Frequently Asked Questions about the 5 Day Pouch Test:
Is this something you came up with yourself or did you get it from your doc?
Good questions. This is a plan I developed based on the post-op stages given me by my center. Over the years I've done it 3 or 4 times to get back on track. When I first did this plan it was for 7 days, but it seems like 5 days works better for me. After all, we can do anything for five days, right?
As I have stated, I tested this plan several ways to see what works for me. Some key elements I felt the plan needed:
--Needed to be approachable like, "Yes, I can do this!"
--Fast resolution to break a carb cycle - hence protein shakes
--Short enough to be doable - 5 days - that is just a blink in time
--Affect a *tightening* of the pouch - most report by the 5th day the pouch feels tighter
When someone, myself, resorts to a drastic-do-over it needs to feel possible to accomplish. When I started at 14 days it quickly went to 7 and then to 5 days. Five days is a work week and we can get through anything for five days. In addition the five days produced the desired result.
Is the idea behind this that we "allow" our stomachs to shrink down a little and thus get that full-feeling sooner again?
The 5 Day Pouch Test is first intended to allow your pouch to rest, just like right after surgery. Next, it is a chance to go through the stages of the post-surgery diet in a quick and practical time period. During this time you should feel a tightness in your pouch, particularly if you have been eating slider foods or drinking liquids with your meals. The focus on proteins will help bring your metabolic hormones into balance (vs. insulin highs and lows) which will help burn fat and reduce hunger cravings. The purpose is not to lose weight, however, many people report weight loss as a happy side effect to gaining control of their eating habits and returning to a protein adequate diet.
This sounds like just another fad diet to me, just a short one.
I can understand this feedback, particularly if it comes from one who has not had weight loss surgery or gone through the stages of the post-op diet. The 5 Day Pouch Test is drastic and it has to be. If a person is feeling out of control with their eating, feeling like they have failed at weight loss surgery and gaining weight then drastic action is necessary. This plan allows that individual to take control in 5 days and exchange destructive eating behavior for appropriate eating behavior that results in feeling good and weight loss. In addition, those who started the plan feeling hopeless and desperate come away with new confidence in their ability to work their surgical weight loss tool.
What does "broken my pouch" mean? I am pre-op and do not understand the term.
Great question. In the early weeks and months following gastric bypass and gastric banding surgery there is a distinct feeling of tightness in the small stomach pouch created by the surgery. It feels tight because it is very small and because patients eat a meal compliant to instructions which is high in dense protein, void of starches including processed carbs and limited vegetable and fruit carbohydrate. New patients also comply with liquid restrictions, which ensure the pouch feels full when eating a small meal. This tightness works to trigger satiation for the patient, to signal fullness.
As patients get further out from surgery there is a tendency to experiment with the pouch, perhaps including liquid with meals or eating foods that exit the pouch quickly, commonly called slider foods. In the worst case slider foods are consumed with liquid, say graham crackers and coffee. In this case the coffee and crackers create a slurry in the pouch and slide right through the outlet to the intestine, thus never filling the pouch. Caught quite unaware by this patients ask, "Is my pouch broken?" They report their pouch does not feel the same tightness as it did early post-op when the pouch was new and they were compliant with the prescribed way of eating. When patients do the 5 Day Pouch Test they are most often surprised to feel the pouch again simply by returning to the way of eating that worked in the first place after surgery.
What are "slider foods"?
In a malabsorptive procedure the pouch is made and the stoma or outlet is attached to the lower part of the middle intestine called the jejunum. The majority of caloric absorption takes place in the jejunum, so depending upon where your surgeon created the outlet the level of absorption can vary. Skilled surgeons will adjust the length of intestine bypassed according to their patient's projected needs based on dieting history and pre-op psychological screening.
