5 Day Pouch Test Quick Review: Liquids

Hello Dear Readers! I know many of you are working your way through the 5 Day Pouch Test this week or this month. In the Official 5 Day Pouch Test Group on Facebook there is active discussion as our members proceed through the back-to-basics programs.  In reading through the posts today I see questions and concerns about the definition of Days 1 & 2 Liquids. I've pulled some information from the 5DPT Owner's Manual that defines each of the options and gives a little bit more information on why each Day 1&2 "Liquid" selection is effective with this plan.
The 5 Day Pouch Test Owner's Manual

Protein Fortified Beverages: Protein shakes, protein drinks, protein breakfast drinks are all protein fortified beverages. Look for ready-to-drink (RTD) beverages that have at least 15 grams of protein and fewer than 5 grams of carbohydrate per serving. Protein powder drinks are acceptable as well, providing they meet the same criterion of 15 grams protein and fewer than 5 grams carbohydrate. Homemade protein smoothies are a favorable addition to the 5DPT menu.

Clear broth or creamy soups: Clear broth and creamy soups are a favorite comfort food for many of us. Canned commercial chicken broth, beef broth, and vegetable broth are enjoyable meals on Days 1 and 2.

Creamy soups are a comfort food favorite for Days 1 and 2. Many creamy soups include dairy products such as milk, cream, sour cream, or half-and-half. For purposes of the 5DPT full-fat dairy should be used as called for in the Day 1 and 2 recipes because it improves satiation longer than no-fat or reduced fat food.

Hearty Soups:  As I developed this plan I learned that more substantial soups made of animal protein, legumes, beans, and low-glycemic vegetables work well to alleviate the discomfort and stress of a liquid diet.

Soups vs. Sliders: It is easy to confuse soup with slider foods since both are liquids that flow more rapidly through the stoma than solid protein. The thing to remember is the soup recipes provided are nutrient dense. Slider foods such as crackers or pretzels washed down with liquids have no nutritional value nor are they satiating.  In addition, when we enjoy soup and observe the liquid restrictions our body benefits from the vitamins and nutrients in the meal while we enjoy a comforting feeling of satiation."

Shared with permission and in compliance with copyright law.
The 5 Day Pouch Test Owner's Manual 2nd Edition (C) 2012

Revealed: Leading cause of weight regain after WLS

Leading cause of regain: Drinking Liquid with Meals

Generally speaking bariatric patients are instructed to cease consumption of liquids 30 minutes before and 30 minutes after eating. In addition they are told to refrain from drinking beverages with meals. The liquid restrictions are intended to keep mealtime focus on a high protein diet of lean animal, dairy and vegetable protein. The high protein food fills the gastric pouch and sustains satiation best when liquid is absent.

When we consume beverages with our lean protein meal the food is washed through the gastric pouch before fully digested. Nutrients are lost as food is washed away and hunger returns more quickly. As we advance following weight loss surgery we tend to relax the liquid restrictions because it is not comfortable to eat food without liquid and dinner conversation is difficult with a dry mouth. An occasional small sip of water with meals may be acceptable and is unlikely to cause weight gain. However the return to full drinking with meals almost always leads to a weight loss plateau or eventually weight gain.

Citrus Juice Pucker Up!

In between meals we need to drink abundant water to promote hydration and flush excess fat and toxins from the body helping to lose weight and keep kidneys functioning properly. But water can become monotonous. Consider this strategy from Katie Lee author of The Comfort Table:
"Citrus is my secret weapon. Squeeze the juice or sprinkle zest over vegetables instead of using extra oil, butter, or salt. You can saute spinach with just a teaspoon of oil, and then add a little citrus juice for a lot of flavor without a lot of calories."  Health Benefit: Oranges, Lemons, Limes, and tangerines offer antioxidant compounds called limonoids that activate detoxifying enzymes."

Managing Protein Beverages and Liquid Restrictions

Pumpkin Spice Protein Latte

Question: Do I need to wait the 30 minutes after drinking a protein shake before I can drink some water?

