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5 day Pouch test (Fix your tool and take control in 5 easy days)

Tuesday, May 26, 2009

These are questions many weight loss surgery post-ops find themselves asking occasionally during their journey. Perhaps it feels like we can eat more food or we know that we are eating more food. Sometimes these questions are asked when there has been a weight regain.

This is the 5-day plan that I have developed and used to determine if my pouch is working and return to that tight newbie feeling. And a bonus to this plan, it helps one get back to the basics of the weight loss surgery diet and it triggers weight loss. Also, it is not difficult to follow and if you are in a stage of carb-cycling it will break this pattern. Sounds pretty good, right?

The 5 Day Pouch Test should never leave you feeling hungry. You can eat as much of the prescribed menu as you want during the day to satiate hungry and prevent snacking on slider foods and/or white carbs. You must drink a minimum of 64 ounces of water each day. A reduction of caffeinated beverages is suggested, but do not stop caffeine cold turkey.

Weight loss is not the intent of the 5 Day Pouch Test, however, many who have tried this plan report a significant drop in weight. More importantly they celebrate a renewed sense of control over their pouch and eating habits and easily transition back to a healthy post-surgical weight loss way of eating.

Understanding Hunger, Appetite and Satiety

Below you will find a brief list of the menu for each day. Please click the "Read more" links for further detail and hints and tips that will enable your success with the 5 Day Pouch Test.

Days One & Two: Liquid Protein
low-carb protein shakes, broth, clear or cream soups, sugar-free gelatin and pudding. Read more.

Day 3: Soft Protein
canned fish (tuna or salmon) eggs, fresh soft fish (tilapia, sole, orange roughy. Read more.

Day 4: Firm Protein
ground meat (turkey, beef, chicken, lamb), shellfish, scallops, lobster, fresh salmon or halibut. Read more.

Day 5: Solid Protein
white meat poultry, beef steak, pork, lamb, wild game
Read more.

Good luck! I believe you are going to like the results when you give this plan an honest try.
Days 1 & 2: Liquid Protein
low-carb protein shakes, broth, clear or cream soups, sugar-free gelatin and pudding.

Recipes for Days 1 & 2

The first two days are all liquids. You can have as many low-carb protein shakes as you like to satisfy hunger or cravings. In addition drink at least six 8-ounce glasses of water each day. The purpose of all liquids is to break any snacking, grazing or processed carbohydrate habits. In addition the liquids will work to cleanse your system and prepare you for the following three days.

Try to reduce your caffeine intake as well, but do not stop caffeine cold turkey or you will feel sick and frustrated potentially losing the desire to continue with the pouch test.


It is very important to drink a minimum of 64 ounces of water each day. This will prevent dehydration, will help curb cravings and will flush your body of toxins and fat. Sufficient water intake improves kidney function and cell processes.



If you notice symptoms of carbohydrate withdrawal you can eat a small piece of melon or an orange. You can also try a dose of Emergen-C which should reduce headache, dizziness or cramping from carbohydrate withdrawal.

Feed the Carb Monster: Recipes for Days 1 & 2


Feeling nauseated? Try sipping some freshly brewed warm green tea. You can add fresh ginger juice to further ease the symptoms of stomach distress and nausea. The nauesea may be the result of a switch from carbohydrate slider foods to richer proteins and the ingredients in the protein shakes.


When we fought to get the surgery we were personally empowered. We had to be, there aren't many advocates out there fighting on the behalf of the morbidly obese.

Yet somehow, if we get to comfortable in our post weight loss surgery life there is a tendency to lose that hell-bent determination. Perhaps we take it for granted. Maybe we just get bored or distracted. Maybe we get discouraged because life after surgery has not been without struggle. Any of these things can cause us to lose hope or feel like failures. I have gone through periods of sadness and suffered feelings of failure since my weight loss surgery. Don't we all? This despair only festers if we regain some weight or sit on a plateau for an extended length of time.

But just like we can work a plan to test the pouch and get back on track, we can mentally train our mind to get back to being hell-bent determined to take personal control of our health. LivingAfterWLS is here to champion you in the cause, we are advocates who believe you deserve to be healthy, you deserve to be kind to yourself and you deserve to achieve the greatest level of success with weight loss surgery when you harness your inner resources.


