and she held out her arms to me. I walked over and hugged her and gave her a candy cane and then turned to the checker. “That’s what this is all about”. I paid and left, I don’t remember the checker, but I remember that little girl.

Another time I was driving home from a visit and cruising along in my bright orange Volvo sedan. I noticed a car going off the off ramp behind me, then swerving back on the freeway and accelerating toward me. It was a black limo and as it pulled up next to me I noticed that the window on the passenger side was down and there was a little boy leaning out the window, with a very excited look on his face. As the cars closed together, I leaned out the window and gave the little one a candy cane (at 60 MPH) and wished him a Merry Christmas. They sped off and went off the next off ramp. I would be willing to bet that the little boy remembers that Christmas.

Being Santa was the highest and best use of my time during that holiday time. But these last stories affected me the most of all.

I was visiting a convalescent home that was managed by a dear friend of mine. I had spent a lot of time in the communal hall with the patients gathered singing songs and getting presents. Most were elderly and many were in wheelchairs. But they were an enthusiastic group. After a half hour or so I asked if I could wander the halls and visit the patients in their rooms, if they had not been able to come out. Marilyn said sure so I wandered off. I would pop into a room, and if the patient was awake, wish them a merry Christmas and then quickly disappear. But as I approached one room the nurse said that there was no reason to go in there, the lady was out of it and was probably asleep. But I persisted. I walked into the room and the woman, very frail and old, was lying there quietly and apparently asleep. I stood next to the bed, and took her hand and held it. She opened her eyes, and looked at me, dressed in that silly red suit and that white beard and wig, and for a second there was recognition. Just for a second, there was a light in her eyes. And then they closed again. I needed a drink after that visit.

The final story was about a Christmas Party given by my wife’s sorority for children with Cystic Fibrosis. It was held at a clubhouse and the party had been going on for an hour by the time I made my entrance. I had two huge bags of presents for the kids and came in to loud and welcoming screams and yells from the kids. Children with CF do not grow very well generally and are often quite small. But there was one little girl standing over in a corner that caught my attention. She was dressed nicely but did not look like she was having a good time. She was probably 5 or 6 years old. When she saw me come in, she took off running toward me and I knew I needed to catch her. She threw herself at me from several feet away and I caught her as she hit my chest. She stuck to me like Velcro. So I dropped the bags of packages and hugged her to me for a minute. She would not let go of me and I sat there with her on one knee and the other kids, one after the other, on the other knee for the whole time I was there. She never spoke or said anything to me. She didn’t have to. I just knew. She died later that next year.

So being Santa was not only a wondrous experience leaving me with so many stories and memories, but it was a significant responsibility as well. It was my gift to myself each holiday season. I accepted the responsibility as well as the love. It was a precious time. I have also come to realize that while my weight influenced how I acted as Santa it also affected my health. What I have done in my weight loss is to stop being Santa and start being healthy. Losses and gains are a part of the process.

Sunday, December 6, 2009

Italian Antipasti

Cooking in Italy and particularly cooking in rural areas is almost always based upon regionally and seasonally available fresh ingredients. The various regions within Italy all have significantly different cuisines and you can tell you are in Umbria for example by the dishes presented. There are differences between Milan, Florence, Naples, Rome, Sicily, the Marche and the Veneto as well as in all of the other specific areas that Italy is divided into. Some areas favor olive oil, others butter or a local favorite in some areas, lardo. Carbohydrates in some areas are dominated by pasta and in others by risottos or polenta. However the common theme in each region is a culinary emphasis, particularly in restaurants and in catering, on what is that region's cuisine.

I would like to share some of the recipes and dishes I have learned to prepare and show how they can fit into a post-bariatric surgery lifestyle. I will start as any Italian meal of substance will start, with the antipasti. Generally antipasti are provided prior to when the actual dinner is served, along with a glass of prosecco (sparkling wine) or a glass of red or white wine from the region. The small bites are eaten along with sips of the wine and can provide a basis for conversation in and of themselves or just accentuate the conversation going on. Dining is both a gustatory experience as well as a social one and that is how it should be. Eating alone or in silence is not very much fun. So I try to make the antipasti beautiful and tasty, sometimes to provoke conversation and sometimes just for their intrinsic value. Following posts will deal with pasta dishes, meats and vegetables and desserts.

Antipasti in the post-bariatric period are often the only dishes selected by diners at restaurants. Frankly I look at the antipasti menu as my entire meal. They are small bites, often deliciously flavored and can encompass significant amounts of protein. They can be filling and satisfying. I love making antipasti for my catering clients. They can be beautiful, tasty and a welcome addition to the pre-dinner cocktails and wine.

I will focus on several crostini as your starter choices. The basis for most of these is my quick beer bread (the recipe was presented in an earlier post). Recently I have been adding ground toasted fennel seeds to the dough for a great new taste especially with mild flavored toppings. Add some garlic and onion powder, and some grated pecorino or Parmesano-Reggiano cheese to liven it up. After baking and cooling (24 hours), slice the bread into 1/2  inch slices, sprinkle or brush a bit of olive oil on them and grill or fry them in a non-stick frying pan to crisp. They then can be used for the preparation of the crostini. I use the whole slice to make the antipasti and then cut it into serving pieces for serving. I then use some beautiful flat serving platters to show them off.

Crostini with funghi pate

To make funghi pate is quite easy. It doesn't have much protein however so it should not be the only antipasti you eat. But it is quite tasty and is a valuable asset to your antipasti arsenal.

Purchase 8 ounces of sliced mushrooms (these can be white button, porcini, chanterelles or other mushrooms). Unless you are a very experienced mushroom hunter, do not use ones you find in the garden or forest. These can cause serious and often fatal medical conditions. Use the ones from the commercial growers to be safe.

Saute the mushrooms in 3-4 ounces of butter and a bit of olive oil. Add some salt and pepper. Some chopped onion works well here as well. As the mushrooms cook down they will release a lot of water, so continue to saute until the mushrooms appear almost dry. Add a pinch of dried oregano or marjoram. Ass the mushrooms cook down add about 1/4 cup of marsala ort brandy. Watch out for the flames here. Keep the fire low and add the alcohol to the pan off the flame.

When mushrooms are done, pour into the food processor; add 1/4 pound of cold butter, and 1/2 cup of chopped parsley. Pulse to reduce the mixture to a medium puree. Place the mixture in a storage container and then into the refrigerator. To serve simply spread the mixture on the warm crostini and sprinkle with some finely chopped fresh parsley. Serve 2 pieces at least to each person.

Crostini with Umbrian chicken liver (fegatini) pate

A lot of folks don't like chicken livers (or livers of any sort). But they can make a very nice antipasti with lots of protein and a nice flavor. Try this one at least once to see how you like it.

