Saturday, February 27, 2010

More than Eight Bites

The focus of this blog has been the recipes and dishes that I have used to help me (and hopefully others) deal with the dietary restrictions placed on us by the weight loss surgery we have had. I have discussed the reasons I had the surgery (vertical gastrectomy, June 2008), issues involving the foods that I have eaten, the various formal and informal gatherings, and the culinary experiences that I have had on this interesting journey through my weight loss. Eight Bites has been my personal mantra for the last two years as it was with my wife’s surgery done in 1981. I have literally lived the majority of my life Eight Bites at a time. I have found that the restrictions placed upon me by Eight Bites have not influenced my appreciation for the actual act of eating good tasting food; in fact I believe it has been enhanced. I have found that I can evaluate a restaurant menu and choose between an interesting antipasti plate with a variety of bites, or a single dish from the secondo menu and have Eight Bites of the same thing. It allows  me an infinite flexibility.

The other day at a wonderful restaurant in Berkeley, California called Oliveto’s; I was eating lunch with one of the followers to this blog. Scott is a young guy, not overweight, but he does enjoy the basic pleasures of eating good food, experiencing new tastes and interesting textures. He and his wife had stayed with us in Italy last year and we struck up a friendship. When I went on my recent trip to California, we met for lunch near where he works. Oliveto’s is a great Italian restaurant, owned by another friend of mine. As we sat perusing the menus, we talked about the cooking class in Denver I had just taught, how he and his wife were buying a house, how things were in Italy, etc. In general we were just carrying on a conversation between friends. However it had been awhile since that hotel “sort of” breakfast I had at 7AM and I was getting hungry. The antipasti looked good but I was in the mood for a bit more substance. So I ordered a grilled fillet of black sea bass on a cannelini bean puree, topped with a salsa verde (green sauce). I grill fish all the time so I knew what it should taste like. The cannelini bean puree I also make frequently as a topping for crostini. But the salsa verde was a new element to me. The combination of the fish, the bean puree, and the spicy salsa was extremely good and it was actually more than Eight Bites. Who was counting?  The salsa tasted like a puree of shallots, parsley, vinegar, garlic and olive oil, which I will try to duplicate here when I serve fish again. It would probably be good on other types of meats as well.

So where am I going here? The restriction of Eight Bites has been placed upon me by my surgery, but changing the way you eat regarding controlling portions has a more universal application. So todays entry is about portion control. Whether its Eight Bites, twelve bites or fourteen bites, what is important is examining the way we eat and looking at the concept of portion control as a means to change our weight, and our lives. As a society we tend to eat too much and that is likely the cause of the epidemic of increasing obesity. We super-size everything, we want a “Grande” meal; we want the large portion, the large soda, and the mega- burrito. We want a lot on our plates so we feel satiated and satisfied that we have gotten our money’s worth from the meal. But what has all this super sizing done, besides increasing your waist size, your BMI, and your overall health risk factors? It has also taught us the lesson that “more is better” and we sometimes still hear our Mother’s admonition that we must clean our plates because of all those starving people in Africa and Asia. What was she thinking?  We can’t send the extra food on our plate to help feed them. So we developed the habit of eating more, and cleaning our plates, and then as we aged and our activity level decreased, the laws of thermodynamics began their insidious journey to our bellies, thighs, and butts. Saddlebags are not just on horses. Calories in and calories out. If the calories in are more than the calories out you will gain weight. It’s a physical law. Where that weight goes on your body has a lot to do with genetics, but it will increase. Since as we age our general physical activity level tends to decrease, as a result we have to learn to reduce our portion sizes as well. So here we are back to portion control.

The physical restrictions place upon me by my reduced stomach, limits me to Eight Bites (or so). But even if you haven’t had a weight loss surgical intervention you can still reduce your portion size. Think about an option where you limit your meals to 14 bites (or 12 bites). For example, if you eat two fried eggs for breakfast (which I do most mornings) and cut each one into three or four bites, you have seven or Eight Bites. For many months after my surgery, this was my breakfast. It was high in protein, and was a restricted volume I was able to put into my newly altered stomach. Now I add a slice of toast (four to five bites) and you have a breakfast of between twelve and fourteen bites. The next most important question is do you need that sausage patty, or the hash browns, or the three strips of bacon?  If you eat your eggs and toast slowly, maybe sipping a cappuccino (use artificial sweetener if possible) and read the newspaper or scan your email, you will feel full. Probably not the first time you try it (you will likely feel hungry) but within a few days, that many bites for breakfast will seem plenty. By the way, put some Tabasco sauce on the eggs if you like (I do). Your calorie intake for that breakfast will be less than 400 calories and it will get your day off to a good start.

