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In This Digest
Slider Foods Lead to Weight Regain for Some
How to Eat Popcorn After WLS
No Snacking. It is the rule that works
The Neighborhood
What about Milk & Cookies?
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Snow Crystals by Kaye Bailey

Whatever else you have on your mind,
Wherever else you think you're going,
Stop for a moment and look where you are:
You Have Arrived!

I believe in you.
You deserve to be healthy.
 You deserve to be kind to yourself.
You deserve to achieve your greatest level of success with weight loss surgery when you harness your inner resources.
--Kaye Bailey
5 Day Pouch Test Owner's Manual


Slider Foods Spell Weight Regain For Some  Patients



White Castle Slyders 


For most people eating sliders is a good thing. Popularized by the American food chain, White Castle, a slider (originally slyder) is a miniature grilled hamburger or cheeseburger on a steamed bun often served with onions and dill pickle and other condiments. They originally sold for a nickel a piece in the 1940s making it affordable to add a side of fries for just pennies. By all accounts this is a good kind of "slider" food.


To the weight loss surgery patient slider foods are the bane of good intentions and ignorance often causing dumping syndrome, weight loss plateaus, and eventually weight gain. Slider foods, to weight loss surgery patients, are soft simple processed carbohydrates of little or no nutritional value that slide right through the surgical stomach pouch without providing nutrition or satiation. The most innocent of slider foods are saltine crackers, often eaten with warm tea or other beverages, to soothe the stomach in illness or while recovering from surgery.


The most commonly consumed slider foods include pretzels, crackers (saltines, graham, Ritz, etc.) filled cracker snacks such as Ritz Bits, popcorn, cheese snacks (Cheetos) or cheese crackers, tortilla chips with salsa, potato chips, sugar-free cookies, cakes, and candy. You will notice these slider foods are often salty and cause dry mouth so they must be ingested with liquid to be palatable. This is how they become slider foods. They are also, most often, void of nutritional value.


For weight loss surgery patients the process of digestion is different than those who have not undergone gastric surgery. When slider foods are consumed they go into the stomach pouch and exit directly into the jejunum where the simple carbohydrate slurry is quickly absorbed and stored by the body. There is little thermic effect in the digestion of simple carbohydrates like there is in the digestion of protein so little metabolic energy is expended. In most cases patients in the phase of weight loss who eat slider foods will experience a weight loss plateau and possibly the setback of weight gain. And sadly, they will begin to believe their surgical stomach pouch is not functioning properly because they never feel fullness or restriction like they experience when eating protein.


The very nature of the surgical gastric pouch is to cause feelings of tightness or restriction when one has eaten enough food. However, when soft simple carbohydrates are eaten this tightness or restriction does not result and one can continue to eat, unmeasured, copious amounts of non-nutritional food without ever feeling uncomfortable.


Many patients turn to slider foods for this very reason. They do not like the discomfort that results when the pouch is full from eating a measured portion of lean animal or dairy protein without liquids. Yet it is this very restriction that is the desired result of the surgery. The discomfort is intended to signal the cessation of eating. Remembering the "Protein First" rule is crucial to weight management with bariatric surgery.


Gastric bypass, gastric banding (lap-band) and gastric sleeve patients are instructed to follow a high protein diet to facilitate healing and promote weight loss. Bariatric centers advise what is commonly known among weight loss surgery patients as the "Four Rules" the most important of which is "Protein First." That means of all nutrients (protein, carbohydrates, fat and alcohol) the patient is required to eat protein first.


Protein is not always the most comfortable food choice for weight loss surgery patients who feel restriction after eating a very small amount of food. However, for the surgical tool to work correctly a diet rich in protein and low in simple carbohydrate slider foods must be observed. The high protein diet must be followed even after healthy body weight has been achieved in order to maintain a healthy weight and avoid weight regain.


Kaye Bailey 2010 - All Rights Reserved


Article Source: Slider Foods Spell Weight Regain For Weight Loss Surgery Patients

The Nurse Warned Me,
But I Gained Some Weight Back Anyway

"Dear Kaye,
Thank you for the Day 6 book. I guess I am one of "those people" - had the surgery and lost and then it came back, the weight. My WLS nurse warned me I could regain the weight and I didn't take her serious or maybe I thought I was more determined than everybody else or smarter or something. I wish I had asked her what would cause me to gain the weight back. I'm not sure that back in 2007 I ever heard of slider foods or liquid rules or anything like that. I just knew WLS was the answer for me. So now I'm up 48 pounds and want to stop it before it gets to 50 pounds and all of the sudden another 50 and I'll be back where I started. Thanks for explaining so many things in the Day 6 book. I wish I read this book before I even had the surgery, maybe I wouldn't be one of "those people" or at least not a 48-pound-regain one of those people.

