Living and eating well after all these years

Originally published Saturday, July 30, in Our Town for the Tracy Press.

This week marked the launch of the revised edition of “Before & After: Living and Eating Well After Weight-Loss Surgery” by Susan Maria Leach.

Leach’s first edition, affectionately known by many in bariatric circles as “the pink book,” has gotten a lot of coverage in this column as I’ve traveled on my journey toward a healthy weight.
I first discovered Leach through her Web site, www.bariatriceating.com, an online superstore of all things a bariatric patient could want or need. It didn’t take me long to find out that her promise of “great taste and good nutrition” was more than just mere words.

The pink book was waiting for me, along with a shipment of protein supplements from her company, when I got home from the hospital after having Roux-en-Y gastric-bypass surgery in 2005.

To this day, I credit Leach’s book and products for helping me to achieve my weight-loss goals without sacrificing my health, appearance or energy.

The revised edition, packaged in a light-blue paperback for convenience, is everything its predecessor was and so much more.

The hybrid of diary, no-nonsense advice and cookbook features 35 more recipes and updated information based on research and discoveries in the bariatric field since the original printing in 2004.

“I have a better perspective as a six-year post-op,” Leach said in an interview this week. “I now understand that people don’t do the right thing automatically. I see so many who give it all up for fast food and sugar, and begin a downward spiral again.”

Leach said she’s realized that many people who have suffered from morbid obesity have a difficult time figuring out how to deal with food. She hopes the new edition’s inclusion of meal plans for every stage of post-op eating will help those people adopt healthier eating habits.

“I offer different good food choices for each meal and simple recipes to combine their grocery list items,” Leach said. “My meal plans train people to create new food patterns that they will enjoy eating and will stick to long term.”

The book’s new recipes reflect Leach’s travels and constant quest for food that is fabulous and healthy. One of her favorite additions is the creamy Tuscan white bean soup, featured on Page 132. She said it’s a replica of a soup she enjoyed with her aunt in Tuscany last year.

“It’s a wonderful reminder of a fantastic trip,” she said. “Plus, it’s a 15-minute recipe that can be used in the earliest stages after surgery but will be a family favorite for years!”
In addition to new recipes, the book also features updated versions of previous favorites, like Leach’s light banana bread.

The new banana bread recipe is a perfect example of what is possible when the marketplace broadens its offerings. She replaces the Splenda (sucralose) and protein powder used in her original recipe with Nature Sweet Crystals (maltitol) and California almond flour.

“This superb sugar replacer makes a delicious, healthy loaf that is indistinguishable from a full-sugar, full-fat version,” Leach writes in the recipe’s introduction on Page 263.

Though the original edition of “Before & After” was a financial success for Leach, she hopes readers feel they get something for their money with the second edition.

“Weight loss surgery was not my first choice; it was my last choice,” she said. “It is so important that people understand it is not a diet that ends at a goal weight; it is a new way of life.”

Product Review: Better Balance Protein Cereal

The folks at Kay's Naturals sure do know their stuff when it comes to protein snacks. I was lucky enough during ASBS to sample a variety of their products, but the Better Balance Protein Cereal exceeds expectation. During the conference, I snacked on the Honey Almond and French Vanilla flavors right out of the bag. This morning for breakfast, I enjoyed the Apple Cinnamon variety mixed with my Fage 0% greek-style yogurt.

Though I like all of the varieties, Honey Almond is my favorite. It reminds me a bit of Smart Start, which was a cereal I regularly enjoyed as a pre-op. Apple Cinnamon tastes like Apple Jacks, and French Vanilla has a great vanilla flavor.

The O-shaped cereal comes in 1 oz. packages, providing 9 grams of soy protein in 100 calories with 1.5 grams of fat and 15 grams of carbohydrate (3g dietary fiber; 3g sugar). The cereal is sweetened with inulin.

Hit or Miss? A definite hit. The Kazemzadehs, who own the company, were nice enough to let me try almost all of their products at the convention tradeshow. Awesome product!

From the "duh" files...

SAN DIEGO -- Though I appreciate the time and effort taken in researching obesity and bariatric procedures and outcomes, some studies make me shake my head in wonder.

For instance, comparing the success rate of bariatric surgery to commercial weight loss programs seems ridiculous. After all, does anybody really think counting POINTS! can hold a candle to rerouting one's digestive tract to reduce capacity and nutrient absorption? That doesn't even seem logical to me, much less a wise use of funding.

