Rules of The Pouch-Revisited

I know we have seen this a zillion times..but I wanted to post it for review. I am keeping a copy on my 'frig and one for work...just to review it all. Just thought others may need a refresher too! IDEAL MEAL PROCESS (rules of the pouch): 1. The patient must time meals five hours apart or the patient will get too hungry in between. 2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal. 3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure. 4. No liquids for 1 ½ hours to 2 hours after each meal. 5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake. 6. 3 hours after last meal, begin drinking LOTS of water/fluids. 7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called "water loading." IF YOU HAVEN'T BEEN DRINKING OVER THE LAST FEW HOURS, THIS 'WATER LOADING' WILL NOT WORK. 8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

Hey there, I am copying this right now and haning it on my fridge and at work too. I need to get with it again. Thanks so much for posting this. Hugs KimC

Good general rules, but not necessarily those which are advocated by all surgeons. For instance, not drinking for 90 minutes before each meal seems very long for a population that is prone to dehyrdration; many programs advocate a 40-minute window. Secondly, for meals, a number of us have found that given quantity restrictions the three-meals per day leaves us lightheaded and hungry, but that having that same amount spread out over 4 small meals works better for us. Third, the meat or vegetable at each meal rule also seems that it, too, could use some modification particularly for those of us who have had many a fine post-op meal with cheeses and eggs, or who have sat down for a protein-bar lunch. Of course, I think the important lesson for all of us to remember is that we need to follows some set of nutritionally-sound rules (in conjunction with our surgeon's protocol) to help in overcoming what was, for many, an long-term unhealthy relationship with food where we tended to eat when we weren't hungry and tended to consistently make poor nutritional choices.

What is the water load? What is the purpose? I am just curious because I have not seen many of these rules...though I am willing to follow!! Amanda

Water loading causes the pouch to become full and also spasm which causes a feeling of fullness that lasts a bit- it keeps us from being hungry at inappropriate times or eating too much at mealtimes. The same thing about mealtime rules- eating in a 15 min period fills up the pouch and leaves it full- by not drinking with/shortly after meals. If you lounge around grazing for an hour you will end up eating too much. My surgeon also implements the knife and fork rule of meals- nothing you can eat via spoon etc- no yogurt- things like that. solid foods stay in the pouch longer creating a better/longer sensation of fullness. He also is emphatic no protein shakes after 6 months.

Interesting- I thought we could only sip...no chugging...which kinda sounds like a water load is unless I am completely missing the boat

Hi Amanda... Every surgeon has slightly different rules to follow. Just listen to Dr. Ehrlich and your nutritionist and you'll be fine!! I've never done the water loading because this is the first I've heard of it. I've followed Dr. Ehrlichs instructions exactly for the past 8 months and am down 96lbs so it's working for me. Good luck!! Have a great evening!! Kim K.

Hi Kim- I have been listening to Dr. Ehrlich...so far things have been great. 138 down...40-60 to go! I was just curious though b/c I had never heard of this.

Wow Amanda...congrats!! That's an amazing amount of weight you have lost!! Good luck on the 40-60 to go. I still have about 80-90 more that I want to lose. Kim K.

Hey Joanie! Nice to see you here & posting. Thanks for putting up the Rules of The Pouch. I'd like to mention a few things, since there seems to be a bit of surprise about them... I'm actually surprised that there are people who have never seen them, or don't know abou****er loading. So, clearly, your post was helpful! Water Loading is for CONTROLLING HUNGER by gving you a false 'full' feeling. 1. It works. 2. Not everybody needs to do it. 3. The further out you get the more important this tool is! 4. Water loading is not chugging or guzzling water. You still sip, just sip faster. 5. If you suffer from snacking or hunger between meals, it is your best friend, even when you've lost all your weight. In general, these rules exist for a reason- because they are the most basic guidelines for what works for all RNY patients, or those with a pouch. Do you have a specific medical situation (not an EXCUSE) for why you can't follow this or has your doctor advised you differently? Fine, but do be AWARE of them as guidelines. If I were to paraphrase the rules to work a little better for all, I would say: 1. Keep track of how long you're going between meals and space them evenly, because if you don't you'll be hungry and may suffer low blood sugar. 2. DENSE PROTEIN AND VEGGIES should make up the majority of your meal. You want cheese instead of meat? Fine- eat cheese. Protein bar instead of chicken- no problem. But the point is DENSE protein and veggies, not soft foods or liquids, should be your focus at every meal. 3. Eat relatively quickly, or else you're grazing, that will not fill you up. 4. Plan a relatively large amount of time after you eat to NOT be drinking. If you're drinking regualrly and often, you're not going to dehydrate in 90 minutes. If you're not drinking regularly, then you need to re-think what you're doing. 5, 6, 7 & 8. Water loading works. Use it to keep from getting hungry or to alleviate hunger. Sip rapidly, don't guzzle or chug. Again, thanks for the post Joanie. It's definately a GREAT reminder!! Best, lisa C