5 Kitchen Items You Need After Bariatric Surgery

The 5 must-have elements in the post-bariatric surgery kitchen.

You’re been approved for bariatric surgery. Congratulations!

So, now what?

You’ll be going through doctor visits, nutritional counseling, psychiatric evaluations, support groups, and more. I got to carry a notebook chock-full of info about my surgery back and forth from my surgeon’s office and home, looking for all the world like a kid going to extra tutoring after school. You will be buried in information about lifestyle changes, diet changes, and physiological changes.

But, somehow, no one will ever answer the question: what do I really need to have at home to make this experience a success?

Here are 5 items that will absolutely smooth your path as you begin your journey to “The Loser’s Bench”.

1. A Bariatric Surgery App

Baritastic Nutritional Tracking App
Baritastic

Get yourself off on the right foot, and start off by loading a nutritional log app on your smart phone. You will be immediately required to start counting grams of protein and carbs at every meal – make it easy on yourself and allow an app to do the heavy lifting for you. The best apps will include the ability to look up nutritional info on the fly, to track meals and snacks, and even to build your own recipes. We like Baritastic because it also includes things like a weight and BMI tracker, daily water tracker, even timers to remind you when to start drinking again after a meal. We also periodically use UnderArmor’s MyFitnessPal for its ability to build recipes piece by piece and then compute nutritional info based on serving size. Get one and use it daily to keep yourself committed both before and after surgery.

2. A Digital Kitchen Scale

A Digital Chef's Scale
EK9333 Electronic Kitchen Scale

Welcome to the brave new world of measuring just about everything you eat. As you prep for surgery, exact weights are going to be important to ensure that you know exactly what you are putting into your body. Post-surgery this becomes even more important: you will only have a small amount of capacity in your new stomach, and it is critical that you get the most nutritional bang for your buck by carefully weighing and measuring every single thing you cook. Don’t guess! And, for Pete’s sake, don’t try to use an old postage scale that you happened to have lying around in your garage. Ahem. Get yourself a new digital scale that allows you to easily zero between measurements.

3. A Water Bottle

Refillable Water Bottle
Quench water bottle

One of the things that will get hammered into you from day one after beginning the surgical process is hydration: dehydration sends more bariatric patients back to the ER than any other complication post-surgery. The general rule of thumb is a minimum of 64 ounces of water a day, every day, for the rest of your life.

Let’s do a little math, shall we? 64 ounces times 365 days = 23,360 ounces of water a year, every year, forever. As of this writing, a case of 24 500 ml/16.9 ounce Dasani water can be picked up at Wal-Mart for $4.98.

You’ll be drinking 4 of those bottles every day to hit 64 ounces a day. At 20.75 cents per bottle, that means you are spending 83 cents on water every day, which works out to $302.98 every year. Not to mention the fact that you will also be generating 1,460 plastic bottles a year that you are (hopefully) recycling.

Instead, buy a refillable water bottle and a water purifier of some kind. Or, even go all-out like we did and get a dispenser and use large refillable 3 or 5-gallon water bottles with it. You’ll be paying around 50 cents a gallon for this water, on average. With 128 ounces of water in a gallon, you’ll be going through 182.5 gallons a year. This works out to only $91.25 + the cost of your water bottle for a year’s worth of water.

Your wallet and the environment will thank you.

4. A Blender

A 1,000 Watt Blender, suitable for making smoothies and purees.
Ninja BL701

If you are just getting started with the bariatric surgery process, you are just beginning to discover the joy of protein shakes. The closer you get to surgery, the more of them you will be drinking. The 2 weeks before and after your procedure, you will be literally living on nothing but protein shakes and the occasional yogurt.

Make life easy on yourself by purchasing protein powder in bulk and making them yourself with a powerful blender. Your brand options will open up dramatically and you can add flavor with sugar-free syrups (like the Torani brand). You can even smooth things out and impart a creamier texture to your shakes by blending ice into your mixture.