Mocha Smoothie by Andie Jamari
Page 6 - Neighborhood Cookbook

Ingredients:
1/2 cup decaffeinated coffee
1/2 cup skim milk
2 Tablespoons vanilla or unflavored protein powder
1 Tablespoon cocoa
4 teaspoons Splenda (or sweetener of your choice)
5 ice cubes

Directions: Place all ingredients in blender container, cover and blend until smooth. Serve immediately.

Serves one. Per serving: 110 calories, 15 grams protein, 11 grams carbohydrate and a trace of fat.



Feed the Carb Monster: Soups for Days 1 & 2

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Pina Colada Protein Shake by BamaGal
Page 6 Neighborhood Cookbook

Ingredients:
1 cup water
2 packets Splenda
2 scoops vanilla protein powder
8 ice cubes
1 teaspoon pineapple extract
1/2 teaspoon coconut extract

Mix all ingredients in a blender until smooth and creamy.

Recipe Note: protein count will vary depending upon the brand of protein powder used. Please consult product label for nutritional information.

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Vanilla Chai Smoothie by Andie Jamari
Page 12 - Neighborhood Cookbook

Ingredients:
1 cup skim milk
1/4 teaspoon ground allspice
1/4 cup Splenda
1/3 cup unflavored or vanilla protein powder
3 teaspoons instant tea mix, unsweetened
3/4 teaspoons vanilla extract
3/4 teaspoons cinnamon
8 ice cubes

Directions:
Place all ingredients into blender container; cover and mix until smooth. Pour into glasses and serve immediately.

Serve 2. Per serving: 110 calories, 16 grams protein, 11 grams carbohydrate and no fat.

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Unjury Hi-Protein Pudding by Andie Jamari
Page 47 - Neighborhood Cookbook

Ingredients:
1 (4 servings per package) package Jell-O sugar-free instant pudding, any flavor
2 cups fat free milk
2 scoops Unjury unflavored protein powder

Directions:
Measure 2 cups of cold fat free milk and add two scoops of unflavored Unjury. Shake or stir until Unjury is completely dissolved into milk. Place the sugar free pudding mix in a medium bowl and slowly whisk in milk mixture. Whisk until smooth. Cover and chill.

Serves 4. Each 1/4 cup serving has 14 grams protein.

Day 3: Soft Proteins

Recipes for Day 3

The next three days you get to eat as much as you want as often as you want! Ahhh, but there's a catch: it has to be solid protein and you only get 15 minutes each time you sit down to eat. No drinking 30 minutes before or after meals and no drinking with your food. A dry pouch will hold your soft protein longer helping your to feel full and fed longer.

Protein Recommendations: canned fish (tuna or salmon) mixed with lemon and seasoned with salt and pepper, eggs cooked as desired seasoned with salt pepper and/or salsa, fresh soft fish (tilapia, sole, orange roughy), baked or grilled, and lightly seasoned.


This starts your program with "soft" protein. Measure your portion (1 cup volume or 4-6 ounces weight) and eat only until you feel full, not overfull. Remember, no water for 30 minutes before or after you meal, and no fluids with your meal. We are going back to the beginning and fluids will prevent you from feeling the pouch. If you need to add a moist condiment ( Miracle Whip or mayonnaise) to the canned fish I understand, but keep it to a minimum so the meat is not too moist. One reason we lose the sense of tightness in our pouch is that we eat "slider foods" - foods that are too moist and do not stay in the pouch very long, they slide right through the stoma.



From Amy: On day 3, is cottage cheese o.k. for soft protein? When I was first starting my wls diet, it included cottage cheese, but that wasn't on your list. Also, when you are doing the liquid part of the diet, can you drink chicken boullion with protein added to it?

Kaye Answers: Amy - Cottage cheese is a good protein and you can include it on Day 3. I didn't have it on the list because it is considered by some to be a slider food. To firm it up a bit you could add a chopped hard cooked egg to your cottage cheese. And yes, during the liquid phase chicken boullion with added protein is great.

Recipes for Day 3

"We MUST give the pouch a chance to do it's job--and not try to get around it with our "monkeying" with the thing." --LivingAfterWLS Neighbor Sandi


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I don't like canned fish. What can I have in place of the canned tuna or salmon?

Try canned turkey or chicken. We have some great recipes for Turkey and Chicken Salad that work well for Day 3 and as part of your regular diet after the 5 Day Pouch Test.



Question: What are slider foods?

