Weight Maintenance / "Rules of the Pouch"

For all of you who have had Roux en Y surgery, and are in your weight maintenance phase, I have a few questions...

Up until now, while losing weight, I've been following all the guidelines re: not drinking for 30 mins before meals, not drinking with meals, and not drinking for 30 mins after meals.

I'm now 125 lbs (sooo surreal!!!).  I originally thought I'd be happy to lose 80 lbs, but now that I've reached my 4th revised goal and lost 102 lbs, I want to start a maintenance program.  I've been reading and re-reading the "Rules of the Pouch".  I'd like to find out if you follow these rules, and if you find they work.  Specifically, do you stop drinking 15 minutes before a meal?  Do you take only 5-15 minutes to eat and finish each meal?  And, more importantly, do you wait at least 1.5 - 2 hours after each meal before drinking?  This last rule sounds very difficult.  I've adapted (not happily, but c'est la vie) to not drinking with my meals, but I'm thirsty after meals, and even waiting 1/2 hour seems long, sometimes.  I really don't know if I could wait 1.5 - 2 hours to take a drink, following each meal (even if I manage to do the pre-meal "water loading").

Also, how did you approach the transition from weight loss to weight maintenance?  I track my protein and calories (and sometimes my carbs), and thought I was eating more than before, but the weight is still coming off, albeit more slowly.  Don't get me wrong, I'm not complaining, but I want to be realistic and maintain at where I am now.  Did you start adding a certain amount of extra calories each day, for example on a weekly basis, and seeing if your weight stabilized?  I would have thought that the calorie malabsorbtion would be over by now (my surgery was almost 9 months ago), but perhaps it's still happening.

Would appreciate your input and hearing about your experiences.  Thank you and have a great day!

 

I drink right up until I begin to eat.  Since liquids go right through the pouch, there is no reason to stop drinking 30 minutes before meals.

I take about 15 to 20 minutes to eat, usually, depending on what I'm eating.  Five minutes for a meal?  Unless it is a super tiny meal, that seems like you'd have to eat awfully fast.

I start drinking about half an hour after meals.  There's no way I'd get enough fluids in if I waited two hours after a meal!

Malabsorption of calories probably lasts a couple of years, but it goes away gradually, not all at once.  Most people continue losing for at least a year, many for 18 months or more.  Unless you are underweight, I wouldn't worry about it.  Many people, though not all, have some small regain a couple years out, so if you are a bit under your goal, that just gives you a little wiggle room in case that happens.  For instance, I got down to 18 pounds below my goal weight, but I gained that back about three years out and now I'm maintaining at goal.

Thanks Kelly!  I agree...it would be difficult to get in all my water if I waited 2 hours to drink, after each meal.  BTW, do you snack?  The "Pouch Rules" are very adament - 3 meals / day and no snacking.  But I don't think that would be realistic for me, re: hunger, and taking in sufficient protein and calories.

Congrats on your years of successful maintenance!

Oh, I eat six or seven times a day.  I would not get enough protein otherwise, plus if I go more than three or maybe four hours without eating, my blood sugar tends to drop a lot.

 

The calorie plan below is the way I lost my weight and now maintain it. I created this plan on my own (I have always had an avid interest in nutrition and I am not  trained or licensed in this field). 

 

*3-6 Months After Surgery: I ate 600-700 calories a day

*6-9 Months After Surgery: I ate 800-900 calories a day

*9-12 Months After Surgery: I ate 1000 calories a day

*12-24 Months After Surgery: eat 1200 calories a day (I ate 1200 calories a day until 15 months when I reached my goal weight)

*24 Months after surgery (or when goal weight is reached before 24 months): Maintenance calories (BMR/RMR & Activity Level). I had much trial and error to find a good balance for me. (Malabsorption of calories lasts approximately 18-24 months). I now eat 1650 calories a day to maintain my weight loss of 190 pounds at a weight of 141 pounds. My height is 5'3.5"

*I do not participate in a formal exercise program due to Rheumatoid Arthritis and Osteoarthritis. I do move around a lot more and do a lot more walking.

 

The Lacto-Ovo Vegetarian eating plan below is the way I lost my weight and now maintain it. I created this plan on my own.