Not just any blender will do, though. If you buy a cheap blender and try to mix up a batch of ice-infused protein shakes you will be left with huge chunks of ice in your drink. And, very shortly, with a dead blender to boot. Instead, stretch a little further and get a blender rated at 1,000 Watts or more. This ensures you have plenty of horsepower to work with. Many of the most powerful blenders can turn ice cubes into a substance closely resembling snow. This is the kind of power you want for making your protein shakes.

Though many patients insist they will never touch another protein shake after the surgical process, the fact is that your blender will stay in use.  It purees during the soft food stage, it assists with the creation of soups, and it will be there when you return to protein shakes. Occasionally, you will hit a months-long stall, and will decide to “reset” things with 2-3 days of protein shakes.

Best to be prepared.

5. A (Good) Chef’s Knife

A Good Chef's Knife can improve your cooking in so many ways.
Calphalon 5″ Santoku

“But Jeremy,” you say. “I have a perfectly good knife here in my knife set that Aunt Thelma gave me for a wedding gift.”

Actually, what you have is a piece of knife-shaped metal, improperly designed and difficult to keep sharp, incapable of standing up to the rigors of the post-bariatric surgery kitchen.

Full disclosure: A million years ago I sold knives for a living. I have the scars on my hands to prove it. And, while I do not necessarily think that every kitchen needs a set of $1,000 Cutco knives, I do think that one really good chef’s knife can vastly improve your quality of life in the kitchen.

After surgery, you are going to be cooking a lot. And cooking requires knife work. You will be cubing chicken. Pork and beef will need to be trimmed. You will be dicing vegetables. During late-night snacks you will even be cutting almonds into slivers to sprinkle over the top of greek yogurt. And a single 5-6″ chef’s knife can handle the majority of the knife work you will need in the kitchen.

After you have bought a good chef’s knife (Calphalon, Victorinox, and Wusthof are all excellent brands), try an experiment. Try dicing an apple or a stalk of celery with your old “knife set” chef’s knife. Then try the exact same operation with your new knife.

You’ll thank me then.

By the way, all photos are of items in use in my household currently. No affiliate marketing or other kickbacks apply here – I am not being paid to recommend anything on this page.

Once again, welcome to the bariatric lifestyle! Let me know if you come across any items you can’t live without in the comments below.

Happy Cooking,

Jeremy

A Day In My Post-Surgery Diet

A Day In My Post-Surgery Diet, with photos and nutritional info.

On a daily basis, I answer questions about bariatric surgery. “Is it expensive?” (Yes, but insurance will usually cover it for the severely obese.) “Does it hurt?” (Oh, my, yes, but the recovery period isn’t too long.) “Aren’t you hungry all the time now?” (No, actually, I am very rarely hungry, usually only after physical exercise of some kind.)

And, most frequently: “What can you eat these days?” Followed up by: “How can you live on portion sizes that small?”

The truth is, I eat pretty well nowadays. I just eat much smaller portions and quite a few times during any given day. I’ve borrowed an idea from one of my favorite blogs, The World According to Eggface, and decided to show what a dietary day looks like almost 6 months out from my Vertical Sleeve Gastrectomy.

Breakfast:

A bariatric breakfast of egg, sausage, cheese and fresh fruit.
315 Calories, 18 grams Protein, 5 grams Carbohydrates

Wow, what an overloaded plate, right?

Actually, all our meals these days are served on salad (actually dessert plates, nice save by my editor) plates, not dinner plates. It actually makes the meals look and feel larger.

To start the day off, here we have 1 egg, 1 ounce of sausage, 1 ounce of colby-jack cheese, and 1 ounce sliced strawberries. The egg (77 calories, 6 grams of protein, 1 gram of carbohydrates) can be boiled, scrambled or fried for the sake of variety. Fried eggs are cooked with cooking spray, not cooking oil. Breakfast meats like bacon, ham, and sausage (summer sausage pictured here, 119 calories, 5 grams of protein, 1 gram carbohydrates) are rotated pretty regularly as well. Cheese is an awesome protein source (110 Calories, 7 grams of protein, 1 gram carbs.), and makes an appearance in just about every meal we make at home. And, though it inflates our carb count, we refuse to live without fresh fruits and vegetables. (Strawberries: 9 calories, 0g Protein, 2g Carbs.) Some type of produce puts in an appearance at every meal we have at home.

