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

Protein, Fat, Carbohydrate: What's the recommended intake after WLS?

Greetings Readers!

 After WLS we are prescribed a high protein or "Protein First" diet to follow for the rest of our life to ensure adequate weight loss is achieved and a healthy weight is maintained using the WLS tool. But years of dieting have conditioned us to count calories above all else, not the nutrients. For traditionalists who are looking for a generalized daily calorie intake I share this section from Day 6: Beyond the 5 Day Pouch Test which addresses the question of daily caloric intake. I hope you find this a useful nugget of info in your WLS toolbox. Also check out this earlier post: Dietary Protein: Quick List and Recipe Links

Shared with copyright permission from Day 6: Beyond the 5 Day Pouch Test by Kaye Bailey

"I am not particularly comfortable giving specific one-on-one nutritional advice to my weight loss surgery Neighbors. First of all, I’m not a health care worker so I’m not qualified to render such advice. Secondly, I cannot see you to make a semi-informed analysis of your health. Nutritional advice is serious business and should only be given after verbal consultation and laboratory blood analysis, always with trusted health care providers."

"What I can do here is provide you the current generalized recommendations so you have a point of reference when speaking with your qualified health care provider. We may not always have the luxury of speaking with our bariatric centers so it is wise to educate ourselves on the current bariatric standards and practices of nutrition."

"In general, based on the broad-canvas study, bariatric centers agree patients should follow a 1,200-calorie a day diet. The protein, fat, and carbohydrate recommendations are based on that recommendation."

"Protein: Common recommendation for daily protein intake is 60 to 105g (20-35% of a 1,200-calorie diet). Protein digestibility and quality are important factors that patients must take into account when making food or supplement choices. The digestibility of protein is increased when accompanied by a full array of vitamins and minerals."

Make this delicious burger tonight: Beef, Bacon & Mushroom Cheeseburger

"Fat: Fat is necessary for the growth and development of the basic components for hormones, skin, hair, transportation of fat-soluble vitamins, and insulation and cushion for the body and internal organs. As a rule, the bariatric profession abides the American Heart Association recommendation of 27 to 47g daily fat consumption in a 1,200-calorie diet. It is beneficial to take fat-soluble vitamins with food sources that are rich in mono and polyunsaturated fats such as avocado, tuna, salmon, olive oil, flaxseed, and canola oil."

Our WLS body will tell us when we've consumed too much dietary fat by causing dietary stress that may include upset stomach, diarrhea, cramping, vomiting. Here is a simple home remedy to help relieve this type of digestive discomfort:
Digestive Stress? Try this simple solution

"Carbohydrate: Carbohydrate provides the body with its preferred source of fuel and is the only source of energy for the brain, central nervous system, red blood cells, kidney, and retina. Bariatric patients are counseled to choose complex carbohydrates over simple carbohydrates.  Bariatric centers do not generally recommend a specific daily carbohydrate allowance, according to Swilley. The report referenced the generally accepted recommended intake for all people provided by the National Academies’ Institute of Medicine of 113g carbohydrate consumption daily in a 1,200-calorie diet. It is unlikely a gastric surgical patient of any procedure could meet this recommendation."

Day 6: Beyond the 5 Day Pouch Test by Kaye Bailey (C) Copyright 2009

Struggling with carb consumption? Check out this article: Why can't I just quit carbs cold turkey?

Check out Day 6: Beyond the 5 Day Pouch Test on Amazon in paperback and Kindle.

What's for Breakfast? Protein First!

Recipe: Spring Eggs

We know the first rule of weight loss surgery is to eat protein first. That means we must eat protein at every meal. The high protein or protein first diet is prescribed for all bariatric procedures and is the dietary guideline patients are instructed to follow for life. The bulk of our calories at any meal should come from animal, dairy, or vegetable protein. This includes breakfast. By eating protein first thing in the morning we instantly raise our metabolism, we promote feelings of satiation and reduce cravings for snacks or simple carbohydrates.

Eating a high protein breakfast effectively staves hunger cravings and snacking binges later in the day because it reduces the circulating levels of the hormone ghrelin, which stimulates hunger. So not only are we raising our metabolism with high protein nutrition, we are managing the brain chemistry that often gets the blame for head hunger and snacking binges. The earlier in the day we eat protein the more likely we are to stick with our high protein diet plan without annoying cravings or sluggishness.



Dietary Protein: Quick List and Recipe Links

Try starting your day with 35 grams of high quality protein including eggs, meat, poultry, shellfish or fish, Greek yogurt, milk, cottage cheese, vegetarian protein, or protein supplementation such as protein shakes or protein bars. I keep hard-cooked eggs on hand for a quick-grab breakfast and more often than not mix my ready-to-drink protein shake with hot coffee (use it like coffee creamer) for a steady supply of morning protein.

For more protein breakfast ideas check out Protein First: Living the First Rule of WLS

Cover Feature Recipe: Beef, Bacon & Mushroom Cheeseburger

Good Morning Dear Readers!

I am so tickled about the recent release of Volume 4 in our LivingAfterWLS Shorts books - this one is Protein First: Understanding and Living The First Rule of Weight Loss Surgery (Second Edition 2017). The first edition was published exclusively in digital format in 2015. Due to the popularity of the first edition we are so pleased to offer the 2017 update in paperback for people who like to touch the book and turn pages. The new cover features two savory, flavor-balanced Protein First recipes. You will find the recipe for Grilled Salmon with Citrus-Pomegranate Sauce on page 78 and the recipe for the Beef, Bacon and Mushroom Cheeseburger on page 79.