Now what about lunch? If you are required you to eat out at lunch with clients or colleagues, the mid-day meal can be problematical. If you have eaten a good protein-laden meal for breakfast it is less likely that you will be starving at lunch. If you just had a croissant or a pastry and a coffee for breakfast, it is highly likely that you will be hungry since these foods digest quickly, lead to increased blood sugar levels and will leave you with an empty feeling that you want to fill at lunch. This can sabotage your fourteen bites quickly.

Look at the menu and assess the possibilities. Is there something on the antipasti or starters list that intrigue you, maybe something you have never tried before?  Experimentation with new flavors and tastes makes your meals interesting and allows you to savor each bite individually. It also allows you to reduce the need to eat a big plate of anything in order to “stay up” with your dining companions. My guess is that they will sit there and watch you eat those interesting bites and not really consider how little you are eating. Frankly it gets them off your back to some degree. And you will not feel obligated to eat more. Lunch out can be fun and still meet the portion needs you are striving for. A well-controlled lunch may be 600 to 800 calories. So in two meals you are at about 900 to 1000 calories. Careful food selection which might include a small vegetable dish or a side salad along with your protein will provide a balanced lunch. My guess is that how much you eat will be less than what you have been consuming in the past. Walk back to the office, or back to the car and you have had a satisfying lunch, good conversation (hopefully) and a solid nutritional middle of the day meal. If you have plenty of protein at lunch you should not have a serious “crash” of blood sugar in the late afternoon when you might really want a piece of cake or some cookies. I would suggest keeping a stash of good quality cookies in your desk drawer, and if you feel the need, eat one or two with a coffee or a glass of water. Stay away from the icing-filled cookies and maybe eat a small shortbread cookie or a ginger cookie. It will satisfy your hunger, satisfy any craving for sweets, and not kill your calorie count. Eating a portion-controlled diet should not be about deprivation and enforced eating restrictions. It should be about smaller servings of exciting textures, flavors and tastes. You are not in prison and you always have the ability to select and consume the foods you want.  

To finish the day, dinner at home is relatively easy to deal with. Plan the meal so you have three to four ounces of meat of fish, a small amount of starches such as rice or potatoes (try to minimize the amount of carbohydrates you consume), and a bit of vegetables or salad. If you are eating with the family, sit at the table and enjoy the dynamics while you slowly eat your dinner. Do not let familial problems alter your perceptions of your meal. Don’t let emotions get in the way of the eating, because if you are upset or angry, you will eat more than you anticipate. If you are eating alone or with your significant other, serve your plate(s) in the kitchen and take them to the table. If you don’t put food in serving bowls and platters on the table you will be less likely to eat more.  Controlling the portions to 12 to 14 bites per meal will automatically reduce the caloric intake and by taking a walk after dinner (hold hands with your significant other please, it aids in the digestive process) you will alter the thermodynamic equation in your favor.

So by limiting yourself to 12 to 14 legitimate bites per meal you will reduce the total number of calories consumed. Just remember not to just eat a big slice of cheesecake and then wash it down with a chocolate milkshake. That dietary plan will certainly alter the thermodynamic balance in the wrong direction. When you get your plate, look at the food and see how it can be divided into bites. Two eggs easily divide into six bites, a tuna sandwich for lunch can be Eight Bites or less, while a four ounce steak can be cut into seven or eight bites.

To meet my Eight Bites limit, I eat a couple of eggs for breakfast and maybe a small slice of toast, a sandwich made on small slices of bread with a high protein filling (like tuna or egg salad, or a BLT) for lunch, and then 3 ounce of fish or meat for dinner along with a small amount of vegetables. Usually I don’t eat much rice or potatoes. To me these are really empty calories, and of little value to my nutrition. I try to zip up the flavors by adding Tabasco Sauce to the eggs, giardineri mix (a pickled vegetable condiment) to the tuna or egg salad, and some interesting chutney or a spicy mostarda to the meat for dinner. Meals become more interesting by adding condiments, and can be changed daily so you don’t get bored. Remember that recipes are recipes, and virtually every one, including the ones I have provided in this blog do not focus on just eating Eight Bites. 