Here are two of what I'd call "duh" studies that were presented at the convention this week:

* Bariatric surgery makes people more sensitive to alcohol -- I don't think any of us with gastric bypass needed Stanford researchers to tell us that our rerouted intestinal tract makes us cheap dates when it comes to running a bar tab.
Dr. John Morton, assistant professor of surgery and senior author of the study, was quoted in today's Science Daily as saying, "I've heard the anecdotes of a patient who will drink one glass of wine and get a DUI, but I wanted to know if there is really a difference before and after the surgery."
Dr. Morton later says in the article that most patients aren't aware of this and that Oprah has done the field a favor by pointing it out on her show about the dangers of cross-addiction. I don't know about the rest of the post-ops in the world, but I discovered that fact the first time I tried wine after surgery. I didn't need Oprah or a study to enlighten me. Furthermore, I had been warned by other post-ops about the phenomena long before I ever had surgery, so I don't think it's as big of a mystery as Dr. Morton professes.

* Binge eating and a sweet tooth lead to gastric-band failures -- Just to make sure we're all on the same page here, a team of Swiss researchers reported that those post-ops who binged on food or indulged in sweets experienced a higher incidence of band failure than those who did not. The conclusion? The best candidates for banding are highly motivated patients who don't binge or eat sweets. Wouldn't you say the same thing for any type of bariatric procedure?

Candelas San Diego

SAN DIEGO -- Words cannot describe the dinner I experienced this evening. We visited Candelas on Third Avenue. And I say visited, because it was so much more than just a place to eat; it was an all-encompassing environment with an amazing atmosphere, above-par staff and cuisine that was out of this world.

Our party decided on a collection of appetizers and one entree to share, because making a decision was so difficult. We all giggled a bit when our server, Tony, went over his recommendations on the menu. He said everything was "amazing" but suggested the duck, poblano soup and the avocado salad. We thought he was just angling for a good tip -- until we were presented with the incredible dishes we ordered.

The Carpaccio Franco ($12) had fan of paper-thin raw ahi drizzled with a lemon-cilantro mustard sauce served around a salad of marinated bell peppers, baby greens and tequila-marinated pear. The ahi was so tender that it melted on my tongue, but I would have liked a little more of the sauce to enhance its flavor.

Taking Tony's suggestions to heart, we ordered the Estructura de Aguacate ($11.50), which was a stacked salad of avocado, scallops, crap, shrimp, parsely and mild jalapeno with a light drizzle of mango-basil vinaigrette. The presentation was awe-inspiring. The salad was molded into a cylinder in the center of the plate with ribbons of dressing poured around the edges. It had a delicate flavor, with each ingredient complementing one another instead of competing for attention.

The Crema Fabiola ($14.50) is a stellar puree of poblano chile and cream with a half of a lobster tail poised in the center. The color contrast between the pink and white lobster and the sage-green soup was eye-catching but nothing prepared me for the taste of the soup. It was an explosion of flavor that led a few of us to consider licking the bowl when we were finished.

The only entree we ordered, the Pechuga de Pato Lucrecia ($25.50) was another sight to behold. The duck breast was cooked in its own juices until medium rare and then fanned around vegetables and mashed potato with a light passionfruit sauce. The duck barely required a knife to cut and its buttery texture dissolved easily on the tongue. Our only regret was that our pouches forced us to leave one succulent piece on the plate along with the potato. Even Tony remarked it was a crime.

We had planned to pass on dessert until Tony mentioned crepes covered in a goats milk caramel that sounded heavenly. The presentation was simple, two crepes swimming in thick, rich caramel with pecans sprinkled over the top. We each took only one bite, knowing that a second would leave us sick all night. But that one bite was all that was needed for an instant trip to nirvana. It was the type of dessert that makes you not want to put anything else in your mouth so you can savor the flavor as long as humanly possible and then burst into tears once it diminishes.

I could not even imagine a better way to end the most hectic day of the convention.

A whirlwind of a day

SAN DIEGO -- Thursday was such a crazy day that it took me until Friday to realize that I didn't publish this post. I'm back-dating it so it's chronological:

I sat in today on an interesting session for primary clinicians. The opening speaker was Dr. Sasha Stiles of Kaiser South San Francisco, where I had my bariatric surgery two years ago. Dr. Stiles is the program's medical director, creating Kaiser's Northern California program with Dr. Prithvi Legha (my surgeon). During my time with Kaiser, I grew to know Dr. Stiles more than Dr. Legha because she is the one who handled my pre-operative screenings and post-operative follow-up. I was very sad when my employer switched from Kaiser coverage, because she is such an amazing doctor. At least I'm still able to be in Dr. Legha's capable hands.

Dr. Stiles provided a brief introduction to the Primary Clinicians Tract that was an overview of the advancements made in the treatment of obesity. For a rail-thin woman, she knows a lot about obesity. She sees 6,000 patients a year through Kaiser's bariatric program, and the South San Francisco facility treats about 200 patients a month.

She didn't report anything that was new or earth-shattering but did pose some interesting questions for the audience to ponder. Her over-arching theme regarding the success of bariatric surgery was that it provides hope for the morbidly obese. Hope, she said, is what motivates patients to make the lifestyle changes required for long-term success.