 

*Drink at least 64 ounces Liquids daily (drink up to a meal, wait 60 minutes after a meal) 

*Take Multi-Vitamin/Minerals, Calcium Citrate, and assorted Supplements (for my specific needs) daily

*Must eat at least 60 grams of Protein a day (80 or more grams beginning at 1200 calories a day)

*Eat Dairy products that are no fat/low fat

*Eat Simple (Dairy, Fruit) and Complex (Beans, Vegetables, Whole Grains) Carbohydrates (I do not count daily grams)

*No more than 15 grams of Sugar per meal (more grams if able to tolerate-I allow myself up to 30 grams Sugar per meal from Simple and Complex Carbohydrate sources and also from Dairy products that are no fat/low fat because I do not seem to dump on Sugar)

*I eat something every 2-3 hours that includes Protein and a Simple or Complex Carbohydrate

 

If interested, please see my profile page.

Great info! I am also at "goal". Curious about maintaining as well. I was told by my Surgeons office at my last appt that our body knows when to stop losing. That as long as we meet our minimum requirements of protein each day, the weightloss will stop. But that if we do NOT get the minimum protein, we will continue to lose but it will be muscle wasting and these are the people who appear way too think and anexoric (sp?). I always have the fear of this....but also the fear of regaining. Hard to know exactly what to do!

On August 7, 2013 at 7:07 AM Pacific Time, anniechanging wrote:

For all of you who have had Roux en Y surgery, and are in your weight maintenance phase, I have a few questions...

Up until now, while losing weight, I've been following all the guidelines re: not drinking for 30 mins before meals, not drinking with meals, and not drinking for 30 mins after meals.

I'm now 125 lbs (sooo surreal!!!).  I originally thought I'd be happy to lose 80 lbs, but now that I've reached my 4th revised goal and lost 102 lbs, I want to start a maintenance program.  I've been reading and re-reading the "Rules of the Pouch".  I'd like to find out if you follow these rules, and if you find they work.  Specifically, do you stop drinking 15 minutes before a meal?  Do you take only 5-15 minutes to eat and finish each meal?  And, more importantly, do you wait at least 1.5 - 2 hours after each meal before drinking?  This last rule sounds very difficult.  I've adapted (not happily, but c'est la vie) to not drinking with my meals, but I'm thirsty after meals, and even waiting 1/2 hour seems long, sometimes.  I really don't know if I could wait 1.5 - 2 hours to take a drink, following each meal (even if I manage to do the pre-meal "water loading").

Also, how did you approach the transition from weight loss to weight maintenance?  I track my protein and calories (and sometimes my carbs), and thought I was eating more than before, but the weight is still coming off, albeit more slowly.  Don't get me wrong, I'm not complaining, but I want to be realistic and maintain at where I am now.  Did you start adding a certain amount of extra calories each day, for example on a weekly basis, and seeing if your weight stabilized?  I would have thought that the calorie malabsorbtion would be over by now (my surgery was almost 9 months ago), but perhaps it's still happening.

Would appreciate your input and hearing about your experiences.  Thank you and have a great day!

 

First congrats on your success and surpassing your goal (initial) and continuing downward.  You won't regret it.

To answer the questions:

1)  I drink up till my meals now.

2)  No I do NOT drink with my meals

3)  I wait at least 30 minutes after a meal before drinking.

4)  I meal my meals within 15-20 minutes as instructed by my surgeon (edited to add this)

 

I've really didn't do much different when I went into maintenance.  I still eat protein forward, weigh daily, no drinking with my meals, etc.  I did allow some foods back into my life bu****ch how much and if the scale goes up I am more diligent in what I eat.

Malabsorption is different for everyone with some being loss but unknown how much for everyone.  Around 18 months to 2 years is the time the villa have grown back to its full potential.

I will be six years out later this month.  I have some real problems with those "rules" (some of them are just plain wrong), but to answer your questions..

i drink right up until I start eating.  Liquids empty out of the pouch almost as quickly as they go in and I have never heard an explanation that actually makes sense as to why you shouldn't drink for 15-30 minutes BEFORE you eat.

it takes me 15-20 minutes to eat.

I have NEVER waited longer than 30 minutes to drink.  It takes, on average, about 30 minutes for the food to slowly exit your pouch into your intestines.  That is why the majority of surgeons indicate that you should wait 30 minutes before drinking.  Waiting 3 to 4 times that long doesn't buy you anything in terms of pouch emptying to hunger, and it will likely make you very thirsty and make it difficult, if not impossible, to get in enough fluids during the day.

I didn't "manage" any kind of transition to maintenance.  Other than the small daily snack I allow myself now, I eat very much like I did when I was a year out. It took me 20 months to get to goal (down 190 pounds) and at the end I was only losing a pound or two a month.  My body decided when I was done losing rather than me having to do anything to stop the weight loss.

It generally takes about 18 months for the body to overcome the caloric malabsorption, so you are still malabsorbing some, of not quite a bit. 

Lora