Sunday, October 2, 2016

Puree Diet: What It Means, How To Do It.

Pureed food is defined as food that is ground, cut, chopped, sieved, put in a food processor, or mechanically broken down to a paste.

In Post Op Patients this is an important stage because it allows increased nutrition as well as more satisfaction.  It also provides a time to learn how to eat.

Maximum Amount:

One half cup of food is the maximum at any one time during this period.  That would be 28 teaspoons. 

Spoons come in different sizes - but this would be the "teaspoon" the spoon most often used to drink tea. Not the tablespoon.  Check your spoons and see which one holds one teaspoon easily - it will probably be the smallest spoon you own. 

How Do You Measure - Eating Out

While some people will bring scales, cups, and measure with scientific accuracy, that is the minority. Most of you will guess.  But there are good ways to guess and there are bad ways to guess. 

Bad Way - looking at a pile of food and with your eyes say "that is half a cup." 

Good Way - knowing a small teaspoon is available in any restaurant and that you can guess how close that spoon is to a teaspoon. You know that 28 spoons will be four ounces - so as you eat, count the number of foods. 


Eat Slow, Small, and Easy

Do not eat until you are full.  If you do that you will eat beyond what the stomach will hold. If you eat too fast you will miss the "full" feeling and can rupture the stomach (trust me, you don't want to do that).

Eat one bite every minute.  No matter what surgery you have, you want to eat no faster than this. 

Never Hungry, Never Full

This is your mantra - during this phase of food you will be saying this. Eat slow, small, and easy - and strive not to be full, but never be hungry. 

Drink and Eat - not at this stage

For gastric sleeve patients there is only so much room in the stomach at this stage. Do not drink and eat at the same time.  It is not worth it - you won't get as much in for food.
If you have a Lap-Band you can eat and drink at the same time - we didn't change the size of your stomach, just how it reacts. 

Eat More Often

The great thing about puree foods is you can eat more often. You can eat three, four, up to six meals a day at this stage. You won't need to - but you might find this filling. 

Recipes:

During this stage there are some nutritious and lovely recipes - and but my favorite is the one I made with my son - cauliflower mash. You can do the same thing with broccoli. 




Saturday, August 27, 2016

Chicken Broth -

Post Op Chicken Broth - no "low sodium"

Your body after any surgery is burning a lot of fat.  When you burn fat you also lose a lot of salt. So if you buy some chicken broth or stock, don't buy low sodium. Chicken stock can be made from any chicken you butcher. To see more about making roasted chicken - see my recipe. It really is a great recipe

Better to Make Your Own

Making your own chicken broth or stock is easy. Buy whole chickens and butcher them for the parts, but you have all of those lovely bones that you might otherwise throw away.  Combine those with a bit of water, some pepper, and a bay leaf and you will get a home made broth/stock that is cheap, makes the house smell delicious, and tasty.

Turn the chicken so the backbone is facing you as well as what is referred to as "the pope's nose." This is the very rear of the chicken - and contains many types of oils that are used.  This is called the pygostyle, found by the chicken butt, or "arse" is delicious when the whole chicken is roasted. But in this case we will butcher the chicken into parts to make some great stock. 

Some chef's say that if you roast a chicken you should remove this as the pope's nose delivers a bitter flavor.  In this case, we will .

Why is it called the Pope's Nose?

A parson from St. Mary's in Nantwich was slow to pay a bill to a carpenter in 1400.  The carpenter carved a chicken in a pew with the parson's prominent nose as the rump of the bird. To this day you can see that carving in the pew of the church.  

Why not just get the chicken parts?

Buying a whole chicken is about $2 less per pound at my supermarket.  It is easy to cut it up.

Instructions (see photos below):

From the Pope's nose cut on both sides of the backbone.  There are some muscles as you approach the neck of the chicken be certain to go between those.

Cut on both sides of the backbone. Now you have a chicken spine.  I further cut this spine into one inch pieces.

Flip the bird over and press the chicken down using all your force to flatten the chicken.  Then use a sharp knife and cut on one side of the breast bone. This separates both halves of the chicken. Cut the breast bone out and toss it into the pan for roasting.

Inside the bird you can easily use scissors to cut out the ribs and other bones - also place those into the pan for roasting.

Roast Over Medium Heat

Roast the bones over a medium heat. Turning them with a pair of tongs until you see the color change and you smell the chicken

Add 4 cups of water, one bayleaf and 9 peppercorns (or about 1/2 tablespoon of ground pepper).  

Bring to a boil.  You will get some foam on the top.  Remove this foam - otherwise it will be bitter. After it boils for three minutes put on simmer and it is ready in 30 minutes.

Once you are done then toss away the old chicken parts, and strain the stock into a vessel and you can use it. I like using this for making my pan-made gravy (see the recipe).

How Long Will Chicken Stock Last?

If you put it into jars and seal them and a layer of chicken fat settles in they are good for six months. If there is minimal fat or you start using it, then it is good for a five days.  After that toss it. 