Purchase about 8-12 ounces of fresh chicken livers (here in our local market they are normally combined with chicken hearts). In the food processor, place 3/4 cup of giardineri mix (pickled vegetable mixture of carrots, cauliflower peppers and onions) and puree until coarsely chopped. Chop an onion into coarse dice and saute with the chicken livers in a mixture of olive oil and butter until the livers are just a bit pink on the inside. Try not to overcook the livers. I think this makes then grainy and may be why some people don't like them. Put the cooked chicken livers and onions into the food processor and add a 1/4 pound of cold butter cut into chunks. Add 1/2 cup of chopped parsley. Puree until smooth but where some of the small bits of the colorful vegetables can still be seen. Place in a container, seal and place in the refrigerator to solidify. To serve, simply spread on the crostini and top with some finely chopped parsley or chives.

Crostini with cannellini bean puree and caramelized onions and garlic

Again this crostini is quite a good-looking antipasti, but it has little protein so serve it with others that are a bit higher in protein.

Purchase a large can of great Northern white beans or fagiolini beans. Drain them and rinse them in cold water under the tap to remove the liquids they are canned in. Place the beans in a saucepan, and add a can of fresh water and a couple of cloves of garlic (peeled). Bring to a boil and simmer until most of the water has evaporated. Add some salt and pepper to taste. This mixture can be made as spicy as you want it with the addition of Tabasco sauce, red peperoncini flakes, or a Creole seasoning mix. Place in a food processor and puree until smooth. Add a bit of chopped parsley for a fresh added flavor and some color. Put in a container and place in the refrigerator to solidify.

In a second pan, saute 1 or 2 finely sliced white or yellow onions in 1/4 cup of an olive oil and butter mixture and a cup of water. Bring to high heat and reduce heat to a simmer. Cook until the water has disappeared and the onions start to caramelize. Taste them to see if you need to add a bit of sugar. Continue to cook until the onions are a golden brown, Watch them as they can burn easily near the end of the cooking. When they are golden, take them off the heat and place them in a container to cool and store in the refrigerator. To serve the crostini, spread some of the bean puree on the bread, and top with some of the onions. A small dollop of spicy chutney can be added here for some extra flavor.

Crostini with fresh ricotta, dried peperoncini, salt and honey (heated)

This is an unusual crostini that I make with thinly sliced baguettes that I brush with olive oil on on side and place in the oven at 350 degrees F for 7-8 minutes to toast.

Purchase about a pound of ricotta cheese (here in Italy we have wonderful fresh ricotta) and place it in a bowl. With an electric mixer whip the cheese to a smooth consistency. Add some dried peperoncino flakes to the level you like, and some salt to taste. The mixture should be spicy but not incendiary. Add some honey to temper the heat. But don't make it a dessert; just add a bit of sweetness. Spread the cheese mixture on the crostini and place them back in the oven until they6 start to get a nice golden color on top. Take out of the oven and serve hot (carefully as these are little napalm packages) or warm.

Crostini with chopped spiced tuna and tomato

This crostini is sort of like a tuna and tomato open faced sandwich and several can make a terrific lunch. This has a good amount of protein and is quite a suitable dish for the bariatric patient.

Open and drain a 4-6 ounce can of tuna packed in olive oil. Puree in the food processor with a tablespoon of pickled capers and a bit of fresh olive oil. Taste for seasoning and add salt and pepper as necessary. Chop two medium tomatoes in a coarse dice, a 1/2 cup of fresh basil, some oregano (died or fresh) and 1/2 cup of parsley. Blend the tomato mixture gently so you don't break it up. Gently add the tuna mixture. Place in a bowl and refrigerate until ready to serve. This doesn't keep well so use it within a day or two of making it. The Tomato/tuna mixture can be spread on the same baguette crostini as above or on the toasted quick bread (the fennel flavored one works great with the tuna). This mixture can get a bit soggy so serve it immediately.  Add a sprinkle of chopped parsley for color.

Crostini with sausage and stracchino, Parmigiano-Reggiano and spicy chutney

I have used this sausage mixture in stuffed peppers as well as on crostini and it is terrific either way. It is high in protein and smooth enough to be easily digestible. I make the crostini up on the grill pan with a bit of olive oil brushed on the bread prior to grilling. Toast them well, and then remove to a rack. As they cool on a rack I spread a small amount of a nice chutney on the bread. The chutney soaks into the bread a bit and flavors the whole piece. Commercial chutney is quite good, but it is easy to make your own and you can season the chutney as spicy as you wish. Try making something like green tomato chutney, or fig with onions, or apple plum chutney. Making chutney can be a lot of fun and will provide you with a custom-made condiment that is quite different from the commercial brands. Check the internet for thousands of recipes.

Purchase about 3/4 to 1 pound of Italian sausage, either in bulk or in links. If in links, remove the casings and saute in a medium skillet until no longer pink. Place the sausage in the food processor with 8-12 ounces of a soft cream cheese (or strachinno cheese in Italy), and a 1/4 cup of grated Parmigiano-Reggiano. Pulse to break up the sausage but do not puree too finely. You want to keep some of the small chunks of sausage intact. This mixture can be made spicier by adding Tabasco sauce or dried pepper flakes. Season to your tastes. The mixture can be stored in the refrigerator for a week or so. To serve, spread it on the chutney topped crostini, and add a small dollop of chutney to the top. Sprinkle a little parsley on the top. Works either cold, or you can heat the sausage mixture and serve it warm.

Tuesday, December 1, 2009

St. Andrew's Day and my first haggis

Last night Elizabeth and I went to a St. Andrew's Day party at a local villa here in Umbria, Italy. St. Andrew's Day is an  annual event here in the Niccone Valley and there was a party for about thirty Scots, Brits, Aussies, Germans, and a couple of us Americans. We had a very nice time, eating haggis and drinking good Scotch whiskey, wine, and dancing Scottish reels!

What can I say about haggis? I have never eaten haggis, so I was as mystified about it as you might be. It was more like a meat and grain casserole than a cohesive slice of meat. Apparently, though I didn't see it, it was about 18" long and wrapped in a synthetic "stomach". They don't use real sheep's stomachs much anymore. I found that out when I asked a Scotswoman.  They do not actually serve the stomach muscle itself; it is just the “packaging” for the grain and meat cooked inside. The stomach acts like the casing of a salami. The haggis was cooked and then was removed from the casing in the kitchen and served from a platter. I took a big spoonful. It was in for a penny, in for a dime!

It was served with pureed cabbage and pureed potatoes alongside. A wee bit of good Scotch was poured into a glass, or in some cases over the haggis and you started to eat. I know its history, and I was a bit skeptical. But I found it had a great flavor and was quite interesting and good.  The texture was a bit strange, sort of like a fine-grained corned beef hash, but I enjoyed it nonetheless and had a small second helping. Not because I didn't want more, but because I was reaching my eight bites. A more typical Italian dinner followed where we were served roast pork, roast chicken and grilled sausages, oven fried potatoes, and a salad. Dessert was a light fruit cup with fresh fruits. A little of bite of this and a little bite of that. I did fine and survived another party as a bariatric eater.

