HeatherS.

Clients who regain weight after bariatric/weight loss surgery often ask us about the ‘5 day pouch test’. This much debated ‘test’ promises to ‘reset’ your stomach and help you lose more weight. It’s so popular in fact, it has its own acronym – the ‘5DPT’. So what’s the deal, is it too good to be true?

Let’s start with a bit of background
The pouch test was ‘created’ in 2007 by a fellow gastric bypass-er named Kaye. She struggled, like many, with discouraging and disheartening weight regain after bariatric/weight loss surgery. In an attempt to recreate that ‘tight newbie feeling’ again, she developed the pouch test.

To start off the 5 day pouch test, she instructs you to ‘get back to the basics’. Or in other words, she wants you to return to the post-op liquid phase that is required in the first few days after surgery. She then recommends that you progress slowly from soft/puree protein, to firm protein and then lastly to solid protein (what’s the difference between firm and solid protein? We don’t know either...). Following this, you are supposed to feel a renewed sense of self.

MYTH...
The 5 day pouch test WILL NOT...
- shrink your stomach
- reduce hunger and increase satiety (feeling of fullness)
- ‘reset’ your body
- cut your cravings for carbs and sweet/salty foods

FACT...
We do however agree with some of Kaye’s suggestions.

1. Always delay your fluids from your solids foods.
--> Stop drinking 15 minutes before your meals/snacks and wait at least 30 minutes after eating to start drinking again. WHY? - Drinking and eating at the same time ‘flushes’ the food out of your stomach too quickly. This causes you to feel hungry soon after eating.

2. Take your time to eat.
--> Eating slowly and savouring your food without distractions increases satiety at meal times. WHY? - This gives your brain time to process that you are eating and lets you get the flavor fix you’re looking for.

3. Ask yourself if liquid protein snacks (aka ‘slider foods’) keep you full long enough (Ex. milk, yogurt, soft cheeses, cereal).
--> While these foods are nutritious and provide good quality protein, they may not help you feel as full as you felt in the first few months after surgery. WHY? - These liquid foods spend less time in your stomach which is why you maybe feel hungry soon after eating.

4. Include a high protein food at every meal and snack.
--> WHY? – High protein foods help keep you full longer.

In our opinion, the ‘5 day pouch test’ is just another diet in disguise. Anything that promises to ‘reset your system’, ‘boost your weight loss’, ‘cut cravings’, ‘kick start your metabolism’, ‘burn fat’, etc. is unfortunately wishful thinking.

There are no short cuts to healthy eating and lasting weight loss. There is only you, your pouch (i.e. your little stomach) and knowing how to use it!

How do I know if my pouch is still small?
Believe it or not, the majority of weight regain after bariatric/weight loss surgery is NOT related to having stretched your stomach. This is good news! In our experience, weight regain is more related to what you eat, the timing of your meals and snacks, and how you are eating. For example, if you feel comfortably full for 2-3 hours after eating the amount of food that fits on a bread plate, which includes a combination of protein, a small amount of grains, and some vegetables, your pouch is likely perfectly fine.

We even asked one of our favourite bariatric/weight loss surgeons about the 5 day pouch test! Here is what he said:
Need help?
If you are looking to get back on track with your weight loss and healthy eating, sign up for our Get Me Back on Track package. Whatever the cause of your weight gain, we will give you realistic strategies and tips to tackle your triggers and barriers to healthy eating. Even simple changes to your home and office environments can make a big difference.

Why do plateaus happen even when we’re doing all the right things? The human body wants to preserve itself. It fights weight loss by adapting the metabolism to accommodate decreased calorie intake and/or increased calorie output. The body's new plan of attack is multi-pronged: increase calorie intake by making you hungrier (so you eat more), use less energy to accomplish physical activity (so you burn fewer calories) and hold on to stored fat (so it can use it for energy).
I think plateaus often happen because we're in a rut. So even if you believe you're doing all the right things in terms of diet, exercise, and mental or emotional effort - try changing them. If nothing else, it will prevent boredom and help you feel that you're taking positive action instead of being a victim of fate.
Here are some things you can try to shake up your routine.

Change the intensity, duration, frequency and type of exercise you're doing, so your body doesn't become too efficient at burning calories when you work out.
Don't neglect strength training - muscle burns far more calories than fat does.
Don't over-train - take one day off exercise a week.
Plan all your meals (the "how much" as well as the "what").
Weigh and measure your food before you put it on your plate.
Log your food intake - you might be surprised to see what and how much you're really eating.
Try calorie shifting: vary your calories - eat 1200 one day, 900 the next, and so on, to keep your body guessing.
Eat 3 small meals and 3 healthy snacks a day instead of 3 meals a day.
Increase your water intake.
Decrease your sodium intake.
Don't weigh yourself every day - switch to once a week.
Don't skip breakfast.

By the way, if you weigh yourself every day and think that no weight loss for three days running is a plateau, you're going to have a long journey ahead of you. Get off that scale, now!
I have one more suggestion that you probably won't want to hear: CULTIVATE PATIENCE. No, it's not one of my virtues, either. Give it a try anyway.