Bariatric Surgery Nutrition

1. My weight does not determine my success nor worth.
“If you accept your personal best at everything else in life, why not weight?” – Yoni Freedhoff
Isn’t that SUCH a good quote?
Is your WLS team happy with your progress, but you aren’t? Why are you still pushing for and obsessing over those next 10 lbs? Reflect on why you feel that you must lose those extra pounds and what will happen if you don’t?
2. I acknowledge that a healthy lifestyle (i.e. eating healthy most of the time and moving my body often) is a part-time job. Some weeks it doesn’t feel like work, but often it does.
It is important to accept that doing well after WLS is not an accident. You have to make the time for your new habits.

3. I see meal planning, grocery shopping, and cooking as acts of self-care.
This mindset shift is HUGE. Embracing this shift requires practicing gratitude. For example, this means being able to acknowledge that although you may not enjoy cooking, you are thankful to have food to put on the table. Or, as another example, maybe you don’t enjoy meal planning, but you can acknowledge how much smoother getting organized on the weekend makes your week flow.
Try viewing these chores from a place of gratitude this week, and watch how much lighter they all of sudden feel.

4. I move my body because it feels good and helps me to re-charge. I don’t exercise to control my weight.
If you are exercising solely for the purpose of controlling your weight, it is only a matter of time before you burn yourself out.
Moving your body should come from a place of self-care. The activities that you choose should be enjoyable and energizing. They shouldn’t feel forced.

5. I am not on a diet. I eat foods that I enjoy. I practice moderation and flexible eating to the best of my ability.
All foods fit.
If you feel restricted, if you’re counting your calories daily, if you’re always hungry, or if you often feel guilty or ashamed about your food choices, you are going to burn yourself out!
If you have dieted for most of your life, you likely have a lot of baggage in this department to work through. For many of our patients, it takes years to work through this mindset shift, so don’t be too hard on yourself.

So, how many of these mindset shifts have you fully embraced? Which ones are still a struggle? Where do you feel stuck?
Try posting these 5 mindset shifts up in your office or home to keep them top of mind as you go about your day. Envision and journal about what it would feel like and look like to embrace all of them.
Click HERE for a FREE printable of these 5 mindset shifts!
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If you need help working through these shifts, speak with your WLS dietitian or psychologist.
Wishing you all much happiness in your WLS journey!
– Monica & Lisa

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

You may also be wondering how in the world do I become more active? I don’t even know where to start, and the gym just isn’t for me.
We teamed up with Myriam, a local kinesiologist, to give you tips on how to start to get your joints moving when you’ve been inactive for too long.
A kinesiologist is a highly educated health care professional who is an expert in body movement. They’re experts in preventing and managing injuries and help people to get fit and perform at their best, among many other things.
In these videos, Myriam will show you exercises that you can do at home to improve the health of your joints and movement to start getting you on a path to being more fit.
Practice these exercises in the comfort of your own home. All you’ll need is:
A chair, A belt or resistance band, A broomstick or long stick. These exercises are great to start BEFORE surgery, early AFTER surgery, or even LONG TERM after surgery. It’s never too late to start being active. Remember that the number on the scale is only part of the story – fitness and exercise is the other half of the equation when it comes to living a longer and healthier life.
How did this activity go for you? Let us know!
– Lisa & Monica

