RICARDO
Before You do this take in consideration that You are not on a Plateau till you have gone 4 1/2 weeks without any weight lost, then yes you are on a Plateau otherwise you are on a Stall. Please remember this! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Plateau Buster Diet
How to break a plateau
#1 - Do this for 10 days to break a plateau
#2 - Drink 2 quarts of water a day
#3 - You must have 45 grams of protein supplement and all your vitamins/minerals supplements each day
#4 - You may consume up to 3 oz of the following high protein foods, 5x a day
beef
pork
chicken
turkey
lamb
fish
eggs
low fat cheese
cottage cheese
plain yogurt or artificially sweetened (?)
peanut butter
beans/legumes
You may also have:
sugar free popsicles
tea or coffee
sugar free soda
sugar free jello
broths/bullion (sp?)
crystal light drinks
#5 - If it's not on the list, you can't have it for 10 days!!!!
#6 - Keep a food diary and try to get up to 30 mins of exercise daily
DETOX FROM THOSE CARBS!
First Thing in the Morning:
16 Oz of Green Tea (Either Hot or iced w.Lemon)
Breakfast: 1/4 cup of eggbeaters with a Meat & Cheese made like an omelet. A side of A Slice of Tomato or Cottage cheese
16 Oz of Plain Water
A snack of String Cheese or a 2 pieces of Lunchmeat
16 Oz of Green Tea
Lunch: A Salad of Lettuce, Kidney Beans,Cheese,Bacon
Bits with Ranch or Blue Cheese
or a 3 oz of Chicken Salad with veggies on side
16 Oz of Plain Water
Snack: Yogurt or Cottage Cheese
Dinner: 3 oz A Lean Meat (Chick, Turkey) with 2 oz of Cooked Green Veggie (Spinach, Kale, Broccoli or green beans)
8 oz Green Tea, 8 oz of Water
The One good Rule is You can Substitute any meal or snack with a Protein Shake.
It really Works. The magic is in the green Tea.
Pouch Rules for Dummies
INTRODUCTION:
A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren't really trying to lose weight. The truth is it may be because they haven't learned how to get the "satisfied" feeling of being full to last long enough.
HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1) Weight loss occurs by actually "slightly stretching" the pouch with food at each meal or;
2) Weight loss occurs by keeping the pouch tiny through never ever overstuffing or;
3) Weight loss occurs until the pouch gets worn out and regular eating begins or;
4) Weight loss occurs with education on the use of the pouch.
PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness.
What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal?
For ten years, Drs. have had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave doctors an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs.
We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.
OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon's "observations" as opposed to "blind" or "double blind" studies, but it IS based on 33 years of physician observation.
Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are effects how the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1 ½ cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch is important.
5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile.
7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight hours.
9. After 1 year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible ("water loading"), the patient will get a feeling of fullness that lasts 15-25 minutes.
11. By eating "soft foods" patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain.
12. The patients that follow "the rules of the pouch" lose their extra weight and keep it off.
13. The patients that lose too much weight can maintain their weight by doing the reverse of the "rules of the pouch."
HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the "rules of the pouch", it doesn't matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
OUTLET SIZE:
Regardless of the outlet size, liquidy foods empty faster than solid foods. High calorie liquids will create weight gain.
EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full.
After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time.
OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time.
IDEAL MEAL PROCESS (rules of the pouch):
1. The patient must time meals five hours apart or the patient will get too hungry in between.
2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal.
3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure.
4. No liquids for 1 ½ hours to 2 hours after each meal.
5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake.
6. 3 hours after last meal, begin drinking LOTS of water/fluids.
7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called "water loading." IF YOU HAVEN'T BEEN DRINKING OVER THE LAST FEW HOURS, THIS 'WATER LOADING' WILL NOT WORK.
8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective.
NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the "rules of the pouch" before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn't work. The real work of learning the "rules of the pouch" begins after healing has caused hunger to return.
PREVENTION OF VOMITING
Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick.
It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient's mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.
In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting.
Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc. will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when "comfortably satisfied," until the patient learns the size of his/her pouch.
SIX WEEKS
After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours after meals.
REASSURANCE OF ADEQUATE NUTRITION
By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition.
Focus should be on proteins and vegetables at each meal.
MEAL SKIPPING
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal.
ARTIFICIAL SWEETENERS
In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets.
AVOIDING ABSOLUTES
Rules are made to be broken. No biggie if the patient drinks with one meal ? as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party? that's OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up.