What you have to add to the culinary equation is your own portion control.

So Eight Bites are not for everyone, but effective portion control can help win the battle with the effects of thermodynamics. It is more what and how much you eat and not just about consuming as much as can possibly fit in your stomach. When I saw the surgical report for my stomach surgery and the doctor’s comment that my stomach was enormous, it made me realize that I had been super-sizing my intake for years and also effectively super-sizing myself. We can do more (and less) for ourselves. 

Gary, this one is for you, in appreciation for all the advice and counsel you have provided. May we continue to be friends and may your fourteen bites keep you happy and satisfied. kfk

Monday, February 22, 2010

Cooking class in Denver

On February 13, I had the chance to teach a cooking class in Denver, Colorado. It started with my trip to California and the desire to get together with a former graduate student of mine who lives near Denver. A high school classmate asked me if I would stay at their home for the weekend and I agreed. Another classmate from high school is a follower on this blog so I wrote to him and asked if the three Antioch guys might want to get together in Denver for a mini-reunion. I decided that I would offer to teach a cooking class similar to the ones we do in Italy. So Jim invited two other couples, plus Gary and his wife to get together on Saturday night at Jim’s house outside of Denver. These two guys had lived about 30 miles apart in Colorado and had not met in 47 years, since high school.

Jim and Sharon met me at the airport Friday afternoon and we drove back to their house reminiscing about old school friends. I fixed a simple dinner of tortellini Gorgonzola, some toasted French bread, and some salad. Tortellini Gorgonzola is a simple dish with tortellini (use meat filled ones if possible, but all types work fine), and a sauce made of 8 ounces of cream, 4-6 ounces of Gorgonzola cheese, two tablespoons of butter and lots of ground black pepper. The tortellini are cooked and then added to the sauce and stirred until coated. It is wonderful hot and can be eaten as leftovers the next day. Later in the evening I made some beer bread for crostini the next day, did the slow oven-roasted tomatoes, and the Italian cream cheese dessert which had to harden in the refrigerator overnight.

On Saturday, I checked the shopping list I had asked Jim and Sharon to do and things looked in readiness. I dressed and went out to lunch with Lisa (my graduate student) to a good Thai restaurant and had a nice piece of curried fish. Then it was back to the house to set up the class materials. My pasta machine had been delayed in Frankfurt, but arrived in San Francisco before I left for Denver. So we clamped it to a counter and I began the antipasti setups and the vegetables for the sauce. At 3PM people started arriving and we were ready to go. There was Sharon and Jim (my hosts), Gary and Paulette, Stephanie, Gary, Louise and Jay. They were ready to participate.

The menu was:
Crostini with salmon and crema
Crostini with porcini saute
Crostini with cannelini bean puree and caramelized onions
Bruschetta with olive oil, garlic and salt
Bruschetta with caramelized pears and Gorgonzola
Cucumber slices topped with spiced goat cheese and slow roasted cherry tomatoes
Tagliatelle with vegetable and tomato sauce
Grilled sausages and grapes
Salad with radicchio, orange slices and fennel in orange vinaigrette
Italian cheese dessert

Instruction started with the longest cooking dish, the tomato sauce. Once it was on the stove we made the pasta dough and set it aside to rest while we did the antipasti. Since almost all of the antipasti were bread (crostini and bruschetta) based I did the sliced bead in the oven, brushing the slices with olive oil and some crushed garlic. I grilled the bruschetta alone then rubbed garlic into the bread, liberally applied a good olive oil and sprinkled on some salt. The pieces were cut into three sections and plated. The materials for the crostini were mixed by class members and the assembly took place at the kitchen table. Everyone had fun, but they were starting to stare hungrily at the dishes spread out on the table. I felt that I had to divert their attention for a bit, so I started rolling and cutting the pasta.

I felt the pasta was a bit moist and added a substantial amount of flour to the surface to keep it from sticking. I had a couple of people roll out the sheets and then showed them how to use the cutter head to make the tagliatelle. The pasta was floured and stacked and I started the water on the stove. Then I told them all to start on the antipasti. It was fun to watch them eat the interesting pieces they had made so simply. Hopefully that is the good takeaway lesson they can use in the future. Wine was poured and consumed. I tasted everything to be sure it was OK and then got back to the pasta. I was pretty much done eating dinner and my Eight Bites had been enough.