Drinking water after surgery can cause some discomfort (like a rock hitting your stomach), sometimes it doesn’t taste right because of taste changes after surgery, and sometimes the temperature of the water can leave you feeling uncomfortable. Other times, you may simply just forget to drink and you just don’t feel as thirsty.
Not drinking enough water can leave you dehydrated.
How do you know if you’re beginning to get dehydrated? There are 3 main ways of figuring this out:
Do I pee 3 times per day, or less? Is my pee dark yellow in colour and smells more than usual? Do I get dizzy when I stand/sit up or bend over? If you’ve had bariatric surgery and answered yes to one or more of these questions, there’s a chance you may be dehydrated. Some of these symptoms can be related to other causes as well, so check with your doctor, bariatric dietitian, or nurse if you’re unsure.
Here are our tips for drinking more water after surgery:
Make water more convenient by…
Buying a fun new water bottle for work and home that gets you excited. Ideally, something colourful that catches your eye; Keeping a water bottle or water glass within arm’s reach at all times, regardless of where you are (e.g. at work, in the car, on the couch, in bed, etc.); Keeping cold water in the fridge at all times. Buy a water pitcher or a water filtering jug and place it at the front of your fridge. It needs to be visible and easy to reach to be convenient; Knowing your environment. Do a tour of your workplace to remind yourself of where the water fountains or coolers are. Check if the cafeteria charges for hot water or if there’s a vending machine that sells water bottles close by; Buy a smaller water bottle to carry in your purse or backpack for when you’re on the go. Ideally, it should hold no more than one to two cups. Large water bottles are often intimidating and if they are too heavy or bulky, they’re more likely to get left behind; Leave a reusable water bottle in your car at all times so that you always have some on-hand.
Get excited and add some flavour by…
Trying infused water. Add one of the following combinations to your water pitcher or water bottle:
Sliced cucumber + fresh mint leaves; Sliced strawberries + fresh basil leaves; Sliced lemon + fresh lavender; Blackberries + fresh thyme; One cinnamon stick (for best results leave overnight in your water bottle); Using flavoured ice cubes.
This idea involves freezing concentrated fruit purees, spirals of citrus rinds, and/or fresh herbs into ice cube trays. Adding one to three of these ice cubes into your water not only adds a fun flavour and keeps your water colder, but it’s also a colourful touch. This is a great alternative to store-bought water enhancers that contain artificial sweeteners.
Example: puree two cups of chopped watermelon with the juice of one lime. Freeze the mixture in ice cube trays. Add two ice cubes into your reusable water bottle; Making a homemade tea with an added twist. Add eight ounces (one cup) of boiling water to the combinations below. Drink hot or refrigerate overnight and enjoy cold.
1/2 sliced lemon + 1/2 inch piece of peeled fresh ginger + 1 tsp honey; A green tea bag + fresh mint leaves; A black tea bag + orange slices or peach slices; An earl grey tea bag + sprig of lavender + lemon slices +1 tsp honey; A white tea bag + mint leaves + dash of lime juice; Treating yourself to some loose tea leaves or flavoured tea bags at specialty shops. Set reminders by…
1. Downloading an app. There are countless free apps out there to help you track your daily water intake and even ones that will send you constant reminders throughout the day to drink;
2. Add a sticky note to your computer monitor. Be sure to change the placement of the sticky note every week so it doesn’t blend into the background;
3. If you’re someone who does repetitive tasks at work, use this to your advantage! For example, challenge yourself to take three sips of water every time you read a new email and every time you send an email;
4. Buy a ‘time stamped’ water bottle or simply recreate one by writing the hours of your work day down the side of your bottle with a permanent marker. For example, evenly space 9 a.m., 10 a.m., 11 a.m., and 12 a.m. down one side of the bottle and 1 p.m., 2 p.m., 3 p.m., and 4 p.m. down the opposite side of the bottle. This strategy will also help you to pace yourself throughout the day.

– Lisa & Monica, your bariatric surgery dietitians

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

You may also be wondering how in the world do I become more active? I don’t even know where to start, and the gym just isn’t for me.
We teamed up with Myriam, a local kinesiologist, to give you tips on how to start to get your joints moving when you’ve been inactive for too long.
A kinesiologist is a highly educated health care professional who is an expert in body movement. They’re experts in preventing and managing injuries and help people to get fit and perform at their best, among many other things.
In these videos, Myriam will show you exercises that you can do at home to improve the health of your joints and movement to start getting you on a path to being more fit.
Practice these exercises in the comfort of your own home. All you’ll need is:
A chair, A belt or resistance band, A broomstick or long stick. These exercises are great to start BEFORE surgery, early AFTER surgery, or even LONG TERM after surgery. It’s never too late to start being active. Remember that the number on the scale is only part of the story – fitness and exercise is the other half of the equation when it comes to living a longer and healthier life.
How did this activity go for you? Let us know!
– Lisa & Monica

