5DPT Bulletin
Trending Questions
The 5DPT Answers You Must Read

January 2014
In This Issue
January Theme
Messing Up
Featured Article
Four Rules Refresher
Soft Carb Snacks
Quit carbs cold turkey
Protein Drinks

January Theme:

A new year traveling the WLS road Together!  
"Take the basic tenets of weight loss surgery, curate knowledge that supports your chosen dietary path, collaborate with others sharing your dietary circumstances, apply personal experience, and build a dietary health-management way-of-life that enables you to thrive. This is the responsibility of every person who desires to live a healthy balanced well-managed life with WLS."
~ 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!  


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Q: What if I mess up again? I'm tired of starting over.

A.  As a lifelong person struggling with the disease of obesity the all-or-nothing mentality of falling off the wagon is something that continues to perplex me. Do you know what I'm talking about? I will have good intentions to have an omelet and tomato slices for breakfast but for some reason I chose instead to have a toasted bagel slathered with cream cheese. Naturally the high carbohydrate and high fat breakfast makes me feel sluggish and miserable so I think, "To hell with it" and continue to make poor dietary choices the rest of the day. Now you know what I'm talking about, I see you nodding your head. (This still happens to me once in a while, I'll be honest with you.)

Years ago in one of the many diet programs I was following, and I am not sure which it was, a counselor talked about dropped eggs as the theory applies to the scenario above. She asked if any of us, while in the kitchen baking, had accidentally dropped an egg on the floor. We all nodded yes. She then asked if we said, "To hell with it" and proceeded to drop the remaining eggs on the floor. We all nodded no, of course not! "Then why, when you drop the metaphorical diet egg do you say to hell with it and break the diet for the rest of the day?" Great allegory!

Dropped eggs happen. We are human. We live in a difficult world. So the next time you drop the diet egg visualize getting a paper towel, wiping up the spill and moving forward. Dropped eggs happen and a great deal of life and living is all about cleaning up messes.

Shared with permission from "Day 6: Beyond the 5 Day Pouch Test" by Kaye Bailey. Copyright 2012 - LivingAfterWLS ~ All Rights Reserved. Pages 26-27.

Day 6: Beyond 5DPT


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Four Rules Refresher

Four Rules

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

Learn More:
5DPT Featured Articles


Beat carb cravings:
Eat Soup!

Carb Monster Soups

Carb Monster
Soup Mixes:
just .90 cents a serving

Why do I love soft carb snacks so much?


Most of us, before surgery, agreed to follow the Four Rules and we likely banished processed carbohydrates from our diet - for life. That's because we understood that eating them before surgery contributed to our obesity - the result would be the same eating them after surgery.  But somewhere down the road we relax the rules and dip into the snack bowl. It is not that we are weak human beings. It is because soft carbs are more comfortable to eat than protein and in our society soft carbs are ever present. After weight loss surgery we call these snacks slider foods.

"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 amounts of food without ever feeling uncomfortable. Many patients unknowingly 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, and it is more comfortable to eat the soft slider foods. Slider foods have played a significant role in every case of post-WLS weight regain that I have ever heard about." (5DPT Owner's Manual page 34)


New Year 2014
Happy New Year! Thank you for joining me for our first 5 Day Pouch Test Bulletin of 2014. I do hope your holidays were meaningful and inspired. And perhaps you are feeling a sense of excitement as we start this new year. I certainly am happy to start fresh in 2014 and have my sights set on dedicating myself to healthy behaviors and living well.

In this 5DPT Bulletin we address the questions people are asking right now about the 5DPT. One thing we have learned about our WLS community is that we have curious minds and an inquisitive spirit. We want to learn the things that support our ongoing weight management efforts. Some of the current hot topics include carbohydrate cravings and withdrawal, struggling on Days 1 & 2, understanding liquid restrictions, weight gain after the 5DPT, and living the Four Rules.

While this bulletin is a tad longer than our usual monthly publication we hope you will spend some time going over the topics. Sometimes it is the smallest nugget of wisdom that can make the greatest difference in our life.  I hope you find many helpful nuggets of knowledge here that serve you well in your life after weight loss surgery. Thank you for including the 5 Day Pouch Test as part of your experience.

