5 Day Pouch Test Blog

If Your Pouch IS Broken: New Procedure

As reported at ClinicalTrials.gov

Incisionless Treatment for Patients With Inadequate Weight Loss Following Roux-en-Y Gastric Bypass

This study is currently recruiting participants.

It is estimated that up to 20% of patients who have Roux-en-Y Gastric Bypass (RYGB) surgery will not meet their weight loss goal, or may even regain some of the weight they initially lost. One possible explanation is that the opening between the stomach pouch and the intestine becomes stretched. If this opening becomes too wide, food may be able to pass from the stomach to the intestine too quickly - causing patients to feel less full after eating.

For some patients, doctors may recommend additional invasive surgery to tighten the opening between the stomach pouch and the small intestine. Although this may help patients resume their weight loss, the risk of complications during a second surgical procedure is significantly higher than the risk during the original gastric bypass.

The purpose of this study is to evaluate an incisionless procedure for patients who have either had inadequate weight loss or have regained weight following gastric bypass. The procedure is designed to tighten the opening between the stomach pouch and the small intestine, which may slow down the passage of food to help patients feel full longer after eating.

Locations: Denver, Colorado; Baltimore, Maryland; Boston, Massachusetts; St. Louis, Missouri; Lebanon, New Hampshire; New York City; Cleveland, Ohio; Philadelphia, Pennsylvania; Dallas, Texas; Milwaukee, Wisconsin.

Read more and get contact information

Back to Basics with Surgical Weight Loss

Recently I've been reviewing the information my bariatric center presented me in 1999 just prior to gastric bypass surgery. One heading caught my eye, "The Rest of Your Life." They told me up-front that I was committing to this lifestyle for the rest of my life. So why then, have I had so many occasions of wandering? The literature states, "Recognize that you have made a decision to change your life, and plan to use the new tool which your gastric bypass provides, to control your weight, and become the slender, healthier person wish to be."

So, I renewed my commitment to the basics of the program presented to me and today outline some of the basics and why they worked back then and still work today.  I understand that many centers offer different guidelines for their patients and encourage you to review your own bariatric owner's manual to re-discover you back to basics. (But don't be afraid to use a few of things I've learned over the years too!)

Do Not Go On A Diet:
"After surgery, you do not 'go on a diet'. You will eat small portions of food and be amazed to find that you are completely satisfied. If you eat correct and healthy foods, your weight loss will proceed rapidly and safely, and you will avoid discomfort."

The key to this guideline is "correct and healthy foods." Too often I've heard the line, "I can eat anything I want, just less of it!" followed by a ha-ha-ha and then the complaint, "I never really made it to goal weight." Slider foods are more comfortable and often come in the form of processed carbohydrate. They do not satisfy and cause hunger cravings. Selecting the correct and healthy foods means protein first (eggs, fish, poultry, nonfat or low fat cheese or yogurt), soft cooked fresh or frozen vegetables and raw vegetables as tolerated, limited low-glycemic fruits (apples, oranges, pears, peaches, grapes, strawberries, raspberries, blueberries),  and limited whole grains.

Eat Only At Mealtime:
"Establish a pattern of eating so that you body will be accustomed to it and you do not become excessively hungry. Avoid eating on the run or while doing something else (watching TV, computer work, driving, etc." Once you have felt satisfied and have left the table the meal is over. Any food eaten elsewhere, or later on, is a snack."

This guideline has served me well. I used to eat in the car, at the computer, in front of the TV. In fact it is challenging to remember where I didn't eat. After surgery I committed to eating only at mealtime in the designated areas. My car and work spaces are cleaner and I'm less distracted.

However, I have identified that I tend to nibble while preparing a meal. Those little tastes and bites add up quickly therefore I am working to be vigilant about what goes in my mouth before mealtime.

My center is firm about "no snacking" and this works best for me when I follow the protein first rule (below). To avoid snacking I use that old dieter's strategy: brush my teeth after each meal and then no eating until the next meal. It works most of the time.

