Sunday, August 21, 2011

Keeping It Real

So they say the first step to recovery is admitting you have a problem so I am going to put a little faith into that and hope to an extent it holds true.

I have been struggling with some weight regain.

There.  I said it.  Since my lowest and relatively comfortable weight for me, of 209, I have gained about 28 pounds...most of it since starting back to work full time.  I know that carbs are my problem and I am still wrestling with what to do about it, but I know I have to do something.

There is something called "The 5 Day Pouch Test" that has existed in the WLS surgery community for some time as carbs tend to be a post op problem after a few years.  Here is what I read about it last night:

Slurry food, more commonly described as slider food ,is a watery liquid food solution of simple processed carbohydrates containing scant nutritional value. The substance usually comes from crackers, pretzels, cracker snacks, popcorn, cheese snacks, potato chips or tortilla chips, or sugar-free cookies, cakes, and candy. The foods are chewed and washed down with liquids into the surgical stomach pouch where the gastric muscles churn them into slurry which slips directly into the intestine to be quickly processed and stored as body fat. Patients of all bariatric weight loss procedures including gastric bypass, adjustable gastric banding (lap-band), and gastric sleeve, are prone to weight gain if copious amounts of slurry food are consumed.

After surgery many bariatric patients find the restrictive feeling following eating to be uncomfortable, yet it is the very nature of the surgical gastric pouch to cause a tight restricted feeling after a small amount of solid food has been consumed. This signals the patient to stop eating. Uncomfortable with this restricted feeling, many patients turn to softer processed simple carbohydrates or junk food that can be washed down with liquids creating slurry. The uncomfortable restricted feeling never occurs and patients can eat unmeasured portions without feeling discomfort. Soon the weight loss they were enjoying has stopped and weight regain begins.

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.

Many patients will mistakenly blame their surgical stomach pouch thinking it has stretched out or is no longer working correctly. However, patients who return to a diet of lean protein and avoid drinking liquids with meals will quickly discover the uncomfortable pouch restriction still occurs bringing feelings of fullness with small servings of food. Continued compliance with the high protein diet eventually leads to weight loss once again. 

For weight loss surgery patients protein is not always the most comfortable food choice because of the tightness that results following eating. However, for bariatric surgery to work correctly and sustain long-term weight loss and weight maintenance, a high protein diet void of simple processed carbohydrates must be followed consistently.

I am apparently a queen of slurry foods.  I read that and though I knew carbs were my issue the ones described; the crackers, pretzels, popcorn , are my crack.  Well and Twizzlers which I have not had in over a week thankfully.

The 5 Day Pouch test takes you through the food stages we went through following our RNY in five quick days.  In short, it is this:

Days One & Two: Liquid Protein
low-carb protein shakes, broth, clear or cream soups, sugar-free gelatin and pudding.
Day 3: Soft Protein
canned fish (tuna or salmon) eggs, fresh soft fish (tilapia, sole, orange roughy. 
Day 4: Firm Protein
ground meat (turkey, beef, chicken, lamb), shellfish, scallops, lobster, fresh salmon or halibut.
Day 5: Solid Protein
white meat poultry, beef steak, pork, lamb, wild game
My biggest concern with this is the first two days and my mood that might accompany that.  Can I work productively while probably feeling irritable?  My other huge problem is my hatred of protein shakes.  I have NEVER found a protein powder that did not make me want to gag.  But I need to.  A majority of WLS patients years out of surgery still have 1-2 protein shakes a day.

I have two other major rules I have broken.  I am again drinking soda, albeit diet soda and I am not obeying the rules of drinking before and after meals.  Essentially, WLS patients should stop drinking 30 minutes before a meal and not drink again until 30 minutes after a meal.  My goal for this week is to resolve the liquids problem.  The pouch test I plan to start a week from tomorrow as The Brit will be away so I don't have to deal with meals other then the simple crap the kids will eat and what I will need  to do.

So what happens after Day 5, you may ask?  It says this:

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.

I read about one women who lost 100 pounds by doing the Pouch Test and then staying on Day 6 for the next five months, so getting back on track is far from impossible.  I need to remember why I have done this.  I worked too hard to get the surgery and has a post op to screw it all up now.

So there you go for keeping it real.



  1. Best of luck to you. At almost 4 years out I am about 15 pounds up from my lowest...but I seem to kind of stay there.

    I do and have always used Body Fortress from WalMart...I get the chocolate or the chocolate peanut butter and make a protein coffee every morning.
    Good luck with the pouch test...can't wait to hear how it works for you!

  2. Look at me! Commenting from Las Vegas!!! I was just so happy to see a new post :-) Darling, you can do anything you set your mind to...I know this all too well and I love you for it. Not to mention the fact that it allows me a little Low Carb "I told ya so" LOL Just be healthy...not a fanatic about it. I do have a protein powder that I love. I can't think of the name of it right now...but I'll loan you some to try.

  3. I have to agree with Jim here, even Weight Watchers throws Carbs into the equation now; so it mean something!! You know what you need to do - you'll succeed!

  4. Heck, I'm thinking about doing it with you!