5DPT Bulletin
Tough Love on Snacking

Bulletin: October 2013
In This Issue
October Theme
Infographic: Was my 5DPT a Success?
Bulletin Archive
No Snacking Works!
Slider Foods
Recipe: Italian Veggie Egg Custard

October Theme:
A Journey
Back to Basics
"When we had surgery most of us vowed we would never go back to the state of morbid obesity and illness that lead us to the operating room in the first place. This suggests that when we fall off the wagon of dietary compliance it is not so much about a moral breakdown or relenting to environmental pressure (think food pushers), but perhaps we simply don't remember how
bad obesity felt."
~ Kaye Bailey

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!  


Key Learning Point

"Weight regain is complicated. Remember, weight regain following weight loss surgery is not a simple matter. According to experts, "Weight regain after gastric surgery is multi-factorial and likely involves a complex interplay between a permissive psychosocial environment, nutritional habits, and a complex genetic and anatomic milieu that effect many physiological regulatory pathways controlling food intake behavior and energy metabolism after the procedure." (Barham K. Abu Dayyeh, 2011)

5DPT Manual page 22" 
~ Kaye Bailey


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5DPT Infographic:
Was my 5DPT a Success?

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5DPT Success Infographic
Was my 5DPT a success?

Soft Carb Snacking

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.

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LivingAfterWLS Newsletter Archive

January 2013 Bulletin:
Obesity is a Metabolic Disease.
Why do we treat it clinically?
View Here

February 2013 Bulletin:
Rule #1: Protein First.
Why protein and how much?
View Here

May 2013 Bulletin:
Day 4: Your New Normal
View Here

June 2013 Bulletin:
Don't blame the equipment, just make the play
View Here

5DPT June Special Edition:
Top FAQ's January - June 2013
Questions & Answers to improve your 5DPT Experience
View Here
5DPT July Bulletin:
WLS Secret Revealed
View Here

5DPT August Bulletin:
Get back to basics fast with the 5 Day Pouch Test
View Here

Gerber Daisy
Question: What is the biggest mistake you see people making on the 5 Day Pouch Test?

Kaye's Answer: Not learning and following the plan or changing the plan drastically.

Learn the plan. Read the plan in full and be sure you understand it. Read the plan completely in order to understand the progression of your diet from Day 1 to Day 5. Pay close attention to understanding the liquid restrictions and slider foods: these are the most common problem areas that lead to weight regain after weight loss surgery.  As you become familiar with the 5 Day Pouch Test compare it to the early dietary stages following your weight loss surgery. Think back to what worked for you then and imagine the same will work for you again. Remember, you already know how to lose weight using your surgical tool. The effort you put into the 5DPT will return you to that place of healthy and reasonable weight management using your tool.

Try not to make too many changes to the plan. Keep it at 5 Days. Don't restrict foods and go hungry. Really pay attention to what changes you are making and constantly think about the Four Rules can be your way of life, not just a temporary means of taking off a few pounds only to put it back later. This is a way of life we agreed too when undergoing surgery and it is for our lasting health. The 5DPT can help you get back to doing what works with WLS to support your lasting health and weight goals.

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Hello (Contact First Name) 

I Fall Flowers hope this newsletter finds you warm and well this second week of October. Thanks for spending time with me in our monthly 5DPT Bulletin.

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.

If you haven't heard, the LivingAfterWLS publications, including the 5DPT Owner's Manual, are now available as eBooks. Check your favorite store or visit the LivingAfterWLS General Store to learn more. Enjoy!

I wish you the very best today and always!


"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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An Interview with Kaye Bailey



Rule #3 No Snacking

76% of WLS post-ops who regain weight 
blame snacking habits

by Kaye Bailey
Copyright 2013 LivingAfterWLS - All Rights Reserved

Recently in one of the online WLS groups there was the age old question "To snack or not to snack after WLS?"  As usual, I took the Four Rules to town. Many in the dialog were shocked to see the Four Rules stating that is not what their center told them. Indeed, each center works a bit differently with their post-patient protocol. All WLS post-ops should follow the guidelines given to them at the time of surgery. None of us would ever consider changing-up our prescription medicine. Think of your guidelines as a prescription, that tends to help us take them seriously.

In answer to the question where do I get my Four Rules: The WLS Four Rules are highly recommended by the American Society of Metabolic and Bariatric Surgeons (ASMBS) as appropriate protocol for patients who have undergone surgical intervention for the treatment and management of obesity. The Four Rules are: Protein First; Lots of Water; No Snacking; Daily Exercise.

I was prescribed the Four Rules by my surgeon, who is a past president of the ASMBS, in 1999 when I underwent laparoscopic gastric bypass. When I have rebelled against the Four Rules I weight gain occurs. When I have complied with the Four Rules I have lost weight or maintained a consistent healthy weight. I credit the Four Rules for keeping my weight within a six-pound window since 2009.  It is difficult at times, to comply with the rules, but it is worth it.

Rule 3: No Snacking 
Post-ops often tell me "My nutritionist/doctor/other told me I need to eat every 3-4 hours to manage my blood sugar."  This may be true for fewer than 10% of weight loss surgery patients.  People with a endocrine or glucose intercurrent illness such as diabetes or hyperglycemia who are rightly told to eat that frequently must monitor blood sugar and must be in the care of an endocrinologist.  Regardless if you call them "meals" or "snacks" they must be balanced specifically for glucose control and be served in measured portions and documented on a food log for the review of a doctor and dietician.