Best Way To Save Chicken Stock

You can also freeze the chicken stock and it is good for a year.  I like to freeze it in an ice cube tray then vacuum seal the cubes of chicken stock. You can then take the cubes out - heat them up or microwave them and you have instant chicken soup - delicious, fresh, and mmm. 



The Pope's Nose - the backside of the bird where we shall begin
This is where the carving of the bird starts.
Using scissors, cut on either side of the backbone. 

Notice these round bits of muscle - cut between them and the backbone. 


Here the entire backbone is cut
Cut the bird in half from the breast bone, then cut the breast bone out


Using scissors it is easy to cut out the ribs, save them.


I've further cut the backbone into one inch pieces and they are roasting over a medium heat 

In a few minutes they have roasted, releasing a great chicken smell. 

Add four cups of water

Add a Bayleaf (you wondered why we had those)

Add some pepper (9 pepper corns)

Bring to a boil and skim this foamy material off - it will make your broth bitter.

Saturday, August 13, 2016

Coffee and caffeine are ok for weight loss surgery patients

You can drink coffee and tea after weight loss surgery - and should!

In my first book, "Weight Loss Surgery: A Lighter Look At A Heavy Subject," I address coffee. Simply put, I give it to my patients in the recovery room after surgery.

Yet on the internet you see the cry for not using coffee after weight loss surgery.  I have to ask - Why on earth?  Even one of the organizations I belong to the almighty American Society of Metabolic and Bariatric Surgery says you should avoid caffeine for 30 days after then ask your surgeon.  Is there a reason for this? None.  They just say it.

Is there a scientific reason? None. Coffee suppresses appetite. Not that much, but a bit.
Coffee is thermogenic - meaning it increases the bodies use of calories.

Maybe some think that coffee causes dehydration. It doesn't.  In fact, when it comes to athletes there is evidence that drinking coffee can increase endurance. Since surgery is like an athletic event - it takes energy to heal from it, it takes endurance to go through it.

Is it a clear liquid? Well - the way some of you make it - yes.  You know the old joke, "If this is coffee get me tea, if this is tea get me coffee."  Clear liquids are used after surgery because of how they behave in the stomach.  Coffee behaves like water, so when my patients are on a clear liquid diet, the first things they drink after surgery coffee is on the list.
Even my son gets coffee in the morning

When I travel I bring coffee.  So if I was in the hospital you can bet I would brew my own

The Aeropress - my portable coffee maker

My weekend variety is made with a chemex
References (because sometimes people have to look things up)

From the ASMBS -  here is their word on the topic (not to be taken as the gospel). https://asmbs.org/patients/life-after-bariatric-surgery

1 Kolasa K.M. et al. (2009) Hydration and health promotion. Nutrition Today. 44:190-203
2 Popkin B.M. et al. (2006) A new proposed guidance system for beverage consumption in the United States. American Journal of Clinical Nutrition, 83, 529-542
3 Silva A. M. et al. (2013) Total body water and its compartments are not affected by ingesting a moderate dose of caffeine in healthy young adult males. Applied Physiology Nutrition & Metabolism, 38:626-632.
4 Killer S. C. et al. (2014) No Evidence of Dehydration with Moderate Daily Coffee Intake: A Counterbalanced Cross-Over Study in a Free-Living Population. PLoS ONE, 9(1): e84154.
5 Ganio M.S. et al. (2009) Effect of caffeine on sport-specific endurance performance: a systematic review. Journal of Strength and Conditioning Research, 23(1):315-24.
6 Goldstein E.R. et al. (2010) Caffeine enhances upper body strength in resistance trained athletes. Journal of the International Society of Sports Nutrition, 7 :5

Friday, March 18, 2016

Roasted Cauliflower Florets

While a whole roasted cauliflower is an amazing food to make - sometimes you need a lot less and you don't want to wait an hour to make it.

These are readily available for those who don't want to chop a cauliflower or if you need less. One of these bags is just perfect for one.

Getting the bag of microwave cauliflower florets is easy. But instead of taking four minutes to zap them in the microwave, I like the flavor of the vegetable after it is roasted in the oven.  It takes a bit longer, but the depth of flavors is amazing, and it makes a great dish for one.

Start by pre-heating your oven to 400 degrees.
The first step - you can do this as soon as you walk in the door even if you don't know what you are going to make. Often I set the oven if I am going shopping for dinner so that when I come home I can quickly prep the food and get it in the oven. Even if I have to cut the temperature to 350 degrees, by the time I open the oven and pop in the food it is going to be perfect. 

Pretty easy to open the bag and spread the florets out on a pan.  You don't need a cookie sheet for these, something smaller will do.

Then the recipe becomes simple. Add kosher salt, pepper, and olive oil.

Place in the oven for 30 minutes- you can leave them - or in the middle of the oven cycle you can stir them around a bit to get other sides toasted.

I have a small pan that I can put these florets into

I buy large quantities of olive oil and keep them in these squirt bottles. Makes it easy to add the olive oil onto the cauliflower.

