5 Day Pouch Test Bulletin

Liquid Restrictions:

More than just rules


Learn Why they matter &

How to work them into your day!

March 28, 2011   

Losing weight and staying sane in a world where
 it's easy to be fat.

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relapse: noun. Recurrence of disease after apparent recovery.

remission: noun. Abatement of signs and symptoms of disease.
(Mayo Clinic
Family Health Book)


I suggest we take a clinical approach toward our obesity. management.

When we lose weight we put obesity in remission. When we gain weight obesity is in relapse.  

As intelligent beings we can take an active role in managing our remission by using our experience and the knowledge we glean from others.


Read further in the March 1, 2011 5DPT Bulletin  

Today's Bulletin
Refresher: The Four Rules
Learning: 5 Day Pouch Test Featured Articles

5 Day Pouch Test Owner's Manual 
5 Day Pouch Test Owner's Manual

The Plan
The Recipes
The Inspiration
The Empowerment

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The Four Rules
The Rules Work
We lived by the Four Rules during the early weeks and months following weight loss surgery. Then we became a little more comfortable and let the rules slide a bit here and there as we tried to "get back to normal." But the fact is, our weight loss surgery will never allow us to be "normal" again. By embracing the Four Rules -- not just during weight loss, but for life -- we can maximize our weight management with the surgical pouch.

It is remarkable how many people report a renewed sense of empowerment when they return to the Four Rules because again they feel the power of the pouch and often weight loss results or weight regain is halted.

As a refresher the Four Rules are:
  Protein First
  Lots of Water
  No Snacking
  Daily Exercise

For more detail check out our 2011 Four Rules Refresher Course


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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

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


Guided Imagery - Topic Overview
What is guided imagery?

guided_imageryGuided imagery is a program of directed thoughts and suggestions that guide your imagination toward a relaxed, focused state. You can use an instructor, tapes, or scripts to help you through this process.


Guided imagery is based on the concept that your body and mind are connected. Using all of your senses, your body seems to respond as though what you are imagining is real. An example often used is to imagine an orange or a lemon in great detail-the smell, the color, the texture of the peel. Continue to imagine the smell of the lemon, and then see yourself taking a bite of the lemon and feel the juice squirting into your mouth. Many people salivate when they do this. This exercise demonstrates how your body can respond to what you are imagining.


You can achieve a relaxed state when you imagine all the details of a safe, comfortable place, such as a beach or a garden. This relaxed state may aid healing, learning, creativity, and performance. It may help you feel more in control of your emotions and thought processes, which may improve your attitude, health, and sense of well-being.


What is guided imagery used for?

Guided imagery has many uses. You can use it to promote relaxation, which can lower blood pressure and reduce other problems related to stress. You can also use it to help reach goals (such as losing weight or quitting smoking), manage pain, and promote healing. Using guided imagery can even help you to prepare for an athletic event or for public speaking.


Is guided imagery safe?

Guided imagery is safe. No known risks are associated with it. Guided imagery is most effective when the person teaching it has training in guided imagery techniques.


Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.


More at WebMD.com


Quick Links

Greetings Neighbors!

One of the first places we go off track after weight loss surgery is forgetting to follow the liquid restrictions. Some centers call them water rules. In short, the liquid restrictions mean to cease drinking beverages 30 minutes before meals and refrain from drinking beverages with meals and for 30 minutes thereafter. This is so our pouch fills more quickly on solid food, we stay full longer, and our bodies have ample opportunity to digest food and absorb its nutrients. Most bariatric centers apply the liquid restrictions to all surgical procedures including gastric bypass, adjustable gastric banding (lap-band), and gastric sleeve. 


As informed and well-intentioned patients we do not willfully ignore the liquid restrictions. The reason it is easy to get away from them is that eating is more comfortable when we mix food with water to form a slurry rather than solid mass which tends to sit like a lump in our gastric pouch. Over time it becomes common to abandon the liquid restrictions all together as we return to a physically and socially more comfortable practice of eating and drinking together. This often leads to feelings of hunger not long after meals, and ultimately may lead to weight gain.