THREE MONTHS
At three months, the patient needs to become aware of the calories per gram of different foods to be aware of "the cost" of each gram. (cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures.
THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY
1. Fill pouch full quickly at each meal.
2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
3. Protein, protein, protein. Three meals a day. No high calorie liquids.
FLUID LOADING
Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached.
The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz.
Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time.
POST PRANDIAL THIRST
It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won't make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow.
URGENCY
The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time.
SIX MONTHS
Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat.
INTAKE INFORMATION SHEET AS A TEACHING TOOL
I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them "back on track." Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to "get it", and a small percentage never quite understand these rules, even though they are quite intelligent people.
HONEYMOON SYNDROME
The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don't need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the "honeymoon syndrome" and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient's weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track.
EXERCISE
In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down.
THE IDEAL MEAL FOR WEIGHT LOSS
The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health.
VOLUME VS. CALORIES
The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don't worry about calories. This is the easiest way to "count your calories." For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings ? it would stuff them way too much.
ISSUES FOR LONG TERM WEIGHT MAINTENANCE
Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off.
COUNTER-INTUITIVENESS OF FLUID MANAGEMENT
I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a "soup" in the stomach that is easily digested.
SUPPORT GROUPS
It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others "get it" and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a "peer pressure" to stick to the rules that the staff at the physician's office simply can't create.
TEETER TOTTER EFFECT
Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left.
Now if you don't concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh.
TOO MUCH WEIGHT LOSS
I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially "break the rules" of the pouch. Drink with meals so they can eat snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories.
A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don't "get" that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger.
BARIATRIC MEDICINE
A much more common problem is patients who after a year or two plateau at a level above their goal weight and don't lose as much weight as they want. Be careful that they are not given the "regular" advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets.
SUMMARY
1. The patient needs to understand how the new pouch physically works.
2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes.
3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch.
The goal is for the patient to become an expert on how to use the pouch.
EVALUATION FOR WEIGHT LOSS FAILURE
The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up.
1) the staple line needs to be intact;
2) same with the outlet and;
3) the pouch is reasonably small.
1) Use thick barium to confirm the staple line is intact. If it isn't, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time.
Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut.
2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call "soft calorie syndrome." This causes frequent hunger and grazing, which leads to weight regain.
3) To assess pouch volume, an upper GI doesn't work as it is a liquid. The cottage cheese test is useful ? eating as much cottage cheese as possible in five to 15 minutes to find out how much foodthe pouch will hold. It shouldn't be able to hold more than 1 ½ cups in 5 ? 15 minutes of quick eating.
If everything is intact then there are four problems that it may be:
1) The patient has never been taught the rules;
2) The patient is depressed;
3) The patient has a loss of peer support and eventual forgetting of rules, or
4) The patient simply refuses to follow the rules.
1) LACK OF TEACHING
An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago.
2) DEPRESSION
Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression.
A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly.
If your patient begins weight gain due to depression, get him/her into counseling quickly.
Encourage your patient to refocus on the pouch rules and try to add a little exercise every day.
Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry.
3) EROSION OF THE USE OF PRINCIPLES:
Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their "new" life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life "normal" like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician's office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer "refresher courses" for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again.
4) TRUE NON-COMPLIANCE:
The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no 'connection' between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude.
A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven't figured out how to do that yet? Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.
This rewrite was done exclusively for the people of this spotlight obesity support group. It should not be sold for any reason.
"Dummies" version rewritten by Sally Perez
I have had stalls along the way. They are extremely frustrating but I know it's my body playing catch-up. When Your not loosing pounds, check your measurements. You may be surprised that the inches are coming off even though the weight is not. In the end, just keep plugging away and follow your Rules.
Protein First, 64 OZ of Water a Day, Exercise at least 30 minutes everyday and take your vitamins.
If you follow the rules, the weight will come off, I promise. If you go more than 4 weeks without a pound or inch lost, then you are on a Real Plateau. That's when you need to do something to shake things up a bit.
Tips for breaking stalls & plateaus:
*Try eating more calories for three days, then go back to eat less calories for the next three days.
*Cut your carbs back to 25-30 grams Maximum a day for 10 days.
* Drink an Extra 16-32 oz of PURE WATER (NO Tea, crystal light etc. Just plain water)
*Add 20 more grams of dense protein to your diet. Fish, shrimp, chicken, beef, scallops, lean pork etc. Watch the hidden carbs in cheese, you would be surprised how it adds up.
