LivingAfterWLS Weekly Digest
Storm of Enthusiasm
Back to Basics of Weight Loss Surgery

July 30, 2013

In This Issue
July Theme
Weight Loss and High Protein Diet
Clarification: Caffeine, Carbonation, Alcohol
Understanding the Four Rules
Recipe: Tuna & White Bean Salad
Petals of Light by Kaye Bailey

July Theme: 

I know you've heard it a thousand times before. But it's true - hard work pays off. If you want to be good, you have to practice, practice, practice. 
~ Ray Bradbury

Knowledge is of no value unless you put it into practice. 
~ Anton Chekhov

"Practice means to perform, over and over again in the face of all obstacles, some act of vision, of faith, of desire. Practice is a means of inviting the perfection desired." 
~ Martha Graham

Don't be afraid to give your best to what seemingly are small jobs.  Every time you conquer one it makes you that much stronger.  If you do the little jobs well, the big ones will tend to take care of themselves. 
~ Dale Carnegie

Check out our July 5 Day Pouch Test Bulletin - it addresses the value and necessity of practice when it comes to managing our health and weight with surgery. Link Here 

"Obesity is a chronic, debilitating and potentially fatal disease."
American College of Gastroenterology - 2008

Check out our special edition Digest: Obesity is a Medical Condition, Not a Moral Failure
Link Here

Refresher: Definitions
OBESITY: noun.
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist-hip ratio and total cardiovascular risk factors. BMI is closely related to both percentage body fat and total body fat.

Obesity - The specifics

~Any BMI ≥ 35 or 40 is severe obesity

~A BMI of ≥ 35 and experiencing obesity-related health conditions or ≥40-44.9 is morbid obesity

~A BMI of ≥ 45 or 50 is super obesity

Learn your BMI at the Centers for Disease Control website: Link Below.  
"A successful surgery does not make a successful patient." Your surgeon can only do his part in your success;
the rest is up to you."

Dr. Guillermo Alvarez
Successful Weight Loss with
The Gastric Sleeve (page 59)

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The Gastric Sleeve

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Weight Loss and a High Protein Diet:
Curb Your Enthusiasm For Carbs
Shrimp Cocktail Salad
We eat less when protein's on the menu.

By Jan Eickmeier
Shared with permission from Prevention. See original article

According to an article in USA Today,a high-protein diet is one of the keys to weight loss success. It fills us up sooner and wards off hunger longer than carbs.

Citing research presented at the 2005 annual scientific meeting of NAASO, The Obesity Society, the paper reported on a study's finding that people who followed a 30% protein diet ate 441 fewer calories per day than when they followed a diet that only had 15% protein. While participants reported feeling more full when eating a high-protein diet, researchers are not sure why it increases satiety.

Experts say more research needs to be done on the long-term effect that a high-protein diet could have on the kidneys and on calcium in the body. They suggest that if you want to increase your protein consumption, choose lean protein such as low-fat dairy products, fish, and beans.

The story theorized that more protein rather than fewer carbs could explain the success of weight loss plans such as The South Beach Diet.



LivingAfterWLS General Store

Warm Wishes!


LivingAfterWLS Newsletter Archive

5 Day Pouch Test July Bulletin
Secret to successful WLS

Special Edition Digest
Must Read:
Obesity Reclassified.
"Obesity is a medical condition, not a moral failure."

5 Day Pouch Test June Bulletin

Don't Blame the Equipment

Cooking with Kaye
July 25, 2013
Refreshing Beverages

Cooking with Kaye
June 18, 2013

The Tricky Salad Plate

Weekly Digest July 23, 2013
Diet Soda is Making us Sick

Weekly Digest: June 10, 2103
Summer Living After WLS:
The Heat is ON!

Weekly Digest: June 1, 2013
Summer LivingAfterWLS:
Make this Your Best Year Ever

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We are about to turn the page on a new month as summer slowly slips away. I hope you are well and have been enjoying some favorite activities of LIVING during this slower-paced season. Thank you so much for selecting this correspondence from the many that fill your Inbox, I appreciate the time you spend with me.

Our July Theme, Practice Practice Practice, has focused on the constant effort health management requires of us, particularly weight management with surgery. Your feedback has shown us this topic has been quite an eye opener for many of us as we share the expectation that we should have been able to get WLS done right from the very start. But time has shown it is an endless pursuit of following the rules, self-assessment, constant learning, and a few detours along the way. There are days when I wonder, "Am I ever going to get this right?" and look at me - the focus of my workday is on understanding life after weight loss surgery!

