Portion Control

Image courtesy of Treehugger.com

The idea of what constitutes a "serving" has been an ever-shifting idea to Americans for quite a while now. All across the Internet, usually on health-related sites, you can find lovely pictures like the one above showing what portion sizes were in years past compared to today. The difference? Today's are uniformly huge compared to what was normal for generations past.

Now, that might not be a bad thing if we as a country had any concept of "later". You know, eat half now, eat half at some point in the future. But along with our expanding menu items is this cultural concept that food waste is bad (which it is), so we should address food waste by clearing our plates any time we eat (which we shouldn't).

This one-two combo of Rules At  The Dinner Table may have single-handedly created our current obesity epidemic. We are given more food than any reasonable person needs in a single meal, then forced by parental or societal pressure to eat all of it. To do otherwise would be "wasteful". And, before too long, this practice becomes "waistful" instead.

I am not unfamiliar with the problem, heaven knows. I used to act as our living garbage disposal. Lor would regularly eat until she was full, then I would finish her plate. At family gatherings, I was the one who was urged to have "just another serving" so food would not go to waste. I finally developed the ability to eat so much that I was perpetually hungry - my digestive system grew habituated to the idea of processing food essentially 100% of the time. Eventually, this led to 300+ pounds, knee surgery, exhaustion, etc. The only way out was bariatric surgery, to correct my out-of-control digestive mechanisms.

On the way to visit the family yesterday, we decided to stop for lunch. Finding places to eat has become challenging, thanks to the "no bread" restriction, but we happened to be driving by a Chipotle, home of gigantic and customizable burritos and bowls. We quickly designed a "steak bowl", which is basically burrito innards in a bowl. Here's what came in our bowl:

• 4 ounces of steak
• 4 ounces of pinto beans
• 4 ounces of shredded cheese
• 2 ounces of guacamole
• 1 ounce each of salsa, sour cream, and lettuce.

Yeah, just the innards, with no tortilla or rice, was over a pound of burrito materials.

Pre-surgery, I used to be able to finish an entire burrito, then eat whatever remained of Lor's. Yesterday, we each grabbed a fork and started at opposite ends of the bowl. Within 15 minutes, we were done.

We had each managed just about a quarter of the bowl, leaving more than half to be put in a box and taken home. I had another fraction of it last night, and will probably add an egg to it this morning and finish it off for breakfast. This is literally all I can manage anymore without making myself ill.

So, my surgery works - no big surprise there, right? But the real question is, why didn't I do this before obesity set in? Why did Lor and I not just order single entrees and split them? Why did I refuse to box up leftovers and take them home, committing to cleaning off both our plates at restaurants instead? Why did I never learn to say "No, thanks" when told to eat more at family gatherings?

Somewhere in the back of my mind is still a version of me that cringes at throwing away food. That feels compelled to eat just one more bite, that is experiencing a compulsion to clean off his plate. Every day, I am having to argue with myself, to remind myself that a diet of 800 calories a day gives me very little room to screw around with - I need to get in what I need, and no more, lest dire consequences result.

While Lor and I get a handle on serving ourselves things like 5 cucumber slices, or 24 almonds, I would urge you that are not currently post-surgical to experiment with smaller portions. Cut recipe ingredient lists in half. Order a la carte, instead of full entrees. Split meals with a loved one. Experiment with separating half of your meal into a to-go box at the beginning of your meal, then "finish" the remaining half, taking the rest home for later consumption. Do what you can to limit that intake now, so that you don't need to have 80% of your stomach (or more!) removed to get a handle on your weight.

Most of all, eat what you love, just less of it. Focus on taste, texture and sensation. Don't eat mindlessly. Life is too short to waste on indifferent dining.

Wishing I Had Known All This 15 Years Ago,

- Hawkwind

In Transition

(Transition Offense, for those who have no idea what I am referring to here.)

I got to spend some time at ABQ Health Partners Bariatrics yesterday for my 1-month surgical follow-up. My Nurse Practioner, Patricia, laughed at the "oops, I ate bread" story, expressed concern that my blood pressure was too low, and congratulated me on my continued weight loss. She then warned me that a stall might be coming as my diet changed, and then approved me to move to the "regular food" diet - ready to eat any food I wanted, provided I abided by the rules we have been getting hammered into us for the past several weeks. You know: protein first, no liquid before or after meals, less than 20 grams of carbohydrates with any meal in a day.

With that, she released me into the wild. Total time in the office: 19 minutes.