*Change your exercise routine. Your body will get used to routine. There ar lots of Exercise Videos out there and sometimes you can find them very cheap in the clearance rack at WalMart. Also if your doing weight training you may not loose any weight at first because you are replacing your fat with muscle. But that's good, because Muscle helps you burn fat.
*Lastly, don't freak when you stop losing I know it's hard not too because our biggest fear is
a) WLS isn't gonna work for me and
b)We have a very real fear of gaining everything back.
Just stick to your rules and it will come off. For some it may be slow and steady and for other it may be 10 pounds in a week and then nothing for 2 weeks. We all loose in our own way and pattern. The thing is once you learn your weight loss pattern, then you know not to fret too much on those weeks you don't loose.
The Ten Commandments of Weight Loss Surgery
1. THOU SHALL NOT DRINK with thy meals.
This means never! This is cheating...cheating yourself. It washes the food out of your pouch and allows you to eat more. This will slow and eventually stop your weight loss. PLUS you will not be getting all the benefits of the wise choices you have filled your little pouchy-poo with.
2. THOU SHALL EAT SLOWLY, very slowly.
This is not a rule for the first few months post op. This rule is for the rest of your life. If you eat too quickly, you will surely stretch your pouch. Eat too quickly and you will learn the hard way...the nausea is stifling. Oh and CHEW CHEW CHEW!! And when you think you are done, CHEW SOME MORE. Or your food will keep coming back to visit you.
3. THOU SHALL TAKE THY VITAMINS.
This surgery is a great tool for weight loss. But, as with all benefits, there are costs...and malnutrition is one of the potential prices of this surgery. Take a multivitamin supplement every day for the rest of your life and it is one you may never have to pay. You will also need to have your blood checked periodically for B-12 levels.
4. THOU SHALL EAT ADEQUATE PROTEIN.
What is adequate? I have heard everything from 50-60 grams a day (which equals about 2 oz. Of protein) to a much higher number ...(to figure out the amount of grams of protein equals in ounces, multiply the # of grams by .0353. That will give you an ounce calculation. It may not sound like a lot, but when you get down to brass tacks, and really look at what you eat at a meal, are you getting in at least 2 oz of meat at a sitting? Then filling in with the rest? Meat is usually very heavy and it is hard to digest so it ends up being the last thing we work on at a meal. A lot of post ops tend to take more of what rests comfortably in their pouch above all have some kind of balanced in your food intake.
5. THOU SHALL EXERCISE.
Just do SOMETHING. Even if it means starting off simply...take the stairs instead of the escalator or elevator. Park at the furthest spot in the parking lot. Carry your shopping basket instead of pushing the cart (on small shopping days of course...LOL).
6. THOU SHALL DRINK at least 64 ounces of water, everyday.
It seems that some people have problems doing this. Use a water bottle and carry it with you everywhere. Sip all day long. Or refill a gallon jug and drain it every day. Do it in 2 pitchers. Do it with 2-32oz sport water bottles. Please note however, that if you are drinking coffee or tea with caffeine, you will have to compensate for the diuretic effects of the caffeine. Caffeine robs your body of water, therefore, you will not only be unable to count the coffee or tea, but you will have to drink an extra cups of fluid for every cup of regular coffee or caffeinated tea that you drink to compensate for the diuretic effects of the caffeine.
7. THOU SHALL EAT WELL BALANCED MEALS.
I think my friends' doctor said it best: Protein first and foremost, then green/yellow vegetables, then fruit, then starches.
8. THOU SHALL NOT EAT SUGAR, in ANY form....no candy!!!
Treat yourself with some fresh fruit!! If I can give up blueberry blizzards from Dairy Queen, anybody can give up sweets!
9 THOU SHALL NOT modify these commandments to suit thy needs.
It will not work. You will only defeat yourself physically.
10. THOU SHALL LOVE THYSELF and be happy with the body God gave thee. God did not intend for all of us to be supermodels, and this surgery will NOT make you one. Happiness comes from within. Be happy with who and what you are. Or you will defeat yourself mentally. Then the battle will be lost before it is ever even begun.
Author Unknown
The Ten Commandments of Weight Loss Surgery
Good Nutrition for Life : Goals to Set Before Gastric Bypass Surgery
Gastric Bypass alone does not cure obesity . Your success will depend on your lifestyle choices . To help you reach your goals it is a good idea to start making lifestyle changes now .