Protein First:
Always eat your protein portion first. When you eat protein first you will experience earlier and better satisfaction from the foods you eat. Protein appears to be the best stimulant of the body's reaction which makes you feel satisfied."

A protein adequate diet will help balance the metabolic hormones: insulin and glucagon. This will decrease swings in blood sugar levels, curb cravings and help keep you satisfied for greater periods of time. In addition, most protein foods are not slider foods and will stay in the stomach pouch longer than fat or carbohydrate rich foods. Protein is not known to cause dumping. Protein serves us with healing and energy. It requires the most energy from our body to metabolize it therefore putting the body into a higher metabolic fat burn than any other food product.

Recommended protein sources: chicken, poultry, lean chicken or turkey deli meats, shellfish, canned water packed tuna, egg, egg whites,  egg substitute, lean red meats and pork, game meat and lamb.

Understand Satisfaction:
"When you feel satisfied you are finished. Don't get trapped in the belief that you have to eat everything on your plate, or that you can't possibly get by with that small a meal. Your meals will be small, and they are supposed to be small. If you feel full and satisfied and you try to eat any more you will begin to feel nauseated and you may throw-up. The point is not to see how close you can come to nausea. Learn to eat until satisfied and to avoid getting sick.

This is one of the most difficult guidelines to learn. I think it was about year four post-op that I made peace with my stomach pouch and quit testing the limits. One reason we often turn to slider foods is they never take us to the verge of nausea. It is more comfortable to not be nauseated. When we eat the proper diet of protein first we quickly become full and that is a signal of satiation or satisfaction. We became obese because we did not learn to recognize gastronomic satisfaction. A full pouch is working exactly how it is designed to work. Listen and you will hear it say, "Thank you. I am full with healthy protein rich food and I will reward you with a healthy body full of life and energy." Listen to your pouch.

Misconceptions About Weight Loss Surgery

As weight loss surgery becomes an increasingly popular treatment for morbid obesity misconceptions abound.  Patients who undergo gastric bypass or gastric banding surgeries are often depressed and disappointed after surgery because they believed the popular misconceptions.

Some common misconceptions about WLS:

Surgery brings joy and boundless energy instantaneously
Laparoscopic surgery is painless
WLS is an easy fix and permanent fix to obesity
WLS guarantees happiness
Others will support the WLS decision
After reaching goal weight patients can go back to normal

Because patients read about the joy and boundless energy enjoyed by others after surgery they assume these feelings occur immediately. Joy is felt after massive weight loss, not after surgery. In fact, for many patients the first six weeks out of surgery are emotionally draining as they grieve for food and feel fatigued and disoriented.

We read the laparoscopic technique used for 85 percent of all WLS is minimally invasive requiring little recovery time. In truth this technique bruises the intestines, liver and ribs. The surgery is painful and recovery is not as rapid as most patients expect. Patients express feelings of failure when they are sore and exhausted from surgery.

For most patients weight loss happens quickly and easily. True to dieting tradition when patients reach goal weight they tend to go back to “normal” disregarding the high-protein low-volume diet. Weight gain results. Unless patients follow the strict WLS rules daily they regain weight.

WLS does not guarantee happiness. In fact, patients commonly describe feelings of anger, bitterness, resentment, panic and self-loathing as they lose weight. They also express happiness, satisfaction, pleasure, delight and self-love. The pendulum of emotions swings wide.

Having WLS exposes one to attacks from others who feel entitled to criticize the gluttonous sloth that could not lose weight by eating less and exercising more. Not all people, including spouses, siblings, parents and friends will support the decision for WLS.

WLS is a lifetime commitment to an extremely restrictive lifestyle that if used successfully will enable a former morbidly obese person to maintain a healthy weight and diminish the co-morbidities of obesity. It should never be considered the “easy way out” or a “quick fix.” It is a lifetime commitment with no returning to normal.