Lunch:

Our homemade "P3" with deli meat, block cheese, nuts and fruit. Protein Brownie Bite for dessert.
424 calories, 21 grams protein, 24 grams carbs

Lunch happens here right after we return from the gym. It is usually the only meal where we are actually hungry, and we tend to eat slightly more to compensate.

During our pre-surgery diets, we were dismayed to discover how hard it was to eat low-carb meals, Early on we discovered Oscar Meyer’s “P3” meals, which placed a meat, a cheese and some nuts in a small package. We lived on those things for months.

After surgery, we investigated and found out that we could build our own versions of the P3 at home at a comparable cost. We actually get larger portions of higher-quality deli meats and get to add produce as well. Here we have:

  • 1 ounce of deli ham (41 calories, 6g protein, 0g carbs)
  • 1 ounce of colby-jack cheese (110 calories, 7g protein, 1g carbs)
  • 1 ounce of almonds (167 calories, 6g protein, 5g carbs)
  • 5 grape tomatoes (15 calories, 0g protein, 5g carbs)
  • 1 ounce of apple slices (15 calories, 0g protein, 4g carbs)
  • For dessert, one home-baked Protein Brownie Bite (76 calories, 2g protein, 9g carbs)

We do go a bit over our usual 20-grams of carbs per meal restriction here, but given that this happens immediately upon return from a couple of hours at the gym I don’t really sweat it. We have a hard ceiling of 60 grams of carbs each day to work with.

Dinner:

Chicken Salad surrounded by cheese and fresh produce.
244 calories, 20g protein, 11g carbohydrates

 

Dinner is frequently our lightest meal of the day. Lor still loves to cook, so she will prep “normal” entrees, which we will then consume over the course of the next 2 or 3 days. Pictured here is a fairly common meal:

  • 1/2 cup of chicken salad, made with shredded chicken, olive oil mayonnaise, sriracha, and diced veggies (107 calories, 13g protein, 5 grams carbs)
  • 1 ounce of cheddar cheese (114 calories, 7g protein, 0g carbs)
  • 1 ounce of cucumber slices (4 calories, 0g protein, 1g carbs)
  • 1 ounce of grapes (19 calories, 0g protein, 5g carbs)

Finally, every day we will usually also have a snack: frequently this is Greek Yogurt, a product I have really come to love over the last few months. (Dannon Oikos Salted Caramel: 120 Calories, 15g protein, 14g Carbs is a pretty typical choice.)

The Grand Total:

This represents a fairly typical dietary day in our household. Adding up the 3 meals and one snack works out to:

  • 1,103 Calories
  • 74g of Protein
  • 54g of Carbohydrates

Are all days like this? No, of course not. Just like everyone else, we slip up from time to time. But, as our nutritionist likes to tell us, the trick is to have more good days than bad days. Not to mention that hitting the gym 6 days a week provides a nice caloric safety net.

Oh, and an example of what used to be a single meal for me, just for the sake of comparison. A Quarter-Pounder value meal from McDonald’s with fries and a coke? 1,120 Calories, 29g of Protein and 146g of Carbs.

And that’s not even super-sized.

No Wonder I Was Super-Sized,

Jeremy

 

All My Sleeve Wants For Christmas Is…

The activity on the bariatric surgery forums and message boards has been ramping up lately, which is great. I love to see new people joining the ranks, asking questions, and getting plugged into the community. However, any time you get a large number of new folks joining an online “community”, there are going to be questions. And, recently, I am seeing the same questions posted over and over and over again: all varying versions of “when can I have/why can’t I have (insert forbidden item here?)”