Visit Kaye Bailey's Author Page on Amazon

Or how about right here so you can make this easy and wonderfully satisfying meaty meal for dinner tonight! I hope you love the burger. It is just one of 36 "Mouth Watering" recipes you will find in the pages of this book that is full of key information that will make an undeniable difference in your weight management efforts. Get this title on Amazon here:

International Customers - Please check the "Buying Options" as their are several independent book sellers that ship outside the US for reasonable rates and fast order fulfillment. Shop Amazon for International Shipping Options for Protein First by Kaye Bailey

Beef, Bacon and Mushroom Cheeseburger

Learn More! Protein First: Understanding and Living the First Rule of Weight Loss Surgery

Page 79 - Shared with copyright permission, LivingAfterWLS LLC and Kaye Bailey.

"This no-bun burger is sure to satisfy anyone's diner food craving. Weight loss surgery patients will not be sad about left-overs for a half-burger makes a stunning effort-free lunch later in the week.

Ingredients:
4 slices thick-cut smoked bacon, sliced half-wise
1 (8-ounce) package sliced mushrooms
1/2 teaspoon salt
pinch black pepper
2 tablespoons apple cider vinegar
1 pound lean ground beef, bison or game
1 tablespoon olive oil
1 teaspoon all-purpose burger seasoning with garlic
1/4 teaspoon black pepper
4 (1-ounce) slices Swiss Cheese

Directions: Set a large skillet over medium high heat and fry bacon, turning once, 8 to 12 minutes until crisp. Remove bacon to drain on paper toweling and drain most of the rendered bacon fat from skillet. Return to heat, add sliced mushrooms and season with salt and pepper. Cook and stir until mushrooms are tender and caramelized. While mushrooms cook form ground meat into four equal (4-ounce) burgers and set aside. When mushrooms are cooked add cider vinegar to pan to deglaze and flavor mushrooms, cooking and stirring 1-2 minutes until vinegar is absorbed.  Remove mushrooms to a small serving bowl, set aside and keep warm. Return skillet to heat, add olive oil and place burgers in pan. Season with burger seasoning and pepper. Cook burgers over high heat about 5 minutes per side. Check for doneness (ground meat should be cooked to an internal temperature of 165°F). Leave burgers in pan but remove from heat. Top each burger with 1 slice Swiss cheese, 2 half-slices cooked bacon and 1/4 of the sautéed mushrooms. Cover and allow to rest for 5 minutes: serve warm. Serve with sliced fresh tomatoes and dill pickle spears to round-out the meal.

Nutrition: Serves 4. Per serving: 523 Calories; 45g Protein, 28g Fat (8g saturated) 9g Carbohydrate."

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Popular Best Seller "Protein First" Updated, New in Paperback

$11.95 - Free Shipping Amazon Prime

Protein First: Understanding and Living the First Rule of Weight Loss Surgery
(LivingAfterWLS Shorts) (Volume 3) Paperback – January 10, 2017

See on Amazon
"The Rule, Protein First, is not temporary during the initial period of weight loss after bariatric surgery. Rather, this rule must be followed for the life of the postoperative bariatric patient who desires life-long healthy weight management by employing surgery, diet, and lifestyle modification in this cause. Understanding “Protein First” is the most exciting knowledge you can hold in support of your lasting weight management goals after weight loss surgery. What’s in it: In this LivingAfterWLS publication, we take an in-depth look at the Protein First rule, why it matters, and how to live by the rule. Protein First is defined, followed by current recommendations for calculating daily protein intake for weight loss and weight maintenance. To help you succeed in living the Protein First rule we offer a well-versed selection of protein sources and scrumptious recipes so you can enjoy your diet and reach your goals. Who it’s for: Protein First is a go-to guide for patients of all current and past bariatric weight loss procedures who want to achieve optimal weight loss and maintain a healthy weight for life."

Protein First: Understanding and Living the First Rule of WLS
(LivingAfterWLS Shorts) (Volume 3) Paperback
Second Edition: January 10, 2017
Available in Print and eBook
Updated Research, new recipes, new helpful tips in compliance with post-Weight Loss Surgery current protocol.
Series: LivingAfterWLS Shorts

    Paperback: 104 pages
    Publisher: CreateSpace Independent Publishing Platform; 2 edition (January 10, 2017)
    Language: English
    ISBN-10: 151921605X
    ISBN-13: 978-1519216052
    Product Dimensions: 5.2 x 0.2 x 8 inches.

Back Cover:

FROM BEST SELLING AUTHOR KAYE BAILEY
When you understand and live "protein first" after bariatric surgery you will achieve optimal weight loss and maintain a healthy weight for the remainder of your well-lived days.

ANSWERS - RECIPES - STRATEGIES
What is protein? How much do I need?
What are the best protein sources? How do I avoid getting bored with protein?
Do I have to eat loads of protein shakes and protein bars?
How can I make protein easier on my WLS pouch?
How do I incorporate "Protein First" in my busy life?

Cover recipes: Grilled Salmon with Citrus-Pomegranate Sauce (front cover image) and Beef, Bacon & Mushroom Cheeseburger (back cover image).

You Can Do This!