Here is a check list to get you started .
Read about dietary changes following surgery
Eat less fried foods, added fats and high fat food items ( ex. Fast Food ) Eat more fruits and vegetables
Read about the importance of Protein and Protein sources in the post op diet plan .
Check for lactose intolerance
Purchase appropriate protein supplements in a large enough quantity to last about 2 weeks .
Avoid all sugars , sweets, deserts and sugared beverages
Wean off all caffeine and carbonated beverages
Eat meals very slow and sip liquids
Write down any questions you may have about your diet or nutrition and have them answered by your doctor or nutritionist .
Successful Habits of a Long Term Gastric Bypass Patients
EATING : Successful patients ate well-balanced meals and two snacks per day . Included 3 servings of protein , vegetables , one serving fruit , two servings bread/starches and two sweets .
DRINKING : Successful patients drank water and did not drink carbonated beverages . On the average patients drank 40 to 60 ox of water per day , 74 % do not drink alcoholic beverages, 55 % do not drink carbonated or sweetened drinks .
SLEEPING : Successful patients slept 7 hours per night on the average . 76 % rated their personal energy at being average or high .
EXERCISING : Successful patients exercised regularly to maintain their weight. Average was 4 x a week for at least 40 minutes .Patients reported exercise as a key factor in their ability to maintain their weight .
PERSONAL RESPONSIBILITY : Successful patients took personal responsibility for staying in control. 69 % weighed themselves at least weekly . General feeling that maintaining their weight was up to them , and surgery was only a tool they used to reach and maintain a healthy weight . By weighing often and allowing themselves only a few pounds leeway, patients stayed in control .
NOT SUCCESSFUL : In those patients surveyed who where not classified as successful , and absence of at least one or more is the six succesful habits was found . The most common was exercise ,constant grazing and snacking and drinking carbonated or alcoholic beverages . In the entire number of patients surveyed , including those that gained back part of their weight, 97 % view gastric bypass a success . The first postoperative year is a critical time that MUST be dedicated to changing old behaviors and forming new lifelong habits. By identifying these six common habits of the most successful long-term gastric bypass patients, the doctors established specific guidelines for new patients to implement .
3 Multi Vitamins a day: OneSource Pre-Natal Vitamins (Walmart $9.95 for 250 caplets)
Rexall Easy Iron 25 mg(Iron bisglycinate)3 days a week (Walmart $3.95 for 60)
Calcium Citrate Plus - 2 a day
GNC Hair, Skin & Nails Vitamins- 2 a Day. they can slow down hairloss and it does make your skin look great. Also try Biotin same results.
There are 4 life stages when your body clings to fat. Here's what you can do to lose it.
> Working Out but Not Losing Weight
> Diet Plateaus
> Weight Maintenance
For years, Michelle Batz, 46, was 120 pounds of pure muscle. But a difficult pregnancy in her late 30s caused her to gain 70 pounds, and although she's since lost most of it, 9 pounds are still glued to her belly and hips today. "It's frustrating because I work out for 45 minutes every morning, don't snack, and always eat meals off of smaller plates than the rest of my family," says the Chicago phys-ed teacher. "I know I still look good for my age, but I want to look like I did a decade ago."
Who hasn't hit the dreaded weight rut, when after a few weeks or months of the pounds flying off, you're suddenly--bam--up against a scale that won't budge? "All dieters reach a plateau at some point, whether it's after a few weeks or a few months," says Louis Aronne, MD, president of the North American Association for the Study of Obesity and a clinical professor of medicine at Weill Cornell Medical College. "After you've lost a certain amount, your body thinks it's starving and sets up roadblocks that make it harder for those last pounds to come off."
To make matters worse, the more weight you lose, the less effective your once successful diet plan is likely to be. The reason: As you lose weight, you may also lose muscle, leading to a slower metabolism. "Female patients come in asking, 'I lost 40 pounds--why is it so hard to get those last 10 off?'" says Scott Isaacs, MD, a clinical instructor of medicine at Emory University Medical Center and author of Hormonal Balance. "Yes, they're still eating the same amount of calories as when they started dieting, but because they weigh less, the nasty truth is they need to consume even less."
