What I Am Talking about When I Talk about Portion Control

Several of my recent meals were eaten at restaurants due to my work schedule and out of town guests.  I managed my GERD very well during this time by selecting restaurants and items that I know are easy on my gut (macrobiotic restaurant, salad bars where I can select my own items exactly).   Most importantly -- I ate slowly and did not finish the entire plate, saving leftovers to take home for another meal.   

EXAMPLE ONE

On Saturday, J. and I went for brunch at a "farm to table" cafe-grocery which serves fantastic egg sandwiches.  I ordered mine without cheese/with tomato, and ate half.  Here is the other half on Sunday at home.  I reheated it in the oven and sauteed fresh pea shoots in a bit of olive oil for a side green.   The tea is hojicha, roasted green tea.  It is one of my favorite morning teas but haven't had it for a while after it became a GERD trigger.  This morning, my gut had no issues with any of this food.  Just good eating and drinking!

Sunday breakfast

EXAMPLE TWO

Last Thursday, a friend came to town and we headed to Souen, a wonderful macrobiotic place with three locations in Manhattan.   I ordered the "garlic greens" with tofu, a favorite dish which arrived in a heaping amount on a large plate with a side of brown rice.   Here is how it looked before I began eating:

And later, when I sensed I was sated but not full/bloated:

I took this home, along with the leftover rice, tossed it into the freezer and will enjoy during some lunch this week!

Cranky Update:  This weekend, my cranky gut seems to be calming down, finally, after three weeks of awful daily reflux, some belching, nausea, and constipation.   I need to reduce my caffeinated tea intake, eat mindfully and I think another week-long "food diary" is in order to see any trends that are going on and keep me on track.   Stay tuned!


BONUS LINKAGE

Sue's Health Blog (a health/food blog by a "real person" which seems to be stalled as of October 2011) featured a post on portion control and how triggers are individualized.   She shares her own experience in this post.  

Recipe: Pasta Fagioli with Leeks (Deconstructed)

"Deconstructed" pasta fagioli

At the end of the work week when I've run out of my "Sunday make-ahead" components and the freshest vegetables, or if I just run out of cooking energy or time, one of my fall-back dinners is some kind of pasta-bean combination and a vegetable on the side.  This may involve tomato sauce -- not a trigger for me, but I know tomatoes can be on the do-not-eat list for many GERDites -- but tastes fantastic on its own, using the greens and beans as flavoring.  Eat slowly, savor the complementary flavors, and enjoy!

PASTA FAGIOLI WITH LEEKS (DECONSTRUCTED)

I usually serve this as separate components that can be mixed on one's plate, or not, as desired.   The versatility is endless -- different pasta, different beans, different onion and/or greens, and you've got a new dish each week for a year!  I often grab a small portion for lunch the next day.   One sanity-saving trick for me in managing GERD is to find dishes I can easily divide up into small, GERD-friendly portions, and this is a good one.  

Ingredients:

High quality pasta: I favor Barilla's high-protein line (the yellow box) for flavor and the protein value (the flour includes legume meal) but this is becoming harder to find.   Update:  I've switched to DeCecco, which is much tastier than Barilla!  I've decided I don't need to eat whole wheat products every meal -- a good white roll or baguette, white flour pasta, and white rice once or twice a week is "okay" with me and seems okay with my gut.   Barilla is a favorite brand of mine overall, and I enjoy sorting through the huge selection at Eataly (where the boxes are "direct" from Italy, in all-Italian language packaging).   In the photo example above, I'm using cellentani pasta, a durum wheat corkscrew style pasta with a good "bite."  DeCecco is also from Italy, and holds up very well in cooking.   The wheat variety is excellent!

Dried beans: I am cooking almost exclusively with my own made-from-scratch beans these days, buying them dry at the Cayuga Organics greenmarket stand, soaking for 2 hours and boiling for 1 hour.   The freshly dried greenmarket beans do not require overnight soaking, a big plus in organizing my meals.  These beans are so flavorful on their own they become almost a "spice" to the pasta.