Protein Drink & Liquid Restrictions:
Take time to absorb & digest the nutrients . 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.
Reminder: Take to heart "Protein First" rule of WLS

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.

Refresher Learning: Understanding the Liquid Restrictions

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.

Looking for some great protein fortified beverages? Check out our wildly popular newsletter:
Ridiculously Scrumptious WLS Recipes for Guilt-Free Autumnal Treats

Late last year we published a newsletter that featured this Multi-Use DIY Pumpkin Spice Protein Mix recipe and ways to use it as we actively seek to increase our daily protein intake. This newsletter was so well received by our subscribers it has been our most popular publication of 2016. You can read this newsletter in full online in our archive: Pumpkin Spice Protein Mix

Gastric Sleeve Patients: The Liquid Restrictions

Sleeve Patients and the Liquid Restrictions - I answered this question for another group but feel it may be useful to others in our WLS Community as well:

The question is should Gastric Sleeve patients follow the liquid restrictions of no liquids with meals and no liquids before/after meals. First, as with all WLS advice patients must follow the advice of their specific bariatric centers, especially the first year following surgery.


What are the liquid restrictions?

Words from the expert:

In my research and writing about gastric sleeve I often turn to a leading expert, Dr. Guillermo Alvarez, who is one of the world's leading experts in the gastric sleeve procedure. In his copyright 2010 book "Successful Weight Loss with The Gastric Sleeve" he mentions the importance of the liquid restrictions four different times (pages 28, 36, 48, 50). He clearly defines the liquid restrictions on page 28: "Avoid combining liquids and solid foods. NEVER drink liquids when eating solid foods. Liquids should be avoided for a period of 15-30 minutes before and 30-45 minutes after eating solid food or meals." On page 36 he writes, "Do not consume liquids and solids at the same time. If you do, you could vomit. Sip fluids slowly 30-45 minutes after a meal. Stop drinking liquids 15-30 minutes before the next meal." Check out Dr. Alvarez's Facebook page here: https://www.facebook.com/endobariatric He is an incredible resource for sleeve patients at all stages pre- and post-operative. Sleeve patients will benefit from reading his book and he's got another one in the works!

The other resource I use in my research and writing about the sleeve is patients themselves. Patients who enjoy the greatest lasting success using the sleeve as a tool follow the liquid restrictions day in and day out. Patients who come to me crying and heartbroken because they've regained weight admit they have long since abandoned the liquid restrictions.

I hope this helps with your question and provides some "food for thought" for our WLS Sleevers.

 Get Dr. Alvarez's book "Successful Weight Loss with the Gastric Sleeve"

Liquids Restrictions & Liquid Meals: Making sense of it

Recently I have observed some confusion in our online communities about the weight loss surgery liquid restrictions. Reason for the confusion are many including different instructions from different doctors and different interpretation of the liquid restrictions by patients.  Sometimes I get confused about the rules when it comes to consuming liquid with meals.

The Four Rules of WLS

For clarification let's note that the professional consensus is people who have undergone any of the currently approved bariatric procedures for weight loss should not drink liquids while eating meals. A meal is considered any food (liquid, soft protein, firm protein, complex carbs., etc) that contains nutrients and is meant to fuel and satiate the body. More often than not patients are advised to avoid liquids for a specified time period before and after eating a meal. This window of time is called by many the "Liquid Restrictions" and some people note it this way: 30/15/30  or 15/15/15. In the first example there would be no liquids 30 minutes before a meal, no liquids during a timed meal of 15 minutes, and no liquids for 30 minutes following the last bite of a meal. If you are unsure of your specific liquid restrictions check with your bariatric center nutritionist, in your dietary guidelines, or with your support group leader.