The sauce had cooked down and the pasta water was boiling so I asked everyone to sit down and dropped the pasta in to cook. It took only a few minutes, though I cooked it a bit longer than they do in Italy. I understand al dente pasta, but I find it too underdone for American tastes. So I cooked the pasta about a minute or so longer. It came out perfectly. I plated the pasta and the sauce in a big heated bowl and added a couple of handfuls of Parmigiano Reggiano cheese, The sauce was lightly used as a condiment and did not drown the pasta. I served the pasta and started the sausages.

I placed the grapes in a large saute pan with a bit of olive oil and started to glaze them. Then I set them aside and started grilling the sausages. The pasta course was done with a bit for leftovers.  I plated the sausages on a hot platter and poured the grapes over them. Then I dressed the salad and sent both out to the dining room. I actually then took a few minutes to sit down and talk and also listen to the conversation. Eating should be a communal activity and the conversation was lively, and often political.

As the dinner was winding down, I slowed the pace a bit and held off on the dessert as everyone settled in for a few minutes. I sliced the cheese dessert into 3” squares since it was so rich and served it on chilled plates. Wine was poured continuously and the dessert got good reviews. Everyone helped clear the table and the dishes piled up in the sink. Most went into the dishwasher and the pans were washed by hand. I opened a bottle of vin santo and had a small glass with Jim. Gary doesn’t drink any longer but then the three of us chatted for another 30 minutes. Everyone left to avoid the impending snowstorm (10” by morning). The evening was over and I was on a bit of an adrenaline high. It seems to get like that after cooking a meal for someone. Slowing down and cleaning up was necessary and accomplished.

The following recipes were handed out at the class:

Crostini with salmon and cream cheese with lemon mostarda
Mix 4-8 ounces of cream cheese with 3 tablespoons of chopped chives and a bit of slat and pepper. Set aside. Grill thin slices of French or Italian bread over the grill to brown and crisp. Spread with cream cheese mixture. Dice smoked salmon into 1/4” dice and sprinkle 1-2 teaspoons on top of the cream cheese. Add a small dollop of lemon mostarda to the top and a very thin 1/8 portion of a thin lemon slice.

Lemon Mostarda
Two cups of water
1 1/2 cups of sugar
Rind from 5 lemons, peeled with a vegetable peeler and sliced into fine julienne
Juice from the five lemons
Slice another lemon into eighths and slice crosswise into very thin lemon wedges, remove seeds
Two tablespoons of yellow or black mustard seeds
3-4 tablespoons of apple cider vinegar (to taste)

Bring water and sugar to a rolling boil and boil for 10 minutes
Add grated lemon peel and juice and return to a boil.
Add small sliced of lemon, and allow to cook at a simmer for 20 minutes
Toast mustard seeds in a dry frying pan until they start to pop
Grind in a mortar or spice mill to a coarse texture
Add to fruit mixture
Taste and add 3-4 tablespoons (or more) vinegar (This is my preferred option)
Simmer for 30 minutes
Ladle into washed canning jars (1/4 pint)
Seal and process for 5 minutes in boiling water bath
Remove from the water bath to a rack
Allow to cool.

Caramelized pear and Gorgonzola crostini
Peel and chop 2 firm pears into ½” dice. Saute over medium heat with a couple of teaspoons of sugar and a squeeze of lemon juice until golden and caramelized. Mix about 3-4 oz of Gorgonzola with a bit of milk or cream to thin it to spreading consistency. Grill thin slices of French or Italian bread over the grill to brown and crisp. Spread Gorgonzola on the bread and top with some caramelized pear. Put on a baking sheet in a slow oven (300 degrees for 5-10 minutes to heat before serving.

Cannelini bean and caramelized onions crostini
Open and drain a can of great northern or cannelini beans and rinse thoroughlty. Place beans in a saucepan with about a ½ can of chicken stock or water and add 3 peeled garlic cloves. Cook the beans for 10-15 minutes until most of the water has evaporated. Puree the mixture with a stick blender or in a food processor. Peel and slice 2 medium onions thinly and saute in a frying pan with 3-4 table spoons of butter, add a table spoon of sugar and 1-2 tablespoons of apple cider vinegar (or what you have). The onions should saute until golden and soft. Grill thin slices of French or Italian bread over the grill to brown and crisp. We used a bit of fig jam on the bread before putting the beans on. Spread with the bean puree and top with some onions. Sprinkle with a bit of Pecorino Romano or Parmigiano-Reggiano and serve.

