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WLS Fact v Myth: 5 Day Pouch Test

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Today I am delighted to announce a collaboration with two very experienced bariatric dieticians who will bring some further professional advice to bariatriccookery.com  Lisa and Monica (see their profiles below) will bring some much-needed, scientific-based information to bariatric patients who are faced with constant (and sometimes conflicting) advice relating to their diet/lifestyle/exercise regime pre- and post-surgery. I have been impressed with their level-headed, measured and well-researched comment. In their own words ….

 

“We’re passionate about helping people work through the exciting yet terrifying roller coaster that is bariatric surgery, and to help people understand their ‘tool’ so that they can continue to use it effectively while developing a healthy relationship with food.”

 

Today we bring you the 1st of their features from bariatricsurgerynutrition.com  and one that I know interests and resonates with so many of you because you’ve asked me so much about the fact and fiction relating to the ‘5 day pouch test’. My views coincide with those that Lisa and Monica report – although they put it more eloquently and back it up far better than I can with comment from other bariatric professionals.

 

I know you will welcome their sage comment, and their features will doubtless provoke a lively discussion (please feel free to leave your comments below). Why not check them out further on their website here and also on their Facebook page here too for up-to-date advice, promotions, and the release of new material, including their books.

 

In the meantime I hope you will join me in welcoming them to bariatric cookery for their 1st feature and read on ….

 

 

   

Who we are…

Lisa Kaouk MPH, PDt/RD  &  Monica Bashaw MScA, PDt/RD

We are passionate and enthusiastic registered dietitians (RD/PDt) specialized in working with adults before and after bariatric surgery. 

With a combined 10 years of experience working in a Canadian bariatric surgical center of excellence (500+ surgeries annually), we are highly specialized in all aspects of bariatric surgery (post-op complications, common nutritional deficiencies, pregnancy, kidney disease, etc.). 

We are patient and committed, and most importantly, we understand that life after bariatric surgery is filled with many new challenges and lifestyle changes.

 

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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:

“The major reason for weight regain is the recurrence of unhealthy eating habits and/or lack of exercise. Maintaining weight loss requires a lifelong commitment to keeping up good habits and having support from family, friends, and your health care team. 

Searching through the medical literature, I could not find any evidence or scientific papers studying and discussing the 5 day pouch test. When something is not discussed in the whole of medical literature, even as a simple case report, it leads me to believe that there is no scientific basis for this reset diet. And simply thinking about how the gastric pouch and anastomosis works, it does not make logical sense to me how a 5 day regimen of liquid and puree diet could possibly shrink the gastric pouch. The original feeling of tightness immediately after surgery is probably because of inflammation, since the stomach was cut and stapled, and also there was inflammation from the creation of the anastomosis (suturing). This inflammation resolves after days/weeks during which time the stomach is healing, and hence the original tightness feeling resolves with it”. 

Dr. Simon Chow, Bariatric Surgeon, MD MSc FRCSC FACS



– Monica & Lisa
 
  
 And, because here at bariatric cookery we don’t want you to be left without some way forward, check out how to get back to the real basics here
 
 

 

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Comments

  1. Thanks for this article Carol, I have been wondering myself if it would be worthwhile to do the 5 day pouch test.. This actually makes a lot of sense ie the restrictions felt after surgery being down to the swelling/healing process going on inside rather than the size of pouch..

  2. Glad to help Elizabeth – this is the 1st of what I hope will be many features from our new collaboration with Lisa and Monica. The pouch test (and there are now a couple of others like it) is something that I think tempts and teases a few people but it’s not based on any research or science and whilst it might help some it disappoints so many. Like our dieticians say it’s simply another kind of diet (and we all know where that took us in the past before wls). Better to go back to basics to deal with poor loss, regain or stalls if you’ve veered away. Thanks for your comment! C x

  3. I was told it was a definite no to protein shakes and powders and we were started on puree from day two after surgery. I also did the food option pre diet all but the milk or yogurt. I have nothing with milk or milk bi-products in. I have tried all the nut milks soya and after trying the lacto free and coconut. I now have an epi pen.

