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Remember that Dorothy in the Wizard of Oz was seeking to learn how she could return to Kansas? But as the story goes she has the answer all along in those ruby shoes. Like Dorothy we each hold the answer to what will work for us when we seek the path to health and weight management with surgery. To an swer the question "Will it work for me?" is to look within; to harness your courage and determination to change the question to the statement  "I will make this work for me!" You are wearing the ruby shoes. How will you use them?

Will the 5DPT work for my procedure?
The 5DPT has been successfully completed by men and women with all surgical procedures. All case studies report returning to the high protein, low carbohydrate diet following completion of the test. Gastric bypass patients report the most noticeable tightness in the surgical gastric pouch and in achieving feelings of fullness more quickly. However, adjustable gastric banding (lap-band) patients and gastric sleeve patients report feeling full sooner after doing the 5DPT. People who have done the 5DPT consistently note that returning to liquid restrictions is the single most important action for optimizing the low-volume capacity of their gastric pouch. Again, if you feel you need to get back to the basics of your post-surgical bariatric diet give the 5DPT a try. It is only five days and you may be surprised how powerful you and your pouch are.

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I had surgery many years ago. Is it too late for me?
Did your surgery come with an expiration date: "Best if used by..." No, probably not. You still have your surgical tool. Is it too late for you to use that tool? Only you can answer this question. I know of people who had bariatric surgery back in the 1980's --when the procedure was a simple staple line down the stomach-- who have successfully done the 5DPT. Many times when people ask me if it is too late to do the 5DPT it is out of fear: fear they will learn their pouch no longer works or fear they will learn the pouch does work. The simple back to basics 5DPT will not cause harm and it is only 5 days of your life. So it is up to you to decide if it is too late.

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This is a good question and comes about because there is not a universal protocal for post-surgery dietary and lifestyle modifications. However, the majority of bariatric programs prescribe a post-op program that includes each of the Four Rules in some manner. Some centers have more rules such as the "Eight Golden Rules" prescribed by many centers for laparoscopic adjustable gastric banding (LAGB) patients.

We encourage people considering the 5DPT as part of their program to review the guidelines provided them at the time of surgery. It is likely you will be able to identify each of the Four Rules in your program. This is because the Four Rules are basic common sense provided in a simply stated manner. At LivingAfterWLS we've condensed them down to nine words: Protein First; Lots of Water; No Snacking, Daily Exercise. Common sense in a nutshell! Of course there is more to it than that and working the Four Rules is not nearly as simple as stating and memorizing them. Take a look at this blog post reviewing the Four Rules and then compare them to your guidelines. I think you will see this is key advice in your successful post-WLS experience.

Helpful Reading: The Four Rules of WLS: Our January Topic

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Without exception patients must follow the dietary program directed by their bariatric center for the first year following surgery. No exceptions. I do not recommend or encourage anyone in the first year post-surgery to do the 5DPT. Please, follow the plan your center prescribed specifically for you.

Remember, your first year of attentive care from your bariatric provider was part of your surgery package. The bariatric center has your health information and surgical information and they are highly invested in you reaching a favorable outcome with surgery. While the 5DPT and other after-surgery programs are effective in our life-long weight management they are written for the general audience. You will see the words, "in general" or "as a rule" or "many patients" etc., that prompts awareness a program is generalized. Your bariatric center, however, is working for you specifically and they understand that one size does not fit all after WLS surgery. Take advantage of the care your surgical center offers - this is truly one of the few times in life where you are the total focus of attention.

In a 2016 Bariatric Times editorial Dr. Christopher Still reminded surgeons of the importance of face-to-face interaction with patients and customary post-WLS dietary and behavioral coaching. "When evaluating a patient for a specific meal and physical activity plan, remember that it is not one size fits all. While one diet may have been successful in one patient, it may prove unsuccessful in another similar patient for a multitude of reasons. Sometimes finding the right plan takes trial and error. When working with your patients, remember to help them focus on realistic goals and finding a routine that is just right for them." This is never more important than during the first year (or even first 2 years) following WLS. Please, stick with your bariatric center in the beginning, get your monies worth, and get your personalized lifestyle plan that affords you the greatest success in weight and health management with your surgical tool.

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Participation Helps! With that said, it cannot be overstated the value that comes from following a 5DPT participant group that uses the plan to get back to the basics they've forgotten. New patients can learn and benefit from the mistakes of others and be well-equipped to quickly spot behaviors that may take us off track from the basics. Don't wait to find yourself well into the danger zone to start learning from others. It is the shared experience of the group that makes the individual strong.

Plan Ahead - Do Not Leave it to Chance

Read, study, and understand the plan completely before you begin. Plan for five days with limited disruptions including life, work, and cyclical (menstruation). Create a meal plan for all five days and purchase the food to avoid tempting trips to the market. In advance cook a pot of Carb Monster Soup and divide into 1-cup portions. Mentally excite yourself over the opportunity to make new friends with your old pouch. Prepare for carbohydrate withdrawal by having fruit on hand or a supply of Emergen-C. Announce your plan to those who will support you and ask for their encouragement. Visualize feeling wonderful over your 5 day rescue and redirection mission. Plan to succeed and you will.

