The cottage cheese test is a technique that was presented at the June 2000 meeting of the ASMBS by Latham Flanagan. Dr. Flanagan designed this test as a standardized, reproducible measurement of the physical size of the stomach pouch in a person who has undergone a gastric bypass procedure. This test works a bit less well for Adjustable Gastric Band patients, because the tested size of the pouch depends on how tight the Band is. There are no reports or data from sleeve or other surgery patients.
The functional size of the pouch varies with many factors such as time of day, the amount of time taken to eat, mood of the patient, other medical issues, and most importantly the type of food eaten. It is expected and appropriate that the pouch will handle a much smaller amount of solid food (chicken for example) than mushy stuff like mashed potatoes or soup.
- A container of small curd low-fat cottage cheese.
- A measuring container with 16 oz of water.
1. Test first thing in the morning before eating or drinking anything else. This will be your breakfast on that day.
2. Open the cottage cheese container and notice the level where the cottage cheese is.
3. Start eating the cottage cheese fairly quickly until you feel full (in less than five minutes).
*Note: that the small soft curds do not require much chewing. The idea with the rapid eating is to fill the pouch before there is much time for food to flow out of it.
4. After eating your "fill" of cottage cheese, you will be left with a partially eaten container that has empty space where cottage cheese used to be.
5. Carefully, pour the measured water into the container of cottage cheese until the water is level with the original top level of the cottage cheese.
6. The amount of water poured into the container is the functional size of the pouch
If this is your first time doing the test you are likely to find that the "cottage cheese" size of your pouch is way bigger than your surgeon told you it was at the time of surgery, this may be due to its natural stretching and because some of the cottage cheese may be flowing out of your pouch at the same time you are eating (even from eating at a fast pace).
You should use this test for comparison purposes of your own pouch over a period of time. During the first year or so, as your pouch size is changing rapidly, you may want to perform this test at 3 months and at the first year surgical anniversary. For sleeve patients,as your pouch “matures”, you may want to repeat the cottage cheese test at 2 years from surgery.
Dr. Flanagan’s research indicates that the average volume of the mature stomach pouch, measured by this method, is 5.5 ounces (163 ml). Remember, sizes ranging from 3 to 9 ounces have NO IMPACT on the person's success in weight loss.This means that unless your pouch holds a greater volume than 9 ounces (267 ml), the exact size of your pouch is not a critical factor in whether or not you can lose excess weight or manage weight.
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The Pouch Reset Plan severely restricts your food intake so it’s important that you do this with your physician´s or dietitian´s approval and support.
To a long, productive, healthy and happy life.
Lucía Chávez, Nutritionist
Flanagan, L. Measurement of Functional Pouch Volume Following the Gastric Bypass Procedure. Ob Surg 1996; 6:38-43