There are two main reasons bariatric patients are at risk for developing vitamin and mineral deficiencies:
1. First of all, and most obviously, you’re no longer able to consume large enough amounts of foods to meet your micronutrient (i.e. vitamin and mineral) needs.
2. Secondly, your body now absorbs and processes foods differently. For example, if you had a malabsorptive weight loss surgery (e.g. gastric bypass or duodenal switch), in addition to eating smaller portions of foods, you’re also not absorbing 100% of the nutrients in the foods that you’re eating.
Interestingly, even in the non-malabsorptive procedures (e.g. sleeve gastrectomy and band) we see changes in nutrient processing. For example, you may no longer have enough stomach acid in your small stomach to efficiently absorb the natural calcium found in dairy products, which is why you’ve been prescribed a special type of calcium, calcium citrate, that doesn’t require stomach acid to be absorbed.
The signs and symptoms of vitamin and mineral deficiencies can be mild to severe.
Some take only weeks to occur, while others take years to develop. While many deficiencies are reversible (e.g. anemia, or low iron), several micronutrient deficiencies are irreversible (e.g. osteoporosis, or bone decay due to inadequate calcium and vitamin D, and neurological damage due to inadequate B vitamins).
Moral of the story? Take your vitamins!
How often should I be going for blood tests?
Your bariatric team will tell you how often you should have blood tests done. It’s most likely that you’ll have a blood test after your surgery, while you’re still in the hospital. Following this, your next blood test will be in three to six months and continue every three to six months until your first year after surgery, depending on the type of surgery you had. If your blood tests are looking great at one year after surgery, this is a good sign and means that you managed to get through the first risky year after bariatric surgery without having developed a deficiency!
But this doesn’t mean that blood tests are no longer needed. You’ll need to do blood tests to check for nutrient deficiencies for the rest of your life. As you get older, your body needs more of some nutrients and less of others as your body changes. Some deficiencies also take a longer time to develop. For this reason, you may still develop deficiencies over time, even five to ten years after surgery. We’ve seen many patients who stopped doing their blood tests because they felt fine only to find out years later that they have multiple severe deficiencies. Feeling good doesn’t mean everything is good. And there’s a reason why.
Before feeling tired, lethargic, weak, or sick, because of a nutrient deficiency, your body goes through the following stages:
You’re not getting enough of a nutrient from your diet and your vitamins; Your body doesn’t have enough of the nutrient stored; You begin to have low levels of the nutrient in your body; Your organs begin to have trouble working properly; You begin feeling unwell and develop symptoms of deficiencies. Feeling unwell is the last step in this process.
These steps can take only a few weeks for some nutrients, and up to several months for others. When you begin to feel unwell, your body has already been through weeks—or months—of missing an important nutrient. Blood tests can catch these deficiencies at a much earlier stage.
For example, say you stopped taking your iron pill. You wouldn’t feel an anemia, or an iron deficiency, developing. Gradually, over time, you’ll begin to get tired and you might figure it’s just your busy lifestyle. You’ll begin to feel worse and wonder if you’re just not getting enough sleep. Then you’ll become increasingly lethargic and notice your hair has lost its shine and is getting brittle. Lastly, you’ll notice that you can hardly get through your morning routine without having to sit down and take a break. You’ll go to your doctor who will order blood tests. The blood tests will come back diagnosing you with anemia. Luckily, you’ll restart your iron supplement which will reverse this condition, although it’ll take about three months until you feel like yourself again. However, some deficiencies aren’t reversible which can leave you unwell permanently.
The bottom line:
Have your blood tests done regularly as suggested by your bariatric team. You’ll eventually only have one blood test per year, but this will only be the case at two years after bariatric surgery or until your blood tests routinely come back normal. If you no longer see your bariatric team, or live too far from your bariatric center, make sure that your family doctor is testing you for bariatric surgery-related deficiencies. The routine blood tests that your family doctor performs aren’t the same ones that your bariatric team orders. We look at so much more. Ask your family doctor if he/she is looking for all the nutrients necessary for bariatric surgery. They can receive this information from the bariatric clinic where you had your surgery.

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

1. Hummus. Despite being made from chickpeas, the average store bought hummus has only 1 gram of protein per tablespoon. Instead, opt for homemade hummus, homemade black bean dip or homemade Tzatziki (made with Greek yogurt) as dips for your veggies.
All of these dips are significantly higher in protein when made at home compared to their store-bought counterparts. 2. Chicken broth. Surprisingly, the average store bought chicken broth has only 1-3 grams of protein per cup. For this reason, your bariatric team likely recommended you choose higher protein soups immediately after surgery (ex. milk based soups or pureed legume soups).
Instead, opt for more filling thicker soups, such as a curried lentil soup, a roasted red pepper black bean soup or a hearty chili. 3. Cream cheese. Despite ‘cheese’ being in its name, the average store bought cream cheese has only 1 gram of protein per tablespoon.
Instead, opt for ricotta cheese (with a sprinkle of sunflower seeds and a drizzle of honey!) or peanut butter on your morning toast. 4. Quinoa. Quinoa is a filling grain product not because of its protein content, but more because of its fibre content. While quinoa is the only grain listed as a ‘complete’ protein, it only has 2 grams of protein per ¼ cup of cooked quinoa.
Always top your quinoa with a true protein source such as meat, fish, legumes, tofu or tempeh to make your meal truly balanced. Quinoa should not be the main event! 5. Almond/Cashew/Rice/Coconut milk. Despite these beverages having ‘milk’ in their name, these alternative milks contain on average a measly 1 gram of protein per cup.
Instead, opt for cow milk or soy milk when you are looking to add an extra splash of protein to your cereals, oatmeal or smoothies. Moral of the story? Don’t let misleading product names or sneaky advertising fool you! Get the facts. Always double check the nutrition facts tables on the back of your foods to learn the full story.
- Monica & Lisa

First off, what is a ketogenic diet?
The ketogenic diet is a very low carbohydrate, very high fat, low-moderate protein diet. Historically, it has been used to control epilepsy in children.
When you don’t give your body carbohydrates (your body’s preferred fuel source), it begins to use and break down body fat as a source of energy, which is called ketosis. The breakdown of fat leads to the production of ketones, and the ketones are what begin to fuel your body (instead of the carbohydrates you were feeding it before). This process can take a few days to achieve, and when done correctly, can be tested by measuring the ketones in your urine with a dipstick. If ketones are present, this means you’re in ketosis.