After dinner and a few more of those wee bits of fine scotch, we moved on to the dance floor to dance Scottish folk dances. The dances were taught to us by a tall, good-looking guy in a kilt. Al and Betty were our hosts for the evening.  Al is quite a handsome guy and his wife Betty is absolutely adorable. Both are retired British military officers who live locally. Elizabeth's feet were a bit sore from her surgery and she didn’t want to dance so I danced with some of the other women there. Dancing is also a new experience in my post-surgery and lost-weight world. It has been a very long time since I danced folk dances which tend to be a bit vigorous. At 300 pounds I could never have done it. But at 165 pounds now, it was fun. It was a good evening. Learned three new dances, danced with some nice partners, and had a great time with the somewhat inebriated couples out on the small dance floor. There was a lot of banging into one another out there. A lot of laughter as well.

To close this post, you can and should go to holiday parties or any other type of party, but think about what and how to eat. Then eat what you should and can, join in the dance and have fun. I have finally discovered that being a bariatric patient gives you a new life and a new outlook. Dance on!

Thursday, November 26, 2009

Thanksgiving in Umbria

This is my first Thanksgiving since moving to Italy a year ago in August of 2008. In November last year I had to go back to California and get my long term visa to stay in Italy with my new wife. So last Thanksgiving I made dinner in my old house for my youngest son, his wife and two children. We had all the basic trappings of a traditional Thanksgiving meal, turkey, mashed and sweet potatoes, vegetables, cranberry sauce and pumpkin pie with whipped cream. In the time in California, I was able to visit some friends and family and to finally get my visa (stamped into my passport with a misspelled middle name). I returned to Italy the day after Christmas and so this year I will be having Thanksgiving dinner here.

Thanksgiving is a uniquely American event. In Italy it is just another day of working, shopping, working in winter gardens, pressing olives for oil, and tending to the myriad number of mundane things that are required to live here. But there is no celebration, no turkey, no stuffing, and certainly no pumpkin pies. The evening meal is the same as normal. This year, a group of Americans and a Brit will be coming together at one of the rental country houses my wife manages and will be having a communal dinner combining Italian and American characteristics. There will be eight people in our group and the food tasks have been divided up among us all. I will be making four different antipasti including: sausage and cheese crostini, mushroom pate crostini, melon and prosciutto, and sliced pecorino cheese and salame. I included a bit of apricot mostarda to put on the cheese slices. My wife and Anne made about 80 pumpkin ravioli Tuesday and they are ready to quickly cook and finish. OK, Paul (Ann's husband) made a few ravioli, but mostly he wandered through the kitchen smelling things on the stove and in the oven and asking questions. I like him.

 We will probably serve possibly three ravioli per person so we won't take them all. I will likely only eat one ravioli since pasta is difficult for me to digest after my surgery. I will make a light bechamel sauce with walnuts for the ravioli. Then David will roast some marinated lamb and make some braised mustard greens with garlic from Kathy's recipe, and we will have some dessert which this year will be grape pie with Greek yogurt from Mara. I am sure there will be plenty of wine poured and stories told around the inviting fire set in the big fireplace.  This will be a good Thanksgiving held in the spirit that it should be. One of a gathering of friends and family, good foods lovingly prepared, good wine generously poured, and good fellowship gratefully shared.

I will eat only what I can accommodate. A few bites of antipasti, a single ravioli, some grilled lamb, possibly a bite or two of mustard greens and a small slice or a few bites of pie. A lengthened dinner allows me the consumption of a few more "bites" that I will gratefully savor. We will try the new olive oil pressed Thanksgiving morning. I will get all of the tastes of the seasonal dishes that I love and still not overeat.

Happy Thanksgiving.

Post script to Thanksgiving: The grape pie was quite something, made with Concord grapes picked from the pergola outside our guest house in September this year and served with a thick Greek yogurt. The freshly pressed olive oil had a peppery flavor, and when drizzled on the lamb and vegetables was excellent.  It was a satisfying dinner and an entertaining evening. kfk

Eating during the holidaze

The winter holidays are some of the most difficult times of the year for those of us who have had bariatric surgery. It is a time of family, friends, gifts, parties and FOOD. To cope with this period of potential excess, it is important to remember why you had the surgery and what you hope to gain (or lose actually) from the process. If this time comes early in your surgical healing period, it is important to be very careful about what and how much you eat. The limits placed on you for those first six months means that your intake is very restricted. Don't let pressure from friends or family push you to eat excessively.

There is a lot of temptation regarding foods during the holidays. Candy, cookies, cakes and other sweets can sabotage your weight loss quickly. They are physically filling and full of carbohydrates, thus limiting the amount of important foods you need to eat. Be extremely careful, but do enjoy that piece of chocolate or a butter cookie, or a few bites of your aunt's apple spice cake. You will notice I said a piece of chocolate, a butter cookie and a few bites of the spice cake. Eating that whole pound of See's chocolate can be a real problem. You can enjoy the wonderful tastes of the holidays without stuffing yourself. Love those eight bites. Especially early in the healing process it is important to be sure you do not over-extend the surgical site.

Parties are the biggest problem you can encounter during the holidays. Most of the people attending will not know the effort you have spent in losing the weight, but may comment on how little you eat. To deflect questions, take a little plate, put a couple of nibbly little things on it and carry it around with you. (A side note: with a wine glass in one hand and a plate in the other, no one will be able to shake hands with you and pass on that ugly flu we are experiencing). People will stop asking you to eat something as long as you have something in your hand. My father used to avoid the issue of drinking too much during the holidays by carrying around a glass with ginger-ale in it. It looked like a high ball and since he already had a "drink", no one asked him if he wanted another. Just keep slowly refilling that glass with ginger-ale or that small plate will small bites. It is the safest way to get through the party intact.

Thanksgiving has come to mean eating to excess with loving friends and family and you need to carefully consider what you are about on that day. Today I will be having Thanksgiving dinner wih nine friends at one of the rental properties my wife manages in the hills of Umbria. We are all bringing things to share for dinner. I will be making antipasti (more about that in a minute), there will be pumpkin ravioli with bechamel and walnut sauce, grilled marinated lamb (hard to get good turkeys here), a variety of vegetable dishes and the usual plethora of desserts. The olive oil from our trees is being pressed this morning so thoughts are not strictly on food, though I guess here in Italy, olive oil is a major food group.

Thanksgiving antipasti will include sausage and cheese crostini with chutney, sliced pecorino cheese, and some winter melon and prosciutto. I will make them in small bites, and will plate them on holiday platters.

The sausage and cheese crostini will be made with sautéed local sausage (seasoned with fresh garlic, salt and pepper only) mixed with a generous amounts of Parmigiano-Reggiano and Cacciota (a cow's milk cheese that is soft and mild). I will puree it in the food processor until smooth. The crostini will be made from fresh local artisan bread that I will grill to toast, rub with garlic, sprinkle with a bit of the fresh olive oil and a sprinkle of salt. I 'll assemble the crostini just before serving so it is warm. A bit of pear or plum chutney will top the sausage mixture on the crostini. Wine will be passed and the air will be filled with stories of past Thanksgivings, stories of friends, and plans for the future. Especially for that olive oil, just pressed this morning.

