So, as many of you may or may not know, I recently (July 2) had bariatric surgery. It was done for a variety of reasons, but the TL;DR was basically I didn’t want to die. I love my union and the health insurance that is a benefit of membership. All I’m on the hook for (so far) is the psych evaluation which turned out to be not in network (but that’s another diary, you came for the food).
As far as bariatric surgery goes, its main purpose is for the recipients to lose weight quickly. To accomplish this, all versions do something in the procedure to make the stomach smaller, whether to band it, bypass it, or to simply remove most of it. The result is that the patients consequently must eat much less—about 4.5-5 ounces at a time—but 5 times a day. Anything more and my stomach literally HURTS. This severely reduces caloric intake, resulting in very rapid weight loss. See the picture above. The left hand picture is a typical plate. The right hand is closer to a bariatric size. HOWEVER—SURGERY IS NOT A FIX-ALL FOR THE OBESITY PROBLEM A PATIENT HAS. The patient can easily regain all weight lost. Join me and explore the stages of eating and some typical bariatric cooking I’m discovering on the way
Anyway, I had the VSG, or the Vertical Sleeve Gastrectomy. See below:
What they do is basically remove 80% of your stomach. Which means you can only eat maybe a 5oz meal tops. Even though it’s lathroscopic, this is major surgery. Compared to other bariatric surgeries, the stitches and what not are extensive—although there are fewer complications than a bypass. Which means a long transition period to regular food. So here are the stages. The times vary from surgeon and nutritionist team to team:
STAGE ONE: Clear liquid: This is the immediate period after surgery. It usually lasts a week. And it’s just that. Nothing but clear liquid. Broth, water, sugar free popsicle, sugar free jello, and the like—except red. Oh—and clear protein. Lots of it. And it all must be one at a rate of ONE ounce every 10 minutes.
Once you get to Stage Two and beyond, nutritional requirements become your life forever. You MUST have at least 80 grams of protein a day. Side effects of not getting your protein include your hair falling out. You MUST take a bariatric multivitamin at least twice a day for the rest of your life. Side effects of failing include severe malnutrition, bones disintegrating, and your teeth falling out. You MUST keep sugar intake low—under 16 grams per meal. Side effects of failing include dumping syndrome (think colonoscopy prep but from both ends). You MUST keep your fat intake to less than 10 grams per meal. Side effects of failing include malabsorption of key nutrients like protein. Oh—and here’s a curve ball: No liquids a half hour BEFORE you eat, and a half hour AFTER you eat. ESPECIALLY the after part.
STAGE TWO: Full liquid: My team kept me on this stage for five weeks to help heal the stomach incision. It’s basically meal replacement products, protein shake,s, strained cream soups, skim milk, that sort of thing with at least 64oz of water during the day. When I was on full liquids, I was consuming around 700 calories a day.
STAGE THREE: Puree: My team had me on this for a week. Here is where I was able to cook again. Basically, think baby food with more protein and less sugar. My first puree attempt was a chicken and veggie thing that something went wrong and I burned out my blender. However, I was able to make a killer tuna salad and puree that. Just some tuna, a bit of giardiniera, a shallot, and a bit of mayo and run it through a smoothie maker. And yes, texture of baby food, but a bit thinner. But packed with good tuna salad flavor. Also on puree stage you can have scrambled eggs. But one of the most popular recipes on puree stage passed around on ALL the bariatric boards is the Ricotta Bake. Essentially a baked ricotta
It starts with the ricotta. I’m using stuff made with part skim milk. I wouldn’t recommend fat free, because it’s like a lump of white. Anyway, I have peccorino, some shredded mozzarella with 2% milk, tomato sauce, and seasonings. Ricotta is basically like eating paste, so you have to really season it. I have S&P, some excellent hot pepper flakes (smoked. Try flatiron pepper company) a ton of Italian seasoning, hot sauce, some dill (it made an interesting blend), and an egg to bind. That shallot and chicken you see I added after I got to regular food stage to pep things up. Cause the bake is good and I like to keep it in rotation. Anyway, mix the ricotta, egg, one ounce of grated peccorino, and all the spices. (plus chicken and shallot) and mix. Spread in a greased baking dish, cover with sauce and sprinkle with mozzarella, and here’s the result:
Serve into approximately 4.5 ounce servings by weight.
STAGE FOUR: Soft foods: Finally some pictures! I didn’t know if I could have this in puree, but I tried to make a French omelette during my soft food stage. Here was my first attempt:
It WORKED! And the inside was practically perfect too. All my other subsequent rolling attempts have been meh as either the non stick on my brand new skillet has worn off or I’m not using enough cooking spray. (can’t have too much fat) But soft foods in terms of meat means meat you can kind of mash to a past with a fork. So things like slices of smoked salmon I’ve feasted on, as well as smoked oysters. But I also make a mean chicken salad:
I’m using canned chicken cause it’s easy. But shallot, poblano, garlic, dill, giardiniera, hot sauce, S&P, and just enough mayo to hold it together. Again, we’re talking 4.5 ounce servings by weight. Mash the chicken with a fork to get thin shreds. Add everything and enjoy.
STAGE FIVE: This is where you get to eat everything everyone else eats. But not really. Say goodbye to pasta, bread, rice, deep fried things, all that good stuff. The pouch (your new stomach) only has room for the necessary nutrients, not the empty calories. So here’s a thing I made the other day. It’s basically the first puree I tried, except I added a can of cream of celery to the puree. If I make this for guests, I’ll add cream of celery and make it a casserole, but since this is for me, I took it out.
So I chop up the leeks and poblano, add them to my sautee pan with cooking spray, add some broth to help the sweat, then add a nice bunch of the garlic. Then chop and add the artichoke hearts and more broth and cook down until soft and tender. Make a hole in the pan and then add the chicken breast. Add broth until it comes halfway up the thickest part of the breast. Turn the heat to high and boil for 5-7 minutes. Cover and turn the heat off and walk away for 20-25 minutes. Let cool, then portion the chicken into 3 oz portions and add 2 oz veg. Makes about 5 servings, with a couple of ounces of extra veg to use in eggs or like that.
So now, all my cooking needs to be high protein, relatively low in fat and sugar. This gives me a diet of between 1000 and 1600 calories a day depending on what I cook.
So, as I embark on this long strange trip, what are YOU having for dinner?