Kaye's Answer: In a malabsorptive procedure the pouch is made and the stoma or outlet is attached to the lower part of the middle intestine called the jejunum. The majority of caloric absorption takes place in the jejunum, so depending upon where your surgeon created the outlet the level of absorption can vary. Skilled surgeons will adjust the length of intestine bypassed according to their patient's projected needs based on dieting history and pre-op psychological screening.

Slider foods slide right through the stoma into the jejunum. My first test of the slider foods was graham crackers and coffee for my after work snack. Now imagine, I could eat a stack of graham crackers and wash it right through the pouch with the coffee and never feel any satiation. What resulted was an easily absorbed slurry that my jejunum sucked up like a sponge - it didn't have to do any work to absorb this simple carbohydrate slurry. Of course, weight gain resulted and I had to give up this little indulgence. Another popular slider food is pretzels. I speak with post-ops all the time who are addicted to pretzels - again, this is a simple carb that your jejunum is very happy to receive and convert to fat. Traditionally dieters are encouraged to eat pretzels or popcorn - fat free and fiber, right? But that doesn't work so well for us. Giving our re-routed bodies these simple carbs is dangerous because our bodies have spent years perfect the art of fat storage - slider foods are to the body a great big lottery win.

By the way, in my example I spoke of a slurry from graham crackers and coffee. Simple carbs, however, will slide right through without the added benefit of a liquid. And several others can talk about cheese nip crackers, popcorn, mashed potatoes, ice cream/yogurt etc.

Lots of times I hear, "But I don't like that uncomfortable tight feeling of solid protein in my pouch." But the very purpose of the pouch is to signal fullness, which often comes by way of slight discomfort when we are eating in compliance with our bariatric owner's manual. The slider foods will never ever signal fullness. They are dangerous and in most cases non-nutritional. When I feel that full-pouch discomfort I try to mentally psych myself up, "YEAH-BABY! The pouch is on the job!!" Silly, but whatever works.


Newbie Coddled Egg for One by BamaGal
Page 17 - Neighborhood Cookbook

Ingredients:
4 cups water
1/4 teaspoon salt
1 large egg

Directions:
Bring water to full boil in saucepan over high heat. Add salt and stir. Carefully crack egg and add to water. Remove pan from heat. Cover and let sit for 6 minutes.

Contributor's note: Coddled eggs are what helped me get through the newbie stage. My tender pouch tolerated them much better than scrambled.

Serves 1. Per serving: 66 calories, 5 grams protein, 4 grams fat (1 saturated) and 1 gram carbohydrate.

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Turkey Bacon and Egg oven Omelet by Galelynn Neal
Page 22 - Neighborhood Cookbook

Ingredients:
12 slices of turkey bacon
6 slices of fat free American cheese
8 eggs
1 cup 1% milk
cooking spray

Directions:
Cut cheese slices into halves, arrange in bottom of a lightly sprayed 9-inch pie pan. Beat together eggs and milk, in medium bowl. Add 6 slices of cooked chopped bacon. Pour egg mixture over cheese and bake in pre-heated 350F degree oven for 30 minutes. Remove omelet from oven and top with remaining 6 slices of cooked crumbled bacon. Cook for 10 minutes longer. Let omelet stand 5 minutes before cutting.

Contributor's note: I microwave my bacon to make it crispy. If you don't like turkey bacon regular will work, but watch out for extra fat content.

Serves 6. Per serving: 203 calories, 18 grams protein, 6 grams carbohydrate and 12 grams of fat (4 saturated).

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Parmesan Tuna Patties by BamaGal
Page 29 - Neighborhood Cookbook

Ingredients:
1 (6 3/4-oz) can albacore tuna
1 tablespoon mayonnaise
1 large egg
2 tablespoons Parmesan cheese
2 tablespoons ground flaxmeal
1 dash garlic powder
1 dash onion powder
1 dash salt

Directions:
Drain tuna. Blend all ingredients in a medium size bowl and form into patties. Fry in oil (I use olive oil, but you may use cooking spray) until brown on edges. Turn. Fry until done.

Contributor's Note: These are VERY GOOD and creamy! Takes away the "fishy" flavor of the tuna. Fry up extras to refrigerate for snacks or quick lunches later.

Editor's Note: Flaxmeal, made of ground flaxseed, is rich in omega-3 fatty acids which appear to help lower the risk of heart disease. Flaxseed adds a mild nutty flavor to foods and should be included regularly in a healthy diet. Weight loss surgery patients should use ground flaxmeal rather than flaxseed for digestibility reasons.