  4. A great article, thank you. I have done well since surgery but have difficulty eating veg and fruit. I also have to follow as near fat free diet as possible. If I don’t follow this I suffer with persistent diarrhoea.

  5. Just goes to show doesn’t it Valerie that our diets pre and post-op and the recommendations vary enormously across surgeries, providers and even continents. This makes it doubly important to follow the regime prescribed to you by your own dietician since they know you, your surgery and any allergies/problems first hand. Always follow their advice. C x

  6. Thank you Sheila, we all have toleration problems (or not at all) to some degree and I’m sorry yours are fruit and vegetables since they are great foods and offer much in terms of versatility and nutrition. It’s good however that you are coping and doing well. Perhaps in time things might well change but do follow your dietician’s or team’s ideas for dealing with this. C x

  8. I don’t mean to sound contrite, but I disagree for multiple reasons.
    First- I have an ulcer, and had a follow up EGD done this past Friday by my bariatric provider. While my ulcer is great, he noted my pouch was “slightly dilated” having increased approximately 30%. If it’s NOT true your stomach doesn’t stretch then odd how my provider could visibly note this. My last EGD in September didn’t show this… so it has happened since then.
    I am pretty sure I know the cause…. soda– started drinking it around Oct/Nov last year. Yes, I went backwards and started drinking soda (which is odd because I never did drink it much even before bypass). My physician recommended the pouch reset. I just started today and found this article because I am trying to decide the benefits between 5 days or 8-10 days as some suggest.
    Second- Stop telling people something doesn’t work and let them try it for themselves — WHAT CAN IT HURT? We all know that many medical interventions are psychologically geared… if I reap benefits of feeling like my pouch went back to normal and begin to lose weight again… then good for me!!

    Background- I lost 160 lbs from RYN over 11 years ago, I gained back 40 lbs, but even with a “stretched” pouch I have gotten off 20 lbs with OrangeTheory Fitness and following Dr. Sears Zone diet… which is BRILLIANT and works for the GB body VERY well! I want to get off 10-15 more and I will be happy. So my search for pouch reset is more about I let myself down stretching my stomach…for stupid soda!!!
    I WILL BE successful at this pouch reset, it WILL work, and I WILL BE back — GAME ON!!!

    if your reading this…. try the pouch reset!!! what have you got to lose but a few days of just having liquids??? I am in day one at 1:30 in the afternoon and you know what- i am positively focused on WHY i am doing it… so yeah i’m hungry and would love the chew food– but am i dying of hunger??? NO!
    Find Your Motivation!

  9. I don’t think the above Doctors have ever had a weight problem. Most of weight problems are really “Head Problems”. What the 5 Day Test does is get your head back into normal eating again as most of us know that we unfortunately have an “Addiction” to food. If this 5DPT works for some people, go for it and all the power to you. To tell someone that this has helped that it did not, it’s only a “Myth” is like telling a person who quit smoking by using lifesavers as a replacement that it won’t last long because there is no nicotine in them. What ever works for a person to do good on their addiction should be applauded not made to feel like they are a failure with an imagination. Deep down, they know they messed up and if this helps them get back on track – great. Like Shannon said – What have you got to lose – maybe just the feeling of failure and this can help you pick up and keep going again. Yes , after 10 years and gaining back 26 Lbs, I am back on the 5DPT and feeling better about myself.

  10. I’m actually a little bothered reading this article. These “facts” and “myths” were simply statements from two nutritionists who were giving an opinion. Every WLS patient will tell you that each surgeon is different, each nutritionist is different, each pre and post op plan is different as is each person’s body.