On the 5 Day Pouch Test website we read, "It is difficult for weight loss surgery patients to follow liquid restrictions because doing so causes tightness to occur in the stomach pouch, which for some is quite uncomfortable. Paradoxically, this discomfort is the mechanism by which gastric surgeries work: it is the signal to stop eating."

Full Article 


Days 1 and 2 of the 5 Day Pouch Test menu include liquid meals only. Participants can plan to have clear broth, protein drinks, or the carb monster soups. A person who has been following a strict weight loss surgery diet free of soft processed carbohydrates (snacks) will be able to complete Days 1&2 successfully on clear broth and protein shakes. To break a soft carbohyrdate snacking habit one will do better to enjoy the carb monster soups which facilitate a more gentle transition from snacky carbohydrates to complex vegetable and grain carbohydrates.


Because Days 1&2 are liquids people following the 5 Day Pouch Test to get back on track often ask if is necessary to observe the liquid restrictions. Yes it is necessary, for two reasons. First we are using the 5DPT as a mechanism to get back to our WLS basics, which includes liquid restrictions. Days 1&2 are the starting point of return to good habits. Next, we need to give our body time to digest the liquid and absorb the nutrients. Learn more about this in the article below.


Any time we eat it should be with the intention of providing our body food that it can digest and absorb in order to efficiently and powerfully fuel the metabolic process of living. If you have practiced guided imagery or meditation for other purposes apply those techniques as you visualize your food as it moves through your body and powers you through the day. Such practices facilitate moments of appreciation and understanding ultimately leading to treating our bodies and health more compassionately.  


Please review the liquid restrictions and your habits if you are using the 5 Day Pouch Test to get back on track this week. Take your knowledge and let it empower you.


You deserve to be your very best!

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

You Can Do This!

"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

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Protein Shakes: Nutrients to Digest & Absorb
Coffee Protein Smoothie Delivering Nutrients by Liquid

As far as I am personally concerned, the only reason for me to ever drink a protein shake meal replacement is so that I can deliver to my body easily digested food that can be efficiently broken down into nutrients to be absorbed out of the digestive tract and into the body. Convenience and economics are secondary considerations for me because I understand the importance of providing high quality protein, vitamins and minerals to my body. My preferred method of doing this is eating solid food. But if I am unable to provide addequate nutrition with solid food it is essential I supplement with a high-quality, preferably medical grade, protein beverage. Most dieticians working with bariatric patients recommend protein supplements made with whey protein isolate.


When I include a protein beverage in my diet it is key to observe the liquid restrictions by drinking no other liquids 30 minutes before or after drinking the protein shake. In addition, I try to take no longer than 15 minutes to consume the shake. This is to ensure that beginning with ingestion when food mixes with saliva in the mouth that I give my body every opportunity to absorb the nutrients in the shake. If I chase a shake with a drink of water without allowing time for digestion and absorption I am missing the opportunity to make use of the nutrients.


For me a high protein low carbohydrate sugar-free protein shake is the best. I look for ready-to-drink shakes or powder that contains 15 to 20 grams protein per serving using whey protein isolate. A single serving should not exceed 200 calories. Using a blender I like to mix 3/4 cup room temperature coffee with 1 scoop vanilla protein powder, 2 tablespoons plain non-fat yogurt and 4-5 ice cubes, blending until smooth. This takes me about 30 minutes to drink and keeps me full for several hours.

Please join us in the Neighborhood and post your favorite protein drink recipe in the Community Kitchen.
Let's Do the 5 Day Pouch Test Together

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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:

5 Day Pouch Test Forum

5DPT: Ask a Question

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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

Three Keys to Back to Basics After Weight Loss Surgery
People who have undergone weight loss surgery and later gain weight are often told to "get back to basics" but we are seldom given more detailed directions. Here are three keys to a back to basics approach in following the weight loss surgery diet.

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.

Gastric Bypass Dumping Syndrome:Three Foods That May 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.

More Articles

Your Top 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

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

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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The health content provided by LivingAfterWLS 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.

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