I get it – really, I do. Not every bariatric patient got to participate in the awesome nutritional counseling that Lor and I did with Albuquerque Health Partners. Some folks are forced to self-pay and end up getting their surgeries out of the country, meaning they might receive little to no nutritional info at all. So, in the interests of public service, I thought I would share a little information (and personal experience) about the forbidden foods most commonly asked about.

1. Bread/Pasta/Cereal: By far the most asked about food types on the boards, everyone wants to know why they can’t have their favorite go-to-in-a-hurry foods any longer. There are a couple of reasons. First, grain-based products tend to have a very poor protein to volume ratio – 2 ounces (2 standard slices) of bread, for example, contain around 20 – 30 grams of carbohydrates and only 4 or 5 grams of protein. Our lives post bariatric surgery are going to forever be focused on increasing protein intake and minimizing carbohydrate intake, to avoid malnutrition. So, sadly, grain-based products tend to be a non-starter for us.

Secondly, once ingested, bread can expand in the stomach for many of us post surgery (myself included.) This can lead to major discomfort, illness and leads to the inability to ingest anything other than a couple of bites, leading to even bigger nutritional deficiencies. Prepare yourself for life without sourdough bread, lasagna, and Rice Krispies.

2. Bananas: Apparently a very popular subject, bananas hold an odd place within the post-surgery diet. They are a fruit (which the great majority of diets want you to be eating), but they make many bariatric patients ill. What gives?

Bananas, as it turns out, are a natural repository of huge amounts of sugar: one medium banana is worth about 25 grams of carbs, over 15 grams of which is sugar. Strawberries, by comparison, only contain about 7 grams of sugar per serving. Though every patient is different, the higher the amount of “pure” sugar one takes in, the greater the risk of “dumping syndrome”: the rapid movement of food from your stomach to your small intestine. One can only find out where the tipping point is by experimentation, but I can tell you from experience that once you go over, you will wish you hadn’t. Any high-sugar food, even bananas, needs to be approached cautiously.

3. Soft Drinks: Not a day goes by that I don’t read on some forum or another “When can I start drinking cokes again?” Soft drinks may be the most evil and pernicious addiction the world has ever known. So, congratulate yourself, bariatric patients: you have kicked the habit. Because there ain’t no goin’ back.

Soft drinks, aside from being highly concentrated sugar delivery devices, are also repositories of carbonation, which can seriously compromise your reduced stomach size. How? Open a bottle of your favorite soft drink. Attach a balloon to the neck. Shake vigorously. See how that balloon inflates? That is what happens to your reduced stomach pouch any time you ingest carbonation. It inflates, just as it is designed to do, to accommodate larger-than-normal meals for our berry-gathering ancestors. Will one soft drink ruin your post-surgical condition? Probably not. But, I can tell you from personal experience, ingesting any form of carbonation will hurt like hell. You have been warned.

Now, pour your experimental soft drink down the drain. Don’t expose yourself to temptation.

4. Beer: My greatest bariatric surgery regret is that I will never drink Guinness again. It hurts me, deep in the secret places of my heart. But it is a sacrifice I was willing to make, and one that comes up frequently in our discussions with other bariatric patients. So, why no beer?

Firstly, see “no carbonation” just above. Beer is delivered in a carbonated liquid, with all the same drawbacks as soft drinks. (Though better taste, in my opinion.) As much as I love the stuff, I am not willing to inflate my new sleeve repeatedly until I can eat half a cow at one sitting again.

Secondly, beer contains alcohol. (Duh.) And bariatric surgery leaves us very susceptible to the effects of intoxicants – in short, we become cheap dates. I used to be able to put away a 12-pack of beer in the course of an evening. A twelve pack will now most likely put me in the hospital. A single drink of alcohol will have an almost immediate effect, and will then wear off pretty quickly as well. I have yet to start experimenting with this myself but have been able to watch it in others. Be wary of any alcoholic beverage, and avoid any delivered in bubbles.