Bruschetta with garlic, olive oil and salt
Slice French or Italian bread into ½” slices and grill either over coals, on a grill, or in the oven until toasted and golden. Remove bread slices to a rack and rub each slice well with a raw clove of garlic. In a bowl put ½ cup of good quality olive oil and with a brush, brush oil generously onto each slice. Sprinkle with a nice coarse salt and put into a warm oven to keep warm

Mushroom crostini
Saute 8 oz of sliced button mushrooms (or whatever you have available) in 4 Tablespoons of butter or a mixture of butter and olive oil. Add salt and pepper to taste. Add ½ cup of chopped parsley and ½ cup of Marsala wine. Cook over medium until nearly dry. Spread mushroom mixture on crostini. The mushrooms can be pureed with a bit of cold butter to make a nice mushroom pate.

Cucumber antipasti with goat cheese and slow roasted tomatoes
Peel and slice two good cucumbers into 1” slices. Mix fresh goat cheese with a bit of salt and pepper and top each slice with a small spoonful of goat cheese. Top cheese with a half slow roasted tomato.

Slow roasted tomatoes
Wash and then slice a basket of cherry tomatoes into halves. Place in a bowl and add ½ cup olive oil and 1 tablespoon or dried basil and oregano, some salt and pepper and a spoonful of sugar if the tomatoes are not that ripe. Turn the tomatoes out onto a large cookie sheet and turn each one over so the cut side is up. Place in a 300 degree oven for 45 minutes, then turn off the oven and allow the tomatoes to dry (overnight is fine). Place in a plastic container and keep in the refrigerator until needed.

Tagliatelle with tomato and vegetable sauce
Make fresh pasta, or purchase fresh or dry pasta (tagliatelle or fettuccini)

Basic Tomato and Vegetable Sauce
Serves 12
Cooking time: 1 ½ hours
It is preferable to use a combination of fresh and canned tomatoes. But local conditions may dictate what you use.
¼ cup olive oil
2 stalks celery
1 white or yellow onion
6 unpeeled carrots
Handful flat-leafed Italian parsley
2 cloves garlic
¼ teaspoon hot red pepper flakes (peperoncini), optional
A few leaves of fresh basil
2 pounds fresh cherry tomatoes
2 teaspoons salt
1 quart tomato puree (called passata di pomodori—look for the Pomi brand in the U.S.)
2 cups water (or more)
1 cup dry white wine (or more)
1 cup grated pecorino Romano cheese, to be added at the end.

Pour enough olive oil into a heavy frying pan (11 inches diameter, 2 inches tall) to cover its bottom, and place it over medium heat.

After washing the vegetables, chop the celery and onion coarsely, mince the parsley and garlic together, and grate the carrots on the largest holes of the grater. Add to hot oil, stir, and cover pot.

After the vegetables have softened, add the pepper flakes, basil and the de-stemmed, washed cherry tomatoes. Sprinkle with the salt and cover.

After 20 minutes, add the tomato puree and stir. Continue to cook, covered, for 15 minutes more, stirring regularly with a flat-bottomed wooden spatula to assure that the sauce is not sticking to the bottom of the pot.

Remove cover and add wine and water as needed, continuing to cook uncovered on low heat for another thirty minutes, stirring regularly.

When the sauce is thick and creamy, remove it from the fire and set aside, covered, to keep it warm. Add to the pasta or polenta, then top with grated cheese and serve.

Italian sausages and grilled grapes
Purchase the number of sausages you will need and either grill them over coals or in a grill pan on the stove. Remove the grapes from the stems and in a saute pan, saute them with a bit of good olive oil until they start to get slightly colored and may start to pop. Place the grilled sausage in a serving dish and pour grapes over all.

Salad with sliced oranges, fennel, radicchio, and lettuce
Make a salad with torn lettuce and radicchio. Peel and slice three oranges thinly and set aside. Slice the fennel very thinly through the root so the slices stay together. Add the sliced oranges just before serving. Make vinaigrette from the juice of one orange, olive oil, salt and pepper and if you wish a small amount of mild vinegar. Pour over salad and toss.

Italian cheesecake
This is a creamy cheesy dessert that requires no cooking. Adjust the amount of cheese to serve the number of people you need.