Amazon Verified Purchase Customer Reviews of Protein First (First Edition 2015)Five Stars "Five Stars. Kaye Bailey always has the best information to keep weight loss patients in line." May 8, 2015

Five Stars "Awesome book. Very informative. This book totally changed my knowledge of how to rethink protein first in a post gastric bypass diet. I have hope to restart my weight koss after 16 years." October 16, 2016

Five Stars "Educational. It is a good read. Lots of information that I didn't know." September 12, 2015

Four Stars "Helpful and Hopeful. This book was easy to read and understand. Provided lots of helpful information. I had my WLS 3 years ago but have had limited success. I know the reason for that has been poor food/beverage choices but doing things "the right way" seemed an impossible lifestyle for me. I am getting "back on the wagon" and found the info and suggestions contained in this book to be very helpful." May 9, 2015

Five Stars "Fantistic Information and Delicious Recipes!!  Well worth the minimal price. A key component to get back on track and continue successful weight loss maintenance for life!" March 14, 2015

Four Stars "A good reminder book. Very informative. An easy , comprehensive read that is helpful to keep post weight loss surgery weight off. Highly recommend." June 28, 2015.

Five Stars "Great Refresher. This book helped me refocus my eating habits. I needed the reminder of protein first. The recipes all sounded delicious." January 23, 2016 

See on Amazon

9 Treats the No Snacking Rule is Okay With!

With January nearing the end and our study of the Four Rules concluding as the topic of the month I'd like to address the idea of **BREAKING** the rules. In the true confessions of weight loss surgery post-ops it is Rule #2 - No Snacking that is usually the first one to be broken after our early post-surgery compliance. We live in a snacking world and this one is hard to keep. Here's a refresher from the 5 Day Pouch Test describing Rule #2:

"Rule #2: No Snacking. Patients are discouraged from snacking which may impede 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 on empty calorie non-nutritional food defeat the restrictive nature of the surgery and weight gain results.  It is seemingly contradictory that the 5DPT allows snacking. High protein snacks are allowed because they keep the metabolism active, they satiate hunger, and they help relieve the symptoms of carbohydrate withdrawal."
Kaye Bailey ~ 5 Day Pouch Test Express Study Guide page 12.

Pumpkin Pie Cheesecake Parfait

In a perfect world we all make a weekly menu, do the shopping and preparation, and stick to our plan like NASA scientists. Then there are the rest of us! Sometimes my best effort is to plan the next meal and even getting that done is a chore. But on my best days, if nothing else, I plan a meal (or an appropriate snack) that I can look forward to when thoughts of food sneak uninvited into my day.

For example in the summer when our raspberry bushes are heavy with berries I looked forward to an afternoon snack of raspberries and vanilla Greek yogurt. In knowing this was on my plate that day I avoided feelings of tedium or deprivation that so often come when maintaining a dietary program. The anticipation of the berries and creamy yogurt served to deflect other temptations.

Ready Reference:  Dietary Protein: Quick List and Recipe Links

So much of our food psychology is looking forward to a meal or treat in association with an occasion. By providing a meal or treat to look forward to we acknowledge that core human desire to anticipate sustenance beyond the act of taking in nutrition. We provide opportunity to feed the psyche and soul as well as the biological necessity for nutrition. When I was obese I spent a great deal of time daydreaming about the next delicious meal or morsel I would eat. Now, with the help of weight loss surgery, I can still daydream about the next delicious food I'll eat but I must be more mindful  of my choices so that they support the health goals to which I am committed in order to keep my obesity in remission. It is a matter or re-allocating those basic human behaviors in a manner that supports our greater goals. And by starting each day with a plan for one meal --one moment of reward and enjoyment-- we can easily harness those behaviors to benefit our health rather than contribute to our illness (obesity). Here are a few of my favorite look-forward-to morsels:

• Fruit and/or berries with dairy protein (yogurt, cheese, cottage cheese)
• Ready-to-eat shrimp and cocktail sauce
• Pickles with Cheddar cheese
• Avocado with chopped hard-cooked egg and diced tomato. Add salad greens or seasonal vegetables for a full meal. Article: The Avocado Advantage
• Turkey Roll-ups (Layer two turkey slices, smear with cream cheese and jelly, roll-up and refrigerate for a wonderful handy snack! Delicious beyond compare!)
• Cooking with Kaye favorite recipe: Light Fresh Turkey Salad
• Protein Pudding (Whisk together 1 package sugar-free instant pudding with 1 can ready-to-drink protein drink. Chill and enjoy. Use serving size recommendations on pudding mix).
• Seasonal Favorite: Heart Healthy Pumpkin Spice Protein Treats with our popular Pumpkin Spice Protein Mix. Link for our Newsletter and Recipes.
• Warm herbal tea or chilled ice tea infused with lemon, berries, fruit, herbs or other seasonal flavor boosters. Try this: Stomach Soothing Thirst Quenching Lemon Ginger Iced Green Tea

Further Reading: Evening Munchies: Slider Food Territory

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

Breakfast Basics of WLS: Instant Download eBook

LivingAfterWLS eBook Short Volume 4 by Kaye Bailey

In this LivingAfterWLS eBook by Kaye Bailey, we take a highly focused look at breakfast, the most important meal of the day. Why is it important? What are the high protein options? What about hectic mornings? We provide options for picky eaters; suggest out-of-the-box meals featuring the flavors of your favorite foods; find a superb use for last night's left-overs; place emphasis on fresh clean ingredients; reveal fail-proof preparation methods for cooks of all skill levels; and give you warm and cold breakfast meals to savor.