This is the first time I have hope since the re-gain started.
Kelly Marca
Northern Ohio"

Printed with Permission.

Day 6: Beyond the 5 Day Pouch Test
Because we are all "One of those people" who have or could regain our weight.

Day 6 by Kaye Bailey

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How to Eat Popcorn After
Weight Loss Surgery

   When it comes to foods that cause weight regain, for surgical weight loss patients popcorn is one of the worst offenders. By all accounts it is a high fiber "healthy" snack. However, for many gastric patients popcorn becomes the king of slider foods leading to digestive upset, dumping syndrome and ultimately weight gain. Many bariatric centers advise patients to eliminate popcorn from their diets first because it is a starchy carbohydrate snack food and secondly because eating it returns the patient to the habit of mindless snacking that contributed to morbid obesity prior to surgery. 

When a gastric bypass, gastric banding or gastric sleeve weight loss surgery patient is compelled to eat popcorn they should follow these eating guidelines that are provided by most weight loss surgery centers. Applying these guidelines is not radical or gimmicky, it is following the rules we agreed to when we signed on for gastric surgery.

--Measure a 1-cup serving for your meal or snack. Do not butter, salt or season the popcorn. Air popped is preferred.

--Cease liquid consumption 30 minutes before and 30 minutes after enjoying your 1 cup serving of popcorn.

--Do not consume liquid while having your 1-cup serving of popcorn.

--Do not exceed the 1-cup serving of popcorn.

If you chose to eat anything else with your popcorn meal/snack you must decrease the volume of popcorn by the volume of other food you will be consuming so that total volume of food is 1 cup.

Nutritional per serving: 1 cup lightly buttered popcorn is 82 calories; 1g Protein; 6g Fat; 6g Carbohydrate. It is 1/2 starch/bread exchange and 1 fat exchange.

Many patients that eat popcorn following these guidelines report an unpleasant experience: Their pouch feels tight and stuck because the popcorn just sits there. Without liquids to wash it through (and make it a slider food) and with our limited gastric enzymes and digestive juices, it takes a very long time for "dry" popcorn to digest in the pouch. Additionally we experience a dry mouth, bad breath and thirst. This is your pouch doing its job: You are supposed to feel uncomfortable when you follow the guidelines and eat something that appears on most "avoid these foods" lists provided by bariatric centers. Thank your pouch for doing a fine job and accept the message it is telling you.

If we ignore the guidelines and eat popcorn while drinking a beverage often our portion size goes unmeasured and we cross over to grazing-style eating. This is a problem with popcorn because popcorn is a high glycemic food and it elevates our blood sugar. If the beverages consumed with it also raises our glycemic load we are in danger of dumping syndrome. More commonly we find people sustaining "low grade dumping" where their blood sugar is elevated to the point of dizziness or "offness" but not enough to manifest the signs of full-blown dumping. Soon this state of "offness" begins to feel normal and it can only be sustained by nibbling or grazing on similar simple carbohydrates such as pretzels and crackers.

I have had my hand in the popcorn tub several times since weight loss surgery. It is so delicious and so tempting and seemingly such a smart healthy choice. I understand. But, sadly, I have answered well into the hundreds of emails, phone calls, and consultations with patients who are struggling with a weight gain that started innocently enough with a hand in the healthy snacking bowl full of popcorn.

Kaye Bailey - 2010 - All Rights Reserved

Article Source: How to Eat Popcorn After Weight Loss Surgery

LivingAfterWLS Weekly Digest

The Four Rules: #3 No Snacking   

When snacking hurts; When snacking helps 


February 9, 2011


I hope this newsletter finds you warm and well this second week of February. Today we continue our discussion of the Four Rules - we are at Number 3: No Snacking. It's a tough one and I dare say most of will or have struggled with snacking following weight loss surgery. And, as you will see from the articles in this newsletter, not all bariatric centers follow the same Four Rules that include no snacking. But what is consistent, across the front lines of those of us living with weight loss surgery, is that out-of-control snacking on poorly chosen foods leads to a stall in weight loss and may possibly lead to weight gain. So please, take a look at the information here and revisit the information you were provided at the time of your surgery. Find your personal position on the "No Snacking" rule based on knowledge, experience, and environment -- it is the most empowering thing you can do for yourself in this ongoing battle of weight management in a world where it is much easier to be fat.  


Happy 2011 - We are all in this together!