What does the macronutrient profile look like?
FAT – A ketogenic diet should include healthy fats such as fats from fish, seafood, eggs, nuts, vegetable oils, dairy, and some meats. There is a lot of poor information on the internet that encourages people to have the majority of their fats in the form of cream, lard, bacon, and fried foods, which are not good for our heart.
CARBOHYDRATES – The ketogenic diet is described differently depending on the source, but on average it means limiting your carbohydrates to 5-10% of total daily calories. For bariatric patients eating around 1200, 1500, or 1800 calories/day, this works out to 22, 28, or 34 g of carbohydrates/day, respectively. That’s very little!
Foods rich in carbohydrates that are limited/eliminated in a ketogenic diet include: grain products (e.g. pasta, rice, bread, etc.), fruit, many vegetables (e.g. potatoes, corn, carrots, squash, etc.), some dairy products (e.g. milk, yogurt), legumes (e.g. chickpeas, beans, lentils), and sweets and sweetened beverages (e.g. chocolate, ice cream, pastries, juice, soda, etc.). That’s a lot of food groups being restricted!
PROTEIN – On a ketogenic diet, protein is considered low-moderate (depending on your protein requirement), or around 15-20% of total calories. For bariatric patients eating around 1200, 1500, or 1800 calories/day, this works out to 52, 65, or 78 g of protein/day, respectively. Are these protein targets in the range that your dietitian has recommended for you? For many of you, likely not.
FIBRE – Fibre falls under the umbrella of carbohydrates. Because you now know that carbohydrates are very limited on a ketogenic diet, you can guess that fibre will also be very limited. A diet very low in grain products, fruits, most vegetables, and legumes means that constipation is going to be a real issue!

I heard that a ketogenic diet leads to rapid weight loss.
It’s true in the beginning, but the important factor here is to understand what kind of weight loss this is. Yes, it’s true that reducing carbohydrates leads to weight loss, however the weight that’s initially lost is mainly water weight, not fat.
Here’s a behind the scenes look at what’s going on: Your body always wants to keep your blood sugar well controlled, so it stores some sugar (or glycogen) in your liver. When you’re sleeping, or fasting, your body uses this stored glycogen to send some sugar into your blood, to be sure that your blood sugar doesn’t drop too low. Glycogen is stored in your body by attaching glucose to water. So when we empty our glycogen stores, we’re actually losing a fair bit of water as well, and that’s the initial weight loss that you see. The weight loss that follows from there is partly muscle loss if you’re not meeting your protein needs (which as discussed above, might be the case) and fat.
While ketogenic diets have been shown to be better for weight loss than other low fat diets, the results are only true in the short term. In the long-term, there doesn’t appear to be any difference. You’re also more prone to rebound weight regain on a ketogenic diet once you re-introduce carbohydrates again (whether by choice, by cravings, or by obligation because you feel unwell without them).

But I thought that the ketogenic diet was proven to be effective?
The ketogenic diet isn’t a new diet at all. It’s actually been used for almost 100 years to treat children with severe epilepsy who don’t respond to medication. However, even these children don’t stay on the ketogenic diet their whole lives, they only do so for a temporary amount of time. These children are followed very closely by their doctor and dietitian to very slowly bring carbohydrates back into their diet.

Despite what you dietitians say, I want to try the ketogenic diet!
Ultimately, it’s entirely your decision to try what you want. We (as dietitians) are only here to guide you through the evidence that’s out there, and as of now, there’s no research on the ketogenic diet after bariatric surgery. There’s also not enough long-term research to know and understand if the ketogenic diet is safe for your heart in the long-term (i.e. more than 12 months of being on the diet).
Three of our biggest concerns as dietitians are:
1) Are you meeting your protein needs?
2) Are you emphasizing healthy fats;
3) Are you just looking for a quick fix?
If you’re using the ketogenic diet as a “reset” just like the last fad diet you tried, you’re only feeding the yo-yo dieting pattern (just playing devil’s advocate here!).

Can I be on a ketogenic diet my whole life?
The honest answer is we don’t know. We don’t have research on the long-term effects of following a ketogenic diet. It’s suspected that it may lead to higher cholesterol levels which may lead to heart disease, but more research is needed to conclude this.