    I am 4 1/2 years post op and have gained weight from being put on and off medicines from other health issues. I’m now finishing Day 3 of a *modified* and *approved by my surgeon and nutritionist* TEN Day Reset. I have lost 7 pounds and feel more like myself post surgery than I have in the last 2 years. This article is really frustrating, and imagine those seeking guidance and resource for wanting to gain control of their weight regain years after their surgery. They see this.

    Like the last two comments, if you are at the point of looking into a “pouch Reset” or revision (because those are the ONLY options when you are far out and have significant weight regain) TRY THIS. You CAN do it.

    My surgeon approved plan says “The goal of this 10 Day Reset is to develop control of healthy eating habits once again. Any meal you eat beyond Day 10 should be no larger than the size of your first. Protein and vegetables first.” Along with many other TRUTHS. Not myths.

  11. Hi Lindsay, many thanks for your comments – it’s always helpful to get a lively debate going on such a tricky subject as regain and some ‘solutions’ for it. Just to play devil’s advocate and for accuracy can I comment that the two authors are dietitians not nutritionists – huge difference in terms of qualifications and that the article also quotes the opinion of a bariatric surgeon too. It’s my belief that you should always follow the advice of your own team who may well have differing views to those of others. I believe the authors in this instance were not only giving their own personal views but also looking for research or evidence to back up the claims of ‘pouch tests/resets’. I am thrilled you are enjoying some success with your new regime and feel you are getting a handle and control over your eating again. C x

  12. I am one year and 3 months post op and lost 60 lbs. Since November 2017, after some life changing events put on about 9 lbs. I stumbled across the pouch reset and starting investigating. From what I can find is that I think it brings you back to becoming aware of what, when and how much you are eating! So if it works for some…Great! Personally, I thought that part of the process was horrible, and would not want to revisit it. For me, after reading your article and several others I know exactly what I’ve done. I’ve gone back to “old” habits, snacking and lack of exercise. So I’m gearing up to get back on track and touch base with my surgeon and nutrition specialist. Thanks for your article. Wish me Luck! J Sparkles

  13. Loads of luck! I think for many regain amounts to the return to old habits and you’re lucky anyway in finding that’s your reason. Addressing early is the key to sorting it out which sounds like you have covered. I’m so pleased you’re gearing yourself up to getting back on track and plan to touch base with your team again – sounds like you’re winner already! C x

  14. I was diagnosed with multiple myeloma 3 years ago and am currently still going through treatment of velcade shots and dexamethasone. My weight gain is up 40 lbs. About 5 months ago I was treated with Revemid and lost 30 lbs then started gaining weight and also diagnosed with hypothyroidism which is a side effect of Revemid. What can I do with this vicious cycle. But am still alive with incurable cancer.

  15. Dear Linda, I am so sorry to hear that you have been and still are suffering so much. The vicious cycle of weight gain and loss between illness and life-saving medications is a very real one. I am no medic so can’t offer any advice on specifics but I would personally concentrate on taking the medications (with their awful side-effects) to preserve your life – the weight regain can be tackled when you feel stronger, better able to cope and hopefully have a turnaround with more hopeful prognosis. I am sure everyone here would wish you well and will keep you in their prayers. C x

  16. May I ask a question is it true that drink fizzy soda can stretch your pouch I sometimes may drink 4 or 5 cans of diet soda a week but I heard it can stretch your pouch is this really true ???

    Regards Nigel ….Dover UK

  19. I have to agree with Dottie. Without a doubt, the struggle with food is a head game. I have followed the 5 day pouch test a couple different times. I can tell the difference within 24 hours. I feel better physically and emotionally. I’m curious to know which scientific studies were reviewed, and were any of them psychological? Secondly, I’m concerned these dietitians don’t acknowledge the difference between firm and solid protein? Foods such as milk/protein shakes are soft proteins, hard boiled eggs or tuna could be firm proteins and red meat would be a solid protein. Finally, when I read this is “just another diet”, what I really heard was “another diet…just like all the other diets you tried in the past and FAILED.” Thanks for the encouragement.