A Note: We have received the fourth printing of the LivingAfterWLS Neighborhood cookbook earlier than anticipated. We are processing backorders as quickly as possible - so look for yours in the next few days delivered by US Postal Service. Thanks for your patience! 

Link to view the previously published Weekly Digests in our 2011 Four Rules Series:


Rule #1 - Protein First:

LivingAfterWLS Weekly Digest January 20, 2011


Rule #2 - Lots of Water

  LivingAfterWLS Weekly Digest February 2, 2011 




The Four Rules: Before surgery most of us were taught the Four Rules we must follow in order to achieve the best results with weight loss surgery - any procedure. Those rules (with minor variations from one bariatric surgeon to the next) are:

  • Protein First
  • Lots of Water
  • No Snacking
  • Daily Exercise  

In order to maintain weight loss and keep the obesity from which we suffer in remission we must follow these rules for life. When we meet patients who have maintained a healthy body weight for several years with weight loss surgery we learn that in most cases they live by the Four Rules. 


If it has been a while since you have given consideration to the Four Rules I invite you today to spend a little time refreshing your knowledge and enthusiasm about Protein First. Actually, this is my favorite rule because it means good food without the guilt! Link to the articles of interest and take a look at some of our great WLS recipes. There is something for everyone as we get excited again about the Four Rules! 



Every now and again it serves us well to step back into our pre-op mindset when we were hell-bent on making surgery work to achieve weight loss and improve our health and quality of living. Take a look at this article with your pre-surgery eyes. I think it will help renew your enthusiasm for working "the tool" and living well today:


Understand the Four Rules of WLS 

Before Going Under the Knife 

Weight loss surgery is frequently perceived as an easy means to weight loss that requires little or no effort by the patient. However, patients who undergo bariatric surgery are prescribed Four Rules of dietary and lifestyle management that they will follow for the rest of their life if they wish to lose weight and maintain a healthy weight. Here is what you need to know about the Four Rules of weight loss surgery before going under the knife.

Link to Article 

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No Snacking. It is the rule that works.

Rule #3 - No Snacking 

Excerpted with permission from Day 6: Beyond the 5 Day Pouch Test by Kaye Bailey

Pages 43-45 - Copyright 2009 - Kaye Bailey - All Rights Reserved

"Without a doubt, the "No Snacking" rule is the most divisive in the weight loss surgery community. In fact, I've received more angry letters on this topic than any other of the Four Rules. One school of thought is that snacking is absolutely forbidden. The other school swears that three meals plus two snacks a day are essential for the nutritional survival of the weight loss surgery patient.

"I am not a doctor and I am not a nutritionist. But I work on the front lines with weight loss surgery patients every day, patients who are many years out from surgery; patients who have lost touch with their bariatric centers. What I do know for certain is this: patients who snack and who are not engaged in extreme athletics gain weight. There is a fine line between snacking intelligently and grazing and few, if any, of us have the self-control to toe the line. In my experience and in my opinion there is no reason for the average person post-WLS to ever engage in snacking. If we follow the I {heart} DIET we will not be hungry in the 4-6 hours between planned meals; there will not be a blood glucose emergency and there will not be a physiological need to snack.

"This may be a very unpopular stand for me to take. But I have spent the last six years working with my fellow weight loss surgery patients and in every case of weight regain snacking has been involved. And in most cases the initial instructions from the bariatric center were for the patient to eat every 3 to 4 hours and somewhere along the third year things went wrong. Snacking on protein bars or nuts became grazing on pretzels and crackers washed down with soda, coffee or tea. Slider foods overruled sensibility.

"No Snacking. It is the rule that works.

"Now, I'm obligated to tell you to follow the very specific instructions given you by your bariatric center. If they instructed you to have three meals a day and two snacks a day that's fine: please do not feel I'm beating you up here. But please, go get your original notes and instructions. Review the list of approved snacks. Copy that list and post it on your refrigerator to keep your memory refreshed. The snacks your center permitted during the phase of weight loss are the only snacks you are allowed for the rest of your life if you want to maintain your weight loss.

"I personally feel the "NO Snacking" rule is a tremendous relief. For several years of my adult life, prior to surgery, I had a 40-minute commute to and from work each day. My morbidly obese irrational thinking had me convinced that I could not last that commute without a large soda and giant cookie: both morning and night. Looking back that was about 1,200 calories of snacking I was taking each day just to "survive" my commute. Twelve hundred calories is equal to our full day caloric allowance after surgery! How was it again, that I became morbidly obese? Hmmm. My car was always full of crumbs and the back seat littered with empty cups and cookie wrappers, not to mention the expense of my snacking habit. What a relief when "No Snacking" took that burden from me.