Planning in Detail: 5 Day Pouch Test: Are you prepared?

Drink lots of water is the universal golden rule for dieters. But even the most devoted water sippers become bored with the flat unexciting taste of water. Fortunately there are many health-supportive was we can spruce up plain water creating a refreshing beverage with added vitamins and nutrients. Online there are countless recipes for making infused water, a fancy word for water that blended with fruits, vegetables, herbs, and/or tea. Here are a few of my go-to blends that both refresh and promote good health with an energy boost.

Using the formulas below you will make a 2-4 quart batch of refreshing infused water. Using a large pitcher or gallon jar prepare the infusion ingredients. Top the ingredients with 6 cups ice, fill the jar with water, and stir. Cover and refrigerate for at least 2 hours to let flavors infuse. Best used within two days of making, but don't expect it to last that long. These refreshing beverages are delicious!

Iced Peppermint Tea: Mint is known to refresh, soothe stomach aches, and suppress appetite. In place of green tea bags use peppermint tea. Add 1/4 cup chopped mint and one lemon, sliced. Mix well and chill as directed above.

Berry-Fresh Kiwi Cooler: In the gallon jug combine 3 cups halved fresh strawberries, three thinly sliced kiwis, and two thinly sliced lemons. Gently muddle all of the ingredients together. Add ice and tea, mix, chill, serve.

Sunshine Cleanse: Combine two thinly sliced lemons, two thinly sliced limes, two thinly sliced grapefruits, and two thinly sliced oranges. Gently muddle with a wooden spoon or spatula.  Add ice and tea, mix, chill, serve. (This is also good prepared with peppermint tea.)

Minty-Cuke Thirst Quencher: Scrunch 1/4-cup fresh mint leaves in the bottom of gallon jug to release flavor and aromatics (I love this refreshing fragrance!). Add two thinly sliced cucumbers (peeled if desired). Half two limes and squeeze juice into jug, discard halves. Thinly slice two limes and add to jug. Top with ice and tea and mix well. Chill and serve adding more ice as desired.

Green Tea: We've long known that green tea is beneficial to our weight loss efforts. It continues to provide health promoting benefits to those with surgery and is a pleasant alternative to water. Most nutritionists agree that herbal teas can be counted the same as water when monitoring our daily water intake. Remember our WLS rule #2 is Lots of Water. To change up your green tea (or freshen your water) try these recipes to make two quarts of refreshing flavor-infused water.
 
Basic recipe: Brew two quarts of green tea using 4-6 tea bags following package directions. While it brews add the flavor ingredients to a gallon jug, top with 6-8 cups ice, add brewed tea, mix well and chill for two hours or overnight before serving. Enjoy several refreshing servings throughout the day.

More reading: Simple Weight Loss Accelerator Won't Leave You Sour

Question: "I'm a stress eater and find myself justifying vending machine snacks even if I'm doing the 5DPT. What is an alternative snack besides a boiled egg?"
   
I've heard from hundreds of people who tell me a stressful life event(s) lead to increased non-compliant eating and ultimately weight gain. In fact, I don't think I've ever met anyone who professed to never eat when stressed. I think it is part of our human evolution and set in our DNA to eat for comfort during stressful times. The most reasonable solution I've found -- though not too easy-- is to take two actions against stress eating. First, come clean with yourself: Stand and admit to being a stress eater. Okay - -that was easy-- especially in a group of commiserating friends here, right?

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The next action is harder and goes like this: "I know that I am a stress eater and I know that stress is a frequent visitor in my life. Rather than saying all-or-nothing to stress eating I will plan and have ready appropriate food to eat in moments of stress." Sure, that could include the old stand-by hard boiled egg. But we can also have ready protein bars and ready-to-drink protein beverages. Cheese snacks, fresh fruit -- particularly citrus-- is effective in relieving stress-induced cravings. Try dairy solutions like Greek yogurt or cottage cheese. Or have a few fresh ready-to-eat shrimp or ready-cooked chicken strips. And don't forget deli meats as in this stress buster snack:

To-Go: Cranberry Turkey Roll-Ups
5DPT Complete Recipe Collection page 47

This is a terrific recipe to use on Day 3 and a great method to keep in mind when preparing portable meals to support your weight loss surgery diet. Experiment with different meats, cheese and condiments to add variety and interest to portable meals. Remember as you progress through the 5DPT you can bring recipes with you: use a Day 3 recipe for a snack on Day 4, etc.