You will find something exciting to start your day no matter your schedule, kitchen skills, or budget!  This all new breakfast companion focuses on variety, quality ingredients, protein options: All hot topics in this Volume 4 of the popular LivingAfterWLS Shorts series. The recipes are supported with 12 informative articles featuring the current scientific beliefs in health, weight management, and bariatric nutrition.

Learn more than a formula: learn why certain ingredients and meals work to support your weight management goals!

Breakfast Basics of WLS: Why you must eat a high protein breakfast every day.

Tempting Recipes:
Just a few of the tempting breakfast recipes that can be prepared in under 15 minutes!

• Mocha Morning Coffee Smoothie
• Cappuccino Cooler
• Strawberry Cheesecake Smoothie
• Kiwifruit-Lime Yogurt Parfait
• Cinnamon Peach Swirl
• Chilled Plate: Caprese Layers
• Melon and Swiss Continental
• Creamy Dreamy Green Eggs
• Fiesta Quesadilla
• Salsa in the Morning Mug Scramble
• Mama Mia Egg Lasagna

Go ahead! What are you waiting for?
Breakfast Basics of WLS just $4.95 instant download


What's in it: Specific recipes and methods to start the day -even on the run- with a healthy high protein meal that supports your goals of weight management and balanced health following all bariatric procedures. From breakfast beverages to quick-fix microwave eggs this guide is sure to please even picky eaters and take away the guesswork out of the most important meal of the day.

LivingAfterWLS Shorts
Who it's for: Patients of all bariatric surgical procedures will benefit from an improved repertoire of morning recipes to support their high protein diet prescribed for weight loss and lasting weight management after surgical intervention for the treatment of obesity.


Breakfast Basics of WLS (60 pages)


No Kindle? No Problem! Just download the free Kindle eReader app and take your Kindle library wherever you go on whatever device you prefer! Easy Fast Portable Efficient! Never lose your eBooks to a phone or device upgrade.

The Four Rules of WLS: Our January Topic

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For me January is always the month to get back to the basics and put things to right in the areas of my life that need some order and re-focus. Not surprisingly, my health management always requires an effort of reordering and focus on the dawn of a new year. I don't know why I drift away from the basics of weight loss surgery health management as the year progresses but I do with the same predictability as the phases of the moon.

So, with your indulgence I'm using the LivingAfterWLS Blog and our different newsletters to study and refresh my understanding of the Four Rules of weight loss surgery. You've already seen some posts related to the Four Rules and I'll continue to work through each rule in detail as the month marches along. Today I'm sharing the Four Rules Summary, with permission, from The 5 Day Pouch Test Owner's Manual. This is a brief rundown on the rules and why we have them - a good reference point to support the rest of our Four Rules discussion. Be sure to click the link for our Four Rules infograph - a free download poster for you to enjoy!

Thanks for joining me this year and I'm looking forward to feeling my best as I set to right my health in this new year!

Four Rules: Weight Loss Surgery basics

Shared with permission from The 5 Day Pouch Test Owner's Manual (2nd Edition) by Kaye Bailey
"As patients we are well aware that WLS is frequently perceived by outsiders as an easy means to weight loss that requires little or no effort by the patient. It turns out there is nothing easy about the post-WLS lifestyle. At the time of surgery we agreed to follow Four Rules of dietary and lifestyle management guidelines for the rest of our life in order to lose weight and maintain a healthy weight. This is our burden and our responsibility if we wish to keep morbid obesity in remission.
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 food; engage in daily exercise.

"In our introduction to a bariatric program we were taught and agreed to follow the standard Four Rules which work in concert with our surgically altered stomach and digestive system to bring about rapid massive weight loss. In fact, most of us were asked during the psychological evaluation if we could commit to following the Four Rules. Like me, I bet you said “Of course” with complete confidence.  What I missed in the orientation was that these rules would be a way of life for the rest of my life. The Four Rules and other WLS dietary basics are discussed in greater detail in Chapter 9. For now let’s take 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 60-105 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 reducing food and caloric intake. Animal products are the most nutrient rich source of protein and include fish, shellfish, poultry, and meat. Dairy protein, including eggs, yogurt, and cheese, is another excellent source of protein.

"Lots of Water: Like most weight loss programs, bariatric surgery patients are instructed to drink lots of water throughout the day. Most centers advise a minimum of 64 fluid ounces of water each 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 strongly discouraged from drinking carbonated beverages. In addition, patients are warned against excessive alcohol intake as it tends to have a quicker and more profound intoxicating affect compared with pre-surgery consumption. In addition, non-nutritional beverages of any kind may lead to weight gain and increased snacking.

From our Four Rules Infographic. Link Here to see the full poster & download free!

"No Snacking: Patients are discouraged from snacking which may impede 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 on empty calorie non-nutritional food defeat the restrictive nature of the surgery and weight gain results.  It is seemingly contradictory that the 5DPT allows snacking. High protein snacks are allowed because they keep the metabolism active, they satiate hunger, and they help relieve the symptoms of carbohydrate withdrawal.

