How does our pouch work for life?

Aug 16, 2008

I posted this a while ago over on the Michigan Forum when someone asked about how the pouch could possibly work for the long term.  Thought it might help here too.

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Your original stomach (before surgery) could hold up to 4 liters of food (that's 16 cups!!).   Your new pouch at the time of surgery was about 1oz and could hold about 2oz of food.  Your surgeon made your pouch out of the least-stretchy part of your stomach, so it's difficult to stretch it. 

BUT...

Our pouches will GROW over time.  Yes, it's a living organ and your body tries to compensate for the rearranging we did to it and it will grow to help get in as much nutrition as possible.  A mature pouch is anywhere from 6oz to 9oz in size... and can naturally stretch to hold up to 12oz of food at a time.  A pouch reaches maturity at about the 2-year mark.  By 6 months post-op your pouch has grown to about 2/3 of it's maturity level.   You're nearly a year out.  So your pouch is no longer 1oz in size ... it's more like 3oz or 4oz right now. 

Studies have shown that the size of your pouch has very little to do with your overall success with weight loss.  Your success has more to do with how well you follow your eating and exercise plan and how well you follow the "rules of the pouch." 

Also remember that your body immediately begins to compensate for the surgery.  Once your body realized that a portion of your instestine has been bypassed and you aren't absorbing all the calories you're eating, it begins to figure out how to become more effecient.  Your intestines grow additional cilia along the intestinal wall -- the little fingerlike tenticles that grab nutrients/calories as food passes by.  No, we won't ever replace those first 100-150cm where various vitamins are absorbed, so we'll always malabsorp nutrients.  But the body figures out how to absorb all the calories we eat eventually.   By the 2-year mark you're likely absorbing every single calorie you eat.   (This is also the case with DS folks too!)

As for not feeling full -- that's perfectly normal.  The nerves in our stomach were cut during surgery.  These are the nerves that signal to our brain when we are full/hungry/etc.  In some people those nerves repair themselves as early as 3 months post-op, but for others it might take 18 or 24 months for them to start working again.  And often they don't have the same "signal strength" as they once had before surgery.  So that's why it's so important to always measure/weight the food we eat. 

By ALWAYS following the rules we were given we will always be able to effectively use the tool we have.  NO drinking with meals -- that's a big rule that so many people get lax on the further out they get.  I have a post in my profile about why its so important to follow this rule.  Once we fall back into that bad habit, we have basically rendered our tool useless.  But once we stop drinking with meals... we realize the pouch tool still works just fine.  And that's just one of the rules we follow.... gotta keep them all at the top of our list. 

So yes, I firmly believe the tool continues to work for the rest of our lives.  As long as we protect it and be kind to it.  But by understanding that it grows, matures and changes is very important when you have to adapt your behavior to what's going on inside your body.

Sorry.. this kind of turned into a long rambling post.  But I hope it helps a bit...
Pam

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