As a follow-up to our practice theme, in August we will focus on Back to Basics. August is a terrific month to review the basics, set goals, and actively get back to working the WLS tool in a manner that it in turn the tool works for us. In today's Digest we visit the Four Rules in a brief refresher.  Also today please see a clarification to last week's article on liquids, and don't miss the featured recipe: Tuna and White Bean Salad.

I often talk about the "Storm of Enthusiasm" that is necessary in the movement toward change. You felt the Storm of Enthusiasm in the days and weeks prior to surgery and your new chance at finally getting control of your health and weight. In the next few weeks we will recapture that Storm of Enthusiasm together! I can hardly wait. The following is a brief excerpt from the 5 Day Pouch Test Owner's Manual:

Losing the edge; forgetting the promises
Shared with permission: 5 Day Pouch Test Owner's Manual
If you have undergone a bariatric surgical procedure to control the metabolic disorder causing you to suffer from morbid obesity then you understand what it means to jump through hoops. Unlike any other life threatening illness people suffering from morbid obesity must prove they are sick enough to undergo surgical intervention and at the same time demonstrate they are mentally healthy enough to adapt to that treatment and its consequences.

Like all WLS patients, I jumped through the hoops to get treatment with hell-bent determination that if I could just get this one break, some help from the good doctor, I would comply with the rules. I would never be "one of those people" who get the surgery only to briefly lose weight and gain it all back. I did everything in my power to convince myself, my doctors, my insurance company, and even my Lord that I would die a miserable sickly death of co-morbidities if I did not have surgery to lose weight and save my life.

And that hell-bent determination carried me well, for a time. I did lose weight and I did comply with the rules and restrictions of surgery. And I did praise my surgeon, and my insurance company, and my Lord that my life was spared and I was healthy, alive, and living. I suppose with all that praising going on I kind of lost sight of the path, left the course really, all in the name of living. Pretty soon I wasn't eating protein first or drinking lots of water. My daily exercise was hit-and-miss and a little snacking never hurt anyone, right? Somewhere the fighting survivor personality gave way to a what-me-worry wanderlust personality that didn't bother to follow the directions.

This learned: We cannot successfully manage our health with this surgery if we enable split-personality behavior.

The minute we give up the hell-bent fighter and survivor personality in exchange for the happen-chance dieter of lost-pounds-past we are at risk of gaining weight, of feelings of failure, and worst of all: we are at risk of succumbing to the metabolic disorder we fought so passionately to have treated with bariatric surgery. We cannot have it both ways. If we truly believe our obesity is a medical condition -and by medical definition it is- then we must yesterday, today, and forever consider it a medical condition. We cannot be gut-whacked one day for the sake of saving our life and the next day abandon the dietary rules like we could a few weight loss programs back when on a whim we joined a strip mall diet program advertising "Guaranteed weight loss! Join Now! Walk-ins Welcome."

I hope you find this digest useful in your ongoing efforts for improved health with weight loss surgery. Today marks the start of summer and I wish you the  very best of health  and wellness.  You have the power to make this your healthiest year ever - Let's do it together!


"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 

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clarificationA clarification:
Caffeine, Carbonation, Alcohol

One of our LivingAfterWLS Neighbors, Marie, asked for clarification of the below article "Caffeine, Carbonation, Alcohol, that was featured in last week's Digest. As I re-read the article clarification is in order and I present that for you now, along with the original article.

The statement from the first paragraph: "Other beverages including coffee, tea, milk, soft drinks and alcohol are forbidden," is directly from the American Society of Metabolic and Bariatric Surgeon's guidebook.  Different surgeons and bariatric nutritionists put different emphasis on the liquid recommendation based on their experience with patients and the type of surgery.

Many surgeons also put a time frame on the recommendations. For example, many new post-ops who have a malabsorptive procedure such as gastric bypass, are generally told absolutely no milk or caffeine or alcohol for the first year. The lactose in milk is a sugar that may cause dramatic episodes of dumping syndrome. In addition, some patients who drink full servings of whole milk are likely to stall their weight loss efforts because of the high fat content (a 1-cup serving of whole milk has 150 calories and 8 grams of fat.)  Patients drinking this much milk often fall short in reaching their daily consumption of water.  The caffeine and alcohol are discouraged (I think forbidden may be too strong of word) because they are absorbed so quickly into the system that the effects can be extremely intensified. This recommendation - to avoid caffeine and alcohol - is usually stringent for the first year post surgery, after which time many bariatric practices allow patients to relax the rule in moderation and with great caution.