Does being on a ketogenic diet guarantee that I’ll keep the weight off?
While more research is needed, one study showed that the participants who were very strict about following the ketogenic diet were able to keep off the initial weight loss for up to 56 weeks (or a little more than one year). We don’t have the research to say if in 10 or 20 years that their weight will still be stable or not. We do know however, that if you don’t find the ketogenic diet realistic for your lifestyle and you end up coming off of it, you will regain the weight (if not more), as with any temporary diet.

Is the ketogenic diet safe?
While it may be generally safe (meaning you’re not going to die) for most people, you should always check with your doctor, especially if you have heart disease, liver disease, and diabetes, as this diet may put your health at risk.
The ketogenic diet is not considered safe for those who have chronic kidney disease.
The ketogenic diet has received a lot of criticism because it’s a very restrictive diet, eliminating many foods and therefore many nutrients that are important for health. Following this diet puts you at high risk for micronutrient deficiencies. Make sure you discuss additional vitamin supplementation with your family doctor or dietitian.

What are the benefits of a ketogenic diet?
Aside from weight loss, following a ketogenic diet has been shown to improve blood sugar control in those with type 2 diabetes, lower triglycerides, lower LDL cholesterol (the ‘bad’ cholesterol), and raise HDL cholesterol (the ‘good’ cholesterol). Although these benefits sound attractive, know that other low fat diets have produced similar results, and would be safer in the long-term since they’ve been better studied and are less restrictive overall.

What are the risks of following a ketogenic diet?
Liver disease? – More research is needed, but several rat studies have shown an increased risk of developing liver disease. While results from rat studies don’t 100% translate into humans, animal studies often give an indication or at least a starting point for how something will affect the human body. More research is needed in human subjects. Muscle loss. – Another risk of following a ketogenic diet is muscle loss, because most patients aren’t able to meet their protein goals. Losing muscle may put you at risk of weight gain. Working with a dietitian while following a ketogenic diet can help you be sure you’re meeting your protein needs. Earlier death? – Like we’ve mentioned, there isn’t enough research yet on the long-term risks of following a ketogenic diet, but a recent study found that low carbohydrate diets (less than 40% of calories from carbohydrates) was linked to earlier death, compared to having a moderate-carbohydrate diet (50-55% of calories from carbohydrates). Remember that a ketogenic diet has around 5-10% of calories coming from carbohydrates. How did they explain this increased risk? The risk with a low carbohydrate diet seems to be because the carbohydrate calories are often replaced with more animal protein and unhealthy fats, rather than plant-based protein and healthy fats. Note that this study was not on bariatric patients, but again, the findings are interesting.

What are the side effects of a ketogenic diet?
Side effects during the adaptation period (i.e. in the beginning of following a ketogenic diet) include:
brain fog, fatigue, headaches, nausea, strong smelling sweat and urine, constipation or diarrhea, and poorer exercise performance. Long-term side effects include:
bad breath, micronutrient deficiencies, and muscle loss.
What are common misconceptions of the ketogenic diet?
Many people believe that it’s a carbohydrate-free diet, meaning no carbohydrates at all. This isn’t the case. You can have in the range of 20-50 g of carbohydrates per day (depending on how many calories you’re eating). If you don’t know what this looks like in terms of food, speak with your dietitian.
Another misconception is that a ketogenic diet is high in protein. This also isn’t the case. A ketogenic diet is moderate in protein for the average person (who hasn’t had bariatric surgery), and is therefore typically low in protein for a bariatric patient. As you likely know, low protein puts you at risk of losing muscle which will affect your overall weight loss, and put you at higher risk of weight regain in the future.

Other than muscle loss, what are other negative nutrition consequences of following a ketogenic diet after bariatric surgery?
Low in fibre – The smaller food intake that you have after surgery already makes getting in enough fibre difficult. This partly explains why so many people are constipated after surgery. A ketogenic diet significantly limits most fibre-containing foods including fruit, most vegetables, grain products, and legumes, so your fibre intake decreases even more. Constipation is therefore even more of an issue! High in unhealthy fats – Many people don’t follow a ketogenic diet correctly and include too much saturated fats (or unhealthy fats) in their diet. For example, they may choose bacon, sausages, and lard, over fish, nuts, and vegetable oils. A diet high in saturated fats has been linked to heart disease. Low in many micronutrients – A ketogenic diet is also low in important vitamins and minerals such as thiamine, folate, vitamin A, calcium, magnesium, iron, and potassium. While you’re prescribed vitamins and minerals supplements after bariatric surgery, these standard prescriptions don’t account for you following a ketogenic diet. If you do decide to follow a ketogenic diet, it’s important to have your doctor or dietitian re-assess your vitamin and mineral supplements and for you to continue doing blood work regularly.
Will I be able to exercise just as much while on a ketogenic diet?
The downside to following a ketogenic diet is that it may actually reduce your exercise performance (across anaerobic, aerobic, and strength related exercises) in the short-term. If you’re doing low intensity exercises such as walking or a leisure bike ride however, you shouldn’t notice a difference. More research is needed to understand how a ketogenic diet affects exercise performance, especially in the long-term.