She called the physicians collectively on the carpet for not doing a good enough job in following up with their patients to ensure long-term success. Studies show that dieting is stressful and that even the most successful weight loss programs have followers who fall off the wagon and start over. Dr. Stiles said anticipating this aspect of human nature can make bariatric programs more successfull, too. After all, if you anticipate that after two years, post-ops will stop attending after-care programs and possibly begin to gain back weight, doctors could then build services into their programs to bring those patients back to the fold in a supportive manner.

Makes sense to me. What do the rest of you think?

Food, fabulous food

SAN DIEGO -- It occurred to me last night after signing off that I've yet to post about food. One of the reasons I promote Susan Maria Leach's book, "Before and After: Living and Eating Well After Weight Loss Surgery," (revised edition goes on sale in two weeks) is because it proves that enjoying great food does not end when you go under the knife.

A lot of non- and pre-ops I meet fear gastric-bypass surgery means a life without taste, texture and gastronomical pleasure, but nothing could be further from the truth. If anything, most of us become food snobs after weight loss surgery. I ate fast food at least twice a week as a pre-op. Now, I could hardly be paid to eat at McDonalds or Carl's Jr. -- the food doesn't even taste good enough to be pouch-worthy. I can find something to eat just about anywhere, but I'd rather not waste valuable space in my gastric pouch on mediocre food.

So, what does the American Society of Bariatric Surgery have served at its annual conference? Last year, I made the mistake of thinking that because it was an event about bariatrics, the catering would reflect the needs of bariatric patients. Wrong. What I forgot in my naivete is that the conference is geared toward bariatric health care providers -- not patients -- so the food did not match what my pouch could tolerate. If it hadn't been for the BariatricEating.com booth last year, I would have surgery fainted for lack of protein. That's part of the reason I agreed to help Susan at her booth this year -- I owe her a debt of gratitude for saving my pouch last year.

So far this year, I've been pleasantly surprised. Yesterday's breakfast was the obligatory continental convention fare: pastries, muffins, bagels, fruit, juice and coffee. The BE.com gang picked up coffees and went to the booth to make protein lattes and cappuchinos. I enjoyed a delicious latte made up of Nectar Cappuccino, Matrix Chocolate, Micellar Milk and hot water (12 oz offers about 25 grams of protein). For my mid-morning snack, I sipped coffee mixed with vanilla Micellar Milk and a shot of Davinci sugar-free Englis Toffee syrup and Cinnamon Bliss (a sugar-free caramel replacement that tastes just like a spicy cinnamon roll). OK, I'll be honest: I had two of those for about 20 grams of protein combined.

Lunch, however, offered something for everyone. The buffet featured a selection of salads and build your own sandwiches. I enjoyed a small green salad with tomato-basil vinaigrette and swiss cheese rolled up with deli ham and grainy mustard -- fast, filling and delicious. I was wise and steered clear of the decadent desserts.

Back at the booth, we were serving Revial soy chips (I'll have to review those at a later time), parmesan cheese crisps, AchievOne, Nectar Twisted Cherry mixed with Cherry-Pomegranate Crystal Light, ThinkThin bars and New Whey protein bullets in addition to the Micellar Milk lattes. Again, my body has never been so happy. My blood sugar only dipped once all day.

For dinner, we attended the conference's welcome reception. Again, I didn't know what to expect. Imagine my delight when I spied appetizer tables overflowing with oysters on the half shell, succulent shrimp, snow crab claws, cheese trays, canapes and beef and turkey carving stations. I didn't even glance in the direction of the pasta and dessert areas, though I did spy a few people enjoying chocolate-covered strawberries and baklava. But personally, those are treats in which I could never eat just one. Instead, I helped myself to oysters with Tobasco and fresh lemon, shrimp and crab sans cocktail sauce, green olive tapenade eaten with a spoon, Jarlsberg cubes, and melon-wrapped proscuitto and brie with a dab of cream cheese and mandarin orange (it was easy to set aside the little squares of toast atop which the melon and brie canapes were served).

Heavenly food aside, the best part of the cocktail party was that you couldn't easily tell the post-ops from the non-ops. We were mostly all enjoying the same delicious cuisine combined with excellent conversation. And like I told a couple of very handsome Australian surgeons yesterday, that -- to me -- is what the gift of surgical weight loss is all about: looking, acting and living a normal life. I could have kissed just about every doctor there for that blessing.

New key studies on morbid obesity and bariatric surgery

SAN DIEGO -- The following studies will be released Wednesday at the American Society of Bariatric Surgery annual meeting in San Diego:

The Impact of Bariatric Surgery on Health Care Costs
Date/Time: 8:45 a.m. Wednesday
Lead Author: Anita P. Courcoulas, MD, University of Pittsburgh Medical Center
Key finding: Bariatric surgery reduces health care costs over time, especially those related to medication usage.