  20. I am on day 2 of the pouch test. Day 1 was awful. Today is better. It’s definitely a head game for me with food. I was sleeved in April 2015 and gained 17 pounds within the past year. I know I am not watching my portions and waiting to drink, etc like I did in the beginning. It’s easy to let these things creep back in if you aren’t careful. I hope that I “reset” my pouch and go back to the basics by the end of this week.

    I disagree with the “myth” that it reduces hunger. Seriously? It really does. If your drink your protein and your water you are fuller for longer. Have these people done this test? Been overweight? Doesn’t sound like they know what they are talking about from my experience and others I know who have struggled and have done this test.

    I also am not having cravings. When I eat junk and drink diet soda, my cravings are fierce! Protein, water, and soft proteins no cravings. I love the feeling of not being stuffed from over eating.

    I have heard nothing but good things regarding the 5 Day Pouch Test. If you are or considering doing this test best of luck! It’s worth it and if you don’t lose or have success you are only out 5 days. Nothing to lose but hopefully something to gain 🙂

  21. I have been looking at the pouch reset recently with stalling, one year out. Although I would love to think it shrinks my pouch, I really didn’t look into it believing this. I guess I am trying to just find a way to get myself moving again. In reality the pouch reset works because you are restricting your calories from what you have been eating. Unfortunately it just goes back to the same way we could lose weight pre-op. Eating less and exercising. It was just harder to stick to pre-op. So what it comes down to is if we are gaining or stalling, we have most likely swayed from what we are supposed to be doing, and in reality we all need to just go back to the rules of post-op surgery. Getting enough protein, fluids, and limiting sugar, breads, grains, etc. Once again….no magic bullet. Just science.

  22. I’ve tried the 5 day pouch test, and it works for what it’s supposed to. It’s not about “shrinking” the stomach pouch, it’s about reminding a patient that the pouch is there, and how it works. The 5 day pouch test is more of a behavioral reminder. If you eat the wrong foods at the wrong time, like you did before, you body will respond the way it did before and retain weight. But if you eat high protein, healthy foods when and how you’re supposed to your post-gastric bypass body will respond accordingly and you will lose weight. I understand you’ve got something to sell, and to do that, you have to “debunk” the opposition, but I’m here to tell you that the 5 day pouch test does what it claims to. It “resets” your behavioral pattern to the time shortly after your gastric bypass. It gives you a “do over” so that you can get back on track.

  23. I’ve done the reset several times for exactly the reasons the folks above have stated.

    It really is a behavioral reset and it reminds me my tiny tum still works the way it’s supposed to. I have had nothing but positive experiences with it.

    I recently tried keto and, oh, man was that awful for my specific WLS needs and it made me gain 20lbs. I should have just done a reset.

    So, I reset to get back to basics: behavior, protein first, and listening to my bff—tiny tum.

    Btw’s, I’m 4 1/2 years post op who went vegetarian two years ago.

  24. I had a sleeve gastrectomy 6 years ago. Did well until year 4. Stress. Started gaining. I have no idea what size my stomach was or was not at that point. And I really don’t care. Because this is reality: the fundus of the stomach where most ghrelin is produced, was removed surgically. Thus I NEVER experience physical hunger. I am 6 years out and could go all day long without any feeling whatsoever of an empty stomach. Conversely, the “hunger” that surgery cannot fix is a mental issue. Put another way, there is a huge difference between true hunger and craving. So I put myself back on a proper, reduced-calorie diet. And the weight came off and has stayed off. This was my experience; I cannot speak for anybody else. But when I was about 3 months into my renewed diet plan, I once again felt that familiar feeling of my stomach telling me to stop. I have no idea if this is the result of shrinkage. But I can tell you that I felt it to be sure. Again, it took a far more than a few days, but even to this day, I am still surprised from time to time at the “full” message my restricted stomach is sending me. And I put the fork down, pronto.

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