Unfortunately, these diet dead ends tend to get even tougher over time. "Age-related influences--a decreased metabolism, shifting hormones, and lifestyle changes--contribute to weight plateaus," explains Christine Gerbstadt, MD, RD, a spokeswoman for the American Dietetic Association and an anesthesiologist in Altoona, PA. But if it seems like every calorie you eat now has a straight-to-your-thighs homing device, new research suggests that there's plenty you can do at different life stages with diet, exercise, and behavior to lose even the most stubborn pounds for good. Try these methods today and see how fast you can get back to the weight you want to be--permanently.
When it comes to dieting, don't believe everything you hear. Hungry Girl has the 411.
Rumor #1: By not eating after a certain time of night (for example, 8 p.m.), you'll lose weight.
The Truth: By not eating after a certain time, there is a chance you might lose some weight. But it's not the time cut-off that will rid you of the pounds. Calories count. And whether you eat them at 9 a.m. or 9 p.m., a calorie is still a calorie. However, if you give yourself fewer chewing hours, you'll likely take in fewer calories and have more active hours to burn them off. This is especially helpful for late-night snack addicts. A lot of people eat great during the day, then pig out on chips, ice cream, brownies, etc., at 9 or 10 p.m. Eek! If this sounds familiar, a cut-off time for eating might be helpful to you.
Rumor #2: As long as something is fat free or low in carbs, you can eat as much of it as you want.
The Truth: No, no, no! We know tons of people (literally, tons) who have gained weight by chowing down on everything with a low-fat or low-carb label—because they simply ate too much. When it comes to weight loss, calories count. (Do we sound like a broken record yet?) Many low-fat and low-carb products are chock-full of calories. You must watch your portions and read labels carefully. Seeing the words "Fat Free" or "Low Carb" is no excuse to devour an entire bag of pretzels or chew a whole pan of bacon.
Rumor #3: Negative-calorie foods make you lose weight.
The Truth: Negative-calorie foods are foods that supposedly contain fewer calories than the amount your body would burn to digest them. Apples, celery, carrots, asparagus, cantaloupe, broccoli and blueberries are just a few of these so-called negative-calorie foods. So, is the rumor true? Should you be filling your shopping cart with apples and asparagus? Well, there is no conclusive proof that negative-calorie foods make you lose weight. Still, you can be certain that these foods won't hurt your diet. All of them are nutritious, low in fat and low in calories. So why not add some of these health-protecting foods into your meal plan? If it turns out that these negative-calorie foods do aid in weight loss, that would just be icing on the cake. (Which, unfortunately, is not a negative-calorie food.)
Rumor #4: Margarine is better for you than real butter.
The Truth: This myth is absolutely false. Most margarine has just as much fat and just as many calories as regular butter. And margarine also packs in oodles of heart-clogging trans fats. While butter, with all its saturated fat, is far from good for you, margarine, with all its trans fats, is even worse. Hungry Girl tip: Try Land O Lakes Light Whipped Butter. It's great.
Chew on This: Think you're doing yourself a favor by not eating breakfast? Think again. Studies show that breakfast skippers actually take in more calories by the end of the day than people who have a morning meal.
WLS TIMELINE – Or Am I Normal?
As you can guess not everything will apply to everyone, however, the following are my observations for the last few years.
By 1 week preop:
Panic sets in – much like the panic before having a baby. What to take to the hospital…pack and repack. Arrange everything you can before going into surgery (cook meals, write letters, read the memorial pages and then go to the message boards to get reassurance, confirm baby sitting, postop help, time off work, travel arrangements, etc.). Dive into whatever final foods you’re just SURE you’ll never eat again. Ask the MB what foods you’ll never eat again. Insomnia! Mood swings. Preop testing, nasty bowel preps (btw, there are NO easy ways to get this stuff down. Just do it!). Wonder if you’re weird because you ARE NOT scared. Wonder if you making a mistake because you ARE scared.
Postop Day 1 through Week 2:
“What the hell did I just DO to myself???”
“Why am I/am I not hungry?”
“I’ll NEVER be able to get in all the fluid/protein/food they want me to.”
“I can eat TOO much – did I break something?”
“I can’t eat enough…will I die of starvation?”
“I can’t believe how badly this hurt! ~OR~ I can’t believe I even had surgery, because there’s so little pain!”
“Why do I have no energy?”
“When can I eat….fill in the blank?”
“Will I ever be able to gulp water again?”
“Why did I GAIN 10 pounds???”
“Wow, I’ve lost 10 pounds!”
You think you've hit your first plateau. Nope. Odds are VERY good you haven't
Postop weeks 2 through 12:
Post op remorse usually fades during this time period. What a relief that is!