Testimonial: 5DPT & Lost 8 Pounds

From our LivingAfterWLS Neighbor Kat:

Good Morning Everyone,

One week ago today I started the 5DPT.  As of this morning I am down 8 lbs.
What I learned over the past week is that I already know what I need to do, I just allowed myself to stray from the basic rules of gastric bypass surgery.

I feel like I have control again and I know that my tool will work if I use it correctly.

I followed the 5DPT Monday through Friday last week. Over the weekend I focused on protein being 50% of my meal. I can honestly tell you that I am unable to eat as much as I was before I did the 5DPT.

Another key - eat slow and give your body time to talk to your brain. Stop eating at the first sense of fullness - because believe me, you're full. Keep going and that is when you get up from your meal and are uncomfortable.

I am doing the 5DPT again this week starting this morning. I am hopeful that Day One won't be as challenging this week as it was last week. I had a headache and lack of energy on Day One last week.

Here's to regaining control and success!!

Take care,

Kat

A Plan to Work the 5DPT

It sounds silly to offer a plan to work a plan but today I offer you a few ideas and hints for making the most of your 5DPT experience. The more prepared and enthused you are when you begin the 5DPT, the better your chances for success. Let's get started and back on track!

First, read the plan and be sure you understand it. Read the FAQ's, Recipes, Testimonials and Forum to learn more. Compare this to your post-op eating stages and take note of what worked for you then.

5 Day Pouch Test Website

Set a date and mark your calendar. Make sure you can follow the plan without the disruption of travel, social events or hormonal cycles. Enlist the support of family and friends. Post to the Neighborhood or your online community asking for support from those who understand.

Print two copies of the 5 Day Pouch Test Journal. Using the first copy plan your meals and snacks for all 5 days. Use this for your shopping list. Shop no later than the day before so you are ready bright and early on Day 1. Have supplies on hand for all five days. If possible prepare some of the recipes for Days 3, 4 & 5 in advance to avoid being in the kitchen.

The night before create a storm of mental readiness by reading, discussing and posting about your plan. Generate the same kind of excitement you had going into surgery. Go to bed empowered knowing you are about take control of that surgical tool you fought so hard to get in the first place.

Rise and Shine! Welcome to Day 1! Step on the scale and record your weight. Start Day 1 off right with a protein shake. Keep track of your progress on the second 5DPT Journal. Note your food, exercise and energy levels.

Continue to focus on the plan during the next four days. Stay enthused by connecting with others. Turn "Head Hunger" into Life Hunger. Nothing is more powerful than "Life Hunger" - the yearning for all the good things to be had when we release unhealthy eating and the self-loathing that accompanies it. Get Life Hunger!

Be kind to yourself. The 5DPT isn't about perfection. It is a systematic method of breaking the slider carbohydrate cycle, returning to a weight loss surgery way of eating and empowering you with the knowledge that your tool works and you can work the tool. Nobody has ever done the 5DPT perfectly. But many have worked it well enough to find hope and power in their tool.

You can do this!!!

What happens after the 5 Day Pouch Test?

Southern Fried Salmon Patties

Another great Day 3 fish cake recipe.

2 tablespoon cornmeal
2 tablespoon flour
1/4 teaspoon cayenne pepper
1/4 teaspoon garlic powder
1/4 teaspoon black pepper
1/4 teaspoon salt (optional)

1 (14 3/4 ounce) canned Atlantic salmon
2 Tablespoons finely chopped onions
1 egg
3 tablespoons mayonnaise
Cooking Spray
1 tablespoon butter (optional)

In a small bowl combine the cornmeal, flour, cayenne, pepper, garlic powder, black pepper and salt. Set aside.

Open salmon and drain thoroughly. Place drained salmon in mixing bowl and flake evenly with a fork. Add onion, egg and mayonnaise and 1/2 the flour mixture. Mix well to combine.