Recipe serves four. Per serving: 284 calories, 32 grams protein, 15 grams fat (3 saturated) and 4 grams carbohydrate.

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Baked Tilapia by Kim Stover
Page 98 - Neighborhood Cookbook

Ingredients:
2 (4-oz) tilapia filets
1 egg white
1 teaspoon Old Bay Seasoning
2 tablespoons Italian seasoned breadcrumbs, divided
2 (1-oz) slices low fat Swiss cheese
cooking spray

Directions:
Preheat oven to 375 degrees (F). Rinse fish and pat dry. Beat the egg white with the Old Bay Seasoning. Coat the filet in the seasoned egg. Sprinkle half a tablespoon of breadcrumbs on one side of the filet. Lay the filet, crumb side down, on a baking sheet that has been lined with foil and coated with cooking spray. Place a slice of cheese on top of the filet and sprinkle the remaining half-tablespoon of breadcrumbs on top of the fish. Repeat with the other filet. Spray the tops of the fish with more coking spray, but be careful not to blast the bread crumbs all over with the gust of air! Bake for 20 minutes. This is one of my favorites!

Serves two. Per serving: 235 calories, 31 grams protein, 9 grams fat (5 saturated) 6 grams carbohydrate and a trace of dietary fiber.


Day 4: Firm Protein

Recipes for Day 4

Protein Recommendations: ground meat (beef, turkey, lamb) cooked dry and lightly seasoned, shellfish, scallops, lobster steamed and seasoned only with lemon, salmon or halibut steaks, grilled and lightly seasoned.

By now you should be experiencing that familiar tightness that will reassure you that your pouch is working. Remember to drink plenty of water between meals. Take some time to meditate and rediscover the wonder of your pouch. Often we don't like that uncomfortable tightness of the pouch, which is why we gradually move toward slider foods that don't make us uncomfortable. It is always my preference to eat moist protein so I don't get uncomfortable, but doing so allows me to consume more than I should. Rediscovering the pouch with this 5-day plan reminds me of how the tool really works. I hope by now you are rediscovering your tool and enjoying the hope and excitement because your pouch still works.



There are two things I know about human nature. First, nobody ever wakes up and declares, "Today is the day I will relax my enthusiasm and get off track." Second, nobody ever wakes up and gets back on track without first saying, "Today is the day I get back on track and I have a plan." Falling off track happens without a plan or script. Getting back on track requires a conscious decision, a carefully designed plan and the determination to make it happen.

Why do we fall off track? There are hundreds of reasons: stress, complacency, happiness, grief, celebrations, devastations, distractions and reactions. Nobody wants to fall of track, but life is full of twists and turns that disrupt our focus. It makes me sad when people talk about shame and failure when they have left the weight loss surgery track for a myriad of reasons. This is not a cause for shame or failure, this is a fact of humanity and indeed of living. But human nature is also resilient and powerful. We have the ability to recover from set backs time and time again.

While you are doing the 5 Day Pouch Test I encourage you to create an inner storm of enthusiasm and hope and energy. Go back to those pre-op and early post-op days and live that moment over again. Read motivational articles and visit the Neighborhood forum. Talk to pre-ops and newbies. Look at your before and after pictures. You can go back and you can use this surgical tool to lose weight, become healthier and feel good about yourself.


Day 4 Recipes: Firm Protein


Recipe Links: Days 1 & 2 | Day 3 | Day 4 | Day 5


Baked Halibut with Herbs - Recipe of the Week
page 98 - Neighborhood Cookbook

Ingredients:
2 6-oz halibut steaks or fillets
1/4 cup dry white wine or low sodium chicken stock
1 lemon, zested and juiced
3 medium cloves garlic, pressed
2 tablespoons capers
2 tablespoons chopped fresh parsley
1 tablespoons chopped fresh tarragon
1 tablespoons chopped fresh chives
salt and pepper to taste

Directions:
Preheat oven to 450. Place the fish in a baking dish just large enough to hold them, and add remaining ingredients. Cover, and bake until done, about 15 minutes; don't overcook. Serve at once, pouring the pan juices over the fish.

Halibut is 40 calories per ounce and 7 grams of protein per ounce. It is rich in tryptophan, selenium, vitamin B3 (niacin), phosphorus and magnesium.