Enjoy the holidays, but remember the limits we have placed upon ourselves. Eat those delicious bites on that small plate and toast your friends well. Mangia!

Friday, November 20, 2009

Working as a cook in Italy

Part of the experience of working as a cook in Italy is making interesting foods, using creative and locally available ingredients and combining them in different ways. While much of the cooking I do has an Italian base, I try to incorporate some new tastes for the people I serve. I make pasta including ravioli using classic fillings such as potatoes and two cheeses, ricotta and spinach, ricotta and lemon sauced with a vegetable tomato sauce. But then I try some new tastes such as a spicy pumpkin and Parmesan cheese filled ravioli in a bechamel sauce with walnuts, or smoked salmon ravioli with grated lemon peel, mashed potatoes and spinach and parsley in a white wine sauce.  I realize these dishes are not strictly for the bariatric patient but they are interesting and contribute to a great dining experience.

A note about parmesan cheese please. In Italy, the more correct and preferred spelling is Parmigiano-Reggiano for cheese made from cow's milk in the specific region around Bologna. If it is a generic version, it is spelled Parmesan(o). Parmigiano-Reggiano is a beautifully made cheese with a great flavor and is normally aged for many months. The producers of this cheese are justly proud of their product and it deserves the credit. Generic parmesan cheeses used in recipes will probably not have the richness of flavor that using Parmigiano-Reggiano would impart, but still will be suitable. When I use Parmigiano-Reggiano in a recipe, the generic version would be acceptable in the event you can not obtain the real thing.

Tonight my wife brought home a whole turkey breast and asked for it for dinner. Using turkey breast meat is a good substitute for too much beef or pork and you can use it in a wide variety of ways. So I prepared it in thin slices which I pounded flat with a mallet. I made a flour mixture with seasoned salt, pepper and some Cajun spice. Then I dredged the turkey slices in the flour and sautéed them quickly in hot vegetable oil until they were brown, and almost done. I poured out the oil and added a cup of water to the hot pan to deglaze it. I then squeezed in about a 1/4 cup of fresh lemon juice, added a 1/2 cup of cured olives and 1/4 cup of marinated artichoke hearts. The sauce was a bit tart so I added a couple of teaspoons of sugar to reduce the sharp flavor. The sauce thickened and I then put the turkey slices back in the pan to heat and finish cooking. I served it with a green salad simple dressed with vinaigrette.

So you see that you can adapt. Last Tuesday, I was to make dinner for some friends and decided to do a simple dinner that was quick and easy to prepare. It included Umbrian chicken liver pate on beer bread crostini, some slices of pecorino cheese with a couple of chutneys, beer bread crostini with smoked salmon, strachinno, chives with citrus marmalatta (described in an earlier post), tagliatelle with pesto and grilled fish, black cabbage with oven dried tomatoes and pancetta, sweet and sour cipollini and for dessert vanilla gelato with brandied cherries. I served the antipasti attractively on beautiful plates with some good wine; while the pasta and fish went into heated bowls as a one dish meal. The vegetables were eaten on the side with a green salad. I used a commercial gelato, and my own brandied cherries. I had put up the cherries earlier this year during the cherry harvest. They were terrific.

Umbrian chicken liver pate.

This is a simple and a fairly inexpensive antipasti. The pate is made primarily in the food processor. Place 1/2 cup of pickled vegetables (giardineri) in the food processor, add 1/4 pound (125 grams) of cold butter cut into bits. The giardineri includes pickled cauliflower, carrots, dill pickles, and red peppers in a vinegar solution and is easily found in your local market. Rinse and drain 1/2 pound of fresh chicken livers. Saute a medium chopped onion in some olive oil over medium heat; add a bit of crushed dried hot pepper and some salt. Add the chicken livers and saute until no longer reddish inside, but still pink. Don't overcook the livers. Add 1/4 cup of Marsala to the pan and deglaze. Pour the entire pan of livers and onions into the food processor and process until smooth. Put the mixture in a covered bowl and refrigerate for two hours until firm. Spread on garlicky crostini, bruschetta, or even spread on crackers.

Tagliatelle with pesto and grilled fish

This dish combines the creaminess of the basil pesto with the crispy heat of the grilled fish. It is a good lunch dish or as part of a larger dinner. It also is not too bad for the bariatric patient as long as they do not overdo on the pasta. Get the lovely basil flavor and eat the fish.

Purchase 4 ounces of fish (look for firm white fleshed fish like halibut, swordfish, tilapia, and rockfish) per person. Cut into 1” chunks and set aside in a bowl. Make a seasoned flour with seasonings you like (can be spicy, mild etc). Mix well and set aside.

Make the basil pesto: In a blender place 2 cups of fresh basil, two garlic cloves, a bit of salt and freshly ground black pepper, ¼ cup of pine nuts (substitute toasted almonds or walnuts, if pine nuts are not available), then add about ¼ cup of olive oil and start to blend. Add additional olive oil in a stream slowly as the emulsion forms. If you are serving the pesto immediately add ½ cup of grated Parmigiano-Reggiano cheese and continue to blend until smooth. Set aside. If you want to make a larger volume, add additional ingredient but do not add the cheese if it is going to be frozen. That can be added when you defrost the sauce.

For four or five servings make up 1 pound of dried tagliatelle or linguine. Cook the pasta, drain and add the pesto. Mix thoroughly and keep warm. Dredge the fish pieces in the flour mixture and saute in a good amount of vegetable oil at 370 degrees F. Brown and cook the fish and put on a warm platter to hold until all pieces are cooked. Don’t use olive oil here. Portion out the pasta into warm bowls and top with 5-6 pieces of fish. Pass lemon wedges.

Black cabbage with oven dried tomatoes and pancetta

Black cabbage (a local Italian vegetable), chard, or spinach can be braised in water with some added garlic cloves. To complete the dish, pancetta or thick bacon is cut into small chunks and sautéed in a bit of olive oil. Add the vegetables and saute quickly. Serve hot.

Sweet and sour cipollini

The little onions that are available in Italy are quite sweet and delicious. They are however a bit of a problem to peel. To solve that problem, drop the onions into boiling water for a minutes and then drain then and cool quickly in cold water. Trim the end off and the onion slips right out of the skin.

To make them agrodolce (sweet and sour), add 1 cup of sugar to 2 cups of water and bring to a boil. Put some salt and crushed dried red pepper in the solution to taste. Cook for at least 10 minutes at a good boil to reduce the water. Add about 1/4 cup to 1/2 cup of apple or white wine vinegar, return to a boil and then start to taste it. You are looking for a balance between the sweet and the sour. When you have reached the taste you want, dump the onions into the solution and cook for 20 minutes until they are tender. These can be canned in sterile jars in a water bath for 10 minutes or simply placed in a covered bowl in the refrigerator. Use them from the fridge in a week of two. Canned, they will store well for months if they seal well.

Cooking is fun and when you treat it as an on-going taste and ingredient experiment, it can be quite rewarding and delicious. Besides you don't have to serve your failures. So cook with confidence, and never let them see you sweat. There are always omelets if all else fails.