"Daily Exercise: In general patients are advised to engage in 30 minutes of physical activity on most days of the week. The most effective way to heal the body from the ravages of obesity is to exercise. Exercise means moving the body: walking, stretching, bending, inhaling and exhaling. Exercise is the most effective, most enjoyable, most beneficial gift one can receive when recovering from life threatening, crippling morbid obesity. Consistent exercise will keep morbid obesity in remission and help compensate for lapses in following the three other rules. People who successfully maintain their weight exercise daily"

Free Four Rules Infograph from LivingAfterWLS

Resolution: Take to heart "Protein First" rule of WLS

At LivingAfterWLS we live by the commonly accepted Four Rules of weight loss surgery, the first of which is Protein First. In dieting language we follow a high protein low carbohydrate diet. This is the diet prescribed by most bariatric centers for patients to follow for life. Scientific and anecdotal evidence supports that following a high protein diet is the most effective way to lose weight and maintain a healthy weight while using the benefits of bariatric surgery.

For quick reference check out this blog:  Dietary Protein: Quick List and Recipe Links

If you are trying to lose weight after surgery, if your weight loss is stalled, or if you are struggling to maintain your healthy weight, now is the time to revisit the Protein First rule.

Eat protein (excerpted from: Inspired Reminders Newsletter)
We know the first rule of weight loss surgery is to eat protein first. That means we must eat protein at every meal. The high protein or protein first diet is prescribed for all bariatric procedures and is the dietary guideline patients are instructed to follow for life. The bulk of our calories at any meal should come from animal, dairy, or vegetable protein. This includes breakfast. By eating protein first thing in the morning we instantly raise our metabolism, we promote feelings of satiation and reduce cravings for snacks or simple carbohydrates. Link to newsletter in our archive: Inspired Reminders Newsletter

Suggested Reading: Understand the Four Rules of WLS Before Going Under the Knife

 WebMd tells us, "Protein is the ultimate fill-me-up food -- it's more satisfying than carbs or fats and keeps you feeling full for longer. It also helps preserve muscle mass and encourages fat burning. So be sure to incorporate healthy proteins like seafood, lean meat, egg whites, yogurt, cheese, soy, nuts, or beans into your meals and snacks."

Eating a high protein breakfast effectively staves hunger cravings and snacking binges later in the day because it reduces the circulating levels of the hormone ghrelin, which stimulates hunger. So not only are we raising our metabolism with high protein nutrition, we are managing the brain chemistry that often gets the blame for head hunger and snacking binges. The earlier in the day we eat protein the more likely we are to stick with our high protein diet plan without annoying cravings or sluggishness.

Try this yummy recipe: Spring Eggs with Salmon and Asparagus

Try starting your day with 35 grams of high quality protein including eggs, meat, poultry, shellfish or fish, Greek yogurt, milk, cottage cheese, vegetarian protein, or protein supplementation such as protein shakes or protein bars. I keep hard-cooked eggs on hand for a quick-grab breakfast and more often than not mix my ready-to-drink protein shake with hot coffee (use it like coffee creamer) for a steady supply of morning protein. For more protein breakfast ideas check out Breakfast Basics of WLS: Why you must eat a high protein breakfast every day.

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Extra Credit Learning: Check out these featured articles

Earlier this 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. You can read this newsletter in full online in our archive: Pumpkin Spice Protein Mix


 Protein Supplementation after WLS
It is common to see the question, "What protein powder should I use?" asked in online groups. What is surprising, to me, is the inconsistency in answers and the passion with which people believe there is only one true and correct answer to the question. Continue Reading:  5DPT May Bulletin Online

Suggested Reading: Understand the Four Rules of WLS Before Going Under the Knife

Weight loss surgery 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. Here is what you need to know about the Four Rules of weight loss surgery before going under the knife. Continue Reading

Dietary Protein: Quick List and Recipe Links

Are you looking for a go-to reference list of dietary protein and some links to our most frequently requested recipes from our LivingAfterWLS Blog archives. I'd love to know what recipes are your favorite! Leave us a comment.

Meat: beef, bison, lamb, game. The term meat is a broadly used term that includes beef, bison, lamb, and game meat. Beef is the most commonly consumed meat in the United States while lamb is the top in meat consumption worldwide. Bison or buffalo is becoming more readily available with the increase of agricultural bison ranches. Bison and game may be substituted for beef in most recipes. People following a high protein diet should select lean cuts of meat to reduce their intake of saturated fat.
Protein and Iron Rich Beef - Osso Buco

Poultry. Chicken, turkey and other poultry are popular sources of lean protein for their ease in preparation and affordability. White meat poultry contains less fat than dark meat, but dark meat protein is a better source of nutrients including B vitamins.
Tarragon is delicious: Try Easy Chicken Chasseur

Pork. There is much talk about today’s leaner pork thanks to improved agriculture practices. Lean cuts such as tenderloin, top loin, rib chops, and sirloin steak are 31 percent leaner than the same cuts two decades ago. Pork cooks quickly and is affordably priced similar to chicken.
Ham and Egg Breakfast Bowl
 
Fish and shellfish. Perhaps the best source of lean protein combined with healthy fats, fish and shellfish support a well-planned high protein diet. Most fish contain the heart-healthy fat known as omega 3 which is shown to improve cardiovascular health and prevent the risk of stroke and heart disease.
Tuna-Spinach-Strawberry Salad

Soy. Plant based soy protein, the base ingredient for tofu, is a low-fat protein option with the added benefit of cholesterol lowering properties.
5 Day Pouch Test Ham and Cheese Soup with Tofu

Beans and legumes. High protein diets tend to be low in dietary fiber. Including beans and legumes in meals provides the benefits of plant protein and dietary fiber in one healthy ingredient. A half cup serving of beans contains nearly the same protein as 3 ounces of broiled steak.
5 Day Pouch Test Beans and Barley Soup

Low-fat dairy. Milk, cheese, eggs and yogurt are not only protein-rich; they also provide calcium for strong bones and a healthy heart. Low-fat, or reduced fat dairy products provide the benefits of dairy with lowered calories.
It's World Egg Day! Yes - How eggcellent is that?