Even if you have a salt-restricted diet adding some Kosher salt to these won't hurt you.

Fresh ground pepper - it just has more flavor than pre-ground pepper.

Into the pre-heated oven. You can see in my oven I have a lot of pizza bricks. Those serve to retain heat so when the oven door opens and close they maintain a radiant heat. 

Look at these beauties! Delicious- a bit of that brown cauliflower is delicious. These provide a perfect bit of food for one person and I use them often as a base for other dishes.  
I had some Chicken Korma in the freezer that had been made Sous Vide.  So I re-heated it by putting it into the Sous Vide while I was cooking the cauliflower. This added to the top of the cauliflower made a perfect meal for one. 

Wednesday, February 17, 2016

Pork Bolognese

Bolognese is the classic Italian Meat Sauce that is great with almost any pasta.

It is made with "soffrito" - onion, celery, and carrot -which Italians would call a mirepoix. This combined with some great ground pork, and garlic, and finished with a great pasta make a classic dish.

Ingredients:

10 Ounces Ground Pork
4 Cloves of Garlic
1 Carrot
1 Stalk Celery
1 Yellow Onion
1 Bunch Parsley
50 g of Tomato Paste (about 2 ounces)
1/4 cup of Grated Parmesan Cheese

Prep

Peel and mince the Garlic
Peel and small dice the Carrot
Small dice the Celery
Small dice the onion

Heat a pan to medium heat. Add Grapeseed oil and salt and pepper to taste. Break up the pork with a wooden spoon and cook until the pork is browned and cooked through.
Move the pork to a small bowl.  Don't scrape the bits off the bottom we will use those.
Reheat the pan over a medium heat. Add 1 Tablespoon of Grapeseed Oil. Take the garlic, onion, celery, and carrot and place the small diced bits into the pan. If the pan is a bit dry add some Grapeseed oil (1 tablespoon should do it).  Mix together and add salt and pepper to taste. 
Add the 2 ounces (50 grams) of tomato paste and stir in until it becomes darker

To this add 1 cup of water and add the pork

Season with salt and pepper and stir as needed. Should be thick in 4-6 minutes.
Place the al dente pasta into the mix along with 1/2 of the pasta water. Add cherry tomatoes, some parsley, and plate with Parmesan Cheese

Roasted Vegetables

Vegetables:

A roasted medley of my favorite vegetables
I remember watching my grandmother make some vegetable stew and I asked her what she was putting in the pot.  She said, "vegetables." I told her they weren't because they didn't come out of a can. 

Modern transportation means year round vegetables, but of course we have some concerns:

Should we get local?
Should we eat only organic?
What pesticides and herbicides are on our vegetables that might hurt our health?
What about food borne illness - the Chipotle experiment?

Roasting vegetables provides three major benefits to raw:


  • Cooking decreases the risk of food-borne illness
  • Cooking deactivates many pesticides and reduces pesticide residue
  • Cooking makes nutrients more bio-available

But the best benefit of roasting vegetables is -- FLAVOR.  More than boiling, blanching, or microwaving - when you roast vegetables together - especially the recipe below- it is simply delicious.

Begin with the easy one: when you cook vegetables, especially when you roast vegetables you kill the bacteria that might be on or in them. Vegetables are the third leading cause of food-borne illness in the United States. All of those have been from raw vegetables.

Pesticides, it turns out, are chemicals that are broken down by heat. So with roasting vegetables you will be removing up to 95% of the pesticides.  So heat not only breaks down the bacteria, it also breaks down some of the harmful chemicals.

While there are more vitamins in a raw vegetable than a cooked vegetable, the key is what can the human body extract from the vegetable. Multiple studies have found that when people eat cooked foods the body is better able to extract the vitamins from the vegetables.  One simple experiment had people eat raw carrots, then check a blood level of vitamin A.  Then the same would eat cooked carrots and check the blood level of vitamin A.  Turns out cooked carrots is a better source of vitamin A than raw.

That in mind - here is how to make some simple raw vegetables into a roasted medley that will delight you.

Ingredients:

A bag of mixed vegetables
1/2 of an onion
1 lemon
6 cloves of garlic
3 T Kosher salt
3 T Olive oil
1/4 cup Chicken Stock


Today you can get mixed bags of vegetables. They have it prepped for you - you just need to add a few different ingredients.  While you can microwave these - it is more tasty to oven roast them. 

You need to slice half an onion into these nice rings 

Add cloves of garlic (you can take off the paper-like coating) You can crush them or just add them straight in.

Slice a lemon like this- and add to the mix

You will need to add a lot of Kosher salt to the vegetables

Extra Virgin Olive oil (use California or Arizona not European).

Then about 1/4 inch of chicken stock

Place in the oven at 400 degrees and this should be done in 30-45 minutes.  

This is also the basis of a "vegetable trivet" that you can put beneath lamb, or chicken, or pot roast, or any meat.

These roasted vegetables are delicious- and best of all- healthy.