Place 8 to 16 oz of mascarpone and 8 to 16 ounces of cream cheese in a mixing bowl. Begin to mix. Add 1/2 to ¾ cup of sugar, a teaspoon of grated lemon peel, two ounces of your favorite liquor (Grand Marnier, brandy, chocolate liquor, coffee liquor). Mix everything thoroughly. In a second bowl put ½ to 1 pint of whipping cream, a ½ cup of sugar (or less) and a teaspoon of vanilla. Mix to stiff peaks. Add ½ of the cream to the cheese mixture, and continue beating. Remove the mixer, and fold in the remaining cream. In a large baking dish, place 1-2 cups of crushed biscotti in the bottom, pour over the cream mixture and sprinkle top with chopped bittersweet chocolate. Place in the refrigerator at least overnight covered with plastic wrap. Serve cold.

Some questions and some answers (at least my answers)

Did you have a gastric bypass?
No. There are currently several surgical options. I had what is called a vertical gastrectomy or a VG. That surgery is done using a laparoscope through a small incision in the abdomen and physically removes between 85% and 90% of your stomach. The surgery results in a mechanical restriction and has little effect on the physiology of the digestive processes. Its effect is to restrict the total amount of food you can eat at one time. The surgery took about 1.5 hours and I then stayed in the hospital overnight. I went home the next day.

What are the differences between the surgeries?
I discussed the surgeries in an earlier blog entry (September 2009, Bariatric Surgery) and will summarize them here. There are two surgical techniques that I call physiological surgeries (the Roux Y and the duodenal shunt). These techniques physically bypass the stomach and insert the esophagus directly into the intestinal tract. These would be defined as Gastric Bypasses, since they bypass and/or also remove the stomach. The third surgery is the Gastric Band. This is an inelastic band that is placed around a portion of the stomach to restrict food intake. It is generally considered reversible and often people have it so they can have it reversed at some point in the future. The other surgeries are not generally reversible.

Was there any pain or post-surgical problems?
In my surgery, I went to the hospital at 10AM, and walked into the surgical suite at 1:30PM. The surgery took about 1.5 hours and I woke up in my room about 4PM. I had no major discomfort or pain that evening and after a liquid breakfast and lunch the next day I left the hospital about 1PM. Over the next few days I had a little bit of an infection in one of the laparoscopic incision sites, but it was treated with some topical antibiotics and a band aid and resolved itself quickly. In general I had no significant post surgical problems. I stayed on a liquid protein diet for three weeks and followed the “manual” carefully. I did not push the process and began to lose weight immediately.

What was the time frame to eating normal food?
I began eating a soft diet at about 3 weeks and at about six weeks I could eat almost anything I wished. For those first months I kept the portions very small and generally soft. I had a few incidences of pain, but they went away quickly. Normal eating began about 3-4 months after surgery, with a somewhat careful selection of foods.

How much weight did you lose and how fast did you lose it?
I lost about 35 pounds in the first month, and 20 more in the second month. Surgery was on June 4, 2008 and by September 2008 I was down 70 pounds. I was down 80 in October and 91 in November. I had lost 100 pounds by Christmas. The rate of loss slowed after the first of the year and by June 2009 I had lost a total of 135 pounds and the weight loss had stopped. Since that time, I have been at a stable weight of 165 pounds with no variability. I believe that I have reached my ultimate goal weight.

How do you feel?
I feel great. I had the surgery to see if it would resolve my outstanding health issue including diabetes (four insulin shots per day), high blood pressure (160/90), and significant sleep apnea. I have a reasonable exercise regimen using a stationary bike and a significant amount walking. When I saw my surgeon for the first time, my biggest health concern was the long term health implications from the diabetes. He gave me about a 93% chance of getting off insulin. I have not had to use insulin since July 2008, one month after surgery. My blood sugar in the morning is between 75 and 90 which is great. Blood pressure is significantly lower and I no longer snore or have sleep apnea (much to my wife’s approval).

What about exercise?
I exercise probably less than I should but try to get in some stationary bike time at least three times per week. I ride for about a half hour each time. I walk a lot and when visiting the hill towns in Italy often have to walk for extended periods in fairly steep locales.

What about all that extra skin?
Depending upon the type of weight loss and how you carried the weight and where, there is a signiciant potential to have extra skin sort of drooping down from the abdomen and often the neck. I was pretty lucky and my mother had very elastic skin so mine is not too bad. It is often necessary to have some plastic surgery, particularly if you have a lot of excess skin. That is something each person who has the surgery must consider.