I stood blinking in the sunlight outside the office, my head swimming at how quickly everything took place, and then realized that I was, finally, able to start eating like a normal person again. Admittedly, a normal person who eats 4-ounce meals that take 30 minutes to ingest, but, you know, mostly normal. 

So...now what?

We briefly discussed going out to a restaurant to celebrate, but after the Panera disaster on Saturday I was not really feelin' it. Other than steakhouses and seafood joints, I could not think of any restaurants who specialized in high-protein, low carbohydrate fare, so I decided to just skip it. Instead, we headed to the grocery store.

Where I bought greek yogurt. With fruit in it.

I remember 6 weeks ago, Lor's absolute delight in wandering the aisles of Trader Joe's and buying all these items she had been missing, and felt kind of jealous. I felt no sense of joy, really. No overwhelming relief that the worst was past and now I could start enjoying my new diet. Mainly, I felt panic. How was I going to handle 60 grams of protein a day without using protein shakes? I felt like someone had taken the training wheels off my dietary bicycle, and I was now teetering precariously as I rolled down the street.

So, instead of a celebratory meal, I had a P3 instead:

12 grams of protein, and roasted meats, hard cheese,and nuts - all things that have been denied me for weeks now. That settled me down the way a stiff drink used to. Heck, eat three of these a day, with two yogurts for snacks, and I am already upwards of 50 grams of protein, right? Nothing to this 60 grams a day thing!

Then, for dinner, came Lor's secret weapon. It turns out she had been planning for weeks to make us a pizza to celebrate my return to real food. Not just any kind of pizza, though - a pizza whose crust was made out of baked ground chicken.

Yeah, let that settle in for a bit. It is a real thing: Chicken Crust Pizza.

Except, instead of going all "veggie friendly", Lor piled it with beef marinara, Canadian bacon, regular bacon, and fresh mozzarella. A single slice of this heavenly marvel came in at a whopping 23 Protein, with only 4 Carbs. The best way I can describe the taste of the crust is a deep dish pizza crust cooked in an oven at the same time as a roasting chicken. We (barely) managed a slice each. (Mind you, each slice is about half the size of a standard slice of pizza. So, yeah, pretty nutrient-dense.)

So, yeah, maybe this "real food" thing will work out after all.

Now I Am Ready To Go Back To The Grocery Store,

- Hawkwind

The Mathematics of Post-Surgery Diet

Photo Credit: Rain Rabbit via Compfight cc

The joy over getting to eat "real food" again didn't last very long here, now that reality has set in. And the reality is: 2 Tablespoons of protein based food and 1 Tablespoon of "Other" does not a meal make.

Consider the simple mathematics here. One of our favorite dishes has been the "Frittatas" that Lor has been making for a couple months now. Essentially crust-less quiches, they are little baked disks of egg that I originally discovered at The World According To Eggface. These tasty treats can be filled with any number of things, making them a perfect post-surgery food.

However, when they contain nothing but egg and cheese (all that is allowed in Stage 3 of post-surgery recovery)...their nutritional value drops pretty dramatically. Consider the numbers: One large egg works out to about 6 grams of protein. One cup of shredded "Mexican Blend" cheese contains about 24 grams of protein. A frittata recipe calls for 4 eggs (24 grams of protein) and 4 ounces of cheese (12 grams of protein). This mixture is then ladled into a mini-muffin pan, containing receptacles for 24 mini-muffins. 36 grams of protein, divided by 24 frittatas works out to around 1.5 grams of protein per frittata.

A recently surgically reduced stomach can handle usually 1, maybe 2 of these little guys.

Have you spotted the problem yet?

3 grams of protein, multiplied by 3 meals per day = not nearly enough protein intake for the day. A full day's worth of protein for Lor, measured in frittatas, would work out to 42 of them. No way to handle THAT load post-surgery.

OK, so let's just do the egg stuff for breakfast, instead of all day. How about we have some canned chicken for lunch instead? A serving of canned chicken, happily, is 2 ounces - just about the amount a post-surgical tummy can handle. 2 ounces of canned chicken works out to 9 grams of protein. You can dress it up, maybe, add some mayo or some chopped celery or something, but at the end of the day, 9 grams of protein is what you are going to get.

So, Breakfast of 2 frittatas = 3 grams of protein. 2 ounces of (hopefully decorated) canned chicken = 9 grams of protein. That brings us to 12 grams for the day. Dinner had better bring it hard.

So, let's select something that we are always reading about as a "natural super-food": Salmon. Surely, some canned salmon for dinner will totally get this daily diet done, right? Let's see...a serving of canned salmon is...3 ounces. Ouch. That is never going to work, not immediately post surgery. Let's cut that number in half then, try to work our way through 1.5 ounces instead. A full serving of canned salmon would be...hey! "17.5 grams of protein"! Excellent!