Tuesday, November 10, 2009

Some different takes on fish

I keep returning to fish dishes, but frankly they are easy to digest, can be quite elegantly presented, and are excellent at dinner parties. These four recipes from the Mediterranean region represent a variety of different cuisines, flavors and presentations. They appear to be complicated but in reality are relatively easy. Work through them slowly and you will be rewarded with some great flavors.

Spanish Salt Cod Fritters with Spicy Tomato Sauce

4 ounces salt cod
1/4 cup (1/2 stick) plus 1 tablespoon unsalted butter
1/2 cup diced Spanish onion
3/4 cup water
1/4 teaspoon kosher salt
1/4 teaspoon cayenne pepper
3/4 cup all-purpose flour
Vegetable oil, for frying
3 eggs
Spicy Tomato Sauce

Place the salt cod in a bowl, cover with cold water, and refrigerate for 24 to 36 hours, changing the water often. Press all of the excess water out of the salt cod and finely chop.

Heat 1 tablespoon of the butter in a medium skillet over medium-high heat. Add the onions and cook until softened, about 3 minutes. Add the chopped cod and cook for 3 to 4 more minutes. Drain any excess liquid and discard liquid. Place cod-onion mixture in the bowl of a food processor and pulse until finely chopped, stopping to scrape down the sides as needed. Set aside.

In a heavy bottomed 2 1/2-quart saucepan, combine the water, remaining 1/4 cup butter, salt, and the cayenne. Bring to a rolling boil. Remove from the heat and add the flour, all at once, to the pan and quickly stir vigorously with a wooden spoon to incorporate the flour into the liquid. Return the pan to the stove, and over a medium-low heat, continue to cook and stir the dough over the fire. Do this until the dough pulls away from the sides of the pan and forms a ball. Remove from the heat and cool dough to 140 degrees F, about 5 minutes.

Put the vegetable oil into a heavy stockpot or deep fryer to a depth of 3 inches and heat oil to 360 degrees F.

To the dough mixture add 1 egg and beat well with a wooden spoon until completely incorporated. Continue adding the remaining eggs, 1 at a time, waiting until each egg is incorporated before adding the next egg. Stir the cod mixture into the dough. This panade is the basis for the fritters

Spoon tablespoon-sized balls of dough into the preheated oil. Fry until cooked through and golden brown, about 4 minutes per batch. Using a slotted spoon, remove fritters from the oil and drain on a paper towel-lined plate. Season generously with seasoned salt and pepper.
Serve hot with Spicy Tomato Sauce.

Spicy Tomato Sauce:

2 tablespoons olive oil
2/3 cup chopped onions
3/4 teaspoon kosher salt
1/4 teaspoon freshly ground black pepper
2 tablespoons minced garlic
1/2 teaspoon crushed red pepper flakes
2 tablespoons tomato paste
3 cups peeled, seeded, and chopped tomatoes
1 bay leaf
3 cups chicken stock
1 1/2 tablespoons chopped fresh basil leaves
1 1/2 teaspoons chopped fresh oregano leaves

Heat the oil in a medium saucepan over medium-high heat. Add the onions, salt, and black pepper and saute until the onions are translucent, about 2 minutes.
Add the garlic, crushed red pepper, and tomato paste, and cook, stirring, for 1 minute. Stir in the tomatoes, bay leaf, and chicken stock, and bring to a boil. Reduce the heat and simmer, stirring occasionally, for 30 minutes. Add the basil and oregano the last 5 minutes of simmering.
Remove from the heat, remove and discard the bay leaf, and pulse the mixture in a food processor or blender until pureed but still slightly chunky. Serve immediately or store, refrigerated, in an airtight container for up to 2 days. Reheat in a saucepan over low heat.
Makes about 2 1/2 cups

Sea bass with pesto, zucchini and carrots cooked en papillote

Cooking en papillote (in a pocket) is an easy and quick way to make delicious fish dishes. Normally these are made with parchment paper, but the use of aluminum foil is an easy and always-available alternative to the parchment paper traditionally used. Cooking with parchment is also quite easy, but often it is not part of our kitchen “toolkit”. As the fish and vegetables bake in their packets, they render a delicious broth that is then poured over the fish at serving time. For the bariatric patient, the 8 oz portion size would likely be too much, however this fish makes a superb leftover meal when served the next day, flaked cold in a salad. Or simply buy smaller portions of fish.

4 sea bass fillets, about 1 inch thick (about 2 pounds in all)
3/4 teaspoon salt
1/2 teaspoon fresh-ground black pepper
1/4 cup pesto, homemade is preferable (recipe follows)
1 zucchini, grated
3 carrots, grated
2 tablespoons extra virgin olive oil
1/4 cup dry white wine
Heat the oven to 450 degrees F.

Make four 12-inch squares of aluminum foil
Place on a work surface and brush lightly with cooking oil
Put a fish fillet in the center of each square of foil.
Sprinkle the fillets with 1/4 teaspoon of the salt and 1/4 teaspoon of the pepper.
Spread the fish with the pesto.
Cover the pesto with the carrots and top with the zucchini.
Sprinkle with the remaining 1/2 teaspoon salt and 1/4 teaspoon pepper.
Gather the foil around the fish and drizzle the fish with the oil and wine.
Fold the edges of the foil to make a sealed package.
And place on a baking sheet
Bake the fish until just done, about 10-12 minutes.
Open the foil packages and transfer the fillets with their vegetable topping to warm plates.
Pour the juices over the top.

You can use other small, flat, white fish fillets, with or without the skin, such as red snapper, pompano, or striped bass. A four ounce fish fillet will give you about 22 grams of protein and about 200 calories.

To make pesto at home is very easy. It requires a blender, a good bunch of fresh basil, garlic, pine nuts, olive oil and grated Parmesano-Reggiano cheese.
Put two cups of fresh basil leaves in a blender
Add 2 cloves of fresh peeled garlic
Add about ½ cup of olive oil and start the blender and puree the mixture
Add the pine nuts as the blender is going
Continue to stream the olive oil in slowly, you will probably use about a cup of a bit more
Add a bit of salt
At the last moment, add about ½ cup of grated Parmesano-Reggiano. It’s done.

If you wish to freeze some, do not add the cheese until you defrost the sauce. Freeze the sauce in small amounts (1/4 cup) in air-tight containers or plastic bags.

Moroccan Grilled Salmon

Tangy plain yogurt mixed with the classic ingredients for chermoula—a Moroccan spice mix—serves as both the marinade and the sauce in this salmon dish. If you like your food on the spicy side, add a pinch of cayenne to the mixture.

2 tablespoons low-fat or nonfat plain yogurt
2 tablespoons chopped fresh parsley
2 tablespoons chopped fresh cilantro
1 tablespoon lemon juice
1 1/2 teaspoons extra-virgin olive oil
1 clove garlic, minced
3/4 teaspoon paprika
1/2 teaspoon ground cumin
1/8 teaspoon salt
Freshly ground pepper to taste
8 ounces center-cut salmon fillet, skinned and cut into 2 portions
2 lemon wedges

Tip: To skin a salmon fillet: Place a fish fillet on a clean cutting board, skin side down. Starting at the tail end, slip the blade of a long, sharp knife between the fish flesh and the skin, holding the skin down firmly with your other hand. Gently push the blade along at a 30° angle, separating the fillet from the skin without cutting through either.