Of the hundreds of people whom I've personally worked with on issues of weight gain after WLs the majority attribute weight gain to snacking. And not surprisingly, many admit to using the advice to "eat every 3-4 hours" as permission to snack.

I believe we need to wake up and kick this dietary advice to the curb.  If one is experiencing such a blood sugar crisis then they need to be managing their blood sugar issues with prick-test blood monitoring and regular visits to an endocrinologist.  When someone tells me they need to eat to manage their blood sugar I ask them, "What was your reading this morning?"  --- Two people out of over 480 have known the answer and were able to show me their monitoring log.

People with a glucose control illness such as diabetes or hypo/hyperglycemia who need to eat that frequently must monitor blood sugar and must be in the care of an endocrinologist. "Meals" or snacks every three hours should be balanced specifically for glucose control and be served in measured portions and documented on a food log.   In conversation most of the 480+ individuals I speak with eventually admit they use the "eat every 3-4 hours" advice as permission to snack.

I know this sounds stern and I know some will unfriend me.  Okay.   But if you sat with as many heart-broken people as I have who are so self-loathing and so disappointed because they've regained weight after surgery maybe you  would be stern too. I practice soft talk and I prefer soft talk. Unkindness is not my thing. But we need to get this loud and clear - of the four rules *No Snacking* is the one that makes or breaks our success.

I know some will say eating every 3 hours raises the metabolism. That is a true statement if the nutritional content is 70% protein with carbs & fat providing the other 30%.  Don't fly this flag. We can better raise our metabolism by walking up and down two flights of stairs twice every 3 hours or doing 2 minutes of arm curls with resistant bands or 2 minutes of deep knee bends.  We all know this but we are far more eager to eat to raise the metabolism than we are to move to raise the metabolism.

Helpful Article:
Three Keys to Lasting WLS Success
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. Link to Article

Now Available Everywhere in eBooks! 

LivingAfterWLS is pleased to announce that our publications by Kaye Bailey are available in eBook format for your portable reading and reference pleasure. Check them out in the LivingAfterWLS General Store. Or with one of our eReader Partners: Amazon Kindle; Barnes & Noble Nook; Kobo ; iTunes Store, Google Play and Primedia eLaunch Bookstore. eBooks are an excellent option for our readers outside of the United States! *Prices may vary by store,  




Slider Foods: Let's Learn More 
Change the focus of your thoughts

 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.  

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

Quotes to Live By 
"Once a musician has enough ability to get into a top music school, the thing that distinguishes one performer from another is how hard he or she works. That's it. And what's more, the people at the very top don't work just harder or much harder than everybody else. They work much, much harder."
~ Malcolm Gladwell ~ Outliers: The Story of Success

"Practice, practice, practice. Most of us assume that Olympic athletes have incredible innate talent. It bears repeating however, that researchers across a wide array of fields have shown that innate ability has relatively little to do with why people go from being good to being truly great. Instead, greatness is all about practice. Elite performers practice hard, in a really specific way, and they practice consistently."
~ Christine Carter, Ph.D. ~ Greater Good: The Science of a Meaningful Life

More quotes in our July Bulletin

Recipe: Day 6 Brunch 
Featured recipe from Day 6: Beyond the 5 Day Pouch Test, page 144.
Shared with permission, LivingAfterWLS, LLC (C) 2012.


Italian Vegetable Egg Custard 

Custard doesn't have to be sweet to be delicious. This savory brunch custard makes great use of fresh summer vegetables. After you have tried it with squash and tomatoes, experiment with other fresh vegetables like peppers, mushrooms, and even diced or shredded winter squash. Explore your creative Receptiveness! See page 74.

Cooking spray
4 eggs
1/2 cup all-purpose flour
2 cups summer squash, shredded
1 cup zucchini, shredded
1/2 cup black olives, sliced, divided
2 Tablespoons Parmesan cheese, grated
1 teaspoon Italian seasoning blend
1/2 teaspoon garlic salt
1 medium tomato, thinly sliced
1 bunch green onions, sliced 1/2-inch thick
1/2 cup mozzarella cheese, shredded

Preheat the oven to 450F and place the rack in the middle of the oven. Spray an 8-inch square baking pan with cooking spray.


In a medium bowl beat the eggs and flour until smooth. Stir in summer squash, zucchini and 1/4 cup olives; mix well. Spread in prepared baking pan. Place in center of oven and bake until custard is set, about 10 minutes. (see note). Remove to a warm trivet.


Mix the Parmesan cheese, Italian seasoning blend and garlic salt together and sprinkle evenly over the baked custard. Top evenly with tomato slices, remaining olives, sliced green onion and mozzarella cheese. Divide into four equal portions and serve warm.

Note: To determine that the custard is done insert a wooden skewer or toothpick into the center about two-thirds down. If it comes out clean the custard is done. If the custard is almost done turn the oven off and leave the oven door slightly ajar so the custard will finish cooking

Serves 4. Per serving: 232 Calories; 12g Fat; 13g Protein; 19g Carbohydrate; 3g Dietary Fiber.



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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.


LivingAfterWLS, LLC
Kaye Bailey, Founder
Evanston, Wyoming 82931