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Herbed Scallops by Beth Omicioli "BuffyCT"
Page 120 - Neighborhood Cookbook

Ingredients:
5 oz. scallops
1/2 clove minced garlic
1/2 tablespoon butter or margarine
2 tablespoons minced onion
1 scallion minced
1 teaspoon minced fresh parsley
1 tablespoon lemon juice
salt and pepper to taste
pinch dried tarragon

Directions:
Saute onion, garlic and scallion in butter. Add scallops, salt and pepper. Add herbs. Cook 5 minutes or until scallops are opaque. Do not over cook. Add lemon juice. Serve warm. Enjoy!

Serves two. Per serving: 88 calories, 12 grams protein, 3 grams fat (2 saturated) and 2 grams carbohydrate.

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Mediterranean Turkey Patties by Lucinda
Page 128 - Neighborhood Cookbook

Ingredients:
2 1/4 lbs. ground turkey
1/2 cup finely minced yellow onion
3 tablespoons fresh minced cilantro
1 large clove garlic, minced
4 teaspoons ground cumin
2 teaspoons ground coriander
1 teaspoon coarse salt
1 teaspoon freshly ground pepper
1/2 teaspoon cayenne pepper
1/4 teaspoon ground allspice
1/4 teaspoon ground cinnamon
1/4 teaspoon ground ginger
2 tablespoons extra virgin olive oil

Combine all ingredients, except olive oil, in a large bowl until well blended (can be refrigerated in a covered container for several hours or overnight). Form the turkey mixture into 6 patties. Heat a large skillet over medium-high heat. Add the olive oil and swirl the pan to coat the bottom evenly. Add the turkey patties and saute for 4-5 minutes on each side. To serve, place a turkey patty on each of six dinner plates and top with a dollop of Greek Yogurt and Cucumber Dip, if desired.

Serves six. Per serving: 298 calories, 30 grams protein, 19 grams fat (4 saturated) and 1 gram carbohydrate.

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Cajun Shrimp
This is an easy recipe. You can substitute a ready-made Cajun spice blend for the custom spice blend here. Use 2-3 tablespoons of a ready-made blend, but be aware of increased sodium content and MSGs.

Ingredients:
1 1/2 pounds large shrimp, peeled and deveined
1 teaspoon paprika
3/4 teaspoon dried thyme
3/4 teaspoon dried oregano
1/4 teaspoon garlic powder
1/4 teaspoon salt
1/4 teaspoon pepper
1/4 teaspoon ground red pepper (1/4 to 1/2 teaspoons)
1 tablespoon vegetable oil

Combine first 8 ingredients in a large zip-top plastic bag; seal bag and shake to coat. Heat oil in a large nonstick skillet over medium-high heat until hot. Add shrimp; sauté 4 minutes or until shrimp are done.

Per 5 ounce serving: 215 calories, 35 grams protein, 6 grams fat and 2 grams carbohydrate. Rich inVitamin B12, zinc and Niacin.

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Salisbury Steak

We provide three ground meat options to suit your personal taste.

Ingredients:
1 pound ground meat of your choice
1/3 cup dry breadcrumbs
1/2 teaspoon salt
1/4 teaspoon pepper
1 egg
1 large onion, sliced
1 can (10 1/2 ounces) condensed beef broth
1 can (4 ounces) mushrooms, drained
2 tablespoons cold water
2 teaspoons cornstarch
Directions
Mix ground beef, breadcrumbs, salt, pepper and egg: shape into 4 oval patties, each about 3/4 inch thick. Cook patties in 10-inch skillet over medium heat, turning occasionally until brown, about 10 minutes. Drain excess fat from skillet. Add onion, broth and mushrooms. Heat to boiling: reduce heat. Cover and simmer about 10 minutes.

Remove patties to a plate, tent with foil to keep warm. Heat onion mixture to boiling. In a small bowl whisk together water and cornstarch. Stir into onion mixture whisking to prevent lumps. Bring to a boil and continue whisking for 1 minute as mixture thickens. Serve sauce over meat patties.

Per serving using extra lean ground beef: 321 calories, 27 grams protein, 21 grams fat (8 saturated), 6 grams carbohydrate and 1 gram dietary fiber.

Per serving using lean ground pork: 354 calories, 24 grams protein, 25 grams fat (9 saturated), 6 grams carbohydrate and 1 gram dietary fiber.

Per serving using ground turkey: 225 calories, 25 grams protein, 11 grams fat (3 saturated), 6 grams carbohydrate and 1 gram dietary fiber.



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