Measure a 1/4 cup serving of the mixture and form into a patty. Lightly dip in the remaining cornmeal and flour mixture. Set aside and continue until all of the salmon mixture is used. (Approximately 6 patties).

Spray a large deep skillet with cooking spray and heat over medium-high heat. Add butter if desired. Fry each salmon patty 2-3 minutes per side, turning once. Serve warm.

Serving is 1 salmon patty. Per serving: 198 calories, 16 grams protein, 13 grams fat (3 saturated), and 5 grams carbohydrate. Rich in B12, Niacin and contains 159mg of Calcium.

Other canned protein may be used in place of the salmon including tuna, chicken or turkey. You can increase or decrease the cayenne and garlic powder to your taste.

More 5 Day Pouch Test Recipes

Fixing Broken Windows

by Kaye Bailey
There is a popular theory in urban renewal that suggests fixing broken windows as they happen is the key to reducing crime and preventing urban decay. The theory is based on a 1982 Atlantic Monthly article by George L. Kelling. He writes, "Consider a building with a few broken windows. If the windows are not repaired the tendency is for vandals to break a few more windows. Eventually, they may even break into the building, and if it's unoccupied, perhaps become squatters or light fires inside."

Perhaps it's a stretch but I believe it is possible to apply the "Broken Window" theory to our post-weight loss surgery health and wellness. The broken window, of course, would be a lapse in compliance with our program: eating unhealthy foods, the absence of exercise and so forth. If we break a window one day and do not fix it the next then we risk breaking another window. But if we practice self-renewal and fix that broken window promptly we can avoid the intrusion of vandals and squatters who would break more windows and pollute our healthy new body.

The challenge herein is that if we allow the broken window to go without repair we then become the vandals to our own building (body). At times it is far easier to give permission to the squatters than it is to kick them out. One day of missed exercise leads to another and another and pretty soon the sloth-squatter has set-up camp in our building. I know for me all it takes is three missed workout sessions and my sloth-squatter is quite at home enjoying the broken windows. But when I saw the pattern I came to understand that one broken window (missed workout) could be repaired without struggle. Repairing three broken windows demands a forceful and determined self-renewal to fix my building.

In cities and in life there will always be broken windows. A broken window is not a sign of failure or neglect. Windows are made of fragile glass that sometimes breaks. And though we may pretend to be tough as steel we are more like glass: fragile and prone to occasional breakage. Windows can be fixed. Fix your broken windows promptly and forbid the squatter's entry. You've worked hard for your new life; give yourself the gift of self-renewal.

5 Day Pouch Test Plan - Fix Your Broken Windows

Food Smart: Making Better Choices

Along with the positive self-talk we need to be knowledgeable in making smarter food choices. With careful planning we can create meals with a full-spectrum of flavor. Patients who address all flavor needs in a meal report feeling more satiated for longer after the meal. They also report feeling fewer post-meal cravings. That's what we are looking for in balance so we are able to sustain weight loss and maintain a healthy weight in the long-term.

We are all busy people and it is easy to say, “I don’t have time to plan my meals.” I’ve said it many times. But lately I’ve decided that I don’t have time to NOT plan my meals because when I make poor food choices I feel sluggish and unmotivated. I accomplish less and fall into a well of self-pity. What I don’t have time for is self-pity.

Diet after Surgical Weight Loss

I believe the first step in making better food choices is purging the home of unhealthy foods and replacing those with healthy foods. Foods that are high in processed carbohydrates, sugar and fat are not good for a WLS patient or the family they love. They do not need to be in our homes. If they are in our homes we will eat them. Just last month after our Superbowl party I found myself mindless munching on tortilla chips with salsa. Why? Was I hungry? No. I munched because they were there. And the sluggishness and guilt followed. Has that happened to you?

