The Pouch Reset Test Diet: does it really work?

You remember those challenging weeks just after surgery don't you? Fluids, puree and blended food before tentatively launching back onto soft and more solid food.

You will know that most weight loss surgeries reduce the size and capacity of the stomach in some way: by cutting a major part of the stomach away (gastric sleeve) or by creating a small upper-stomach 'pouch' (gastric band) above the rest of the stomach or by artificially filling the stomach with an inflated gastric ballon. Some gastric bypass surgeries alter more than just the stomach size by altering the path of food and drink along the rest of the intestinal tract (RYGB and BPD).

There is no argument that the human stomach is very elastic. It expands (stretches) to hold the food and drink consumed at a meal and then relaxes back (contracts) when it has processed the contents. The logical thought is that the smaller stomach 'pouch' created after surgery does the same thing - stretch and shrink. Right? Yes and no.

Yes. It is true that the small stomach 'pouch' stretches and adapts to hold more food and drink.

West Australian research shows that the small mini-stomach created by gastric sleeve surgery absolutely does stretch as months go by and stabilises about two years out from surgery. The sleeved stomach's volume increases by around 50% at 12 months after surgery. These results suggest to me that the sleeved stomach doesn't shrink back fully after it receives food (gets stretched) and perhaps the body is even attempting to restore the stomach's capacity to a more normal or full-size capacity.

No. I have found no evidence to show that the small stomach 'pouch' ever shrinks back to the size it was created immediately after weight loss surgery. This doesn't mean it can't happen; it's just that the studies are not there to say it does.

Fans of the reset-your-pouch diets say the pouch shrinks back; they also say the reset will kickstart weight loss.

Ask yourself, if a smaller stomach is all that you need to lose weight, why are there so many different styles of weight loss surgery? And, if a simple diet could prevent re-operation, ask why don't surgeons, general practitioners and dietitians recommend it? For that matter, why not just avoid weight loss surgery entirely if you can shrink the stomach that much?

Reset diets assume that the newly sized mini-stomach is the sole reason why weight loss happens but that is not correct.

Studies from around the world show that it is not the size of the remaining stomach sleeve or 'pouch' that necessarily causes weight loss. There is something much much trickier and more complex going on that dampens your appetite, especially in the first year including changes to hormonal, neuronal and chemical signaling and regulation for appetite, hunger and satiety and, after some surgeries, changes to food preferences and desire.

Is there any harm or benefit in trying to reset your gastric sleeve or bypass pouch?

In the absence of evidence to say a reset diet works, I can't say you will benefit. You would be the judge. I can say, more importantly, you need to be careful to make sure the plan you follow does no harm either physically or psychologically.

The online pouch reset plans that suggest you go back to fluids like you started day one after surgery and then move to puree and onto soft foods.

Going back to fluids, purees and then soft food makes close to zero sense.

The reason for fluid and puree phases immediately after gastric sleeve and bypass surgery was to avoid putting too much 'strain' on your freshly cut and stitched-up (stapled) stomach. Some say "effort-free no-lump food means the the stomach doesn't have to work too hard". Your stomach has well and truly healed so there is no need for the baby-style fluid and puree stages now! The reset plans with this fluid and puree staging that I have seen online are also nutritional nightmares, best avoided.

The only smidgeon of advantage of returning to a fluid only phase after gastric sleeve or bypass surgery may be to increase your food and eating awareness. It helps alert you to auto-eating and situations that trigger the desire to eat. If you are eating solid food when you are meant to be drinking, you will notice it. You will become more aware and conscious of what you are doing. More midful.

If you want to 'do another diet' choose a formulated meal replacement or very low calorie diet meal replacement.

Do something better than the reset diets doing the rounds on weight loss surgery forums.

Rather than follow one of the 'reset the pouch' diet plans, go back to your original and personalised notes that guided you through the early weeks and months. Chances are the advice included a basic reset:

R Refresh your approach to eating, sleeping and leisure time
E Enjoy small measured serves that don't over-fill your stomach
S Sip on water, unsweetened tea or coffee and, if desired, sugar-free low-joule drinks
E Explore your total food selection to maximise nutrition and include enough protein
T Tune into the signals of satiety, 'I've had enough to satisfy my hunger'.

Go back to refresh what you learnt to do immediately after your surgery. This is a brilliant idea.

How about after a gastric band or lapbanding?

You will definitely not feel full if you return to fluids and purees in an attempt to reset the gastric band mini-stomach or 'pouch' for better weight loss. It simply won't happen.

Indeed, the opposite often happens. A person with a gastric band who eats mainly mushy, meltable, puree smooth types of food (think yoghurt, smoothies, vegetable mash, juices, chocolate, ice-cream) often can not lose weight or even reports weight gain.

However, if you regularly regurgitate, vomit or experience pain in your chest, shoulder or shoulder blade after eating, you may benefit from a trial on fluids and small volumes of pureed food.

This tests your band and 'pouch' in a round-about way and may 'rest and settle' the stomach area surrounded by the band.

If you don't experience any discomfort during a trial on fluids and purees but the discomfort immediately returns with solid food, several problems could be present. The first one is in your control. The others are for the doctor to deal with.

1. Your eating style needs improvement: check the size of each bite is not too large, work on how well you chew and break food up in your mouth, slow down your pace of eating and swallowing, and build your ability to trust that you have had enough even though you may not feel quite full.
2. If your eating style is excellent, go back to the doctor who adjusts and checks your band. The band may simply be too tight and it needs to be loosened (have fluid taken out).
3. Still discomfort? Go back to the doctor again. It may be that part of the lower stomach wall is popping back up through the middle of the band. You will need medical tests. Your band has moved or slipped.
4. If you have lost a lot of weight, your band may have slipped. You lose fat from the stomach wall, which means the gastric band is not as snug as it used to be; a bit like the way a ring and wristwatch become loose after fat loss. There is no way the band or pouch can be reset except with surgery to reposition the band.

What will you do today to improve and keep great results?

Regardless of the type of weight loss surgery, check your eating style:

• Slow down your eating pace. If you have a gastric band, you may need to wait up to 90 seconds between each swallow.
• Chew well and clear the mouth between small forkfuls (spoonfuls). There is no need to rush when the meal is small.
• Skip energy-laden drinks, such as sugar-drinks (soft drinks, cordials, energy drinks) and drinks containing alcohol (beer, wine, spirits, cider, liqueurs).
• Choose nutrient rich foods including protein rich foods. Protein is nature's natural appetite suppressant.
• Stick with a smaller serving size that is just enough to take your hunger away without either making you feel over-full or leaving you hungry soon after - a fine balance that takes time to to discover. Serve more and you will attempt to eat more - human nature at work! Serve too little and you will slip into a less helpful grazing and snacking pattern.
• Learn to recognise the differences between true tummy hunger and head hunger. Head hunger is driven by social occasion, desire, emotions, or mood. Respond to head hunger with something other than food.
• Stop grazing and random snacking. Between meal eating and drinking is easy to forget and accounts for stalled weight loss and weight regain in many.

What will you do? What else could you do?