You seem to have to drink a lot of water?
The post surgical period is one of rapid weight loss and it is necessary to drink a lot of water to help the body flush away the various metabolites that require excretion. The surgeons recommend 60-70 ounces of water per day and generally not to be taken with meals. It is not that difficult to be sure that you drink a sufficient amount of fluid.

Did it change your life?
Absolutely! I had been heavy for almost 50 years, ever since high school. I was unhealthy and in 2006 had a minor heart attack and double by-pass heart surgery. With the surgery I lost over 165 pounds. I can do a lot more physically than I used to do, and have no significant physical problems. So yes, the surgery changed my life for the better. I will be around longer for my grandchildren and for my new wife.

Did it change your lifestyle?
It didn’t change who I was inside my head, but it did change how I looked and the things I was able to do. Physically I went from a size 54 jacket to a 42, a 46 inch waist to a 32 inch waist, and from a 3X shirt (size 19-20) to a 16. I am able to wear clothes that I have never been able to wear before. I could exercise for a half hour when before I pooped out at 5-10 minutes. I have a pretty well-developed social life with my new wife and my friends seem to appreciate the fact that I am healthier and can do more.

How can you work as a chef and have this surgery?
For the past year I have been working rather steadily as a cook for my wife’s catering business. I serve as a ook to groups from 4 to 40 people. I make antipasti, pasta, sauces of all kinds, grilled meats, and a variety of desserts. I have found that I can eat one or two bites of things I make and appreciate the flavors, textures, and tastes. I have also found I don’t need to eat a lot of anything to feel satisfied. I love to make nutritious as well as beautiful foods for my guests and to see their appreciation and enjoyment of the meal. I don’t feel the need to eat excessively while I am doing so.

What can you eat (and can’t eat)?
Early on after the surgery I carefully assessed any new foods I ingested. I ate only one new food at a time as I learned what worked for me. I found that ground beef was problematical early, as well as tomato sauces and red wine. So I restricted those items. Highly seasoned and spicy foods did not seem to create problems. Pasta still causes me some problem, especially here in Italy where it is not cooked to the softness I need. Al dente here is simply not cooked enough and pasta tends to just sit in my stomach for long periods of time. I cook my pasta a bit longer and have fewer problems. In general when I go out to restaurants, I look at the appetizer menu first to see if I can see if there are interesting things there. I am restricted to 8-10 bites per meal so a full dinner is out of the question. I either share my meal with my wife or I will order an antipasti (which often I can’t finish). I love a bite of dessert and often get to share one either with the table or my wife.

What overall effects has it had on you?
As I stated before, it has totally changed my life. I am healthier, and working on getting stronger. I no longer inject myself with insulin. I look a lot better and enjoy wearing nice-looking clothes. I have been extending my skills in the kitchen. So I have a new life, and hopefully an extended one. I enjoy what I do, who I am and how I look now.

What about your family and friends, what are their perceptions?
The role of family and friends are critical in dealing with the issues of the post surgical time and your subsequent weight loss. They can sabotage you by trying to get you to eat more than you should. They can affect your self-esteem by saying “You are too thin”, “You need to gain some weight” or “You don’t look healthy.” Or conversely, if they are supportive of your weight loss they can be inordinately helpful. You need to be sure how you feel about the comments from family and what they say about them as well as you. Friends who have known you at your larger size will have some issues with your weight loss. But if they are true friends they will understand why you did what you did. This is an ongoing process of discovery and change. Try to minimize contact with those who are not supportive and increase the contact that is supportive.

Conclusion and processes
This is a life-changing process. If you did it for the right reasons, the results will be wonderful and healthy. If you did it for the wrong reasons, the end result can be problematical, like regaining the weight so dearly lost. It is important for each person contemplating this radical process, to fully understand the whys of their weight as well as the reasons for changing it. Myself, I will never allow myself to go back to being heavy again. I hope these answers have helped. Please remember they are based upon my experiences and the people I have met who are either contemplating the surgery or examining the after effects.