Now, I do not personally sit on a stop watch while fasting from liquids, but I do stay mindful of the rule. It is important for two reasons: first the pouch or sleeve will stay full longer if the food is allowed to digest before being washed through with liquid. Secondly, the longer the food is allowed to travel through the digestive system without being pushed by liquids, the more nutrients will be observed. When we are eating so few calories, because of the surgery, it is highly important that we give our body ample time to make the most of what we feed it.

Liquid restrictions should be followed when eating a liquid meal such as a protein fortified smoothie or one of our favorite 5 Day Pouch Test Soups.  We want to feel full and satisfied longer which will prevent snacking after meals, and we want to enjoy the benefits of the nutrition we provided our body in the meal.

We addressed the topic of Rule #2 - Lots of Water, and the Liquid Restrictions in a detailed newsletter in 2011. It is available for you online in our archive:

LivingAfterWLS Weekly Digest
February 2, 2011
The Four Rules: #2 Drink Lots of Water
Understanding & Accomplishing Water Intake
Without Floating Away!

Check it out here in our Archive:
Weekly Digest 02022011

To learn more about the liquid restrictions
take a look at this featured article from the 5 Day Pouch Test:


Restrict Liquids, Drink Lots of Water - HUH?
Making Sense of WLS Guidelines

In a country where food and drink go hand in hand weight loss surgery patients are challenged to follow the liquid restrictions as instructed by their bariatric center. But understanding and following the liquid restrictions plays a key role in long-term weight maintenance following gastric bypass, gastric sleeve, or adjustable gastric banding (lap-band) surgeries.

In general, bariatric centers instruct weight loss surgery patients to avoid drinking liquids for thirty minutes before a meal, during the meal, and for thirty minutes following the meal. This easily adds up to 90 minutes of no liquids three times a day: four-and-one-half waking hours. It is easy for patients to become frustrated with these restrictions because another rule of weight loss surgery is to drink lots of water, at least 64 ounces a day. Understanding why the liquid restrictions are necessary and how water intake affects weight management will increase the likelihood a patient will follow the guidelines.

Link to Continue Reading: Restrict Liquids, Drink Lots of Water - HUH? Making Sense of WLS Guidelines

5DPT June Bulletin: Make the Play

Greetings!

Ladies and Gentlemen! Coming soon to a yard near you: SUMMER!

Are you as happy to feel the warm sunshine and good vibrations of the season  as I am?  Long days, cool nights, slower pace (I hope!), fresh vegetables, fruits, and berries; no more heavy coats, and good times all around. On top of my list for summer fun is major league baseball. And let me tell you, I am a sucker for the baseball metaphor. I don't think any other sport produces better metaphors that speak to life than baseball.  So it comes as no surprise that a commentator caught my attention when he said, speaking of a frustrated outfielder who had just tossed his mitt, "Don't blame the equipment: just make the play." How easy it is to take that and apply it our WLS afterlife. I've expanded on that theme in this month's featured article Don't blame the equipment.  (And in case you are curious, Go New York Yankees!)

Liquids Days 1&2: In today's issue I've also covered in detail Days 1 and 2 of the 5DPT - the liquid days. There is ongoing confusion about how liquids are defined and what the options are for days 1 and 2. Most frustrating is that many people go hungry on days 1 and 2 for lack of understanding about the liquids. I hope you find this information helpful and supportive. And of course, don't miss our featured recipe this month - soup of course. Check it out: Lemony Chicken Soup.
   

5 Day Pouch Test Support
Sending a big shout-out this week to Marie and Lori who host a terrific Facebook group for our Neighbors interested in connecting over the 5 Day Pouch Test. Drop in and say hello and enjoy the empowering support of this blossoming group. Find them here.

CHEERS!
Kaye

View Bulletin in our archives: June 5DPT Bulletin

Protein Shakes: Nutrients to Digest & Absorb

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.

Safely Slim Protein Shakes






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.

5 Day Pouch Test Bulletin 3/28

Read the full bulletin in our online archive


Liquid Restrictions - More Than Just Rules

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!
Kaye

"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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