LivingAfterWLS Publications

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Protein First: Understanding and Living the First Rule of Weight Loss Surgery

Instant eBook Download.
Just $4.95

In this LivingAfterWLS eBook, we take a highly focused look at the Protein First Rule: why it matters, and how to live by the rule in a world addicted to the instant gratification found in inexpensive, readily available, convenient non-nutritional simple carbohydrates. An understanding of Protein First is the most exciting knowledge patients can hold in support of lasting weight management goals after weight loss surgery.

What’s in it: A current and comprehensive dialog discussing the weight loss surgery high protein diet, standards for calculating daily protein intake, and recipes to support the weight loss surgery high protein diet.

Who it’s for: Patients of all bariatric surgical procedures will benefit from an improved understanding of the Protein First diet prescribed for weight loss and lasting weight management after surgical intervention for the treatment of obesity.

Evening Munchies: Slider Food Territory

After weight loss surgery, and truly for most of our dieting life, the evening munchies have been a nemesis for many of us. That feeling as the day winds down that a little something snacky would be oh-so-good right now. For me, denying the evening snack urge is unsuccessful. So I've had to re-define "snack" to things that support my health and weight loss goals.

Refresher: Understanding Slider Foods

Here is a new way of looking at this nightly battle of mind over body:

What if the Evening Munchies was a blessed opportunity to one more time nurture your body with nutrients? Rather than it being a danger zone to traverse with the potential to undo all the good work you've done during the day, what if it was an opportunity to gift yourself the reward of healthy indulgence? Here are some options:

• Cheese, cottage cheese, string cheese
• Yogurt with chopped almonds and a drizzle of honey (promotes sleep)
• Fresh strawberries dipped in dark chocolate
• Warm tea with milk or frozen protein drink or "shake"
• Protein Oatmeal (Quaker Instant) with milk or yogurt & chopped almonds
• The left-over chicken-fish-meat etc. you couldn't finish at dinner
• Microwave Mug-Eggs (one of my favorites!)
• Bran Muffin (good before bed to start the morning regular)

The Strategy:

• First - acknowledge you enjoy a bite to eat in the evening.
• Second - acknowledge your health and weight loss goals.
• Third - define specific food morsels that allow you to enjoy an evening snack while promoting your health and weight loss goals.

I have learned that I seldom succeed when I "forbid" myself specific food or eating occasions (such as NO SNACKING AFTER 7pm, etc) I do much better when I acknowledge and solve the puzzle while keeping the big goals in mind.

Learn more ways to stick to the WLS High Protein diet in my book Protein First: Understanding and Living the First Rule of Weight Loss Surgery available for instant download on Amazon Kindle and wherever fine eBooks are sold.

Spring Eggs with Salmon & Asparagus

Young thin asparagus is a luxurious spring delicacy. Look for it at the market beginning in February. Bunches should be bundled tightly enough to prevent breakage, but loose enough to avoid collaring the tender vegetable spears. Store refrigerated, the cut ends of the stalks in water, until use. When properly stored young asparagus will stay fresh four to five days.

Larger asparagus may be slightly woody with tough outer fibers. Remove the tough fibers with a vegetable or carrot peeler. This reveals the tender insides while removing the tough outer fibers that some people with gastric conditions find difficult to digest.

Suitable for Day 6 & Beyond the 5 Day Pouch Test

Serving Ideas:  Serve warm with fresh buttermilk cheddar biscuits or warm buttered toast. Provide additional shredded Asiago Cheese and chopped parsley for garnish. In the summer vine ripened sliced tomatoes compliment this meal and provided heart health nutrients and sunshine sweet flavor.

Ingredients:
8 large whole eggs
1/4 teaspoon salt
1/8 teaspoon pepper
2 tablespoons milk, 2% low-fat
1/4 teaspoon baking powder
1 tablespoon butter, chilled and quartered
8 ounces asparagus spears, peeled and sliced
2 ounces Asiago Cheese, shredded
4 ounces smoked salmon, flaked
2 ounces parsley sprigs, coarsely chopped

Start to finish: 30 minutes
Spring Eggs Serves 4. Each serving provides 257 Calories; 21 grams protein; 17 grams fat (7 saturated); 4 grams carbohydrate; 1 gram dietary fiber. A good source of vitamin C, vitamin A, B-Vitamins including folacin (folate).

Directions: Place the oven rack in the lower third of the oven: heat oven to 325F.  Liberally coat a 2-quart oven safe casserole dish with unflavored cooking spray. (Alternatively, coat four 6-ounce custard cups with cooking spray and place on baking sheet lined with parchment paper for easy clean-up.)

In a medium bowl whisk eggs, salt, pepper, whole milk, and baking powder until slightly frothy and well blended. Pour mixture into prepared casserole or custard cups and bake 6 minutes. Remove from oven, stir with a fork, return to oven and bake 4 minutes, removing and stirring again. If eggs are curdled and near done to desired consistency evenly top them with the butter pieces, asparagus spears, shredded Asiago Cheese, and flaked smoked salmon. Return to oven a bake 2-4 minutes keeping a close watch. Remove them immediately when they reach your desired consistency. Garnish with chopped parsley.