Greens:  In this case, I used leeks, steam-sauteed in a bit of olive oil until softened.   Greens (kale, chard, bok choy, spinach, and so on) steam-sauteed with olive oil and fresh garlic work very well too.  

Resources: The Acid Reflux Solution by Dr. Jorge Rodriguez

I was excited to learn about The Acid Reflux Solution, a new book for treating GERD.    Published in March, this eating-for-an-acid-free-life plan was developed by a gastroenterologist who himself suffered from reflux, and makes sense to me.  Dr. Jorge Rodriguez advocates controlling reflux by changing your relationship with food and, in a word, mindfulness.   Particular "trigger" foods are discussed, but "Dr. Jorge" also advises it's not just particular foods -- but timing, portions, and other factors that come together to manage reflux.  His advice for a healthy gut includes:

• Small portions
• Trigger foods (caffeine, animal fats, fried foods, etc.) in moderation
• Good motility -- lots of fiber to keep things moving
• Reducing water intake during and around mealtimes

My lived experience coincides with his findings, and I love his easy-to-understand explanations and common sense, holistic approach.

Note:  In full disclosure, I have not yet read the actual book but I have a good sense of his philosophy from his website/blog, TV appearances and reviews.  Apparently, Dr. Jorge is on his way to becoming the next Dr. Mehmet Oz!

Dr. Jorge's professional website

Healthy World blog (Dr. Jorge's blog about reflux, eating for health -- well-organized with tags)

Dr. Jorge on The View (April 2012)

Secret Weapon: Fruit/Floral Tisanes

Peach Tranquility, a fruit and floral tisane

When I started my diet management plan for my GERD, I was appalled by the thought of "giving up" tea.  Tea is a big part of my life -- I enjoy it, rely on it, look forward to it, shop for it like other people buy fine wine.  Herbals never excited me.   When I realized that caffeinated tea was one of my triggers, I decided I would minimize the amount of tea I drink daily, reducing it from three cups to one (maybe two, on a hectic day).    By staggering the amount of black or green tea I drink, and by having it later in the day -- not first thing in the morning -- and by going on mini caffeinated tea hiatuses (24-48 hours without any tea), I can usually drink any tea with no GERD side effects. 


One thing that has helped me keep my tea in my diet is my willingness to develop a taste for herbals.  I usually start the day off with lemon verbena tea or chamomile.   By late morning, I have a cup of black tea -- Oolong or a classic black tea (Ceylon, Earl Gray) -- or I'll just have a cup of Pu-ehr in the afternoon.   Before or after dinner, I enjoy another cup of tea.  This one is herbal or possibly an Oolong.

Lemon verbena is a favorite herbal, but "Peach Tranquility," a fruity blend from Teavana, is becoming my herbal tea of choice.   (Note on Teavana:   Yes, this is a mall chain, and yes, the sales help are known to be pushy, but the tea itself is outstanding.  So are the accessories.)  Peach Tranquility is tasty, soothing, fun to brew (look at all that stuff!), and completely agreeable to my cranky gut.

CAVEAT:  In checking around the web, I found a few recommendations for GERD sufferers to avoid fruit-based infusions -- they will be too acidic.   I have no problem with this one.   As always, you'll have to see what works for your particular gut.

Creative Night, 4/11: Books, Letters, and Successful GERD-Friendly Meal Out!

Dinner at EAT, Brooklyn.

In one of our efforts to "de-stress," J. and I have decided to spend one night a week devoted to "creative pursuits."  We both have several projects that are half-done or pending, with "no time" to do them -- something that has been frustrating us.  (Weekends are already stuffed with activities, from greenmarket shopping and prepping food for the week, to bike rides and other fun excursions.)

So, we have launched "Creative Night," one evening a week dedicated to our individual projects.  No housework or cooking allowed (unless "cooking" is one of the creative activities that night).   I'll document my Creative Nights here, as it's part of my de-stressing plan.

Last night's activities involved a trip to the library, writing a note to J.'s parents, and dinner at a restaurant I've wanted to try for months.

