Pouch stretching after Bariatric Surgery. Let’s talk about it.
One of the things you may be worried about the most, is the possibility of stretching your pouch after bariatric surgery.
Because if you don’t feel as much restriction – you’re more likely to regain right?
Well…..that’s not necessarily true!
In this article we talk about whether it’s possible to stretch your pouch, what may be the cause and what you can do to actively prevent it from happening.
So keep on reading – because things are about to get interesting!
But first….why pouch stretching is such a common fear after Bariatric Surgery
There’s one common denominator in all bariatric journeys: Bariatric Surgery is a tool to help you change your lifestyle for the better.
And if you feel like that tool “isn’t working anymore” because your portions increase, it can feel absolutely terrifying.
But….it doesn’t have to be!
First, it’s important to understand the anatomy of your pouch.
Secondly, it’s invaluable to get a better understanding of how you can maximize your restriction so you can optimize your bariatric tool to its full potential. Yes, even years down the line! And yes, also when you no longer eat 1/2 cup serving size per meal (it’s okay for portions to increase!).
The anatomy of your pouch after Bariatric Surgery
Bariatric Surgery resizes your stomach to about 20% of its original size. Immediately after your surgery, your pouch or sleeve is still swollen. This means that part of your restriction is caused by the swelling in your stomach.
Once the swelling subsides, you’re more likely to eat larger portions.
Now, back to our anatomy “class”.
Did you know that your stomach, and now your pouch or sleeve, is naturally designed to stretch and shrink? Yes. It’s true!
The lining of your pouch is muscular tissue of which one of those linings is called the rugae. These muscles stretch and shrink like an accordion.
They stretch after eating – and your pouch shrinks back after digestion.
Your pouch will stretch out somewhat the farther out of surgery you get. This is normal. You’re not meant to eat the smallest amount of food forever.
But how much stretching is too much? And is there something you can do to be more mindful without going into “full panic-mode” (nope, we do want to remain calm and in control, right?).
The link between overeating and stretching your pouch
One of the reasons for pouch stretching is overeating consistently (including grazing).
In other words, you can potentially stretch your pouch if you’re overeating all the time, without looking into the reasons why this may be happening.
Overeating after bariatric surgery is more likely to happen if you:
- Don’t pay attention to your bariatric fullness-cues
- Graze on slider foods consistently
- Don’t separate your solids from your liquids anymore
- Eat too fast
- Fall prey of too many emotional eating cues, stress or lack of sleep
- Have a hard time eating nutritious meals and snacks filled with protein and fiber.
If you’re not aware of these mechanisms, it’s going to be so much harder to get back in control of your tool. So let’s talk about one of the most fundamental principles of making the most of your pouch: maximizing your restriction using nutrition as a tool to do so.
The link between what you eat and how much you can eat
Restriction is referred to as the sensation of fullness after bariatric surgery. And it determines greatly how much food you’re able to eat in one sitting.
If your restriction is high, you can eat less. But it also works the other way around: if your restriction is low, you can eat more.
Seems like common sense, right?
But it isn’t always as simple as it sounds. To understand how to maximize your restriction, we have to break down the characteristics of certain macronutrients and food groups altogether.
For starters, both protein and fiber are filling. High-protein foods such as chicken, fish, dairy, eggs and legumes will keep you full for longer. Because protein is dense and requires more energy to digest.
Also, high-fiber foods such as fruit, vegetables and food sources that contain complex carbs (for example whole grain foods, potatoes and legumes) can help you maximize your restriction.
Slider foods on the other hand, won’t keep you full for long as they’re easier to digest and leave your pouch faster (this process is referred to as gastric emptying: the speed of which food passes from your pouch into your small intestine).
Simply put: the type of food that you eat can also make it seem like you stretched your pouch (because you can eat more of them, like slider foods). While other foods (high-protein and high-fiber foods for example) can make you full quicker, giving you a different sensation of your restriction.
And to make things more complicated, it’s not just what you eat – but also how you eat that can impact your restriction and the likelihood of overeating / stretching your pouch. Let’s dive in!
Eating slow and separating solids and liquids: 2 key habits to stop overeating
One of the toughest habits to change when it comes down to certain eating behaviors, is trying to eat slower after bariatric surgery. You see, when you eat too fast – you may miss your bariatric fullness cues altogether. Which makes it more likely to overeat. Not to mention the digestive issues that can happen when you take that one bite too many, too fast (yikes!).
Another situation in which overeating is more likely, is when you’re not separating your solids from your liquids. When you drink together with your meals (not advised!) you’re more likely to “‘flush” the food through your pouch faster as opposed to waiting those (usually) 30 minutes after your meal.
“But how do I know if I actually stretched my pouch out?”
Eating larger portions or an increased appetite doesn’t necessarily mean that you have stretched your pouch beyond the norm. Remember that it’s normal that your portion size increases. Also, keep in mind that your stomach’s lining is made out of muscles that can stretch and shrink.
The only way to accurately determine whether your pouch has stretched to the extent that it impacts your bariatric weight loss journey negatively, is through an endoscopy or barium swallow test done by a licensed medical specialist. These tests can determine whether you have stretched your pouch or dilated your stoma (the passage between your pouch and your small intestine)
“Do It Yourself” pouch stretching tests are NOT reliable. And your bariatric team should always be your go-to when it comes down to medical and personal questions.
“So…should I be worried about stretching my pouch?”
Pouch stretching is possible, yet unlikely if you turn the bariatric guidelines into your new habits.
If you overeat consistently and aren’t being mindful of the factors that contribute to overeating, then yes – it’s technically possible to stretch your pouch out beyond the norm later down the line.
But here’s some food for thought.
If you let your portion size determine your post-op success, aren’t you downplaying the impact of your own habits? Isn’t the mindset shift you’re working so hard towards equally, if not more, important as opposed to fluctuating appetite?
The scope of nutrition and mindset after bariatric surgery is complex. And when you feel overwhelmed make sure to ask for personal guidance so you can move forward in your journey. Hold yourself accountable and continue to let go of the self-limiting beliefs that get in the way of your success. You got this, okay?
About Your Onederland
“The easy way out” they said. Bariatric surgery is “cheating” they uttered. But whoever “they” are, we’re here to tell you that you’re brave for using bariatric surgery as a tool to reclaim your life.
Sure, the weight may come off faster, but that doesn’t mean that you don’t have to actively change your lifestyle (and mindset) for long-term success (because it’s hard work!).
Your Onederland is here to support you.
And we give you our free bariatric blog jam-packed with invaluable tips for your journey.
We’ll always have your back. Unconditionally.
- Mechanik J.I., Youdim, A. Jones, D.B., et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric patient: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery, Obesity (Silver Spring). 2013;21Suppl 1:S1-27.
- Quercia I., Dutia R., Kotler D.P., et al. Gastrointestinal changes after bariatric surgery. Diabetes Metab. 2014;40(2):87-94.
- Ansari el W. & Elhag, W. (2021). Weight regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps – a Scoping Review. Obesity Surgery; 31: 1755-1766.9.
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