You TRY hard to stick to your doctors diet regimen/protocol and wonder if you’re evil when you slip off the wagon by eating….fill in the blank.
You accidentally gulp water and freak that you’ve broken your pouch.
You accidentally forget to chew something to death and fear you’ve plugged your stoma.
You FEAR strictures, fistulas and leaks every time you burp, get nauseated, have diarrhea, feel a muscle cramp, etc. This fear is not abnormal and you ‘could’ have one of these since this is the prime time for it – however fear is no way to live. There are common symptoms attributed to these. Hopefully you’ve researched them postop and can shelve the fear and keep a reasonable eye out for them.
You discover that you vomit or burp mucus, foam or fluid occasionally. This is called frothing, the foamies, or just mucus. It typically IS just mucus, caused by your healing pouch.
You discover your body has weird ways of telling you that you’ve eaten enough/too much (i.e., sneezing, sniffles, runny nose, hiccuping, etc)
You wonder if it’s normal to poop once, twice, three times a week.
You discover one day the scale is evil (you’re loosing too slow) and the next day its your friend when it rewards you with 1, 2, 5 pounds gone.
You wonder if you’re losing too fast and how will you stop it when you get to ‘goal’.
You wonder if you’ll EVER get to ‘goal’.
You try numerous types of protein drinks/bars, etc and wonder if protein is ‘for life’.
You swear you will never eat or drink….fill in the blank…as it is evil or forbidden (pop, cookies, popcorn, gum, etc.).
You discover that many (not ALL) long-term postops have discovered that very little is forbidden or evil to them in moderation and with care.
Months 3 through 18:
You worry you are a slow loser and have days you doubt the tool will work, or wonder if it’s broke. I am NOT mocking. Some people’s tools DO break during this period of time, but it is in the minority, not the majority.
You wonder if you’ll ever get to goal.
You made goal and worry you’ll not stop losing.
You worry because you can eat TOO much.
You worry because you still eat too little.
You worry about getting in enough protein.
You worry you’re getting in too much protein.
You ponder whether carbs are evil or not.
You question again whether diet pills are evil. (They ARE!)
You compare your losses against everyone else’s.
You discover that you had an exercise guru hidden within you and are now an exercise maniac.
You discover that you HATE exercise and try and force yourself to get moving.
You may have hit your first plateau. Don't panic!
Months 19 and beyond:
You may hit a plateau. Don't panic!
You reach goal and worry you'll regain.
You wonder if you'll stop losing!
You wonder if you'll EVER make goal (you've likely heard about the dreaded window and fear it closed at 18 months - be aware, I continued to lose to goal for 20 to 22 months).
You find yourself sliding; eating the wrong foods; slacking on exercise; and freak when you regain 10 pounds. Time to get back on track!
This is NOT to discourage you from asking questions. If anything this is to encourage you to. This is to show you that all your fears, doubts, worries and hopes are VERY normal – and to not be afraid to ask that question that is eating at you. I have purposely not provided ‘answers’ to most of the above questions, because we all need to discover our own path on this long loooong journey and everyone’s answer will be slightly different, as will their journey. So if you’re worried, curious, knowledgeable or just flummoxed…ASK, TELL, RESEARCH!
Good luck to all – preops and postops and just the curious
DRUGS THAT CAN DAMAGE THE POUCH:
Advil
Aleve
Anaprox
Ansald
Anthra-G
Arthropan
Ascriptin
Aspirin
Asproject zolid
Bextra
Bufferin
Butazolidin
Celebrex
Clinorial
Darvon compounds
Disalcid
Dolobid
Erythromycin
Equagesic
Felden
Fiorinal
Ibuprofin
Indocin
Ketoprofen
Lodine
Meclomen
Midol
Motrin
Nalfon
Naprosyn
Nayer
Orudis
Oruval
Pamprin-IB
Percodan
Ponstel
Rexolate
Tandearil
Tetracycline
Tolecin
Uracel
Vioxx (off market...not safe for anyone)
Voltaren
ALL "NSAIDS
DRUGS THAT ARE CONSIDERED SAFE:
Bendaryl
Amigesic
Anacin
Dimetap
Robitussin
Safetussin
Sudafed
Triaminics
(All) Tylenol (cold products)
Tylenol Ex Strength
Gas-X
Phazyme
Imodium Ad
Colace
Dulcolax-Suppositories
Fleet Enema Glycerin-Suppositories
Milk of Magnesia
Peri-Colace
Tylenol
PROTEIN INTAKE
It is important to eat protein at each meal. In order to get 40-60 grams of protein each day, eat the protein foods first, and have skim milk or yogurt daily.
