Wednesday, March 23, 2011

Crackers and cheese

There is a commonly held belief in our weight-conscious society that eating slowly will help you lose weight. This belief has been around for a long time and has attained the level of “truth.” But is it “truth”? The hard science behind this “truth” is generally lacking. As a scientist, I believe in the scientific method. This method moves from a question, to testing, to an answer, and then to another question. Science moves forward on the development of a sound hypothesis or question. The next phase is the design of rigorous experiments and the testing of that hypothesis to determine if it can be disproved. It is inherently difficult to disprove an idea so it is imperative that we attempt to do so. If we cannot rigorously disprove a hypothesis, it becomes a theory and therefore simply another question. A lot of the weight loss documentation in the field seems to be based upon proving a hypothesis or justifying the specific question or idea that is posed. It often appears that many of these research efforts are designed ultimately to sell some diet plan, diet pill or quick fix program to those of us out there struggling with weight issues.

Back to the issue of eating quickly or slowly. Dieters are counseled to eat slowly and chew their food many times, and put their fork down between bites. This enforced slowing of the consumptive process is theoretically intended to trick the body into sending messages to the brain that you are full and then this tells you to stop eating, before you eat too much. Fast eating may overwhelm the body’s intrinsic hormonal and psychological systems and allow you to eat more, because the message to the brain that you are full is delayed. I have also said that eating your Eight Bites slowly can be incorporated into a active social process which includes eating with friends and family who have not had bariatric surgery, may not be heavy, and may not be on a diet. So what do we do? Eat fast or eat slowly?

After WLS, your body processes eating inputs differently than before. Eating fast or slow was relevant to the information inputs from the stomach to the brain. After WLS when you are physically restricted from eating too much, a different set of conditions occurs. You are now responsible for how much food is put into your body (stomach or what is left of it). The hormonal and neural inputs have been altered and no longer function at the same level. After WLS, you have to learn to feel that you are full, or preferably one bite less than full and stop eating. Overeating after WLS has a variety of effects. It can be painful from over-distending the stomach or pouch; and it can in the early period immediately after surgery cause the surgical site to rupture causing a serious infection (peritonitis) that is often life-threatening. So after WLS you have to learn to know your body better than you did before. After WLS you have to feel and know when to stop eating.

This knowledge is a combination of stomach capacity and your own ability to look at what you are eating and say that is enough. Enough? That is probably the most difficult thing we have to understand after we have undergone the surgical procedures to lose the weight. How do we know what enough is? If you have lived your life never limiting your capacity to eat, this is a difficult thing to understand. First you have to know how much food you can physically put into that newly altered physical environment called your digestive storage system (previously known as your stomach). Your doctor’s instructions are very clear on how that early period post-surgery should be handled. You are likely drinking high protein liquids, which do not put excessive pressure on your surgical site and also provide you with the nutrition your body needs. It is actually pretty easy in those first weeks and months as you rapidly see yourself losing weight, and losing inches. It is easy to succeed when you are succeeding easily. When you switch to a more normal diet is when things get more difficult. Over time as the weight falls off you start to get back into a more “normal” mode of eating. Breakfast, lunch, dinner, and snacks all become part of your normal life. In a year or more post-surgery you will reach a point where you will not lose any more weight. If you are near your ultimate goal you may be satisfied. If you are not, it may be time to critically evaluate the factors in your nutritional world.

This is the time you need to look clearly at what you are eating, when you are eating, and how you are eating in this new environment. This is a time for total honesty with yourself. You went into this weight loss regimen for a reason. What was it? Was it for your health and the desire to increase the potential for a longer healthier life? An honest appraisal of your motives is critical at this point. It may make the difference between your successful weight loss and the potential to put weight back on.

In the last few months I have put approximately 12 pounds back on and I contacted my doctor. His response was because I had been having my heart issues in January and February, I had cut back on my exercise and also probably was retaining fluid as well. So I increased my exercise after the angioplasty. But I also started to examine what and when and how I was eating. After you have WLS you tend to think that calories don’t really count anymore because you can only eat a small amount of food. It can be a very slippery slope if you stop considering what caloric values foods have. And can be even more slippery, if you neglect the exercise so fundamental to the maintenance of the weight loss.

You need to examine what you are eating in light of both the volume and caloric values. I realize that you are eating much smaller amounts than you used to but it is time to examine the true nutritional value of the food you are eating. The first thing is to make a list of what you ate today. Include the estimated amounts in your list. I created spreadsheet that had one worksheet that was a list of foods, their caloric values per unit, and the total grams of proteins, fats and carbohydrates. A second sheet held a calculation sheet. To start I input the foods I ate the day I created the spread sheet, and I found out my day’s intake was 1600 calories instead of the 800-900 calories I thought I was eating. Wow! In my case I found I was snacking on too many crackers and cheese. Ten crackers were about 100 calories, an ounce of cheese is about 100-120 calories, and a tablespoon of butter is 100 calories. So snacking on crackers and cheese at intervals during the day can add 400-600 calories to your diet. That can take you from 900 calories per day to 1500 calories per day, and gradually put on a few of those unwelcome pounds again. If anyone wants a copy of my spreadsheet just email me at and I will send it to you.