Slider foods slide right through the stoma into the jejunum. My first test of the slider foods was graham crackers and coffee for my after work snack. Now imagine, I could eat a stack of graham crackers and wash it right through the pouch with the coffee and never feel any satiation. What resulted was an easily absorbed slurry that my jejunum sucked up like a sponge - it didn't have to do any work to absorb this simple carbohydrate slurry. Of course, weight gain resulted and I had to give up this little indulgence. Another popular slider food is pretzels. I speak with post-ops all the time who are addicted to pretzels - again, this is a simple carb that your jejunum is very happy to receive and convert to fat. Traditionally dieters are encouraged to eat pretzels or popcorn - fat free and fiber, right? But that doesn't work so well for us. Giving our re-routed bodies these simple carbs is dangerous because our bodies have spent years perfect the art of fat storage - slider foods are to the body a great big lottery win.
Featured Article: Slider Foods Spell Weight Gain for WLS Patients
What happens after the 5 days?
After the 5 Day Pouch Test is when things get exciting. Having successfully broken a carb-cycle, regained a feeling of control over the surgical gastric pouch and possibly losing a few pounds one is ready for re-entry into a compliant way of eating. This means focusing on protein rich meals, observing the liquid restrictions and avoiding starches, particularly processed carbohydrates and slider foods. Three meals a day should be two-thirds protein, one third healthy carbohydrate in the form of low-glycemic vegetables and fruits. Consumption of whole grains is not forbidden, but should be limited to one serving a day.
If necessary between meal snacks should be protein dense. Natural food protein is great including hard-cooked eggs, lean low-sodium deli meats, and limited servings of nuts or low-fat cheese. In addition, protein bars or beverages may be used for between meal supplementation.
Patients should drink at least 64 ounces of water a day and take their prescribed supplemental vitamins. Caffeinated beverages should be limited to one or two a day and carbonated drinks are discouraged. Alcoholic beverages should be limited to one per day or less.
What are liquid restrictions?
After surgical weight loss patients are advised to avoid drinking water 30 minutes before meals and 30 minutes after meals. (The time restriction varies from surgeon to surgeon, but most use the 30 minutes before, 30 minutes after restriction. Follow your surgeon’s specific directions.) In addition there should be no liquid consumed while eating. Following these liquid restrictions allows the pouch to feel tight sooner and stay tight longer, thus leaving the patient feeling satiated for longer periods of time without experiencing the urge to snack.
One exception to the mealtime liquid restriction is an alcoholic beverage. Due to the rapid absorption of alcohol after a gastric stomach reducing surgery patients should not drink alcohol on an empty stomach. Patients who elect to include an alcoholic beverage in their regular food plan should drink it only with meals. Alcoholic beverages should be limited to one serving per day or less
Featured Article: Understanding the Liquid Restrictions of WLS
How often should I do the 5 Day Pouch Test?
The 5 Day Pouch Test should be done if you are feeling out of control with your eating, if you have fallen into a slider-carb eating pattern, if you are at a weight loss plateau or have gained weight. It can also be done simply for cleansing and appreciating our weight loss surgery tool. Many patients have successfully done the five day pouch test and followed the five days by repeating Days 4 and 5 over and over. Other patients have elected to include extra days of liquids in their plan. It is perfectly OK to adjust the plan to your specific needs. Patients who do not desire the liquid phase have reported success by doing 3 days of Day 3 followed by Days 4 and 5.
Why do I need to take only 15 minutes for meals? My center told me to take 30 minutes for each meal.
Many bariatric centers recommend patients take 30 minutes for meals. Some even instruct patients to use a stop watch and time 3 minutes between bites of food. The reason is to slow down the eating habits of the recovering morbidly obese person. After some time patients who comply with the 30 minute meal rule tend to be able to eat more and often linger over the meal, even though satiation has resulted. Consequently they eat more food, particularly if they are not following liquid restriction and using liquid to wash the food through the pouch.
During the pouch test a person is following the liquid restriction and eating a high protein diet. By limiting the time to eat to 15 minutes one will enjoy the satisfaction feeling that is the desired result of a gastric pouch. The following is from the Gastric Bypass Owners Manual from Alvarado Hospital:
"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."
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The complete 5 Day Pouch Test plan including inspiration, instructions, and recipes in Kaye Bailey's classic empowering style. 100-page easy to read paperback with hints, tips and encouragement that enables you to take charge of your weight loss surgery tool. If you have ever asked "Is my pouch broken?" then this book is for you. Available exclusively at the LivingAfterWLS General Store.
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