I’ve been having episodes of low blood sugar after bariatric surgery. Can I follow the ketogenic diet?
If you’ve been experiencing low blood sugar after surgery, it’s not recommended to start a ketogenic diet. It’s important to understand why you are experiencing low blood sugar as soon as possible.
Here are some of the most common reasons for low blood sugar after bariatric surgery:
Dumping syndrome due to high sugar intake Going long periods of time without eating Not eating enough carbohydrates or not spacing your carbohydrates out during the day Excess exercise An overactive pancreas Diabetic medication that is not adjusted properly Speak with your dietitian to figure out why your blood sugar keeps dropping.

I plan to try the ketogenic diet for a few weeks and then come off of it.
If that’s the case, then don’t bother. The reason this diet works for weight loss is because you are in ketosis (which in itself takes a couple of days to achieve because you need to use up your glycogen stores). If you come out of ketosis, you will no longer see the effects, and thus begins the yo-yo dieting effect.
Always remember – Temporary changes yield temporary results!

I’m already on the ketogenic diet, how can I come off of it safely?
If you’ve already started the diet, reintroducing carbohydrates can lead to bloating, unstable blood sugars, and weight regain. To minimize these effects, begin by including whole grain products, rather than refined processed carbohydrates (e.g. white bread, breakfast cereals, pretzels, etc.). Whole grain foods include quinoa, brown or wild rice, oatmeal, bulgur, and barley. Sweet potatoes would also be appropriate. Include 1 to 2 tablespoons at only one meal per day for up to one week. If you’re feeling okay, begin including one fruit at one snack for a few days, and then try reintroducing yogurt and milk.

But aren’t there doctors and health gurus out there promoting the ketogenic diet?
Yes, there are, but there also were doctors and health gurus promoting the Atkins diet, the Pritikin diet, and the Dukan diet back in the day. There will always be people out there trying to capitalize on the newest fad diet to sell you on the weight loss dream and to take your money. It’s easy to point fingers and put the blame on specific foods or food groups, but ultimately the only way of eating that has been proven effective time and time again, is moderation. As dietitians, we know very well that ‘moderation’ (which means something different for each of our clients) isn’t sexy, but it’s key to having a healthy long-term relationship with food.

I’m pregnant and I want to follow a ketogenic diet.
Following a ketogenic diet during pregnancy is not recommended. While your body can handle being in ketosis, the production of ketones is harmful to your baby’s development, particularly their brain development.

SUMMARY…
– A ketogenic diet is very low carbohydrate, very high fat, low-moderate protein diet.
– A ketogenic diet should emphasize healthy fats, but many sources online emphasize online unhealthy fats (e.g. bacon, sausage, lard, cream, etc.).
– A ketogenic diet is very low in carbohydrates. This means that it’s not only grain products that are limited (e.g. pasta, rice, bread, etc.), but also fruit, many vegetables, some dairy products, legumes, and sweets.
– By default, a ketogenic diet is also low in fibre which results in constipation in many patients.
– A ketogenic diet is considered low-moderate in protein. Most bariatric patients aren’t able to meet their protein needs on ketogenic diet which results in muscle loss.
– We don’t know the effects of a very high fat diet on health long-term, but it likely isn’t good for heart health.
– Many of the benefits of a ketogenic diet (e.g. weight loss, improved blood sugars, lower triglycerides, lower LDL cholesterol, increased HDL cholesterol, etc.), are similarly seen in low-fat diets (while being way less restrictive overall).
– There are many unpleasant side effects to following a ketogenic diet including constipation, poorer exercise performance (at least short-term, no research on long-term performance), muscle loss, bad breath, and micronutrient deficiencies.
– You likely need to take additional vitamin and mineral supplements while following a ketogenic diet. Regular blood tests are still very important.
– A ketogenic diet is not recommended in a variety of health conditions, and is even considered dangerous for some (e.g. patients with chronic kidney disease and pregnant women). Always check with your family doctor and dietitian before making drastic changes to your diet.
– The ketogenic diet has not been studied in people who have had bariatric surgery, so the short-term and long-term effects are unknown.
– The ketogenic diet is very restrictive and is therefore not sustainable for the majority of people. Eating out and socializing around food become almost impossible.