Now back to the original question that started this entry, should you eat fast or slow? A recent research study published by a group of Dutch scientists suggested that eating slowly doesn't make you eat less than if you eat more quickly. The researchers compared what happens to meal size and appetite by having a group of volunteers eat a leisurely two-hour lunch, and at another time, eat the same lunch in just 30 minutes. They found that the volunteers did indeed feel fuller after the leisurely meal, and were still satiated several hours later. But despite feeling full, when presented with an offering of traditional snacks several hours after lunch, the group who ate the slow meal snacked on as many calories as they did following their 30-minute meal. What this means is that regardless of whether they ate quickly or slowly, it did not translate into an unwillingness to snack on post lunch snacks. So in terms of dieting, snacking is a potentially big problem. As I have personally seen, eating typical post WLS meals is not a difficult proposition. However eating snacks between those meals can almost double the total caloric input for a day.


What does this mean for those who have gone through the process of some version of weight loss surgery? The physical restrictions placed upon our eating habits at first keeps you satisfied as the pounds come off. Calories are irrelevant and unimportant. But when you get to the flattened out spot on your weight loss chart, the physical restrictions begin to play a less significant role. It then is up to you. You need to decide what you want to eat, and how often you want to eat. There are three directions you can go here: 1) You can remain at the weight you achieved by balancing the calories you consume with the calories you expend on a daily basis; 2) you can continue to lose weight by increasing your caloric output through exercise; and 3) you can gain weight back by consuming more calories that you expend. Thermodynamics rules this decision making. Snacking defeats the objective to maintain your weight unless you increase the calories expended (exercise). Your doctor can give the mechanism to lose weight, but it will be up to you to maintain that weight. The discipline necessary to effectively make it through this journey can be difficult. Sometimes you just have to sit down and give yourself a good talking to and realize that if your weight is to be what you have sought, it will be up to you. In my case I have given up eating so many crackers and cheese.

Sunday, March 6, 2011

Fried Potatoes and Eggs with Cinnamon Toast

A friend was going to be here on Sunday and I wanted to do their favorite breakfast. Potatoes and eggs, with cinnamon toast. I cut up several good sized Yukon gold potatoes into about 1 inch cubes and put them in some cold water to get rid of a little of the starchiness. The potatoes are not peeled as the skins when sautéed are quite good. Three or four potatoes are about the right amount for two breakfast servings. I always keep in mind how much carbohydrates I could eat as well as my guest. If you do make more than can be eaten that morning, put the remaining potatoes in a bowl and reheat the next day. They are not as crispy but still make for a nice addition for breakfast.

To make the potatoes, I drain the potatoes well and chopped a medium onion into a coarse dice. Into a non-stick saute pan I put about ¼ cup of canola oil and brought it to a temperature of about 330 degrees. At that temperature the potatoes will cook relatively quickly and will not absorb too much oil. I then add the chopped onions and the potatoes and start to quickly saute the vegetables. As they begin to brown, I pour in about ½ cup of water and immediately put a lid on the pan. The water quickly steams the potatoes and when it is evaporated you will hear the potatoes starting to sizzle in the remaining oil. The onions should not burn when using this combination oil and water technique. The vegetables will cook nicely together. When the potatoes are golden and crisp, put them in the oven at 350 degrees to hold until you make the eggs.

Eggs are the salvation of the WLS diner. They are so versatile and nutritious that they should be an integral and important part of your high protein diet. They provide a very high quality protein source and can be served in hundreds of ways. In Larousse Gastronomique, an early compendium of French cooking methods and dishes, there are many pages of egg preparations ranging from the simple to the extraordinarily complicated.

My guest liked their eggs sunny side up and I like mine over easy. To cook a beautifully fried egg sunny-side up, you need to start with a non-stick saute pan set over medium-low heat. You really don’t want to overcook the eggs and want the whites set but the yolks still slightly runny.

Put a pat of good butter in the warm pan to provide rich flavor and break two eggs into a bowl. When the butter has melted and has stopped foaming, slide the eggs from the bowl into the pan and start to cook them gently. The whites will start to cook first and then you can add a pinch of pepper. When the whites are fully cooked but still a bit soft, give the pan a little shake to free the eggs from the pan and slide them out on to a warm plate. Over easy is a bit trickier but you start using the same technique. After you shake the pan to release the eggs you can gently flip the eggs in the pan so they cook for 20-30 seconds on the other side.

Plate the potatoes on a warm plate and place the eggs next to them to serve.

Now to the cinnamon toast. I like using a baguette sliced in half horizontally and opened up flat. Spread the bread with butter and sprinkle on a mixture of sugar (1/2 cup), cinnamon (1 teaspoon) and a small pinch of nutmeg. Place on a baking sheet and then into the oven with the potatoes. Allow the toast to get a light brown and the sugar topping is a bit melted.

Thinking in Eight Bite increments

This breakfast provides a good level of protein in the eggs, complementing flavors in the potatoes and onions, and then a little sweetness and crunch with the cinnamon toast. However you still have to think about the volume you should eat. My estimate of the breakfast portion size is the two eggs, about ½ cup of the potatoes, and a 3” piece of the cinnamon toast. This will give you the nutrition you are looking for as well as a sense of eating a nicely flavored breakfast. Don’t be afraid to indulge your tastes every once in awhile with things like cinnamon toast. There is just no need to eat to excess. Thomas Keller at the famous restaurant The French Laundry in Yountville, California says that he serves small portions because we really only remember the taste of that first bite or two. So tastes and those small bites are important.

Tomorrow I will make a couple of nice espressos, plate the eggs and potatoes, portion out the cinnamon toast and call my buddy to breakfast. It will be a nice way for me to start their day. And it will be the start of a good day for me as well.  So invite your friends to visit and make a simple breakfast to start their day.