by Kaye Bailey

Often when we hear about a diet that puts the body in a state of ketosis we are fearful having heard that ketosis is a potentially dangerous imbalance of blood glucose, the result of a low carbohydrate, high fat high protein diet. Ketosis results when the body switches from burning glucose for energy to burning ketones for energy. Glucose comes from carbohydrates which are the bodys first choice to metabolize for energy. Ketones are used for energy when there is not enough glucose (from carbohydrates) present in the bloodstream to use for energy.

Clinically stated, "Ketosis is a condition in which levels of ketones (ketone bodies) in the blood are elevated. Ketones are formed when glycogen stores in the liver have run out. The ketones are used for energy. Ketones are small carbon fragments that are fuel created by the breakdown of fat stores. Ketosis is potentially a serious condition if keytone levels go too high."

Most patients of bariatric surgery are instructed to follow a high protein, low carbohydrate diet with a modest amount of fat. The body only needs proteins and fats for building and repairing tissue and cells, carbohydrates do not play a part in this metabolic function. Additionally, the body can get all its energy from fats and proteins. A ketogenic diet, which was first developed in the early 1900s, is a high-fat and low-carbohydrate diet. When following a ketogenic diet the body will switch from being a carb-burning machine to a fat-burning machine. As a result weight is lost.

Perhaps the best known ketonic diet is the Atkins plan in which ketosis is deliberately achieved by way of high fat high protein and low carbohydrate diet. According to the Atkins program proper monitoring via urine tests will keep ketosis within safe limits and the dieter can reach an ideal body weight without suffering unbearable hunger. Most weight loss surgery patients are discouraged from following an Atkins-type diet because of the high fat content. Surgery reduces the amount of gastric juice available for digestion and many patients do not tolerate high fat foods.

Speaking to the general population (not necessarily weight loss surgery patients) experts are divided regarding the health risk versus benefit of a ketogenic diet. Some experts say it is dangerous because if keytone levels are not properly monitored there may be a strain on the kidneys, and a significant loss of calcium excreted through urine may cause kidney stones or osteoporosis. Proponents of a ketogenic diet cite human evolution in their argument saying during most of the time that humans have existed we have been a hunter-gatherer species living in a ketogenic state for extended periods. Documented studies suggest that after a 2 to 4 week period of adaptation human physical endurance is not affected by ketosis. Some studies go so far to suggest that humans do not necessarily need a high carbohydrate intake in order to replace depleted glycogen stores for energy.

Patients of weight loss surgery should work closely with their bariatric center to develop a diet and lifestyle program specific to their condition of obesity and recovery. While many consider the primary goal of weight loss surgery to be weight loss to improve physical appearance, the higher goal is improved health, energy and longevity.

Can I repeat the liquid days instead of going to Day 3?

I have worked on an answer to this question for several years now and have been unsuccessful, which frustrates me because I'm asked this frequently. What I have found is that people who practice a true vegetarian diet do not need the 5DPT because they are living in strict compliance with the vegetarian guidelines and are not likely to have a processed carb snacking habit. People who are (and I mean no offense by this) emotional or political vegetarians are the ones most often asking for a Vegetarian 5DPT. When asked to pinpoint their vegetarian dietary requirements they often say, "Oh, I don't eat anything with eyelashes."  That is an emotional dietary parameter.  In many cases they have left their dietary choices to emotional chance rather than nutritional sensibility. My advice to these "vegetarians" is to engage in the study of true vegetarian eating and if they so choose deliberately follow that dietary way of life. When the basics of WLS are included with a true vegetarian diet it is unlikely weight gain will result. That said, some of the carb monster soup recipes for the 5DPT are vegetarian for those who are interested.
Carb Monster Soup Recipes

What happens after the 5DPT?

Beginning on Day 6 after the 5DPT we slowly include complex carbohydrate vegetables and fruit in the diet at a ratio of two-thirds protein to one-third complex carbohydrate when measured by volume. We continue to follow the liquid restrictions and avoid slider foods and stay intently focused on the Four Rules. Now that we have recaptured that hell-bent determination that propelled us to have surgery in the first place we use the momentum in our pursuit for a healthy lifestyle of weight management with bariatric surgery.
Day 6: Beyond the 5 Day Pouch Test


I did the 5DPT and lost weight, but it didn't stick. Why?

The motivation for doing the 5DPT should always be to get back on track with the WLS dietary guidelines, not to lose weight. That means we take what we learn during the 5 days and apply it to our lifestyle on Day 6 and beyond. If we do the 5DPT simply to knock-off a few pounds and then go back to the very habits that lead to weight regain we will, naturally, regain the weight and then some. When we consented to weight loss surgery we agreed that for the rest of our life we would follow certain dietary guidelines. If we have drifted from the original guidelines the 5DPT can get us back to basics. At that point we must follow the guidelines we agreed to if we wish to sustain weight loss and keep our obesity in remission. "Use this as a means to return to following the instructions you were provided by your surgical weight loss center and nutritionist. Go back to doing what worked for you when you were at your best and losing weight or maintaining weight." (page 24 - 5 Day Pouch Test Owner's Manual).
Learn About: WLS Split-Personality Syndrome

Where can I get support when I'm doing the 5DPT? Support is essential when making any lifestyle change for the sake of improving our health. Enlist family and friends to help you with the 5DPT. Explain the program to them and why it is important. Avoid those who you know routinely sabotage your efforts to improve your health. Bariatric support groups are a steady resource of knowledge and encouragement, find one at your bariatric center or a non-affiliated group in your community. Online support groups offer 24/7 networking with like-minded people from nearly every corner of the globe. Consider joining our LivingAfterWLS Neighborhood, an online community we call "a safe haven circle of friends" bonding in our quest for better health and weight management with surgical weight loss.

I messed up on Day 1. Should I start over and repeat Day 1 until I get it perfect?

I have never done the 5DPT perfectly and I do not know anyone who has. Rather than make the 5 days about perfection make this time about learning. Little mistakes will not stop the world from turning. So forge ahead doing your very best and forgive little mistakes. Learn from each day, make notes on your 5 Day Pouch Test Journal, and emerge on Day 6 knowing more about yourself and how to work your tool. You can do this!


What if the 5DPT shows me my pouch is broken? What then?
If you have given the 5DPT your best effort and you still feel like your pouch is not working in the way it was intended to work please see your bariatric surgeon. Several diagnostic tests are available to determine the state of your pouch. In some cases a surgical revision may be necessary due to a pouch failure. Notice it is a pouch failure, not a personal failure when a revision is necessary. Revisions for gastric surgery are common and often patients are made to feel like moral failures if they require a revision. This is not the case. A revision is a medical procedure to correct a medical condition. Seek the care of a qualified bariatric team and do what is necessary to protect your health.

Important Information: I am me, I am not my disease 

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Put the Power of the Pouch in your hands with Kaye Bailey's two best selling books: The 5 Day Pouch Test Owner's Manual (2008) and Day 6: Beyond the 5 Day Pouch Test (2009). Over 300 pages of inspiration, motivation, empowerment and know-how to get you on track with weight loss surgery and keep you there! Great recipes, inspiring hints and divine secrets! Spoken in Kaye's compelling voice of compassion and "You Can Do This" spirit. SKU #1241714797

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