SIGNS OF INADEQUATE PROTEIN:
~~Hair loss
~~Brittle nails
~~Slow healing
INCREASING PROTEIN
**********Use Double Milk
**********Add low-calorie Nestle Quik, low-calorie cocoa, Alba or low-calorie instant breakfast to skim milk.
**********For Lactose intolerance~~~Put Lactaid or Dairy Ease in milk or use soy milk if lactose intolerance is a problem.~~~Choose lactose-free low-fat milk available in the dairy case of most grocery stores, If not available, ask for it to be stocked.
**********Eat an omelet, scrambled egg or low-calorie fruit-flavored yogurt.
**********Combine cottage cheese with canned fruit.
**********Spread tuna or chicken salad, made with low-calorie mayonnaise, on low-fat crackers.
FAT INTAKE
Keep total fat intake below 30-40 grams per day.
**********Read labels~~~To identify hidden fats.~~~To identify unrealistic portion sizes.
**********FAT-FREE is not CALORIE-FREE.
**********Too many calories, no matter the energy source, will slow weight loss.
Calorie per gram of energy nutrients comparison:
Carbohydrate = 4 calories/gram
Protein = 4 calories/gram
Alcohol = 7 calories/gram
Fat = 9 calories/gram
CHEWING
Swallowing food without chewing adequately causes pain, discomfort, nausea, or vomiting. It is possible to stretch the pouch and disrupt the staple line.
Guidelines are:
**********Do not skip meals.
**********Take 30-60 minutes to eat every meal. At first, take longer.
**********Chew each bite 20-30 times until the food is of pureed consistency.
**********Use a dessert spoon or long-handled baby spoon to better control bite size and speed of eating.
**********Savor the flavor and texture of each bite of food.
**********See the dentist, if your teeth are in poor condition.
**********Explain the reason for eating slowly if asked.
***************************************************Some people think this surgery is the cure for everything. It is not. When you think about it we still have to so-call "Diet" We all have dreams that Oh yes I am going to look like her, and I am doing this for my health yada yada yada. Reality is this....we are given a tool to "HELP" us not to eat this or eat that and it limits our intake of food. I am sure if a poll was taken and people really really wanted to tell the truth instead of OH it was the BEST thing I ever DID, they still have regrets, frustations, because they didnt lose what someone else did or whatever. We all lose at different paces. Someone that weights 500 lbs in 6 months may lose 200 lbs while those that weigh 300 might only lose 70 lbs in 6 months and then people sit and think "Ok why is he losing more then me and we had the same surgery the same day"?
Why because the more you weigh the more you will lose quicker then someone that weighs less then you. A lot of people do not understand this part of it. Truthfully this surgery is not all it is cracked up to be. Yes you can be down so much weight but people need to be honest about it, it is not a cure. We could all gain the weight back in a few years UNLESS we diet which I hate that word (diet). Gotta face facts we will be on a diet the rest of our lives. Yes there will be certain foods that you will never be able to eat again. Mine is bread which is great because bread was my down fall. I researched this surgery for almost 2 years before I had it done but truthfully I didnt know anything! They do not tell you how you will get depressed afterwards, how you cant eat this or that starting out, how you WILL lose a lot of hair after 3 month period if you do not eat enough protein which I have but it still did no good. I had to cut my hair short so you would not notice so much and that is sad. They dont tell you about the stalls the plateau's you'll hit or if they do you might turn a blind eye to it and all you see is how much weight they have lost. I am sure as people read my profile they will not agree with what I have to say but then they are not in my shoes................................................
So please research everything, dont turn blind eyes towards one thing and look at something else. And remember you will and we all have, you will hit stalls where you wont lose anything for like 3 weeks or so and then you'll hit plateau's for 2 or 3 months at a time so just dont get digusted (myself included) and just hang in there. But do remember the most important thing of all is this is only a TOOL it is not the cure to all of our problems. We still will have to watch what we eat and change our life styles. Good Luck!
hobbies,golfing,cooking,meeting new people.
MEMORY LOSS
Simple answer: the brain runs on carbohydrates. If you are eating a diet that is too low in carbs, it's going to malfunction a bit. Add some good carbs every few hours and it will help. Protein's great for weight loss, but carbs are necessary for the brain.