Review last week's Digest in our Archive

The universal advice WLS patients receive from surgeons    

Not the Queen's Tea Dieters are often told - drink water. Drink a minimum of 64 ounces a day - eight glasses a day. Gastric-bypass patients don't have a choice: they must drink lots water. Other beverages including coffee, tea, milk, soft drinks and alcohol are forbidden. Water is the essential fluid for living. Water is one of the most important nutrients the body needs to stay healthy, vibrant and energetic. A tell-tell sign of a gastric bypass patient is the ever-present water bottle.

Caffeine: The restrictive and malabsorptive nature of the gastric bypass causes several things to go wrong if a patient partakes of caffeinated black coffee or black tea**, high-caloric carbonated beverages or alcoholic beverages. The caffeine assimilates into the blood stream very quickly causing jitters and nervousness more-so than a normal digestive system. The high-caloric beverages are easily absorbed through the shortened intestine causing a weight plateau or weight gain. And alcohol is absorbed with break-neck speed causing intoxication, vomiting or dumping.

Knowing this bariatric centers advise patients to drink water throughout the day to avoid dehydration. However, patients are told to avoid drinking water with meals as it will facilitate food movement through the small stomach pouch allowing a person to consume more food.

Nutritionists say a precise measure of the body's need for water is to divide body weight (pounds) in half and drink that many ounces every day. That number could well exceed 200 ounces a day for morbidly obese people actively engaged in weight loss. Most doctors advise gastric bypass patients to consume 64 to 72 ounces of water daily.

**Please note that more and more bariatric centers are encouraging the consumption of quality herbal tea for weight loss surgery patients. A variety of formulas are available that effectively treat some of the unpleasant side-effects of gastric surgery such as constipation or water retention.

We are so impressed by the health benefits and effectiveness of herbal tea formulas that we carry a healthful selection in the LivingAfterWLS General Store: Herbal Teas for WLS

Herbal tea 
Herbal Tea Sampler for Weight Loss
While not a fussy tea drinker Kaye Bailey is now a strong believer in the health promoting benefits of traditional herbal tea. She uses these traditional formulas regularly to support health, promote weight loss and sustain weight maintenance.

Our Carefully selected herbal teas made in the USA by Triple Leaf Tea are produced to the highest manufacturing standards following authentic traditional Chinese medicine. Many weight loss surgery patients report feeling improved health and increased weight loss when including tea in the diet prescribed by bariatric nutritionists. Purchase our popular sample bundles of 12 servings or purchase each blend in a cello-wrapped box of 20 servings.

Learn More about Our Tea

Evaluate your weight management with surgery. Use our LivingAfterWLS Quarterly Self-Assessment to see where you are today and plan for where you are going.

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fourruleUnderstand the Four Rules
of Weight Loss Surgery

By Kaye Bailey 

Weight loss surgery (WLS) 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. All surgical weight loss procedures including gastric bypass, adjustable gastric banding (lap-band) and gastric sleeve, promote weight loss by decreasing energy (caloric) intake with a reduced or restricted stomach size. The small stomach pouch is only effective when a patient rigorously follows the Four Rules: eat a high protein diet; drink lots of water; avoid snacking on empty calorie snack foods; engage in daily exercise.

As part of their introduction to a bariatric program most patients are taught the Four Rules, which tend to be consistent from one bariatric program to the next. Many patients agree to follow the Four Rules which will work in concert with their surgically altered stomach and digestive system to bring about rapid massive weight loss. Some patients mistakenly believe they can return to the eating and lifestyle habits they practiced before surgery once they have lost the desired amount of weight. However, patients who return to their pre-surgery lifestyle and diet often fail to achieve full body fat loss and frequently regain much of the weight they initially lost.