"One reason we are prone to break the "No Snacking" rule is because traditional snack foods are ever present in our society and they tend to set more comfortably in our stomach pouch than protein dense food. Have you found yourself able to eat an endless bag of crackers or chips yet struggle to get a few bites of roast chicken down? The crackers are soft and when consumed with liquid create slurry that never compacts in the pouch the way protein does. The cracker slurry slides right through in a steady stream: slider food (more on this in Part II: I {heart} DIET Basics). Solid protein, on the other hand, settles in the pouch like an unwelcome second cousin on your sofa and lingers just a little too long. So naturally we prefer to eat something that gives us comfort, not discomfort.

"But the fact is, the pouch when it is used correctly, is supposed to be a little bit uncomfortable. The discomfort is the signal to stop eating. When we are snacking on slider foods we do not get that signal and we do not stop eating."

Link to more informative and helpful articles about Rule #3: No Snacking.

Snacking on Soft Carbs
Snacking on Soft Carbs. Over the last 10 years countless bariatric patients have told me,  "It seemed harmless at first to eat a few pretzels (crackers, chips, cookies, etc.) but pretty soon I was eating them all day and the weight started coming back." This is a common mistake made by weight loss surgery patients that eventually leads to regaining some weight previously lost with weight loss surgery.

Three Keys to Lasting Weight Management
Nearly a quarter-million people in the United States will undergo weight loss surgery this year to arrest their morbid obesity and lose weight. In spite of the drastic nature of gastric surgeries not all patients will reach a healthy weight and some may eventually regain weight they lost initially with surgery. Read full article. 

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Can we live well and have cookies too?

As you know at LivingAfterWLS we believe in the standard "Four Rules" of life after gastric band or bypass surgery, and that includes no snacking. But you know, we are all human and once in a while a carefully planned intelligent snack will bring great comfort to a stressful day or tide us over until the next meal. There is no surgery that will ever take away our need for nurturing food that brings us comfort. When we try to eliminate all the "bad" foods and "comfort" foods a feeling of deprivation results often followed by an unhealthy binge and then feelings of disappointment or failure. Nobody wants that.


What if you had the power to enjoy a wholesome cookie and beverage, between meals, knowing it was a nutritious and emotionally fulfilling gift to your body? Would you be game to try it?


Today we welcome cookies and milk back into our weight loss surgery way of living!


Ah, but there are some rules:


First: you must prepare the cookies from the recipes provided in the exact portion sizes. The recipes are from the American Diabetic Association and are safe for people controlling or in remission of diabetes, as many WLS post-ops are. The correct portion will not result in a dumping situation for malabsorptive patients.


Next: you must exercise portion control and enjoy your snack in a calm mindful setting taking at least 10 minutes (preferably 15) to eat and savor each bite and sip. Ten minutes of enjoyment beats the self-loathing that follows a snacking binge any day of the week. You deserve ten minutes in your day to nurture your soul and revive your energy: this snack will do both without guilt.


Enjoy 1 small cookie with 4-ounces of vanilla or chocolate RTD (Ready to Drink) protein shake. Find a restful spot and take at least 10 minutes to enjoy your snack: it is remarkable how filling and fulfilling this small amount can be. By forcing yourself to take time-out you can enjoy the snack and be mindful of your body.


Before you click to email me the question, "Isn't this the exact slider food situation you tell us to avoid?" Ah, I knew you were thinking that! Because you will take only one cookie and measure your 4-ounces of protein drink and take the time to enjoy you are disqualified from the slider food penalty here. Between the cookie and the shake you get about 6 grams of protein and a whole lot of satisfaction. This snack becomes a slider food when you eat several cookies with an unmeasured non-nutritional beverage.


Finally, after enjoying your snack focus on how good you feel about your personal power to measure and enjoy a responsible portion of a smart protein-wise flavorful treat. Who knows, we could start a revival of the good 'ole days!


Oatmeal Raisin Cookies


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The Reality of Food Cravings

Kaye takes a look at food cravings and considers that perhaps food cravings are more the power of suggestion than the body's cry for food. She discusses how we can better manage external cues as we pursue healthy weight management with weight loss surgery.
Take a look: Food Cravings

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Thank you for being a loyal Neighbor of LivingAfterWLS. We are proud to serve you in your weight loss surgery journey.



Kaye Bailey

LivingAfterWLS, LLC

The health content in the LivingAfterWLS website is intended to inform, not prescribe, and is not meant to be a substitute for the advice and care of a qualified health-care professional.