5. NSAIDS: Post-surgery, pain is a big issue. And many patients are dismayed to find out that their favorite pain relievers are no longer allowed thanks to the changes to their digestive system. Those that have previously taken things like Asprin, Advil, Aleve, Motrin, and other Non-Steroidal Anti-Inflammatory Drugs are informed that these are entirely off the menu and that they need to switch to acetaminophen-based products. Those of us that can’t take acetaminophen (like myself) are basically just out of luck.

But, why?

The reduced size of the stomach pouch has many interesting side effects. The one that affects pain relievers is this: a smaller stomach pouch has a reduced size, meaning a smaller amount of stomach acid (for breaking down things like drugs) and a reduced amount of mucus (for protecting the stomach lining against the tissue-damaging effects of things like drugs.) This means that the corrosive side effects of NSAIDS can burn right through the reduced protective layer in your stomach and start directly affecting the walls of the stomach pouch, resulting in things like ulcers. In a large stomach pouch, the side effects are mitigated by the sheer amount of real estate. In our surgically reduced stomachs? Not so much. Switch to Tylenol if you can. If you can’t, due to medication interactions like mine, you will have to learn to grin and bear it.

Hopefully, this gives everyone a little clearer idea as to why so many of our favorite things have been seemingly randomly removed from our lives. Just remember – there are a host of healthy food items out there that you have likely not even tried yet. Instead of pining over the comfort foods you have lost, go out and discover some new, healthier ones. I, for one, was happy to trade chocolate chip cookies for the ability to walk several miles without being in pain. What are you willing to trade your favorite foods for?

Waiting To Trade Whiskey For Beer Next Year,

– Hawkwind

The Expertise of Experience

I finally made time to get my hair cut yesterday, something I do every 2 – 3 months and really should do every 4 weeks. At my local hair salon, my normal hairdresser was off for the day, so I got placed in the care of someone new – a friendly, chatty mother of four who wanted to know what the inkpot-and-quill tattoo on my forearm represented.
“Oh, I am a writer,” I said as modestly as possible.
“Really? What do you write about?” was her interested query.
“Health issues, mainly.”
And, with that, we were off to the races. She wanted to know about high-protein diets. (Yes, with appropriate nutritional supplementation.) About avoiding kidney and liver damage. (Drink more water, and try to cut out soft drinks.) About which was the truth: fish is good for you because of fish oil, or fish is bad for you because of mercury. (Both, really, but if you really want just the oil and not the taste of fish, just take a fish oil supplement.) I talked more during that half an hour than I probably had in the 8 hours preceding it. (Sorry, Lor!)
It was very interesting to discover how much confusing information is out there in the general public pertaining to dietary health. This intelligent woman, trying to look out for the health of her family, had so much conflicting data that her dietary planning was at a standstill. All of the hard-won experience Lor and I have earned in the past few months, involving radical surgery, major lifestyle changes, and thousands of dollars in medical bills should be available to normal people without having to suffer through the costs of morbid obesity, right? So, how do we go about getting this info into the hands of our friends and neighbors?
Talking about it seems to be a good starting point. Most people, when they hear about my surgery, want to focus on the procedure. But most people I talk to don’t need bariatric surgery. They could get positive results from making a few of the changes that Lor and I have made, without having to go through all of the “other” stuff that went along with our treatments for morbid obesity and diabetes. It is entirely possible that I need to begin shifting my focus when interacting with people on the subject. Like, “Yes, I had to have surgery, but you can have positive results by exercising, avoiding processed foods, and focusing on hydration.” It is an interesting focus shift that I hadn’t really considered previously.
As my haircut wrapped up, my hairdresser commented that, instead of being a writer, I really ought to be a nutritionist or dietitian. I laughed and thanked her, then mentioned that I had a dietitian, and that it was a very technical position requiring many years of education and training.
My hair artist looked me over, and said: “You? What do you need a dietitian for?”
If I Wasn’t Married, I Would’ve Kissed Her,
– Hawkwind