THE BOOKS

I am thrilled our library is open late on some weeknights.  I marched in and checked out:

• Tea: History Terroirs Variety, an oversize book on tea harvesting and enjoyment by a noted tea house.
•  When Did the Statue of Liberty Turn Green & 101 Other Questions About New York City, a compilation of interesting questions (and answers) by the New York Historical Society Library.
• The Art of Flourishing: A New East West Approach to Staying Sane and Finding Love in an Insane World, a "how-to" style book fusing Western lifestyles with zen, mindfulness, and other Eastern concepts…not sure how long I'll last reading this one, but there may be a few takeaway points here. 

THE MEAL

Then, I took myself to dinner at Eat, a restaurant epitomizing the "farm to table" approach.   Eating out is always a challenge for my cranky gut and picky palate.   Usually, I find that the vegetarian -- and especially vegan -- dishes served at restaurants are far too spiced.   Cumin, chipotle, black pepper, and other bold flavors muffle the clean vegetable taste I am hoping for.   Even the Whole Foods hot/cold bars are loaded with extraneous spices, wrecking the dish for me (I do not need red pepper flakes on all my vegetables, thank you).   Elsewhere, the one vegan soup is "Spicy Black Bean."

Eat's cooking philosophy matches mine -- that when you have terrific produce, you don't need much more, that recipes should bring out the flavors of the vegetables -- not drown them in counter-flavors, rendering them undetectable.   Nothing ruins a dish for me more than it being too spicy-hot, making my mouth scorched and unable to taste anything other than the "heat."  That's my personal taste preference; I know many people prefer hot spices on their food, and think complex flavors make a dish, but a more mild approach is what works for me.   Note: GERD-wise, spicy foods can be a trigger for many people, though as I noted before, my gut isn't bothered by them.

So, I was in bliss with Eat's "greens and beans" dish, composed of sauteed kale (with all stems trimmed --  bravo! -- something restaurants do NOT usually do), a creamy brown rice, and expertly prepared pinto beans -- all from the local greenmarket.   I was going to read while I ate, but decided to take a completely mindful approach, slowly savoring each forkful, chewing well, and taking moments to just breathe and relax between bites.   The portion was also pleasing -- perhaps a tiny bit more than I'd have at home, but not that much more, so I felt just right afterwards.  No GERD symptoms!

I could not leave without grabbing some desserts to go -- a gluten-free brownie, and chocolate chip/nib cookie.  Both not vegan, but with locally-sourced ingredients…

LINKAGE

Eat's Twitter feed 

Eat's Facebook page

Eat on Yelp - Four Stars

Linkage: GERD Treatment Breakthrough -- Magnets!

Breaking news -- LINX, a new FDA-approved magnet-based treatment is proving to be a successful remedy for GERD that is not managed by diet, medications, or other means:

On Monday, April 9, Santiago Horgan, MD, chief of minimally invasive surgery at UC San Diego Health System implanted the new FDA-approved LINX device in a 29-year old patient suffering from gastroesophageal reflux disease (GERD)... The LINX system is composed of a series of titanium beads, each with a magnetic core, that are connected to form a ring shape. It is implanted at the lower esophageal sphincter (LES), a circular band of muscle that closes the last few centimeters of the esophagus and prevents the backward flow of stomach contents.

One patient praised LINX: "This device has changed my life.  I suffered from GERD for years. Now I can eat what I want, when I want, and where I want.


Here is the UCSD press release/story.

Nashville's News5 includes an interview with Dr. Horgan about LINX

One patient's account from the Pittsburgh-Post Gazette, March 2012

And a video from WebMD about the magnetic band surgery option




For me?  No -- but anything avoiding lifelong medication is something to applaud.  


Addendum:  Still, surgery is surgery -- even minimally invasive surgery.  I'd rather work with my food intake and stress management as a way to control symptoms.

Bad Week (Reflux! Belching!): What's Next

What I need to be eating more of...

Disappointing update!   My belching, fullness, tight throat, reflux, and churning stomach -- even some nausea -- returned this week.   For whatever reason, I have been eating fast, gulping my liquids, and taking in too much food in one sitting -- a recipe for GERD.   I catch myself during or after meals, vow to eat mindfully next time, and then I do not take my advice, and experience more discomfort.