Combine yogurt, parsley, cilantro, lemon juice, oil, garlic, paprika, cumin, salt and pepper in a small bowl. Reserve 2 tablespoons of the sauce; cover and refrigerate. Place salmon in a medium sealable plastic bag. Pour in the remaining yogurt mixture, seal the bag and turn to coat. Refrigerate for 10 (or up to 30) minutes.

Meanwhile, preheat grill to medium-high.

Oil the grill rack. Remove the salmon from the marinade, blotting any excess. Grill the salmon until it is browned and just cooked through, 4 to 5 minutes per side. Top the salmon with the reserved sauce and garnish with lemon wedges.

Grouper Poached in Olive Oil With Grape Leaves

This dish is served with rice cakes and is certainly of Mediterranean origin. Serves 2. Grape leaves can be fun. Use them for dolmas and other Greek dishes.

2 grouper fillets (4-6 ounces each)
Salt and pepper
Jar of preserved grape vine leaves
Chives, left long and blanched for 1 minute in boiling water
Olive oil enough to cover the fish bundles

Rice Cakes
1 cup of cold cooked rice (preferably Arborio)
1 egg, beaten
Some grated Romano or Parmesan cheese
Salt and pepper to taste
All-purpose flour for dredging
Oil for frying

Green Pea and Caper Sauce
1 cup of green peas (fresh or frozen)
1/4 cup extra-virgin olive oil
1 tsp. Dijon mustard
2 Tbsp. of fresh lemon juice
1 Tbsp. of finely chopped capers
1/4 cup chopped fresh dill
1/4 cup chopped fresh chives
Salt and pepper to taste

Take the preserved grape leaves out of the jar and briefly rinse them to remove excess salt. Remove any stems from the leaves and place them vein-side up on your work surface. Place two long stems of blanched chives on your work surface in cross (+) formation. Set one grape leaf where the chives intersect, then begin to lay enough grape leaves just overlapping each other in an outward circular pattern. The number of grape leaves required to bundle your fillet depends on how large your leaves are and the size of the fish fillet.

Lightly season your fillet with salt and pepper and place in the center of your grape leaves. Now carefully bring the other edges of the grape leaves (with the chive stems) up towards the top of the fish fillet and wrap your bundle. Carefully tie the bundle up with the chive stems.
Place a pot large enough to hold both bundles on your stove-top and add some olive oil (eyeball it). Gently heat up your olive oil (medium heat) to an approximate temperature of 250-300F. Your olive oil should be just “quivering”. Gently drop your bundles into the olive oil know side down and poach for 20 minutes. Keep the oil quivering.

Mix the rice, cheese, beaten egg, and salt and pepper for your rice cakes and form the mixture into patties. Dredge lightly in flour and reserve. Add about 1/2 inch of cooking oil into a large skillet bring to about a temperature of 350-360F. Carefully place your rice cakes in the hot oil and fry for about 3 minutes per side or until golden brown. Place on a paper-towel covered plate and keep warm.
Carefully remove your fish bundles and place on a paper-towel covered platter. Reserve.

Make your pea and caper sauce. You can use either fresh or frozen (thawed) peas, place in a small pot of salted boiling water for a couple of minutes. Drain and blanch in cold water (peas should be slightly warm). Add the peas to a food processor with a bit of the cooking water and puree. Now add the mustard, lemon juice and with the processor running, add a slow stream of olive oil (you may use the olive oil used to poach the fish). Add the capers, chives and dill and pulse a few times to blend in. Adjust seasoning with salt and pepper.

Spoon some sauce onto the bottom of each warmed plate. Place your poached grouper bundle (tied-side down) on top of the sauce. Place a rice cake on the side of the plate and garnish with chives and chopped fresh dill. Serve warm.

Tuesday, October 27, 2009

What about Pasta?

I apologize for the lengthy screed on regaining weight, but I will now return you to the cooking and recipe portion of this blog. It's late October and it is getting into fall and winter here in central Italy and the cold makes it less interesting to sit out on the terrace and drink my morning cappucino. Most of the birds have left for warmer climes and there are times when I would like to go someplace warm as well.

In my on-going search for new and different foods to serve our guests, I have found that I need to develop cooking skills that I have never used before. Yesterday it was making ravioli. I have found that the thicker pasta used to make ravioli does not digest well in my smaller stomach. It tends to just sit there for what seems like a very long time, making me feel full and very uncomfortable. Since starches are not digested well in the stomach, their residence there can be lengthy. Starches are normally digested in the intestinal track where various digestive enzymes called carbohydrases work on breaking down the molecular structure of the starchy foods. This digestion turns the starches into simple sugars that are easily absorbed through the intestinal wall. So when I eat ravioli, I generally eat just one and reserve stomach space for proteins and other foods which are more easily digestible.

OK, back to making ravioli. Here in Italy, pasta making is a way of life. Virtually every house has a manual pasta machine and almost every Italian woman has been taught from an early age how to make the pasta from her region and othere regional specialties. There are basically two types of pasta, northern and southern. Pasta is simply a combination of flour, water, and sometimes an egg. Just combine the flour, water and egg to make the dough. The dough is kneaded until smooth to develop the gluten. The gluten is what gives pasta its texture. Allow the dough to rest before rolling into sheets with a rolling pin or pasta maker.

The traditional method of making and kneading the dough by hand has worked for centuries, although it is a slow method. It is, however, a Zen experience and if you have the time and muscle, do it. On the other hand you can use a food processor and cut the time down significantly, but then you don't get that Zen thing going on.

I put pasta into two categories, northern Italian and southern Italian. While it might be an oversimplification, it makes it easy to understand.

Traditional pasta from northern Italy is normally made with soft wheat (all purpose) flour, eggs and sometimes olive oil to form a tender dough. It is great for making long, flat noodles such as papardelle and tagliatelle as well as ravioli, tortellini and lasagna. Sauces used in the north are highly varied but include Bolognese (a meat sauce which sometimes includes milk as part of the tomato-based sauce), pesto (which is commonly a puree of basil, pine nuts, garlic, olive oil and Parmigiano-Reggiano cheese), or cheese cream sauces which might include the local blue-veined cheese Gorgonzola. Gorgonzola is made in either a dolce (sweet form) or a piccante form (sharper and tangy).

The traditional pasta from southern Italy is often made with semolina flour, a flour made from durum wheat, the hardest of all wheats. It is mixed solely with water to form a stiff dough. To make a lighter dough, half semolina and half all purpose flour can be used. The dough is forced through dyes to create many different shapes including macaroni, penne, fusilli and spaghetti. The pasta sauces of the South are often spicier and use more tomato as in Puttanesca, Amatricana and Tomato. The Internet will direct you to all of these recipes easily.