I wish you the very best of health this New Year! You have the power to make this your healthiest year ever - Let's do it together! 
Kaye Bailey

"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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Struggling on Days 1 and 2?
Over-eagerness may be to blame 

by Kaye Bailey
There is no doubt about it: the 5 Day Pouch Test is an enthusiasm generating phenomena. More people have done the 5DPT after hearing by word of mouth how someone else took back their WLS tool and lost some weight too, in 5 easy days. If we are struggling and don't know how to "get back to basics", if we have lost all hope, and suddenly we learn about someone just like us who got back on track in five days, it is easy to get caught up in the enthusiasm.  Just like the young child eager to ride a two-wheel bicycle without training wheels we are prone to crashes when we take off too quickly without learning the rules.

I don't consider this over-eagerness a failure: it is simply misdirected energy leading to an  unsuccessful execution of the plan.  There are four errors of over-eagerness that I see frequently, but can easily be avoided:

    Restricting caloric intake
    Poorly scheduling the 5DPT
    Lack of Planning
    Pursuit of Perfection

Let's take a look at each point of over-eagerness and consider ways to harness the energy and excitement while taking intelligent and reasonable steps to work the plan.

Restricting caloric intake. Do not restrict food or caloric intake on the 5DPT. You can have as many liquid meals as needed in response to hunger or cravings. Some people are inclined to restrict food intake during the 5 Day Pouch Test: this is not encouraged because it leads to increased hunger cravings and frustration. Do not restrict food intake: less is not better. Pay close attention to the signals your body gives and when you are hungry eat something from the approved menu for the day. Soups are measured in 1-cup servings and protein drinks are measured as the recipe or package directs. Stick with these portion sizes and eat what you can in 15 minutes. After 15 minutes discard what is uneaten and take pause to experience your pouch noting feelings of fullness and satiation. Wait at least one full hour before your next serving of liquid meal. Use this time to be mindful of your body; to get in touch with your pouch. Learning to feel the pouch and listening for authentic biological hunger signals is essential to your successful weight management. If you are truly hungry after waiting one hour then have another serving of one of the approved meals. Again, take only 15 minutes to eat and continue to be alert to the signals your body sends.

Carb Monster Soup Recipes: Days 1 & 2

Poorly scheduling the 5DPT.  Mark the date. Set a date and mark your calendar. Make sure you can follow the plan without the disruption of travel, social events or hormonal cycles. Enlist the support of family and friends. It is fairly common for people to schedule the 5DPT to begin on Monday and end on Friday. But many have found that scheduling Day 1 for a Saturday works more favorably for them. On Days 1 and 2 one generally needs frequent bathroom breaks, which may be uncomfortable in a workplace. Consider that as you schedule your plan. Additionally, many of us have made the mistake of completing the 5DPT on Friday only to celebrate with weekend binge eating come Saturday. If our plan starts on Saturday and concludes on Wednesday we can more easily transition to a Day 6 lifestyle on Thursday, thus avoiding the weekend binge phenomena. Consider all of this before scheduling your 5 Day Pouch Test.  Scheduling it for the right time significantly improves our chance for success.

Lack of planning. You must plan ahead to have the prescribed foods available once the plan begins. You must also take the necessary steps to remove trigger foods from your environment as much as possible. Before the plan begins, please make preparations: this will ensure your success. Plan your meals for all five days and do the grocery shopping before starting the 5DPT. We all know that the supermarket is temptation alley, do your best to avoid going there for these five days. Many people are surprised at the relief and empowerment they feel upon making their food plan for five days. With the menu choices made there is little to dwell upon and we have spare energy to focus on getting back on track.

LivingAfterWLS free download planning tools

Pursuit of Perfection.  At least once a day I receive this question, "I messed up on Day 1: Should I start over to get it perfect?" I have never done the 5DPT perfectly and I do not know anyone who has. Rather than make the five 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, review the key learning points and make notes on your 5 Day Pouch Test Journal. Emerge on Day 6 knowing more about yourself and how to work your tool. You can do this! One of the biggest dietary mistakes we make is thinking we must be totally perfect or totally imperfect. We do not have to manage our plate with an all or nothing strategy: this has never worked for keeping our obesity under control. Start thinking about doing your best in the moment and on the day and celebrate the little moments. Our LivingAfterWLS motto embraces this: "Stop for a moment. Look where you are: You Have Arrived." Now is everything.  Never forget that perfection is not the goal in anything: doing our best on the day and in the moment is always the goal.  


