Pouch....

 I'm sure this question has been ask before but I'd like to ask it again. Can a person really s t r e a c h out their pouch by eating to much? Dave

From what I read, heard and talked with the professionals at my WLS clinic, here is what I can tell you.  The pouch is made out of the more muscular part of the stomach also the part with more nerve cells which control that "hunger" feeling... both on the top connecting to your esophagus and the bottom pyloric valve (which is bypassed)... the part that actually moves, pulsates and facilitates digestion into the small intestine, then they take over.  On the other side of the stomach is the nice stretchy part like a latex balloon that expands away from your liver and outward (distal).  Since the pouch is made out of more muscular material on the top, left side (proximal) it doesn't stretch as far and can't really "grow" to a much larger size compared to your original stomach.  Rightly so because the body's anatomy doesn't allow the part of your stomach connecting to your esophagus and intestines much "moving around room" inside your abdomen... but your distal stomach itself is free to balloon up and down as food is consumed.   Post-op your stomach should roughly be able to hold 2-3oz of food content, if any more would be consumed, you would end up blowing chunks.  Over time, its said that the pouch will grow and stretch to roughly 8-10oz.  It's not as if the stomach will simply regrow because the programming of the cells won't let that happen... Just like us fatties get stretch marks on our skin from our large bellies, legs, butts etc... the same goes to the inside... if the stomach stretches, I think that you start experiencing complications from attempting to stretch the pouch on purpose by bingeing.  Thin stomach wall causing a tear, ulcers, bleeding, popping staples, suitures, etc... not to mention it would be difficult to do without throwing up.  Most people who gain their weight back post-op is not because their pouches grew to some huge monsterousity... it's because they learned how to cheat with their new weight loss tool in the form of grazing.  You can't fill your pouch with more than a few ounces of food at a time, but you can do it often and fill it with unhealthy stuff that will pack on the pounds. 

This is a very controvertial subject. Some say yes some say no. I don't think it does because the pouch is made of the part of the stomach that doesn't strech much.  also the pouch is open on both ends so it is difficult to build up much pressure. I personaly feel, and i don't have any proof of this, but i feel that as we heal our pouches are able to handle more food without ****** off the pouch.

I was told that your stomach becomes the size of a thumb after an RNY and grows to be the size of a fist within 6 mos and then it stays at that size.  I just mention this since you had your surgery in March and may be concerned that you are able to eat more than you thought possible.  BUT, yes, with a lot of overeating, it is possible to stretch the pouch.  This is more of a concern in the early months following the surgery.  Once you get to be  6 mos post-op, you can still make your new stomach grow, but it will take the effort of too much eating for a long time.

