[Perfesser]

I keep seeing questions about the rules, so I thought I’d shed a little light on them from a veteran’s perspective. Once you fully understand them, it becomes easier to live them. You know what they say – for best results, read and follow directions. These rules will ensure a lifetime of health and weight control. Once they become part of you, maintenance becomes much easier!!
**************************
30/30 Rule – don’t drink within 30 minutes of starting or ending a meal.

Many find this a tough adjustment, but there’s a perfectly valid reason for it. We used to have this huge stomach that’d hold enough to feed two starving families. No longer! Now we have a tiny pouch. We eat until we get the signal to stop. (Some of us take longer to learn that signal – others have it beaten into them as the last warning before Vesuvius!)

In spite of what we’ve been doing for the last how many years, that tiny little pouch holds an adequate amount to nourish us and sustain a healthy life. So we take our time and eat until it’s full, then we stop and digest awhile. That’s the ideal.

But if we drink while eating, it flushes all that food out of our pouch (which doesn’t seal at the bottom like our stomach used to!) When we flush it out, the full feeling goes away, and we are then able to eat the same amount again. The first lot is in our intestine being digested, so if we flush the pouch clean and refill it, we can effectively eat twice what we need to to lose weight healthily.

So we don’t lose weight. We gain weight. So many people have returned with sad stories of regain, and one of the most common threads running through their stories is that they scrapped the 30/30 Rule. One of the most important, one of the first things to go, then they wonder how they found all that lost weight.

5/9/11 - Dixie just posted a link to the best video for explaining this rule that I have ever seen. Go check it out!!

CT

[Perfesser]

Protein first, fruit & veggies second, carbs if there’s room. This one is easy. You have a tiny volume available. You need to focus on good nutrition. That’s the order of importance for us. If you fill your pouch with something of lesser nutritional significance, you can’t fill it with something worth eating.
*****************************
Complex carbs. No “white” carbs. Refined carbs are one short metabolic step from going straight into the blood as energy. What you don’t need as energy is run through the liver and sent out to storage as fat. Isn’t this where we came in?

Complex carbs (whole grains, etc.) take a lot more to convert to energy than refined carbs. As a result, the energy boost is spread over a longer period of time at a lower level. No spikes, less excess to storage, less dumping.

Refined carbs are highly processed. White rice, white flour, white sugar, white starches, white gravy … picking up a theme here? They go instantly into the blood as energy you don’t need, so they’re rerouted to storage. Also, there is a whole lot less nutritional content in simple carbs (like … none!!)
********************************
Drink!! At least 64 ounces, 2 standard quarts, 1.6 Imperial quarts, 2 liters. Each and every day. Non-carbonated.

One of the most desired things for a newbie recently out of surgery is to lose weight. Losing weight involves the body pulling fat out of storage and metabolizing it. There are waste by-products of fat metabolism. Some of them cause ketosis. You can recognize it by the killer bad breath and the yucky taste in your mouth.

Water flushes these waste by-products out of the body. It’s just that simple! You want to flush out the waste, pour water down your throat. When it comes back out, it’s loaded with stuff you don’t want inside you.

Longer term, it keeps the body clean of metabolic wastes. This is the carrot.

The stick is that if you do not drink enough water, your body cannot flush itself out. You stop losing weight. Sure, you’re going to stall anyway a time or two. Don’t aggravate the situation.

The big stick is that if you don’t drink enough, you will find yourself in the ER with an IV pumping fluids, electrolytes and minerals into you. This is avoidable. It’s as easy as raising your glass and swallowing.

This is not optional. Your body doesn’t care how hard you find it, or how much you dislike water, or any of the dozens of excuses people use. If you want your body to work for you, give it what it needs. Find a way to make it happen, or plan your ER visits around your spare time.

On a related note - caffeine! Caffeine is a diuretic. It pulls water out of you. For every cup of tea or coffee (or the equivalent in other forms of caffeine, like wake-up pills) you consume, you need to drink that same volume of non-caffeinated beverage, preferably water, JUST TO STAY EVEN!! So if you drink 48 ounces of water and a 16 oz Starbuck's, that is NOT 64 ounces! It's 48 ounces!! You then need to drink another 16 ounces to counteract the Starbuck's (so it's 48 + 16 (w/caffeine) + 16 (to cancel out the caffeinated beverage diuretic effect) plus another 16 ounces to get to 64. So that would be a total of 96 ounces to equal 64!! (How much do you like that coffee? Is it worth it??)

CT

[Perfesser]

Protein!! At least 60 grams a day. Each and every day for the rest of your life, or at least for as long as you want to maintain healthily.

Protein is the body’s building blocks. Everything good in your body is made of it (and water!) Healing is enabled by protein, and cannot happen without it. When the surgeon slices, dices, splices and staples your guts, that’s a considerable amount of internal damage. Protein is the only thing that can fix it.

Your body will find protein and bring it to the repair site. The easiest and preferred place to find it is in your stomach, but most newbies have a hard time reaching the required levels in the near-post timeframe. (This relates to hair loss, too. The body sends protein to the follicles, where they convert it to hair. Cut off the flow of protein, you get weak hair. A few months after the shortage, it starts falling out. A few months after the flow resumes, the loss stops.)

