5 Day Pouch Test Bulletin
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Improving your 5 Day Pouch Test Experience in 2011
January 17, 2010

Losing weight and staying sane in a world where
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Understanding Ketosis in the WLS High Protein Diet

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.

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5DPT Featured Articles
The Featured Articles

page on the 5 Day Pouch Test website is frequently updated with relevant articles to support your pursuit of health with weight loss surgery. Below are just a few of our top-viewed featured articles.

Link Here

for the full index


What your Bariatric surgeon Forgot to Tell You That Will Cause Weight Gain

A significant number of people who undergo bariatric surgery for weight loss will at some point regain some of the weight they lost initially with surgery. Patients who stray from the high protein diet prescribed by weight loss surgery nutritionists to eat simple processed carbohydrates, called slurry foods, are likely to gain weight.

Learn why


Slider Foods Spell Weight Regain For Weight Loss Surgery Patients

Soft processed carbohydrates, slider foods, are the bane of good intentions and ignorance often causing dumping syndrome, weight loss plateaus, and eventually weight gain  for gastric bypass, gastric band (lap-band), and gastric sleeve bariatric patients. Learn what slider foods are and why they cause weight regain for weight loss surgery patients. Full article.

Full article


Understanding the Liquid Restrictions of WLS

Liquid restrictions are imposed on patients of all bariatric procedures including gastric bypass, adjustable gastric banding (lap-band) and gastric sleeve. For thirty minutes prior to eating and thirty minutes following eating patients are to abstain from drinking fluids. They must not partake of liquids while eating. Learn why liquid restrictions play a key role in weight loss for bariatric patients.

Full Article


Gastric Bypass Dumping Syndrome - Three Foods That Cause It

As pre-op weight loss surgery patients we are taught to fear the mysterious dumping syndrome and in most cases we are told that avoiding sugar will prevent the occurrence of dumping syndrome. So it comes as a surprise when after having a malabsorptive gastric surgery we experience symptoms that we think are dumping syndrome, yet sugar has not crossed our lips. In this article we take a look at dumping syndrome so that we can understand the full picture - beyond the sugar - and avoid the foods that may cause it.

Read more

Quick Links
Snow and Sky by Kaye BaileyGreetings Neighbors!

Today in the 5 Day Pouch Test Bulletin I have gathered the most frequently asked questions about the 5 Day Pouch Test and provided short answers with links to more details. It is great that we get so many questions about the 5DPT - as I have known all along, weight loss surgery patients are eager for knowledge and understanding. You want to work your weight loss tool in the best way possible and knowledge empowers you to do just that. So take a moment to look over the FAQ's and Answers. Maybe you will get a few things answered or feel renewed commitment to putting the power in your pouch!

For more informative and inspiring reading please visit
our 5 Day Pouch Test Articles Collection.

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Top FAQ's & Answers about the 5 Day Pouch Test
5 Day Pouch Test Owner's Manual How much weight can I lose?
The 5 Day Pouch Test is not a plan to lose weight, although many people who do the test report weight loss. When we reach a point where we feel we need to "get back to basics" with our weight loss surgery the 5DPT is a tool to quickly get us back on track. Closely following the plan helps us break a slider food snacking habit that may have stalled weight loss or caused weight gain. We take our stomach pouch through the dietary progression we followed after surgery with two days of liquid pampering and three days of advancing from soft protein to firm protein to solid protein. During the 5 days we focus on the Four Rules, especially Protein First. We observe the liquid restrictions and focus on the very reasons we had weight loss surgery in the first place. Most importantly, the 5 Day Pouch Test gives us a renewed sense of confidence in our surgical pouch and our personal power in following a healthy eating plan supports weight loss and weight maintenance. Any weight loss is incidental to that and should be considered a bonus, not the foremost objective. By the way, using the 5DPT Journal has proven to be one of the most effective ways to keep the momentum of the 5DPT going. Download it Here for Free

Will the 5DPT work for my procedure? (Lap-Band, Sleeve)
The 5DPT has been successfully completed by men and women with all surgical procedures. All case studies report returning to the high protein, low carbohydrate diet following completion of the test. Gastric bypass patients report the most noticeable tightness in the surgical gastric pouch and achieving feelings of fullness more quickly. However, adjustable gastric banding (lap-band) patients and gastric sleeve patients report feeling full sooner after doing the 5DPT. Specifically they note that returning to liquid restrictions is useful in optimizing the low-volume capacity of their gastric sleeve or lap-band stomach. Again, if you feel you need to get back to the basics of your post-surgical bariatric diet give the 5DPT a try. It is only 5 days and you just might be surprised how powerful you and your pouch are. The 5DPT Plan.

I had surgery X-many years ago. Is it to late for me to do the 5DPT?
Only you can answer this question. I know of people who had bariatric surgery back in the 1980's --when the procedure was a simple staple line down the stomach-- who have successfully done the 5DPT. Many times when people ask me if it is too late to do the 5DPT it is out of fear: fear they will learn their pouch no longer works or fear they will learn the pouch does work. The simple back to basics 5DPT will not cause you harm and it is only 5 days of your life. So it is up to you to decide if it is too late. Helpful read: Three Keys to WLS Succes

How soon after surgery can I do the 5DPT?
Without exception patients must follow the dietary program directed by their bariatric center for the first year following surgery. No exceptions.

How often can I do the 5DPT?
From page 62 of the 5 Day Pouch Test Owner's Manual, "If a patient is following the program outlined by their center, if they are losing or maintaining weight and feel energized and in control then do not do the 5DPT. It is a desperate action for desperate times. It is not a gimmick or a trick diet; it is a method of taking control when things are out of control. Think of it as your bariatric airbag and hope you never need to use it. But if you do find yourself in peril this airbag is there ready to be deployed."
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The LivingAfterWLS Neighborhood is your compassion-driven online social space for sharing your weight loss surgery and learning about others with weight loss surgery. We welcome Neighbors with any surgical procedure (or not) and at any stage in their weight management. This is our safe haven circle of friends. Below are quick links to some great destinations in the Neighborhood:

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Secrets of Day 6 and Beyond

More FAQ's & Answers

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

You can repeat the liquid eating plan of the 5DPT Days 1 & 2, but as soon as you do that you are doing a liquid diet; you are not doing the 5 Day Pouch Test. The intent of the 5DPT is to quickly progress through the post-op dietary stages and get us back to basics following our weight loss surgery high protein, low carbohydrate diet. Please follow the 5DPT as it is written: it was developed to help you achieve the best results with your weight loss surgery. We tested it many many times so you don't have to. 5DPT Plan

Is there a 5DPT for vegetarians?
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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