Our final thoughts…
Many patients are quick to blame carbohydrates for weight regain. Instead of jumping to a ketogenic diet, we recommend reviewing the bariatric basics and booking an appointment with your bariatric dietitian.
If you absolutely insist on trying a ketogenic diet, we suggest a “modified keto diet” that consists of more plant-based protein and healthy fats, with enough protein to be sure you’re maintaining your muscle mass.
What are your thoughts on the ketogenic diet? Have you been tempted? Are you currently following a ketogenic diet?
– Lisa & Monica, your bariatric dietitians

P.S. For more tips on healthy living after bariatric surgery, follow us on Facebook (@bariatricsurgerynutrition) or check out our highly praised book HERE!

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

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I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

Drinking water after surgery can cause some discomfort (like a rock hitting your stomach), sometimes it doesn’t taste right because of taste changes after surgery, and sometimes the temperature of the water can leave you feeling uncomfortable. Other times, you may simply just forget to drink and you just don’t feel as thirsty.
Not drinking enough water can leave you dehydrated.
How do you know if you’re beginning to get dehydrated? There are 3 main ways of figuring this out:
Do I pee 3 times per day, or less? Is my pee dark yellow in colour and smells more than usual? Do I get dizzy when I stand/sit up or bend over? If you’ve had bariatric surgery and answered yes to one or more of these questions, there’s a chance you may be dehydrated. Some of these symptoms can be related to other causes as well, so check with your doctor, bariatric dietitian, or nurse if you’re unsure.
Here are our tips for drinking more water after surgery:
Make water more convenient by…
Buying a fun new water bottle for work and home that gets you excited. Ideally, something colourful that catches your eye; Keeping a water bottle or water glass within arm’s reach at all times, regardless of where you are (e.g. at work, in the car, on the couch, in bed, etc.); Keeping cold water in the fridge at all times. Buy a water pitcher or a water filtering jug and place it at the front of your fridge. It needs to be visible and easy to reach to be convenient; Knowing your environment. Do a tour of your workplace to remind yourself of where the water fountains or coolers are. Check if the cafeteria charges for hot water or if there’s a vending machine that sells water bottles close by; Buy a smaller water bottle to carry in your purse or backpack for when you’re on the go. Ideally, it should hold no more than one to two cups. Large water bottles are often intimidating and if they are too heavy or bulky, they’re more likely to get left behind; Leave a reusable water bottle in your car at all times so that you always have some on-hand.
Get excited and add some flavour by…
Trying infused water. Add one of the following combinations to your water pitcher or water bottle:
Sliced cucumber + fresh mint leaves; Sliced strawberries + fresh basil leaves; Sliced lemon + fresh lavender; Blackberries + fresh thyme; One cinnamon stick (for best results leave overnight in your water bottle); Using flavoured ice cubes.
This idea involves freezing concentrated fruit purees, spirals of citrus rinds, and/or fresh herbs into ice cube trays. Adding one to three of these ice cubes into your water not only adds a fun flavour and keeps your water colder, but it’s also a colourful touch. This is a great alternative to store-bought water enhancers that contain artificial sweeteners.
Example: puree two cups of chopped watermelon with the juice of one lime. Freeze the mixture in ice cube trays. Add two ice cubes into your reusable water bottle; Making a homemade tea with an added twist. Add eight ounces (one cup) of boiling water to the combinations below. Drink hot or refrigerate overnight and enjoy cold.
1/2 sliced lemon + 1/2 inch piece of peeled fresh ginger + 1 tsp honey; A green tea bag + fresh mint leaves; A black tea bag + orange slices or peach slices; An earl grey tea bag + sprig of lavender + lemon slices +1 tsp honey; A white tea bag + mint leaves + dash of lime juice; Treating yourself to some loose tea leaves or flavoured tea bags at specialty shops. Set reminders by…
1. Downloading an app. There are countless free apps out there to help you track your daily water intake and even ones that will send you constant reminders throughout the day to drink;
2. Add a sticky note to your computer monitor. Be sure to change the placement of the sticky note every week so it doesn’t blend into the background;
3. If you’re someone who does repetitive tasks at work, use this to your advantage! For example, challenge yourself to take three sips of water every time you read a new email and every time you send an email;
4. Buy a ‘time stamped’ water bottle or simply recreate one by writing the hours of your work day down the side of your bottle with a permanent marker. For example, evenly space 9 a.m., 10 a.m., 11 a.m., and 12 a.m. down one side of the bottle and 1 p.m., 2 p.m., 3 p.m., and 4 p.m. down the opposite side of the bottle. This strategy will also help you to pace yourself throughout the day.