I made my pasta dough in the northern style with only all purpose flour. I weighed out the flour and added one egg for every 100 grams of flour. This results in a more tender, softer pasta. I mix the eggs into the flour and then I kneaded the mixture into a smooth dough using my hands on a floured board. The dough changes texture as you push it along the board, the graininess gets less and less as the dough hydrates and incorporates the flour. It is simple yet it does require some experience. Try making some pasta dough some Saturday afternoon. Turn on some music you like, weigh out the flour, add the eggs and get to work. Feel how it changes. When it is smooth, wrap it in plastic wrap and put it in the refrigerator to rest for a few hours or even overnight.

When you are ready to work with the dough, let it warm a bit on the table before rolling it out. I use a pasta machine that kneads and rolls the dough into 6" wide strips and is the most common method employed in Italy. Historically in northern Italy women have rolled out the dough using long thin rolling pins. The rolled out dough can be 2-3 feet in diameter and is done on a very large floured board. It is not ready to use until it has been rolled to 2-3 mm in thickness. I watched a young woman roll out her dough very quickly using lots of flour. As the pasta dough got larger, it began slipping around on the board. Then I noticed that she tucked an edge of the pasta over the edge of the board and held it in place with her hip. She could then still used both hands to roll, but the pasta remained still. A neat trick (thanks, Francesca).

To make the ravioli, I need to put something inside it. So the filling becomes a significant element. Perfect ravioli is a combination of the pasta dough, the filling and the sauce. They need to complement each other. Classic fillings here in central Italy include potatoes with two cheeses (mozzarella and pecorino), ricotta with spinach, ricotta with lemon and anisette, and pumpkin with potatoes, spices, amaretto cookies, and Parmigiano-Reggiano or pecorino cheeses. The first three are generally served with a thick tomato and vegetable sauce while the pumpkin is more commonly served with melted butter and fresh sage. As I have explored the ravioli-filling world I have developed several different versions that I like. One was with smoked salmon, some mashed potatoes for structure, chopped spinach, parsley, and some lemon peel; in another I used smoked trout in place of the salmon and without the spinach. Both were great when served in a light butter sauce with a bit of cream and a splash of white wine.

Another filling I worked with was chopped spinach and mushrooms sauteed in butter, seasoned with salt, lots of pepper and Marsala, cooked and pureed. When the spinach was added, the whole became thick and easy to work with. It also had a much different flavor than spinach and ricotta (the classic filling). Yesterday I made the spinach and mushroom filling, a pumpkin filling, and a new one using pureed pears, diced pears, and fresh, soft pecorino cheese.

I had a couple of folks over to lunch and to act as tasters. I had some problems with the preparation of the pasta. It was quite soft and probably needed more flour. It also rolled out a bit thin making the ravioli difficult to fill without tearing. I will probably add more flour when I next make the pasta, and will roll it out a little thicker. The pumpkin ravioli were not all that popular as they did not have a punched-up flavor. I will need to work on that one. On the other hand, the spinach and mushroom pasta was great with a bit of thick tomato sugo under it and on top. I added a sprinkle of grated Parmigiano-Reggiano and it was well received. The pear and pecorino ravioli was also very good. The addition of the chunks of pears took the filling to another level. I served it with a melted butter and sage. Two people liked that sauce, on the other hand my Italian friend was not thrilled with it. As foodies do, we discussed the shortcomings and decided that the ravioli was great but the sauce should have been a mixture of cream seasoned with salt and pepper and olive oil, with maybe some chopped, toasted walnuts on top.

I ate one of the spinach ravioli and one of the pear to see how they were; that was my lunch.
So you see that you can cook interesting exciting foods and serve them to friends, without the overwhelming need to eat them yourself. I think that my experience making pasta was a success and as I learned this new skill I was able to enjoy the process, have others enjoy the results and still keep focused on why I had my surgery in the first place.

From central Italy, the land of a thousand pastas and as many sauces, I bid you good cooking.

Monday, October 26, 2009

Regaining the weight so dearly lost

There is a strong perception out there that people who have bariatric surgery will often regain the weight they lost. It seems that individuals that I talk to about my experience have stories of friends or acquaintances who had the surgery and then regained the weight. I have several of those stories myself. It seems like there are fewer stories about long term successes. A nurse friend said that while the surgery works for some, most people will regain weight and that is why insurance doesn’t often cover the procedures. I would like to discuss in this entry the possible reasons for weight loss failure including the surgical procedure itself, pre- and post –surgical counseling and support, and the emotional side of eating.

The surgical procedures

There are generally four basic surgical procedures available for bariatric patients. There are some significant variations between the surgical procedures, and are based upon individual surgeon’s preferences. The general procedures are all are based upon one basic principle. That is the restriction of food input. How that is accomplished varies with the procedure selected by the surgeon.

The general procedures are the Lap Band, vertical gastrectomy, Roux en Y gastric bypass, and the duodenal switch. The procedures are either mechanical (Lap Band and the vertical gastrectomy) or what I call mechanical/physiological (Roux en Y gastric bypass, and the duodenal switch). Mechanical surgery rather simply reduces the physical capacity of the stomach and restricts the volume of food that can be ingested at one time. The Roux en Y gastric bypass and the duodenal switch are more complex procedures that reroute the movement of food from the esophagus directly into the intestinal tract, and while providing restricted eating also alter the actual physiological processing of the food in the digestive tract where almost all digestion actually takes place.

For the insertion of the Lap Band a small tunnel is made behind the top of the stomach to let the device through and allow it to be wrapped around the upper part of the stomach, like a wristwatch. It is then locked securely in a ring around the stomach. This creates your new, smaller stomach pouch. The rest of the lower stomach will stay in its normal position. A small access port, which is used for band adjustments, is fixed just underneath the skin. The access port is used by the surgeon to inject saline (sterile salt water) into the band when you have an adjustment.

The Duodenal Switch procedure is also called the vertical gastrectomy with duodenal switch, biliopancreatic diversion with duodenal switch, DS or BPD-DS. It generates weight loss by restricting the amount of food that can be eaten (removal of stomach or vertical gastrectomy) and by limiting the amount of food that is absorbed into the body (intestinal bypass or duodenal switch). It is more controversial because it has a significant component of malabsorption (bypass of the intestinal tract), which seems to augment and help maintain long-term weight loss. Of the procedures that are currently performed for the treatment of obesity, it seems to be the most powerful and effective, but may also have more complications associated with it. Most surgeons do not perform this procedure because of the overall concerns about the long term effects of malabsorption.

In the Vertical Gastrectomy (VG) the stomach is divided vertically and more than 85% of it is removed through the small incision in the abdominal wall. This procedure is not reversible. The stomach that remains is shaped like a banana and measures from about 4-7 ounces (120-250cc) in volume depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume. In the Roux-en-Y gastric bypass, the stomach is divided, but not removed, and the pylorus is excluded. The esophagus and a portion of the stomach muscle are then connected to the lower part of the duodenum (first section of the small intestines). The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary as can the Lap Band.