Ingredients:
1 pound deli-style turkey, reduced-sodium, sliced
4 ounces cream cheese spread with chives and onions
2 tablespoons cranberry sauce, no-sugar-added

Directions: Place two slices of turkey on a cutting board and spread with 1 teaspoon of cream cheese spread, and 1 teaspoon of cranberry sauce. Roll tightly, and secure with a toothpick and place in refrigerator container. Repeat with remaining ingredients, and cover tightly with plastic wrap. Nutrition: Serves 4. Per serving: 232 calories, 27 grams protein, 10 grams fat, 5 grams carbohydrate.

Please follow the 5DPT as it is written: it was developed to help you achieve the best results with your weight loss surgery. We tested it numerous times so you don't have to. As written, the timing of dietary progression and the specific recipes achieve the goal of returning bariatric patients to the dietary and lifestyle prescribed to support life-time weight management. This has been tested multitudes of times by countless individuals, like you, each with their own set of circumstances while uniting in the goal to get back to the basics. The plan, used as written, works. People may achieve a successful result making tweaks and doing it their own way. But then again, it may be a wasted effort.

Just like the surgery, the 5DPT tool must be used with purpose
"Always keep in mind that the 5 Day Pouch Test is to be used a vehicle to get back on track with your WLS basics. It should not be used as a fad diet to quickly knock off a few pounds. Include the 5DPT in your weight management when you do not feel in control of your eating or cravings, when you have strayed from the Four Rules and basic tenets that have worked in the past to help you lose weight, and when you simply need to get back to the basics of WLS. Do the 5DPT when you are in a place mentally to take charge of your health and commit to getting back on track. This gives you the best chance for success. The focus should always be on learning to use the tools that will keep us on track for the long-term." 5DPT Express Study Guide, page 51

Success Tip: Use the 5 Day Pouch Test Journal
Please do not stop reading, I know keeping a food and exercise log is inconvenient. But it is a waste of five days if we do not make a record of what happens and learn from that record. The two-page journal is not complicated. You track your food, activity, motivation, and energy levels. You record your weight. In so doing you learn how your eating and activity affect your daily function. You identify hunger trends and also learn how, with the 5DPT you arrested them, and you have a blueprint for making your Day 6 plan.

Download the Free 5DPT Journal

Question, "I started yesterday and cheated at the dinner party I went to. We have a dinner meeting tonight. I will be restarting tomorrow. I hate that I am so weak."

Kaye's Answer: "I do not think anyone who undergoes weight loss surgery is weak. This is one of the most courageous things we will do in our lifetime. Now, I do strongly advocate scheduling the 5DPT when there will be fewer of life's disruptions, but it sounds like you have a very active lifestyle which will need consideration as you embark on the 5DPT. So look at your calendar and look at the plan and devise opportunities for the schedule and the plan to work together, not against each other.

At a dinner party do you have a menu or is the meal set by the hosts? With a menu find something with a nutritional profile near something on that day for the 5DPT. When the host sets the menu be polite and gracious and eat what you can - it is not necessary to belabor our dietary needs when someone has given us a plate a their table as their guest. Remember that at any meal we can observe the liquid restrictions and avoid appetizer snacking on nutrient void foods. Focus on your enjoyment of others and the event, dwell not on the rules and the "forbidden."

And perhaps most important, remember that one bite or one meal has nothing to do with the next bite or next meal. Each time we eat is independent of any other time we eat. So if at one meal you find yourself with less-healthy choices, at the next opportunity select more healthy food that supports your weight loss goal. None of this is about weakness: it is about pouch management in the same world where it was easy for us to become obese. You are much stronger than you think."

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When this gets asked in social groups I often see this answer: "I don't know why you couldn't use this or that" or "Sure, that sounds fine to me."

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Sadly, the answer is not quite so easy. I'm not a recipe snob and I certainly don't insist people follow my recipes exactly. But, the 5DPT recipes --as they are written-- have been tested by at least 8 individuals as part of a complete 5DPT plan development test. When a recipe did not yield the desired results of satiation, nutritional profile, and weight loss it was eliminated. When a recipe consistently produced desired results -- including weight loss -- we kept it in the plan. We know these recipes are successful for a variety of people with different lifestyles, cooking abilities, and back-on-track goals. That is why I always point people to our recipes first -- they get results.

Website Link: Official 5 Day Pouch Test Recipes

Will other similar recipes work? Maybe. Maybe not. If you need to make a recipe change or substitution try to do it with something that matches the nutritional profile of the recipes provided. Additionally, if you are making recipe or menu changes then up your commitment to the behavioral basics of our post-WLS diet such as the liquid restrictions, the protein first rule, avoid simple carbohydrates and slider foods, etc.

More than anything in the world I want you to succeed with this plan! Do your best to follow it as we developed it. We did the testing over and over and over so you don't have to. This is not intended as a scolding, just an explanation for why the best results come from staying true to the plan and focusing on YOUR weight management goals with WLS! I want you to succeed! Here is a link to the website for your reference! 5 Day Pouch Test