Dave, Here's som info from an older re-post of mine... ___________________________________________ There’s some conflicting info out there about- "Stretching the Pouch" – And - "Stretching the Stoma." Some of it is complete ‘urban legend’ Aimed at explaining why one procedure is ‘better’ than another. Typically this information is passed on from someone Who did not have the procedure they are ‘slamming,’ and know little other than- "What I’ve heard is…." That’s where all of that crap like-- "Most people gain it back…" "RNY’ers can Never chew gum, eat red meat, or take pills again…" And such come from. I’m in no way an expert at all. I did have A LOT of extra time on my hands Early on due to complications to do nothing but research and even directly e-mail Different Bariatric Clinics/Doctors and take part in a lot of On-Line chats with Bariatric Surgeons. Many do these, and they are very valuable. They even post the transcripts for those who missed recent chats such as-- http://www.communitymemorial.com/chat/bariatric_chat.cfm or- http://doctorsimpson.com/chattranscripts.php Many are accessible and the Surgeons are great about answering questions To those who sign up for their newsletters and such. Like- http://www.lapsf.com/office-information.php Having 9 months of "down time" to ask questions, Got a lot of answers. So, The "Stretching" question? ------------ Equally reputable Docs have stated different opinions on it. Dr. D. Rodriguez, founder of the Texas Bariatric Center, since 1998 Says- "It is expected and appropriate that the stomach pouch will enlarge somewhat As the months pass after gastric bypass. Some of this enlargement Is an actual increase in size, and some represents a softening (regaining of elasticity) of the pouch and its outlet." Similarly, Dr. Latham Flanagan, MD – (website is at The Oregon Center for Bariatric Surgery) Indicates that the average size of the mature pouch is 5.5 ounces. He also states that – "…sizes ranging from 3 to 9 ounces have NO IMPACT On the person's success in weight loss. The pouch actually grows Rather than stretching as most think. For most of the patients that have the surgery, The pouch stops growing at about 6 oz and the largest is about 9 oz." Compare this to normal stomach sizes between 24 to 64 ounces. Flanagan was the one who presented the "Cottage Cheese Test" To the June 2000 meeting of The American Society for Bariatric Surgery. (ASBS) Although he had been using it for quite some time. Although- Albert Wetter, M.D., of the Mills-Peninsula's Bariatric Surgery Program, Among the first to participate in the American Society of Bariatric Surgeons’ "Center of Excellence designation process," presents the pouch as "Stretchable."- According to Wetter- "It is very important that you protect your stomach pouch by not overeating Or drinking too much fluid at one time. It's normal for the pouch to stretch somewhat over time, But frequent stretching will increase stomach capacity and lead to weight gain. This defeats the purpose of gastric bypass surgery." Faced with conflicting info from reputable sources, I asked my Doc- "What’s Up?" He’s also part of a ‘flagship’ program and designated a "Center of Excellence." His response? "…Not every patient is a University Professor digging for the studies To back up every detail. So, it’s easier for some Surgeons to just say- Don’t do ANYTHING that will defeat your success! Sometimes that’s easier And it’s more effective that loading them down with a bunch of statistical data. If a Surgeon has a patient or two who have to go to the hospital to have gum removed From their Stomas, he’ll begin telling all of his patients- Don’t Chew Gum! Rather than tell them not to swallow their gum or – "…be careful because I’ve seen a few cases where patients have had this problem." So, "Stretching the Pouch" – And - "Stretching the Stoma." The answer isn’t so much do they stretch or even what size are they. The Real answer is that the FUNCTIONAL size varies with many factors. Such as- Time of day, The amount of time taken to eat, And (most importantly) the type of food eaten. It is expected and appropriate that the pouch will handle A much smaller amount of solid food (i.e. chicken) than mushy or liquid stuff like soup. The "Cottage Cheese Test?" It is meant to be a standardized, reproducible measurement Of the physical size of the stomach pouch in a person Who has undergone a gastric bypass procedure. If you are curious about your Pouch size, here it is------- Purchase a container of small curd low-fat cottage cheese. Begin the test with a full container, And perform the test in the morning before eating anything else (this will be your breakfast on that day). Eat fairly quickly until you feel full (less than five minutes). Note that the small soft curds do not require much chewing. The idea with the rapid eating is to fill the pouch Before there is much time for food to flow out of it. After eating your "fill" of cottage cheese, (just to first feeling of full, not to pain.) You will be left with a partially eaten container that has empty space Where cottage cheese used to be. You can measure the remaining amount and calculate the amount. Dr. Flanagan’s Protocol suggested- "Start with a measured amount of water (16 ounces, for example), And pour water into the partially empty container of cottage cheese Until the water is level with the original top level of the product." Obviously, the amount of water poured into the container, Equals the functional size of the pouch. You will probably find that the "cottage cheese" size of your pouch Is bigger than your surgeon told you he/she made it at the time of surgery. But "worry about this causing problem with weight loss?" Remember the statistics- 17% of RNY patients reach their Ideal Body Weight. 68 % of RNY Patients Lose between 75% to 99% of their excess body weight. *(That’s 85% of All RNY patients reaching a BMI in the NORMAL RANGE!) 10% or 10 in 100 lose an average of 63% of their excess body weight. *(most of these will be Overweight like the rest of the non-Morbidly Obese People in the country) 5% or 5 in 100 RNY patients lose less than half of their excess body weight. Further, Most Bariatric Surgeons state that – "…it is not the pouch size that causes people to regain weight, but that They never learn how to use their pouch properly. The pouch is misused By grazing throughout the day, drinking hi-calorie liquids, Or eating soft easily digestible foods that are high in carbohydrate and fat, Such as fried potatoes, sweets, breads, and pasta." Worried that "this weight loss tool will stop working and I will resort back to my old self." Very Common Worry. As common out here as Deep Navels! 5 out of a Hundred may have that problem. But not due to it becoming "Stretched Out." Yes? Continue using this first year to Re-Learn new eating habits And Food choices, and later on down the line, It will be easier to just Keep doing what you’ve gotten in the habit of doing. That’s a pretty effective tool. "Keep doing something Habitually…." It’s how most of us got Obese to start with. Yes? Forgive my long-winded ramble as an answer. I just prefer more info than the simple- "Don’t Do ANYTHING that will Defeat your Success!"   One last bit---- "The pouch" is made from the upper most portion of the stomach The extreme Proximal / Lesser Curvature portion Comprised of the ‘Cardia’ and a portion of the ‘Fundus.’ Which is the least "Stretchy" and more muscular of the stomach tissue. Hope this helps - Best Wishes- Dx

Thanks guys for all your input....espically you Dx. I knew you would have something to write about this topic. But again to all of you, Thanks!..... Dave PS: the reason I posted this question was that my dietition and shrink said last night at our support meeting the the pouch would stretch if I ate to much. They wanted me to try and eat 5 to 6 small meals a day instead of 3 with a late snack. I tried doing that before and I was told I was eating to much sugar (the sugar in fruit). I was eating a pear or a small apple twice a day just to say I was eating something. Believe me I have changed my way of eating. I eat lots of green vegies and maybe 3 oz of meat (lean) at dinner and a salad with cottage cheese mixed in it for lunch. For breakfast I have 2, 1" cubes of a home made protein bar that I made up with 1 cup of black coffee (decaf). I'm still losing weight and hope to reach my 100 lb loss at the end of my first 6 months post-op.....anyway to cut this post short, I'm going and do what they say and eat 6 small meals a day again to make them happy. They can't say I didn't do what they asked.

Even if you could stretch it, which I doubt very much, then it would take an amount of food that is so uncomfortable that nobody would probably put themselves through that kind of pain. I think a more important scenario to worry about is falling into the habit of "grazing" on high carb/fat foods throughout the day. That's how most people gain their weight back.. not from a stretched pouch.