Other changes in my diet over the past two weeks include:

• More caffeinated teas:  I have not been curbing my tea intake, and have been drinking 2-3 cups daily, sometimes two of those are black or green teas.
• More dairy and fats: Recent trips out of town and family visits in town resulted in my eating much more cheese and other dairy than usual.  (I've reduced my cheese intake to one weekly pizza meal and occasional grated cheese on pasta.)    At a pasta dinner out, I smeared "real" butter on the bread.   Last week's meals included cheese-filled pasta dishes, creamy desserts, non-vegan cakes and doughnuts.  I've also had many pieces of milk chocolate.
• Lack of whole foods/vegetables/fruits:  I have not been able to cook many "whole foods meals" for weeks due to either lack of time/opportunity to buy ingredients, lack of time to cook,  or both.   For some reason, my fruit/vegetable intake has been less than usual -- I pack an apple and then don't eat it, for instance.  

I don't know if any of these are in fact my triggers.   This is just a record of what has been different, diet-wise.  

GOING FORWARD: RE-SET

I need to "re-set" my diet, return to mindful eating and more "cooking from scratch."   More trips out of town and very busy weekends ahead will make this challenging.   BUT it is not unachievable with a few guidelines for myself:

• Mindful eating can be (should be) done anywhere, so I will focus on eating slowly -- and stopping when full
• Mind my teas:  Chamomile tea in the morning, one black/green tea later if I wish, Pu-ehr tea daily if I want for the probiotic effects
• I'm not Martha Stewart:  I do not need to feel guilty if I don't cook everything from scratch, or eat a few meals comprised of prepared/frozen foods (canned soup, canned baked beans, frozen vegetables, Whole Foods hot/cold bar)
• On the other hand, I prefer to run my kitchen like a farm-to-table restaurant:  If I can't get to the farmer's market because I'm out of town, I need to remind myself that I can get to the produce section of my supermarket or the "local/organic" section of some neighborhood gourmet shops.  If I don't have my dried beans, I do have canned beans or a box of tofu.  If I am too tired to cook, just breathe and ignore fatigue for one evening and make food to last a few days.  (Know my limits but know when to push myself, too. Because when I achieve a good meal, I feel relaxed.  And cooking for a few days provides some "down time.")
• Better cooking organization/time management: So I CAN maintain my farm-to-table meals.  Apparently, there is a whole "Once A Month Cooking" movement online, with its own OAMC acronym!   
• Taking time for myself:  (In other words, reduce stress -- the big GERD trigger.)  I've recommitted myself to my stationary bike, Tai Chi, and quiet reading time.  Weekly "creative nights" are a new activity J. and I decided would be good for us and our projects -- the first one this week was a success, and I'm already looking forward to next Wednesday.  It's a chance to "get things done" but also shut out some of the "noise" of life -- a weekly mental "re-charge."  Simple rules: no cooking (heating up is fine), no household chores, just enjoy and focus on our various "creative" projects for 2-3 hours.   I'll be making collages, digitizing a 1940s scrapbook and a paper on 18th Century merchants, reading, and working on this blog!

 EXCITING LINKAGE!

In searching for tips on cooking and time management, I found this brilliant site:

Vegan Once-A-Month-Cooking

I'm discovering "mom" blogs often have great organizing tips! Check out recipes/strategies found on:

Once A Month Mom: Vegetarian Menu

Not necessarily vegan but veganizable -- Mark Bittman's Top 12 Make-Ahead Dishes

Recipe: Grits and Greens

Here I've served grits and kale with veggie sausage.   Fabulous!

One of the most GERD-friendly meals I eat is grits, greens and beans or some other protein side  -- not so much a "recipe" as another "composition" of foods.   Quaker Old Fashioned grits provide some protein (4g) and nutrients (20% of your folic acid!) and being corn-based, are a lovely change from pasta, rice, and other grains.  (Polenta, another corn-based dish, is similar to grits, but different.)  For my GERD-prone gut, the mushy texture is welcome; as I noted in another post, my GERD tends to be calmer when I am eating soft foods like polenta, soups, and such.   Grits are especially easy for me to digest and I never have reflux issues after eating them.