Alternative Method: Cooks that are confident in their stove top skills may prepare these eggs in a skillet following the usual best practice and method for skillet scrambled eggs.

Store leftovers in single-serve microwave safe containers. Gently reheat 30 to 60 seconds and enjoy another high protein meal.

Hot Off the Press: 5 Day Pouch Test Bulletin May 2015

Have you read it yet? The May 5 Day Pouch Test Bulletin? This is a don't miss issue full of so much information that you need to know to maintain a healthy weight and avoid regain after weight loss surgery. Subscribers check your Inbox folders. To read it online just link below to our online archive, free for your benefit and enjoyment!
 5DPT May Bulletin Online

Introduction: "Thank you for joining me today in this information packed 5 Day Pouch Test Bulletin. I have been following various conversations in social media groups about weight regain after bariatric surgery and share with you today articles that I hope will promote a calm understanding of how weight regain happens. Featured topics include slider foods, ways to relieve nausea, and protein supplements. I hope you find something useful as you pursue a long lasting healthy weight with surgery. Thanks for taking time from your busy life to join me here today."

Featured Articles:
The Slider Food Trap: Why do we turn to these foods when we know better?

We know that they contribute to obesity because they were likely a part of our diet prior to surgery. Common sense tells us that if food contributed to our obesity before surgery it will surely cause weight gain after surgery. We promised our surgeon to follow the dietary rules after surgery, yet somehow that grit determination wanes and little by little we find our old comfort food snacks back in hand. Continue Reading

Effective ways to relieve feelings of nausea

• I don't know about you, but I'm a frequent flier in the nausea club since having WLS. My surgery was in 1999 and I have yet to break the code of understanding why sometimes I just feel sick and queasy: sometimes after I eat, sometimes when I've had nothing to eat. Smells and odors will bring on tummy turbulence for me quite quickly and eqNot the Queen's Teaually unexpectedly. Continue Reading

Protein Supplementation after WLS

• It is common to see the question, "What protein powder should I use?" asked in online groups. What is surprising, to me, is the inconsistency in answers and the passion with which people believe there is only one true and correct answer to the question. Continue Reading

Check out the full newsletter in our public archive:  5DPT May Bulletin Online

New eBook Release: Protein First

New today from Kaye Bailey:
Protein First:
Understanding and Living the First Rule of Weight Loss Surgery

Hot of the Press! In this third release in our LivingAfterWLS short-read eBook series by Kaye Bailey we take an in-depth look at the Protein First Rule, why it matters, and how to live by the rule in a world bursting with simple carbohydrates.

Protein First: Understanding and Living the First Rule of Weight Loss Surgery (LivingAfterWLS eBook Shorts 3)

If you are asking “How much protein should we be eating for a Protein First diet?” here are the answers. Stop leaving your WLS results to chance and make a plan with current information and facts. Leaving it to chance and hoping for the best isn’t working for many of us; we are not eating the amount of protein our bodies need for optimum health, weight loss, and weight maintenance. Valuable information for all bariatric procedures and patients at all stages post WLS.


42 Tempting PROTEIN FIRST Recipes from Kaye's Kitchen!

"The reason I take time to research and report this information to you is because it can singly make a difference in the amount of weight you lose and your overall health and well-being. As disgusting as this (digestive) process is, the chewing and the mixing and the grinding – it is the difference between health and sickness, and vitally important to weight loss management and the avoidance of weight loss stalls." (Ch. 3 - Stumbling Blocks)

Super Value Priced just $4.95 (approximately 70 pages)

Exclusively at Amazon Kindle
Protein First: Understanding and Living the First Rule of Weight Loss Surgery (LivingAfterWLS eBook Shorts 3)
No Kindle? No Problem! Just download the free Kindle eReader app and take your Kindle library wherever you go on whatever device you prefer! Easy Fast Portable Efficient! Never lose your eBooks to a phone or device upgrade.

Go ahead! What are you waiting for? Get on track with Protein First right now!
Protein First: Understanding and Living the First Rule of Weight Loss Surgery (LivingAfterWLS eBook Shorts 3)

Quick Recipe: Ham and Egg Breakfast Bowl

The 5 Day Pouch Test: Express Study Guide

In celebration of World Egg Day I share this recipe, with permission, from the American Egg Baord: Incredible Edible Egg. Check out Incredible Egg for great recipes and tips for including eggs in your high protein WLS diet.

"Is your breakfast incredible? If not, then start your morning with eggs. They are all-natural and contain high-quality protein to keep you fuller longer and energized all day long. Plus, with 64 percent more Vitamin D and 14 percent less cholesterol than previously thought—eating delicious eggs for breakfast is a no brainer." ~ Incredible Edible Egg - American Egg Board

1-Minute Ham & Egg Breakfast Bowl

Eggs, ham and cheese join forces in a three ingredient breakfast bowl that's fast and mess-free.
Prep Time: 15 seconds
Cook Time: 45-60 seconds
Servings: 1 serving

Ingredients
1 thin slice deli ham (1 ounce)
1 EGG, beaten
Shredded Cheddar cheese

Directions
Step 1     LINE the bottom of 8-oz ramekin or custard cup with ham slice, folding ham in half, if necessary. POUR egg over ham.

Step 2     MICROWAVE on HIGH 30 seconds; stir.  MICROWAVE until egg is almost set, 15 to 30 seconds longer.

Step 3     TOP with cheese.  SERVE immediately.