For patients to lose all of their excess weight and maintain that weight loss they must follow the Four Rules for the rest of their life. Before undergoing any surgical procedure for weight management one must be fully aware of the Four Rules and willing to commit to them for life. Below is a quick look at each rule as it applies to WLS patients:

Protein First: At every meal the WLS patient will eat lean animal, dairy, or vegetable protein before any other food. Protein shakes or supplements may be included as part of the weight loss surgery diet. Patients are advised to consume 60-100 grams of protein a day. Eating lean protein will create a tight feeling in the surgical stomach pouch: this feeling is the signal to stop eating. Many patients report discomfort when eating lean protein, yet this discomfort is the very reason the stomach pouch is effective in lowering energy intake. Patients should not consume liquids while eating solid food because liquids will cause the stomach pouch to empty too quickly preventing nutrient absorption and satiation.

Lots of Water: Like most weight loss programs, bariatric surgery patients are instructed to drink lots of water throughout the day. Water hydrates the organs and cells and facilitates the metabolic processes of human life. Water flushes toxins and waste from the body. Patients are prohibited carbonated beverages and advised to drink caffeinated or alcoholic beverages sparingly.

No Snacking: Patients are discouraged from snacking which may prevent weight loss and lead to weight gain. Specifically, patients are forbidden to partake of traditional processed carbohydrate snacks, such as chips, crackers, baked goods, and sweets. Patients who return to snacking or grazing defeat the restrictive nature of the surgery and weight gain results.

Daily Exercise: Patients in recovery from morbid obesity must increase their daily activity and progress to formal fitness building activities that include aerobic conditioning and muscular strength and endurance. Walking, swimming, and biking are all encouraged following gastric surgery. Patients who continue to follow an exercise routine will sustain weight loss and live healthier lives. Patients who do not include exercise as part of their bariatric weight loss program will most likely regain weight and suffer from co-morbidities they hoped to relieve with surgical weight loss.

Nice Tool: Four Rules Infographic

   Four Rules Infographic Nearly a half-million Americans this year will undergo some form of bariatric surgery for the treatment of their morbid obesity. Surgical intervention is proven to be the best treatment for many people in affecting long term weight loss and weight management. However, surgery does not work alone. Patients who are compliant with the Four Rules of dietary and lifestyle change are most likely to enjoy improved health and mobility following a bariatric intervention.

Click image to view graphic in full scale or Link Here



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recipe Fuel Your Brain at Lunch:
Tuna & White Bean Salad

Shared with permission from Cooking with Kaye, page 46, by Kaye Bailey.  Copyright (C) LivingAfterWLS ~ All Rights Reserved

Tuna and White Bean Salad

 Freeway Chef, easy lunch, lasting satiation, nutritional super salad


This is a great salad on days when you need after-lunch brain power and mental stamina while curbing afternoon hunger. A Swedish study found that people who ate fish midday consumed 11% fewer calories at dinner - that's enough to lose 8 pounds in a year - compared with those who ate more carbs and less protein. One serving of this salad provides 33 grams protein and healthy Omega 3 fatty acids.


Ingredients for Dressing:

2 tablespoons red wine vinegar

1 tablespoon capers, rinsed and drained

1 tablespoon olive oil

teaspoon dried rosemary, crushed

1 small garlic clove, minced


Ingredients for Salad:

4 cups salad greens, ready-to-eat

1 (15-ounce) can great northern beans, rinsed and drained

2 (6-ounce) cans albacore tuna in water, drained, flaked with fork

2 hard-cooked eggs, coarsely chopped

cup roasted red peppers, diced


Cooking with Kaye: Methods to Meals
135 High Protein Recipes You will Love
Learn More

Directions: Whisk together dressing ingredients in a small bowl, set aside to allow flavors to blend. Whisk again just before dressing salad. For salad, in a large bowl toss together salad greens, beans, tuna, eggs, and red peppers. Just before serving toss with vinegar and caper dressing. Divide salad evenly among four chilled salad plates, season with salt and pepper.



Nutrition: Serves 4. Each serving provides 295 calories, 33 grams protein, 7 grams fat, 24 grams carbohydrate, 6 grams dietary fiber.


Try This: In place of canned tuna use leftover fish from the Crispy-Crusty-Crunchy Coated Protein Chapter. Cold water fish such as salmon or cod also provides healthy omega 3 fatty acids to improve brain function and promote heart health.


Page 46 Cooking with Kaye: Methods to Meals

5 Day Pouch Test Recipes    |    LivingAfterWLS Recipes

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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.


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Kaye Bailey, Founder
Evanston, Wyoming 82931