Oh...right. Right. We're only eating half a serving. OK, so 8.75 grams of protein for 1.5 ounces. Less than canned chicken, then. Depressing. So Breakfast was 3 grams of protein, Lunch was 9 grams, Dinner is 8.75 grams. 20.75 grams of protein, total. 

So, that was depressing. Where else can we get some protein...oh, right! Snacks!! We get two yogurts a day, too! So, let's grab a yogurt for each of our snacks during the day. Each of our Dannon Greek yogurts is worth...12 grams of protein. So, 2 yogurts works out to 24 grams of protein! Which brings us to a total of...44 grams of protein for the day. Out of a requirement of 60 grams a day for Lor.

Well. That sucks.

Guess we are not done with those freakin' protein shakes just yet after all.

Wondering How I Am Going To Manage 100 Grams A Day When It Is My Turn,

- Hawkwind

The Choices of the Unwise

Yesterday I made some poor choices.

And no, not the ones you are thinking I made. I did not stop off at Ronnie McDoncald's house then swing by the grocery store on the way home to buy a chocolate cream pie. No, instead, I sort of forgot to eat. 

The evidence is right in front of me, in the MyFitnessPal app set up on my phone. (An aside - if you are trying to lose weight, embrace MyFitnessPal. Not a kickback in it for me or anything - it is just that good.) Yesterday's breakfast is listed (Decaf, English Muffin with carefully controlled amounts of Peanut Butter and Jam, topped off with trail mix), but then, for the rest of the day...nothing.  Factor in the exercise I did last night and I netted a whopping 469 Calories for the day. Not good.

I can also guarantee that I didn't have enough water - I remember filling my 20 oz. water bottle one time. Tack that on to my 14 ounces of decaf (I have a BIG coffee cup), and I am almost 30 ounces short of my minimum intake for the day.

Far from being a "diet victory" (Yay! Under 500 calories!), this was a loss of massive proportions. For one thing, today I feel like crap. My head is pounding, my stomach is upset, and I could not force myself out of bed this morning. Hangover, anyone? I didn't even get to catch a buzz at the front end in order to earn the day after. 

But, the real problem is that post-surgery, this kind of behavior will get me hospitalized. Both dehydration and malnutrition are major issues for those that have gone through any kind of bariatric surgery. Pulling this kind of stunt after my sleeve is installed will be every bit as bad as binge eating, and more dangerous in the short term.

So, what happened?

To be honest, I am not sure. I diligently prepped all 6 meals and snacks for Lor yesterday, so it isn't like I was never in the kitchen. Since her liquid phase started, I have not been eating my "real food" at the same time she does, or in her presence, out of respect for her pre-surgical process. But yesterday, somehow, I just never got hungry, and never remembered to eat after I had created (blended) a meal for Lor. Despite a busy day,  I had plenty of time. I just never got around to it somehow.

And getting kickstarted this morning will be even more difficult! Ever tried to eat with a hangover? If you haven't, good for you - but the rest of you know what I am talking about. It isn't like I can have a Bloody Mary with an egg in it. I can't even have fruit juice. Instead, I am going to have to re-hydrate until I can eat something, then wait for my day to normalize. Joy.

The lesson we should all carry away from this? If you are dieting, especially if you are pre- or post- surgery, DON'T SKIP MEALS. It creates bad habits, and you won't like the short-term effects either. You have been warned.

Wishing I Could Put My Head On a Shelf Until The Feeling Goes Away,

- Hawkwind

The Memorial Day Minefield

Photo Credit: smartvun19 via Compfight cc

Since it is the "official" kick-off for summer, we tend to spend some time with our families over Memorial Day weekend. In both of our families, get-togethers mean food - lots of carbs, lots of sugar, lots of alcohol. For Lor and I, this meant that this weekend was going to be a series of excellent chances to really screw things up. Here's how we did.

Saturday was the combination Mother's Day/Father's Day/My Birthday get together at my parent's place. Mom was out of the country on Mother's Day, and both Father's Day and my birthday this year will be taking place during Lor's first week post-op. We decided to place all our early summer holidays into one giant Memorial Day basket. 