If it can’t find protein in the stomach, there’s a huge reserve of it in your muscles. That’s the next place to get it. Your body WILL repair the damage. It WILL find all the protein it needs. It doesn’t care where, it’ll get it.

I knew a guy who said it was too hard to get in the protein he needed. He dropped a couple hundred pounds, but he lost way too much muscle. He became weak – very, very weak. The guy was a material handler in a factory. He drove the forklift and moved raw materials to the lines and took finished goods to shipping. He got to where he couldn’t lift 25 pounds. Had a real hard time pulling himself into the seat of his forklift. The last time I saw him he was 2 years post-op, and had worked his way back up to a 40 pound lift!! (By way of contrast, at no time did I ever lose my strength. I can move things weighing 150 pounds around in my garage, from floor to workbench, from bench to the back of the truck, etc. This week, every day after work I shoveled a couple of cubic yards of pea gravel into my trailer, took it home and shoveled it back out. Pea gravel weighs 1.3 tons/yard. I got my protein in from the git-go and have had no problems.)

CT

[Perfesser]

Vitamins and supplements. Parts of the digestive system that absorb certain essential vitamins are no longer connected. We just plain do not get the full value from what’s in the food we eat. Your body needs vitamins to function. So we have to supplement. This is a more-or-less permanent situation - we need to do it the rest of our lives. Some of our members have gotten away from doing this and have had near-death medical experiences as a result.

The corollary to this is that you need to have periodic blood tests to see how you’re doing in this area. How do you know that what you’re doing is working if you never check?

This is life or death for us. DO NOT TAKE THIS ONE LIGHTLY!!! It’ll kill you.
********************************
There are great threads from years ago on pouch rules here and here.
*********************************
Medical followup. It has been found that among those who do not maintain contact and regular checkups with their medical staff, weight regain is much more common than it is among those who keep in touch for at least annual monitoring.

Hmmm – why would that be? If you don’t care enough to check how you’re doing, do you think you’re going to care enough to do what you should be doing? Evidently not. The numbers are clear. Those who stay in touch, maintain much better than those who don’t.

End of story.
*********************************
Support groups. Whether in real life or online, nothing can compare to the accountability and sense of community of a good support group.

Picture a bed of coals in your grill. They’re all hot and glowing, ready to do wonderful things. Take one aside and separate it from its group. Watch it go out. Put it back in the midst of the group and watch it come to life again. This is you. This is why we take part in support groups.

Peanut and I live too far to participate in a group at our surgeon’s practice. This is ours. Well, mine, actually. I am her support group. Everybody needs one.

We have often seen a former member return after an extended absence, telling a sad tale of woe and weight regain, needing the help and accountability of belonging to a support group. Ya’ gotta do it!!
*********************************
There are undoubtedly more rules that I am leaving out. Feel free here to ask about one or explain one that I’ve forgotten. It’s late, and I’ve had a full day.

CT

[dixieladybug]

CT you are priceless. What would we do without you? The only thing i can think of is to chew chew and eat s l o w l y.... that was a hard one for me. Habit was to wolf it down and drink sweet tea until i could eat no more. As a wise man once said ( YOU ) chew it until it runs down your throat. Good advice...

[gail1011]

Awesome thank you very much!!

[Dr. Mel]

I am so glad that you posted this information. Everytime I read it, it just reinforces it for me. Thanks!

[KeriM]

Very valuable info, thanks Perfesser!

[Suzi-Q]

Perfesser - You rock!!!!

[Perfesser]

Thank you, Dixie - I had intended to cover chewing, but it got late last night and my brain disconnected.

Used to be, way back in the bad old days of unlimited intake, that we could chew 2-3 times and drop it in the stomach, where it would be processed for digestion. (Don't remember that? Go to any buffet restaurant and watch people eat. It ain't pretty!!) The stomach produces digestive enzymes that it mixes into the food through a churning action, which also breaks up the food into a runny consistency for further processing in the intestines. That's why we could get away with gulping our food with no ill effects (apart from weight gain and all those other health problems, that is! )

Our stomach no longer does all of that for us. It's on permanent vacation, sitting off to the side and out of the digestive loop. No food goes in, so no food can be processed as it once was. There is no mixing of digestive enzymes and no churning action anymore.

But our food must be broken up to be processed in our intestines! If not, our newly remodeled systems will reject it. That could mean sending it back or just a hard hit of real pain in our guts. Our "pouch" has a lot in common with "ouch"! Without digestive enzymes and fluids mixed in, it won't digest, which brings with it its own opportunities for problems.

The only way we have now of accomplishing these two necessary functions is to use our mouths. Saliva starts digestion of the food. Teeth break it down and churn it into the needed consistency. If we do not chew, chew, chew, and then chew it some more, it will not digest properly. For some, this represents a major change in eating habits. I have no problem with it, but even two years later I have to remind Peanut to slow down and chew. For some reason, I have fewer problems than she does. Go figure!!

So if you want to give your food the best chance of being digested, and give your pouch the best chance of doing it in a friendly manner with minimal drama, chew it excessively. Chew it until it runs down your throat! (Our surgeon's nurse told us to chew it until it would run off the backside of a spoon, but I don't intend to pull it out to check!! )

Oh, yeah, this also has the advantage of slowing your intake down and letting your body get that "full" signal to your brain in time that you can act on it! Ever taken one bite too many and gotten a rejection on it?

CT