The Roux-en-Y gastric bypass has minimal malabsorption compared to the Duodenal Switch. The design of the duodenal switch was done to reduce the adsorption of nutrients through the intestinal wall and into the body. It was part of the procedure and drives a significant part of the weight loss regimen.

As with any surgery, bariatric surgery does carry some inherent risks and potential complications. These can include: Deep vein thrombophlebitis 0.7%; Non-fatal pulmonary embolus 0.5%; Pneumonia 0.5%; Acute respiratory distress syndrome 0.25%; Splenectomy 0.9%; Gastric leak and fistula 2.0%; Duodenal leak 1.5%; Distal Roux-en-Y leak 0.25%; Postoperative bleeding 0.5%; Duodenal stomal obstruction 0.75%; Small bowel obstruction 2.0%; and possibly death 1.0%. (Surgical risk data from Laparoscopy Associates of San Francisco website LAPSF.com)

Pre-surgical evaluation and support

As part of the pre-operative workup, most patients are required to have a psychological evaluation with a counselor. I believe the need for this evaluation is relatively evident and very significant. The discussion should revolve around the reasons for the weight gain, the time frames, factors influencing it, thinking about the surgery as an option, alternatives to surgery, and the question of what happens next. Frankly the most important part was the analysis of the factors influencing the weight gain. These include emotional eating, compulsive over-eating or other eating disorders, lack of self-esteem or social factors, genetic tendencies, and hormonal imbalances. It is very important to be very honest with the analyst in evaluating the potential for surgery. This is not a frivolous venture and in general is a one way ticket. Do not think of bariatric surgery as just a stop gap procedure to help you lose weight and then you can have it reversed and go back to a normal eating habit. You really can’t go back. The habits and mechanisms that got you to gain weight are likely still there.

During the psychological evaluation the counselor will be assessing a number of elements and trying to determine the answers to these questions:
What is your drug use?
What is your alcohol use?
Do you have untreated depression?
Do you have suicidal tendencies?
Do you have any eating disorders?
Do you understand the surgery and the needed lifestyle changes?
What is your ability to make lifestyle changes?
Can you follow and comply with the dietary demands?
Will you follow the exercise regimen?
Do you understand the importance for post-operative follow-up?
Can the surgeon rely on you to follow their directions?
Do you understand that not following the directions puts you at risk?
Do you have unrealistic expectations about what will happen?
Do you have adequate support in your social circle and at home?

Post Surgery follow-up and support

Many successful gastric bypass weight loss surgery patients say that their support network helped them immensely in maintaining their new healthy lifestyle changes. From family and friends to bariatric program support groups, there are options available for people interested in gastric bypass surgery and for dealing with the rapid weight loss that follows.

Talking to your family and friends about weight loss surgery and your interest in it is very important. They are most often highly supportive; however there are times when they may not be supportive of your decision. They are likely concerned that you might have unrealistic expectations about the outcome, or you will regain the weight lost, or there are risks that they fear. Speak frankly about your feelings, show them the data, and help them understand that while the process is designed to promote better health for you, they will reap the benefits of you being around with them for a longer time. They may also have preconceived notions about weight loss surgery.

If you find that they are unsupportive, it doesn’t mean you are alone. It is important that you follow the path that you decide upon. Many people have had weight loss surgery and have been very successful with the care they received from those outside their normal circle of family and friends. This is your decision and your life. You need to feel comfortable with the decision, understand the potential outcomes, and be willing to work toward a successful outcome.

Weight loss surgery support groups are an excellent resource of weight loss information and support. You’ll find people who share your goals of health and wellness. A support group is a forum for celebrating successes, such as the your weight loss and resolution of health issues. The support group is for people who have common experiences, who can share their feelings in a safe environment, and develop relationships that can contribute to improved physical and emotional health after their weight loss surgeries.

If you are thinking about weight loss surgery, and you want to learn more about the patient’s perspective or help reluctant family and friends to understand, attending a support group meeting can be invaluable.

Reasons for regaining weight

The most significant issue for post surgical patients is to maintain their weight loss, maintain their health and maintain their sense of “why I did this in the first place”. Regaining weight can be due to emotional eating, compulsions, or the simple fact that if you can eat a bit more after awhile (the stomach stretches a bit and accommodates more food), you will. Be careful and keep in mind that while you can stretch the pocket or the pouch to accomodate more food, should you?

People who snack or eat without thinking because they feel depressed, anxious, or afraid are more likely to regain weight than people who may occasionally overeat because of external factors. External factors include the holiday eating season (such as Thanksgiving and Christmas) and celebrations with family and friends. If you concentrate on the dietary requirements for your continued weight loss and then its maintenance the potential to regain is lessened.

Celebrations and parties, spending time with the family watching a favorite show, cook outs on warm summer evenings are social activities that have long been tied together, and you shouldn’t have to give them up. Eating and events are tied together. However after bariatric surgery and with your new healthy habits, you won’t want to eat as much as you used to and, most likely, you won’t be able to. These social occasions and situations can present challenges.

Sometimes even the most well-meaning family and friends may try to push food on you or may have difficulty supporting you. They may be unaware that certain comments they make or things they do are not supportive. You may get frustrated because a family member continues to bring home high-calorie foods, even though you are trying to avoid them. My advice is to take a bite, it won’t kill you and then explain why you can’t eat more. Ask them to bring other types of foods and offer suggestions. You may be upset because a friend who only knows the myths of bariatric surgery thinks it is the easy way out. That is a hard one to get people to understand. It is not an easy way out, it is a lifestyle change and it is for you, your health and well-being. You may never convince them (particularly if they are slender and have never experienced weight issues). Remember why you did what you did.

So with regard to the potential for regaining weight there are a number of things you need to do or understand:

1. Be sure you fully evaluate the reasons for your weight gain and why you are looking at bariatric surgery as an answer. If a single session with the counselor does not resolve your questions or their questions, do another session or more. Get to the bottom of the issues. Be forthright and honest.

2. Select a surgeon you are comfortable with and discuss all of the positive and negative aspects of the surgery, the weight loss potential, other health effects AND the potential to regain the weight. They have the most current data on the successes of the different surgeries and you need to be sure they discuss the known and potentially unknown outcomes and issues with you. Do not be frightened by the risks. Going out to the car and driving to work carries risks. But you need to know the risks.

3. Follow the post operative “rules” to ensure that your weight loss gets off to a good start. It will be amazingly fast at first and you will marvel at the rapid results. But be patient and things actually will get even better. Do not overeat. You need to relearn how to eat and how you feel as the stomach fills and empties. Try to eat to within one bite of full and then stop.

4. Go to group sessions if you feel the need to get that additional support. Your doctor will provide you with locations and times. If you need help with questions ask them, either to your doctor or in the group. If you are still a bit conflicted about the psychological component go seek additional counsel. This is for you and you alone. You have set yourself on this path and you need to be disciplined in its journey.

5. As you move along on your weight loss, add bits of new tastes or maybe old ones you would like to try again. Do not be afraid to taste, just don’t overeat.

And oh yes, do drink plenty of water. Mangia!!!