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Q: Why can't I just quit carbs cold turkey without the 5DPT?
Blame it on your biology   

Have you ever had a particularly bad snacking day only to find yourself the next morning promising to give-up snacky-carbs for good, cold turkey, right now. And by noon that will-power is forgotten as you reach for the snack of choice. And then the self-blame begins: "Why am so weak? Why am I a failure? Why don't I have will-power?"  I've lived this scenario more times than I care to admit and I know I'm not alone.

But it turns out we aren't just a bunch of weak-bellied carb-addicts. There is a biological reason that motivates the reach for the snack: our body has become accustomed to digesting and using processed carbs as it's primary source of fuel. Withdrawing them cold turkey puts the metabolic process in panic and serotonin levels drop. "You may be powerless to resist baked goods, pasta, and their carb cousins," according to Wurtman and Marquis in "The Serotonin Power Diet. "The reason for this specific, very tough-to-ignore craving for carbohydrates is that your brain is forcing you to yearn for them so that it can produce serotonin."

With the 5 Day Pouch Test we methodically transition from fatty non-nutritional processed carbs to healthy complex carbohydrates found in grains, vegetables, and fruits. The body still produces serotonin from these carbs while benefiting from the healthy nutrients and fiber missing from processed carbs. While some cravings for carbs are experienced the biological trauma is not as severe as when processed carbs are withdrawn cold turkey without providing a similar replacement fuel.

Below, from the 5 Day Pouch Test Owner's Manual page 49:

Carbohydrate withdrawal:
When any heavily consumed food is withdrawn from the diet the body is likely to experience symptoms of withdrawal that may include headache, dizziness, cramping, and nausea. This is not unique to our WLS body; this is a simple fact of biology.  On the 5DPT when processed carbs are withdrawn many people report symptoms of "carbohydrate withdrawal." Do not suffer through this.  If you notice symptoms of carbohydrate withdrawal eat a small piece of melon, some berries, an apple or an orange. Any low-glycemic fruit or vegetable will reduce the symptoms of carbohydrate withdrawal.

You may also try a serving of Emergen-CŪ energy booster fizzy drink mix, which is known to reduce the symptoms and discomfort of carbohydrate withdrawal. In addition, Emergen-CŪ provides B vitamins for energy and C vitamins for immunity along with many other vitamins and minerals. You can count a serving of Emergen-CŪ as part of your daily intake of water. Do not be put off by the 5 or 6 grams carbohydrate per serving: these are beneficial nutrient dense big-bang-for-your-buck carbs. Enjoy!
For nausea, try sipping freshly brewed warm green tea or ginger herbal tea. You can add fresh ginger juice to further ease the symptoms of stomach distress and nausea. If you made the Fennel & Celery Soup (page 36) for a grumpy pouch and have some left then enjoy a 1-cup serving of this soup. It is a known remedy to digestive discomfort and distress resulting from dietary change.

Helpful Article:
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


You deserve to be your very best:
Obesity be damned for getting in the way!


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  5 Day Pouch Test FAQ's
Trending Questions 

Can I repeat the liquid days instead of going to Day 3?
      You can repeat the liquid eating plan of the 5DPT Days 1 and 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 the basics of following our weight loss surgery high protein, low carbohydrate diet. People are sometimes tempted to repeat the liquid days because they have recorded a pleasing weight loss on Days 1 and 2. Keep in mind this weight loss is primarily water loss. In order to keep losing weight one needs to follow a high protein diet that elevates the metabolism into high thermic burn: this is when true weight is lost. 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 numerous times so you don't have to. 5DPT: Days 1 & 2

Are dairy products okay to use on the 5DPT?
     If you can tolerate milk and dairy products include them in your 5DPT and beyond. See the recipe section. Many WLS patients become lactose intolerant so that is why there is always a caution about using milk products. For those who can tolerate dairy, when used in moderation, it can be a healthy part of your diet.

Are yogurts or cottage cheese allowed on Days 1 & 2?
       No, cottage cheese and yogurt should not be used as stand-alone menu choices on Days 1 and 2. However, they may be used as ingredients in protein smoothies. You can introduce yogurt and cottage cheese to your diet on Day 3: Soft Protein.

I did the 5DPT and lost weight, but gained it right back when I went back to normal.  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.
Four Rules
Protein Drink & Liquid Restrictions: 
Take time to absorb & digest the nutrients
Coffee Protein Smoothie
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 adequate 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.

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