Alongside the usual burgers and brats (without buns they work out perfectly for a low-carb diet), I had requested two special things - beer, and Chili Relleno Won-Tons. What the heck is that, you ask? Take a won-ton wrapper, fill it with spices, ground beef, and cheese. Add a seeded and roasted green chile to the center of the mix. Wrap and deep-fat fry. Heaven. These little bombs have been the centerpiece of the High Holy Day of my family's religious observances (that is, the Super Bowl) for years now - my Dad usually has to make 30 - 40 of them, and we wiped them out every year. Obviously, they will be vanishing from our diet after our surgeries, so Dad made us a dozen of them. I managed to only have two and bid them a fond farewell.

We had also planned on bringing one of Lor's homemade sheet cakes, but sanity prevailed at the last minute. We baked a dozen small cookies instead of a birthday cake. I had two and called the whole thing a win. I had been planning for this party to be my final beers ever as well, but 2 beers escaped and made their way into my fridge. Since Lor doesn't drink beer at all, I felt I would not be sabotaging her liquid diet by having them at some point in the future. I decided to hang on to them and drink them later...maybe during the first week of Lor's pre-surgical liquid diet. Everyone I talk to that has gone through the liquid diet phase tells me that I might need them.

Sunday was our gathering with the Lor half of the clan. Same burgers and hot dogs (just wrap 'em in lettuce and your carb levels are perfectly safe), and a metric ton of fresh fruit. Lots of forbidden foods like enchiladas and Rice Krispy treats and potato chips, but we managed to get through without injuring our diets. Well, Lor may have had a 1-inch by 1-inch Rice Krispy treat, but cut a lady some slack - she goes on a month of nothing but protein shakes starting on Wednesday. 

We also got to spend LOTS of time talking about the upcoming procdeures. I described the Vertical Sleeve Gastronomy so many times that I started thinking I should carry a banana around with me to demonstrate the size and shape of the remaining stomach post-surgery. We did hear quite a bit of "I could never do that!", but we also got a few "Tell me a little more about this surgery..." conversations. I am beginning to think we should take this show on the road, trying to bring this whole "surgery to correct obesity" thing out of the shadows and into the light where it belongs. Maybe after both our surgeries - we'll have a lot more energy then.

Nutritional visits, pre-surgical evaluations,  psychiatric appointments, and the beginning of Lor's liquid phase are all taking place within the next 5 days. We have arrived at where the rubber meets the road!

Kinda Happy I Saved Those Last Two Beers,

- Hawkwind

45 Grams to Deconstruction

One of the very first changes that was made in our household was institution of a new diet. Before either of us ever met a dietitian, we looked over the (intimidating) packets of information we were sent home with from our surgical consults, and decided there were changes we could make immediately. We amped up our fruit and vegetable intake via smoothie creation once a day, we got rid of all our sugared snacks (goodbye, Ghiradelli), and we immediately stopped drinking carbonated beverages. But things got a bit more complex after the first visit with a dietitian. We were sent home trying to: A) Increase our water intake to 64 ounces a day (but that is a WHOLE other article), and B) Reduce our three meals a day to 45 grams of Carbohydrates each.

Now, 45 grams is not much. 45 grams is equal to, say, 12 ounces of fruit juice. Or a Whole-Wheat Bagel. Or 3 whole Oreos. It was becoming clear that many favorite foods were going to be vanishing from our lives - not at the "2 weeks before surgery" point, but more like the "right now" point. We began our transition from bread, pasta, and cakes to Kale and cheese.

This is where the support of friends and family members can be HUGE. For example, in preparation for our Easter get-together this year, my Mother called me to ask what could we actually eat? This is going to be great training for our lives post-surgeries when options will be even more restricted. We decided to stick with our usual cookout menu of burgers and brats, just without the use of hamburger and hot dog buns. Add a mixed green salad, and a small amount of fresh fruit for dessert, and voila - Lor and I can participate without feeling like we are screwing up everyone else's meal.

That type of compromise and cooperation is going to be important in the months to come, I think. Both of our families are food-centric, with family get-togethers all planned around who is going to be bringing what food item. As we begin to change our diets dramatically, it is hardly fair to expect every one else in the family to follow along - they didn't require Gastric Sleeve surgery, after all. But this idea of component-based meals, where Lor and I are free to select items or portions that work within our diets while everyone else can eat as they choose, seems to be an excellent solution. We don't want to lose out on the social interaction that comes along with preparing meals and sitting down with the family.

We just want to make sure that we are around for the next few decades, so we can continue to spend time with each other.

Already Plotting For Thanksgiving,

- Hawkwind

PS - Since there has been a little confusion, Misdirected is published Monday through Friday. Saturdays and Sundays are reserved for all the stuff I should've been doing while I was writing and reading other blogs!