Here are some food replacement suggestions:

Replace soda with water, green tea, no-sugar-added juice

Replace whole milk with 1% milk or soy milk

Replace candy bars with high-protein low-sugar health bars

Replace chips, pretzels & popcorn with dry-roasted salted soy nuts

Replace ice cream with low-sugar yogurt topped with fruit

Replace chocolates with chocolate covered raisins (measured portion)

Replace bread with toasted seasoned whole-wheat pita chips

Remember that eating well is not a punishment. It is not deprivation. It is liberation from the bonds of obesity that kept us from living.

Success Secrets of long-term Maintainers

These are some of the success secrets I have gathered over the last several years. When I hear something powerful I write it in my "Inspiration Book" and use it as yet another tool when I'm discouraged. I hope you will enjoy these. And if you have a slogan that works for you please email me, we can spread the word.

LivingAfterWLS Power Tools

Surgical weight loss is not just about the weight you lose, its about the life you gain.

Maintain the eating habits that helped you lose weight.

Avoid the trigger foods that you have not been able to control.

Accept the four rules. Embrace them. They didn't tell us these are the rules until you get to goal weight. They said these are the rules. That meant the rules for life.

Learn smarter ways to fix your favorite foods. Use healthier ingredients, less fat, better grains, fresh veggies, fruits and herbs. LivingAfterWLS Recipes

Savor the Flavor. Treat mealtimes as an opportunity to pamper your body with good nutrition.

Water. Water. Water. When you are losing weight, there are many waste products to eliminate, mostly in the urine. A high water intake helps your body to rid itself of waste products efficiently, promoting better weight loss.

Become arrogant about the foods you put in your body, treat your body respectfully.

Plan your menus so that you are not caught off guard.

Cultivate a passion for healthy living. It's much easier to overcome obstacles if you are passionate about what you are doing.

Learn what eating pattern keeps your metabolism running efficiently and follow that pattern to avoid hunger.

Continue to eat low or non-fat proteins. Following the protein first rule helped you lose weight and will help sustain weight loss.

Protein tends to turn off hunger (offers more satisfaction) the best and the effect lasts the longest. Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.

When you think you have head hunger for food redirect that head hunger with thoughts for a healthy body and all the enjoyment that comes with being healthy. Do not indulge the so-called head hunger.

Is bounce-back weight gain inevitable?

The two questions I am most often asked are, "Can my stomach stretch back to normal size?" and "Is weight regain inevitable?" These questions are closely related.

According to Dr. Alan Wittgrove, the father of laparoscopic gastric-bypass, "The pouch size starts at 15 cc and over time will stretch slightly but not much. The pouch size does appear to be a very important part of the operation’s long-term success. Even though the pouch stays small, patients will be able to eat more as the months go by because scars become more supple with time and the outlet will enlarge slightly."

Patient's often falsely blame a stretched pouch for weight regain. The harsh truth is weight regain occurs when patients are non-compliant with the guidelines outlined by the bariatric centers. Specifically patients who snack or graze on processed carbohydrates (slider foods) invariably gain weight. This leads to panic or self-loathing followed by more snacking and a seemingly unstoppable cycle of weight gain. It breaks my heart when I read a letter that says, "Am I a failure at this too?"

I believe, because we dieted our way to morbid obesity, we expect surgical weight loss to be another diet. We have a starting weight, a goal weight and a then we can get back to normal. And if we do go back to normal, i.e.; eating the foods that made us obese, we will become obese again.

WLS does not have to be part of the yo-yo diet cycle. We can lose weight and sustain that weight loss for life. But we have to change our eating habits, we have to follow the rules and we have to struggle with it almost daily. There is no finish line.

I am fighting some holiday pounds right now, the result of haphazard grazing. It is tough. But I'm back to basics and seeing results. I have found the more I strive to work with the weight loss surgery pouch instead of trying to outsmart it, the more I can enjoy my health and happiness free of obesity.

So, in answer to the second question, weight regain is not inevitable if we commit to a new way of life. We have to take full responsibility for behavior change and behavior monitoring.