Bariatric Surgery in Adolescents: Analysis of 309 Cases
Date/Time: 9 a.m. Wednesday
Lead Author: Esteban Varela, MD, MPH, VA North Texas Health Care System and University of Texas Southwestern
Key finding: Bariatric surgery outcomes in adolescents appear to be as safe as for adults.

Preoperative Weight Gain Does Not Predict Failure of Weight Loss or Co-morbidity Resolution of Gastric Bypass for Morbid Obesity
Date/Time: 10:30 a.m. Wednesday
Lead Author: Michael C. Harnisch, MD, Duke University
Key finding: Gastric bypass surgery can be performed safely with improvements in co-morbidity and extended weight loss regardless of preoperative weight gain or loss.

Presurgery Psychiatric Disorders are Associated with Smaller Reductions in BMI at 6 Months After Gastric Bypass
Date/Time: 10:45 a.m. Wednesday
Lead Author: Melissa A. Kalarchian, Ph.D., Assistant Professor of Psychiatry and Psychology, Western Psychiatric institute and Clinic University of Pittsburgh Medical Center
Key finding: Preliminary analyses suggest pre-surgery psychiatric disorders are related to poorer weight outcome at six months after gastric bypass. Results suggest that intervention to improve psychosocial functioning, especially anxiety and depression, may improve surgery outcomes.

Laparoscopic Adjustable Gastric Banding in Patients >65 Years of Age
Date/Time: 2 p.m. Wednesday
Lead Author: David A. Provost, MD, University of Texas Southwestern Medical Center, UT Southwestern Medical Center
Key finding: Laparoscopic gastric banding provides a safe and effective weight loss option in patients 65 years and older

Dinner at Henry's

SAN DIEGO -- We ate dinner tonight at Henry's, an Irish Pub near the intersection of Market and Fifth. Though Henry's definitely has a pub atmosphere, the food choices were superb. No bangers and mash on the menu at this place.

Eating among post-ops is such a refreshing change from what I'm used to. Five of us are post-ops -- from two to six years out from surgery -- and discussing what to have for dinner is a fun experience in itself. No mention of pizza or fried foods.

The biggest decision we had was whether to order our own entrees or share. We all decided that we hadn't eaten enough during the day so we opted not to share. Us post-ops were copy cats; we each ordered the salmon with dill cream sauce and a double portion of veggies instead of mashed potatoes. Being the "youngest" post-op in terms of when I had my surgery, I ate the smallest amount but I held my own with the veterans.

What I loved most was watching each of them following the rules even at their stage: No drinking with meals, protein first, eating slowly and chewing each bite thoroughly. We had incredible conversation on topics ranging from WLS issues to work topics to just life in general. It was like a night out with my best girlfriends, except that these girlfriends eat the same way as me.

Gringas like to party

SAN DIEGO -- Popping in for a second after helping to set up the BE.com booth at the ASBS convention center. I've learned many skills in my short time here. For instance, there is a lot of skill behind the building of a trade show booth, particularly when the shipping company crushes most of your boxes and leaves you to make do with damaged products. You'd never guess we had any trouble by looking at it, though.

Susan Maria Leach's new edition of "Before and After: Living and Eating Well after Weight Loss Surgery" hits bookstore shelves at the end of the month. The new version of the "pink book," as its known by many fans, is now a teal blue paperback that features updated information on the various types of surgeries, meal plans and even more recipes than its predecessor. Presale orders are now being taken at BE.com.

The best part of hanging out with the BE.com crew is that I never go hungry. We were all famished at light-headed while working on the booth, but that wasn't a problem because we had plenty of Revival soy chips, Power Crunch and Oh Yeah! bars and Protein DeLite Protein on the Go (chocolate coconut is soooo tasty!). My blood sugar hasn't been as level as it is today in weeks -- and I've been traveling -- not too bad, if you ask me.

Flying Southwest

Even after two years, the novelty of flying at a normal size has not worn off. Though I still feel like a world-class klutz when trying to negotiate my suitcase and carry-ons throughout the maze of airport lines and security checkpoints, I'm amazed at how effortless it is to move around -- even when loaded down with all my luggage.
This was my first time flying Southwest. I can see why people enjoy it. The lines weren't overly long, the staff was nice and the peanuts were yummy. I love that the seat belt fits me now, but the best part is still the tray table. Not only does it drop down completely, but I can also cross my legs beneath it!
Off to the convention center...more later

Look out, San Diego

I'm leaving tomorrow morning for the American Society of Bariatric Surgery annual conference in San Diego. My goal is to blog daily from the event but if this year is anything like last year, I'll be lucky to eek out a posting or two each day. The conference is jam-packed with educational sessions, events and an overwhelming trade show.