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

 

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 the 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 the 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 70 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, with a side of 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) meals 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