The Pouch Reset – Losing Weight After Weight Regain

Click play to listen to the interview.

Angie has spent much of her life on a roller coaster of weight loss and weight regain. She went through stages where she would starve herself and times when she gained weight quickly. She tried 357’s in high school (caffeine pills with 357 grams of caffeine) only to cause thyroid and pituitary gland issues.

In 2001 Angie had gastric bypass surgery. She lost over 200 lbs from her heaviest weight, 500 lbs. But it didn’t stick. In Angie’s case, her bariatric surgeon (who had his license revoked and is no longer practicing) never gave her post-operative diet guidelines. In fact, she ate an entire garden salad while she was in the hospital.

Without a solid foundation to implement healthy lifestyle changes, Angie stretched her pouch. And while she lost 200 lbs within a year, it was quick to come back. Without diet guidelines, she ate what she wanted. And while she experienced some discomfort with certain foods, for the most part she ate until she felt full. Trying to break a lifetime of poor eating habits with little to no support from her bariatric program, Angie felt helpless. Until she met Dr. Parrish.

Dr. Parrish is a bariatric surgeon in her area and offered his help. After an upper GI scope to visualize Angie’s pouch, he gave her two options.

  1. He could perform a revision surgery.
  2. They could do a pouch reset.

Angie opted for the less invasive option, a pouch reset.

If you’re just getting started and interested in bariatric surgery, check out this article. 

What is a Pouch Reset?

The stomach is an amazing organ. It stretches to accommodate large amounts of food and then shrinks back to it’s normal size as the food is pushed into the digestive track. Even after bariatric surgery, the stomach continues to stretch and then contract. Folds of tissue within your stomach, called rugae, expand and contract in response to food (Rugae – Wikipedia).

Today, we are inundated with food. And it’s easy to eat until our stomach’s physically cannot hold more food (the stretch). Historically, this was OK, since food was scarce as animals and plants were not available year round. But when we continue to eat until we can’t hold more food and do this day in and day out, our hunger and full signals get skewed. Soon, it’s only when our stomach reaches the ‘I can’t eat another bite’ stage, do we start to say, ‘I’m full.’

One theory is that when you overeat, the rugae in your stomach stretches, and with a constant flow of food it never returns to its normal size. This causes your stomach to accommodate larger and larger amounts of food before you feel that sense of ‘fullness.’

A pouch reset is a tool to get your stomach back to its normal size. This is done by severely reducing your food intake.

Note: While you can do your own pouch reset, it is strongly recommended you do it with the support of a bariatric surgeon and dietitian. In Angie’s case her insurance covered 100% of the cost of her pouch reset.

How Does it Work?

The pouch reset mimics your immediate post-surgery diet. A normal post gastric bypass diet typically has four to five stages and lasts 8 to 10 weeks. The pouch reset uses similar guidelines but lasts only 8 to 10 days. Remember, you are severely restricting your food intake so it’s suggested that you do this with the help of your bariatric surgeon and/or dietitian.

Angie’s pouch reset had the stages below:

Day 1

  • Clear liquids only.
    • Water
    • Broth
    • Jell-O (sugar free)
    • Decaf tea
    • Decaf coffee
    • Sugar free Popsicles
    • Sugar free drinks that are not carbonated.

Day 2 and 3

  • Full liquids.
    • Protein powder mixed with a sugar free non-carbonated clear liquid.
    • Sugar free pudding.
    • Soup with soft noodles.
    • Non-fat yogurt
    • Carnation instant breakfast. Sugar free option.
    • Very thin creamed soups. No chunks.
    • Sugar free sorbet.
    • Very thin hot oatmeal. Check the sugar content.
    • Diluted no-sugar added juice.
    • Sugar free, nonfat ice cream.
    • Thinned applesauce.
    • Remember the goal is to not eat or drink anything that is going to stretch your stomach. So drink or eat these in very small amounts and limit your intake to very thin/liquid consistency foods.

Day 4 to 6

  • Pureed foods.
    • Almond milk or coconut milk makes a great protein shake.
    • Hummus
    • Cottage cheese (low fat)
    • Soft cereals – Let your cereal sit in the non-fat milk until it’s soft.
    • Soups – no chunks
    • Scrambled eggs – these are a great source of protein.
    • If you can puree the food, it’s acceptable as long as it’s healthy and easy to digest.
    • It’s best to stay away from meat at this point.
    • Again, you are trying to reduce the size of your stomach so no solid foods at this point.

Day 7 to 9

  • Soft foods.
    • Soft cereals – Let your cereal sit in the non-fat milk until it’s soft.
    • Soft vegetables – steam or boil them until they are soft.
    • Soft cheeses – limit these, they are typically high in fat.
    • Ground chicken or beef. Add some beef or chicken stock to keep the meat soft.
    • Soups
    • Scrambled eggs – these are a great source of protein.
    • Soft (steamed) fish. Remember to chew well.
    • Canned tuna and salmon (you can add low fat mayo). Great source of protein.
    • Mashed fruit. Bananas, avocados, and canned fruit (watch sugar content).

Day 10 and Beyond

  • Healthy foods.
    • Introduce these foods slowly and in healthy portions. The size of your fist should be the size of an entire meal.
    • Typically, a post bariatric surgery diet will focus on protein and vegetables but always consult with your surgeon.
    • Drink liquids at least 30 minutes prior to eating and 30 minutes after eating.
    • Eat slowly. Allow at least 30 minutes per meal. Chew well.
    • Fruits are typically OK in moderation. Stay away from sugar and nutrient lacking carbohydrates (pasta).
    • Track what you eat on a daily basis. The Baritastic app allows you to do this and gives you great tips and information specific to weight loss surgery.

Below is an easy to use graphic that you can save or share with a friend that walks you through the stages of a typical 10 day pouch reset.

Angie’s Results

Before she knew about the pouch reset, she decided she needed to start eating healthier. She lost 107 lbs prior to starting the pouch reset. After the pouch reset she lost another 100 lbs. She now eats healthy and much smaller portion sizes. She feels full after a fist-sized meal. She gets her protein and gets her veggies.

The pouch reset is not easy. You’ll need support and some serious willpower. But it can be done and you can get back on track. Angie’s story is inspiring and educational. Please listen to the podcast.

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