However, once again, how your body processes and responds to grits may be different from mine.  I was surprised to find this Livestrong article about acidic foods and GERD listing "hominy grits" as a trigger food along with tomatoes, green beans, mayonnaise, lemon juice, and other acidic food suspects.  (I rarely have issues with tomatoes or any of these foods. Hmmm.)

Meanwhile, the Myrtue Medical Center in Harlan, Iowa offers this "Bland Diet GERD" one-sheet guide,  sourced from the American Dietetic Association and Simplified Diet Manuel.   The "bland diet" includes grits as a recommended grain.

So, try grits and see how they work with your gut!

GRITS & GREENS 

This "recipe" is very flexible -- you can vary the greens:  kale, chard, spinach, collards, you name it.   I usually just chop up the greens and saute them with olive oil and maybe some pressed fresh garlic.  For the beans, making them "from scratch" really makes this dish exciting, but canned beans will work, too; I especially like navy, yellow-eye, and black beans though kidney and pinto are tasty as well.

The challenge is making the grits so the result is creamy, not watery or gritty.  The trick is in the stirring -- you will need to put everything down while making this dish, and stir-stir-stir.  The more you stir, the more creamy the texture will be.

First:  Boil water in a pot that will allow for bubbling grits and plenty of room to stir.  The amount will depend on how much grits you need; check back of box for the ratio of grits to water.  I never add butter, though that is a possibility.  For GERD diets, I recommend avoiding unnecessary fats.

Step 1: When water comes to a boil, slowly pour in the dry grits.

Next: Get ready to stir!  Stir gently on and off until the grits return to a boil.   Lower heat and simmer loosely covered with a lid.   Stir often until grits thicken.  Some sticking to the bottom is okay, but if the texture is too sticky or thick, it's time to add some water to thin the mass.

Step 2:  Stir, simmer loosely covered, stir again and again til thickened.

Once thickened, keep stirring.  The whole stirring process may take 8-15 minutes or more and is critical to achieving a smooth texture.  You should taste the grits periodically to see how"gritty" they are once they are thickened.  If necessary, add water and stir.  I often need to add water two or three times during this process.

Grits with Earth Balance, broccoli, and kidney beans.

When done, the grits should taste smooth, no chewy or gritty pieces.  Serve with sauteed greens and beans.  You can top the grits with vegetarian (or dairy) butter; grits and cheese (dairy or non-dairy) is another good combination that I have not tried, but is popular in restaurants experimenting with grits. Another side that works well is vegetarian/vegan sausage, shown here -- serve with or without the beans for a satisfying meal.  I've frozen leftover grits with good results -- just put into freezer safe container, add a handful of veggies and beans and you have an instant homemade frozen meal for lunch!
 

BONUS RECIPE:  This grits recipe from Anson Mills uses coarse yellow grits.

Linkage: Videos from the U of Wisconsin's Integrative Medicine Program

Quick status update:  Overall, I am maintaining my lack of the "food in throat/lump in throat" feeling -- and it is encouraging!  It seems the longer I go without this concern, the more I feel this issue may be resolved for good.   However, this past weekend, I ate larger quantities -- knowingly!  (why do I do this?!) -- and I caught myself eating fast a few times.   I've felt some reflux, belching, and overall "bloating" as a result.  It was a second "birthday weekend celebration," so I allowed some indulgence, but still -- is there any excuse for overeating or gulping down food?   I'm not being hard on myself; instead, I'm using the past days as "evidence" that my slow eating/small portions is the right approach.

U OF WISCONSIN'S INTEGRATIVE MEDICINE PROGRAM

Poking around the web, I found a few things of interest.  Here's some useful linkage:

From the University of Wisconsin's Integrative Medicine program, here are two engaging videos featuring Dr. David Kiefer and Dr. David Rakel.   I love their conversational, anecdotal style.  Good reminders for those of us well-versed in GERD, and a great introduction to these topics:

Stress and GERD:  Dr. Kiefer and Dr. Rakel

Discusses stress effects, exercise.

Lifestyle Behaviors and GERD: Dr. Kiefer and Dr. Rakel 

Overall discussion of GERD; excellent introduction and refresher.