Sunday, February 21, 2010

Current Recipe Index by entry

The little bites- Antipasti and Tapas
Basic tomato topping for bruschetta or crostini:
Basic cream cheese topping

Braised Pork and a Smoked Salmon antipasto
Braised Pork with onions and raisins
Smoked salmon and crema with chives

Beer Bread and Fish Stew
Beer Bread
Kurt’s Fish Stew

It’s just chicken
Chicken and Sausages with peppers
Grilled Chicken in orange mustard marinade

If it swims, it's probably good for you
Fish poached in sugo
Salmon Patties
Slow cooked tuna
Grilled fish kebabs

Shrimp, Scallops, and Squid
Bacon-Wrapped Ginger Soy Scallops
Spicy Shrimp with Mangos and Snow Peas
Scarred Squid
Marinated shrimp

Antipasti, Parties and some new clothes
Sautéed mushrooms and Marsala
Stuffed peppers
Fresh mozzarella slices with olive oil and salt

Today its Eggs
Baked eggs with Spinach
Baked eggs with wine and Asiago cheese and chicken and apple sausage
Artichoke and mushroom frittata
Asparagus and steamed eggs (alone or wrapped)
Cheddar Cheese Egg Casserole
Tortilla Espanola with Aioli

Condiments that add excitement
Apple or Pear mostarda
Lemon or citrus mostarda
Pear and Ginger mostarda
Dried Apricot and Onion Conserve
Fig marmalata
Pepper marmalatta

It's some more fish
Tuna Salad undone
Blackened spicy fish
Grilled fish with Spring Herb Hollandaise Sauce

Friends for dinner
Salmon crostini
Oven-dried tomatoes and marinated mozzarella
Stuffed, deep-fried squash blossoms
Pumpkin filled ravioli
Veal scaloppini

I know! More fish.
Baked Fish fillets

Foodies, chefs and cookbook authors
Baccala and potato bruschetta
Tomatoes with mozzarella
Crostini with peperoni agrodolce and Strachinno.
Sweet peppers stuffed with a sausage and cheese mixture
BBQ salmon
Braised chard with tomatoes

Comfort Foods -1
Neapolitan Meat Loaf
Meatloaf with Roasted Tomato Relish and Roasted Garlic Mashed Potatoes
Albondigas (Meatballs in Garlic-Tomato Sauce)
Lamb Meatballs in Almond Sauce
Chicken Sausages

What about Pasta?
Potatoes with two cheeses (mozzarella and pecorino),
Ricotta with spinach,
Ricotta with lemon and anisette, and
Pumpkin with potatoes, spices, amaretto cookies, Parmigiano-Reggiano or pecorino cheeses.
Smoked salmon, mashed potatoes, chopped spinach, parsley, and lemon peel
Smoked trout in place of the salmon and without the spinach.
Chopped spinach and mushrooms

Some different takes on fish
Spanish Salt Cod Fritters with Spicy Tomato Sauce
Sea bass with pesto, zucchini and carrots cooked en papillote
Moroccan Grilled Salmon
Grouper Poached in Olive Oil With Grape Leaves

Working as a cook in Italy
Turkey scaloppini with artichokes lemons and olives
Umbrian chicken liver pate
Tagliatelle with pesto and grilled fish
Black cabbage with oven dried tomatoes and pancetta
Sweet and sour cipollini

Italian antipasti
Crostini with funghi pate
Crostini with Umbrian chicken liver (fegatini) pate
Crostini with cannellini bean puree and caramelized onions and garlic
Crostini with fresh ricotta, dried peperoncini, salt and honey (heated)
Crostini with chopped spiced tuna and tomato
Crostini with sausage and stracchino, Parmigiano-Reggiano and spicy chutney

Primo piatti - First plate sauces
Basic pesto sauce
Sugo do pomodori e verdure
Sugo di Cinghiale (Sauce of Wild Boar, Herbs, Olives, Juniper Berries and Wine)
Sugo all'amatriciana
Sugo alla Puttanesca
Bechamel sauce and variations
Gorgonzola and cream sauce

Christmas in Umbria
Crostini (bruschetta) with braised cavolo nero and anchovies
Spicy shrimp
BaccalĂ  pate

Felice Capodanno, New Year's Eve 2009
Frittura of fennel
Tagliatelle with Classic Meat Sauce
Grilled Marinated Leg of Lamb

Comfort Food with an asterisk
Crispy chicken and dipping sauces
Barbequed Brisket (oven)
Paprika-Glazed Baby Back Ribs
Pork Chili
Corn Bread

Leftovers: Making something good from stuff in the fridge
Barbecued chicken salad
Basic hash
Surfer stew