The other problem that affects the mind is low blood sugar, which is caused by eating too little. The solution to that is to eat small meals more frequently--every two hours, something small. Eat right before going to bed (I eat a bowl of cottage cheese).
Sleep is essential, so cut out all coffee, tea and other stimulants.
I agree about vitamins. I take a B complex which includes B-12 and a lot of other important B vitamins. I take two times as much as the bottle says, with the permisson of my doctor.
Don't worry too much about it. With a few changes in your routine, you can reverse this. Be careful.
POUCH RULES FOR DUMMIES
This publication is for information purposes. Although it is intended to be shared, it should not be sold under any circumstance.
INTRODUCTION:
A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is, it may be because they haven’t learned how to get the "satisfied" feeling of being full to last long enough.
HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1) Weight loss occurs by actually "slightly stretching" the pouch with food at each meal or;
2) Weight loss occurs by keeping the pouch tiny through never ever overstuffing or;
3) Weight loss occurs until the pouch gets worn out and regular eating begins or;
4) Weight loss occurs with education on the use of the pouch.
PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness.
What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is over-stuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal?
For ten years, I had patients eat, until full, with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 ozs., with some as large at 9-10 ozs.
We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch, but how it is used that makes weight loss maintenance possible.
OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon’s "observations" as opposed to "blind" or "double-blind" studies, but it IS based on 33 years of physician observation.
Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage, as I was able to follow my patients closely. The following are what I found to effect how the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1.5 cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch is important.
5. By lightly stretching the pouch with each meal, the pouch sends signals to the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile.
7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight hours.
9. After one year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible ("water-loading"), the patient will get a feeling of fullness that lasts 15-25 minutes.
11. By eating "soft foods" patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain.
12. The patients that follow "the rules of the pouch" lose their extra weight and keep it off.
13. The patients that lose too much weight can maintain their weight by doing the reverse of the "rules of the pouch."
HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the "rules of the pouch", it doesn’t matter what size the pouch ends up. The feeling of fullness with 1.5 cups of food can be achieved.
OUTLET SIZE:
Regardless of the outlet size, liquidy foods empty faster than solid foods. High-calorie liquids will create weight gain.
EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full.
After six months, about 2/3 of the pouch has grown larger, due to the natural healing process. At this time, the patient can drink one cup of water at a time.
OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1.5 cups at a time.
IDEAL MEAL PROCESS (rules of the pouch):
1. The patient must time meals five hours apart or the patient will get too hungry in between.
2. The patient needs to eat finely cut meat and raw or slightly-cooked veggies with each meal.
3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure.
4. No liquids for 1.5 hours to two hours after each meal.
5. After 1.5 to two hours, begin sipping water and over the next three hours, slowly increase water intake.
6. Three hours after last meal, begin drinking LOTS of water/fluids.
7. Fifteen minutes before the next meal, drink as much as possible as fast as possible. This is called "water-loading." IF YOU HAVEN’T BEEN DRINKING OVER THE LAST FEW HOURS, THIS ‘WATER-LOADING’ WILL NOT WORK.
8. You can water-load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task; but, is useless if left on a shelf, unused. Practicing working with a tool makes the tool more effective.
NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the "rules of the pouch" before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the "rules of the pouch" begins after healing has caused hunger to return.
PREVENTION OF VOMITING:
Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz. cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick.
It is extremely difficult to learn to deal with a small pouch. For the first six months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.
In the first six weeks, the patient should slowly transfer from a liquid diet to a blenderized, or soft food, diet only; to reduce the chance of vomiting.
Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc. will swell, in time, and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz. cups and literally eat 1 oz. of food at a time and wait a few minutes before eating another 1 oz. of food. Stop when "comfortably satisfied," until the patient learns the size of his/her pouch.
SIX WEEKS:
After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1.5 hours after meals.
REASSURANCE OF ADEQUATE NUTRITION:
By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on protein and vegetables at each meal.
MEAL SKIPPING:
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two ozs. of protein at each meal.
ARTIFICIAL SWEETENERS:
In our study, we noticed some patients had intense hunger cravings, which stopped when they eliminated artificial sweeteners from their diets.
AVOIDING ABSOLUTES:
Rules are made to be broken. No biggie if the patient drinks with one meal–as long as the patient knows he/she is breaking a rule and will get hungry early. Also, if the patient pigs out at a party–that’s OK because before surgery, the patient would have pigged out on 3000-5000 calories and with the pouch, the patient can only pig out on 600-1000 calo