Hints:
Don't overcook.  Scrambled eggs will continue to cook and firm up after removed from microwave.

Microwave ovens vary. Cook time may need to be adjusted.

It's World Egg Day! Yes - How eggcellent is that?

The 5 Day Pouch Test: Express Study Guide

"World Egg Day is a unique opportunity to help raise awareness of the benefits of eggs and is celebrated in countries all around the world. The International Egg Commission has proclaimed the second Friday in October as World Egg Day. Countries throughout the world will be joining in the celebration of the egg." International Egg Commission

In honor of World Egg Day I share this article with permission from Medical News Today by James McIntosh.

"Eggs are a common food source and have been eaten by humans across the world for thousands of years. Eggs are produced by the female animals of many different species, but by far and away the most common choice for consumption is the egg of the chicken.

The US is regarded as the world's largest exporter of eggs1 and it is estimated that in 2014, 256 eggs will be produced for each member of the population - the highest rate of production in the past 8 years.

Eggs are considered to be one of the best sources of protein available. One medium-sized egg weighing 44 g typically contains 5.53 g of protein. Nutritionists often use eggs as a point of comparison when assessing whether another food is a good source of protein or not. Around 12.6% of the edible portion of an egg is protein.

A medium-sized egg typically contains 5.53 g of protein and only 63 Calories. Around 9% of an egg's content is fat, found almost exclusively in the egg's yolk.

The majority of fat in an egg is that which is generally regarded to be the most healthy; approximately 38% is monounsaturated and 16% is polyunsaturated, with only 28% being saturated.

Eggs are also a rich supply of long-chain omega-3 fatty acids. These are predominantly in the form of docosahexaenoic acid (DHA) which helps with the maintenance of brain function and normal vision.

These fatty acids are most commonly found in oily fish and so eggs provide an alternative source for people that are unable to eat fish.

Possible health benefits

As suggested by their wide nutritional content, there are several health benefits that can be derived from eggs:

•     Strong muscles: the protein within eggs helps keep muscles working well while slowing the rate at which they are lost.
•     A healthy brain: eggs contain vitamins and minerals that are needed for the regular functioning of cells, including the brain, nervous system, memory and the metabolism.
•     Good energy production: eggs contain all the daily vitamins and minerals that are needed to produce energy in all the cells of the body.
•     A healthy immune system: likewise, vitamin A, vitamin B12 and selenium are all key to keeping the immune system healthy.
•     Lower risk of heart disease: having a healthy immune system helps. Choline plays an important part in breaking down the amino acid called homocysteine, which is associated with the development of heart disease.
•     Healthy baby development during pregnancy: nutrients within eggs help to prevent birth defects such as spina bifida.
•     Healthy eyesight: lutein and zeaxanthin help to prevent macular degeneration, an eye condition which is the leading cause of age-related blindness. Other vitamins also promote healthy vision.
•     Weight loss and maintenance: the high quality of protein within eggs has been found by researchers to keep people energized and feeling fuller for longer. Feeling full prevents unhealthy snacking and reduces overall calorie intake.
•     A healthy appearance: some vitamins and minerals within eggs help promote healthy skin and work to prevent the breakdown of body tissues. A strong immune system also contributes to a healthy look overall.

McIntosh, J. (2014, October 10). "What are the health benefits of eggs?." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/articles/283659.php.

Recipe: Heavenly Deviled Eggs

Earlier this week we published our Cooking with Kaye newsletter that is full of great recipes for game time entertaining - think Superbowl! One of our most requested recipes, Healthy Deviled Eggs, was featured in the left-hand sidebar. Who doesn't love a good deviled egg or two? Or as we call them at our house, Picnic Eggs.

Newsletter link:
Cooking with Kaye: Dining on Man Food

Here is another terrific stuffed egg recipe that is lower in cholesterol and includes healthy chopped red and green bell pepper. This recipe makes 20 stuffed halves and a serving is two halves providing 8 grams protein and 5 grams carbohydrate, 6 grams fat.

Incredible Egg

Heavenly Deviled Eggs

Ingredients:
12 large eggs
3/4 c nonfat sour cream
2 green onions, finely chopped
1/3 cup finely chopped green bell pepper
1/3 cup finely chopped red bell pepper
2 teaspoons Dijon-style mustard
salt to taste
3 Tablespoons finely chopped parsley
sweet paprika for dusting

Directions:
Cook eggs following boiling directions (below). Cool. Peel eggs, then cut lengthwise in half, and remove yolks. Discard 8 yolks. Arrange 20 egg-white halves on a platter. Chop remaining 4 egg-white halves very finely. Mash the 4 yolks with a fork. Transfer whites and yolks to medium bowl. Stir in sour cream scallions, green and red peppers, mustard, and salt. Spoon egg mixture into egg white halves. Sprinkle with parsley and dust with paprika. Keep chilled until serving. Enjoy!



 From the American Egg Board:

How to Hard Boil an Egg:

PLACE eggs in saucepan large enough to hold them in single layer. ADD cold water to cover eggs by 1 inch. HEAT over high heat just to boiling.
REMOVE from burner. COVER pan. LET EGGS STAND in hot water about 12 minutes for large eggs (9 minutes for medium eggs; 15 minutes for extra large).
DRAIN immediately and serve warm. OR, cool completely under cold running water or in bowl of ice water, then REFRIGERATE.

Recipes using Hard Boiled Eggs from American Egg Board