– Lisa & Monica, your bariatric surgery dietitians

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

I heard I should be avoiding carbohydrates, is this true?
This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day.
What are carbohydrates actually?
The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products.
In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes.
Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast?
Confused?
This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one!
In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health.
The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:
 Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);
 Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).
 Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’).
Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer.
Examples include:
 Barley;
 Oats;
 Quinoa;
 Whole-grain products;
 Legumes.
Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long.
Examples include:
 Pastries;
 Donuts;
 Chocolate;
 Candy;
 Juice;
 Regular soda;
 Sugary cereals.
After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach.
Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day.
Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS.
- Lisa & Monica

You may also be wondering how in the world do I become more active? I don’t even know where to start, and the gym just isn’t for me.
We teamed up with Myriam, a local kinesiologist, to give you tips on how to start to get your joints moving when you’ve been inactive for too long.
A kinesiologist is a highly educated health care professional who is an expert in body movement. They’re experts in preventing and managing injuries and help people to get fit and perform at their best, among many other things.
In these videos, Myriam will show you exercises that you can do at home to improve the health of your joints and movement to start getting you on a path to being more fit.
Practice these exercises in the comfort of your own home. All you’ll need is:
A chair, A belt or resistance band, A broomstick or long stick. These exercises are great to start BEFORE surgery, early AFTER surgery, or even LONG TERM after surgery. It’s never too late to start being active. Remember that the number on the scale is only part of the story – fitness and exercise is the other half of the equation when it comes to living a longer and healthier life.
How did this activity go for you? Let us know!
– Lisa & Monica

Drinking water after surgery can cause some discomfort (like a rock hitting your stomach), sometimes it doesn’t taste right because of taste changes after surgery, and sometimes the temperature of the water can leave you feeling uncomfortable. Other times, you may simply just forget to drink and you just don’t feel as thirsty.
Not drinking enough water can leave you dehydrated.
How do you know if you’re beginning to get dehydrated? There are 3 main ways of figuring this out:
Do I pee 3 times per day, or less? Is my pee dark yellow in colour and smells more than usual? Do I get dizzy when I stand/sit up or bend over? If you’ve had bariatric surgery and answered yes to one or more of these questions, there’s a chance you may be dehydrated. Some of these symptoms can be related to other causes as well, so check with your doctor, bariatric dietitian, or nurse if you’re unsure.
Here are our tips for drinking more water after surgery:
Make water more convenient by…
Buying a fun new water bottle for work and home that gets you excited. Ideally, something colourful that catches your eye; Keeping a water bottle or water glass within arm’s reach at all times, regardless of where you are (e.g. at work, in the car, on the couch, in bed, etc.); Keeping cold water in the fridge at all times. Buy a water pitcher or a water filtering jug and place it at the front of your fridge. It needs to be visible and easy to reach to be convenient; Knowing your environment. Do a tour of your workplace to remind yourself of where the water fountains or coolers are. Check if the cafeteria charges for hot water or if there’s a vending machine that sells water bottles close by; Buy a smaller water bottle to carry in your purse or backpack for when you’re on the go. Ideally, it should hold no more than one to two cups. Large water bottles are often intimidating and if they are too heavy or bulky, they’re more likely to get left behind; Leave a reusable water bottle in your car at all times so that you always have some on-hand.
Get excited and add some flavour by…
Trying infused water. Add one of the following combinations to your water pitcher or water bottle:
Sliced cucumber + fresh mint leaves; Sliced strawberries + fresh basil leaves; Sliced lemon + fresh lavender; Blackberries + fresh thyme; One cinnamon stick (for best results leave overnight in your water bottle); Using flavoured ice cubes.
This idea involves freezing concentrated fruit purees, spirals of citrus rinds, and/or fresh herbs into ice cube trays. Adding one to three of these ice cubes into your water not only adds a fun flavour and keeps your water colder, but it’s also a colourful touch. This is a great alternative to store-bought water enhancers that contain artificial sweeteners.
Example: puree two cups of chopped watermelon with the juice of one lime. Freeze the mixture in ice cube trays. Add two ice cubes into your reusable water bottle; Making a homemade tea with an added twist. Add eight ounces (one cup) of boiling water to the combinations below. Drink hot or refrigerate overnight and enjoy cold.
1/2 sliced lemon + 1/2 inch piece of peeled fresh ginger + 1 tsp honey; A green tea bag + fresh mint leaves; A black tea bag + orange slices or peach slices; An earl grey tea bag + sprig of lavender + lemon slices +1 tsp honey; A white tea bag + mint leaves + dash of lime juice; Treating yourself to some loose tea leaves or flavoured tea bags at specialty shops. Set reminders by…
1. Downloading an app. There are countless free apps out there to help you track your daily water intake and even ones that will send you constant reminders throughout the day to drink;
2. Add a sticky note to your computer monitor. Be sure to change the placement of the sticky note every week so it doesn’t blend into the background;
3. If you’re someone who does repetitive tasks at work, use this to your advantage! For example, challenge yourself to take three sips of water every time you read a new email and every time you send an email;
4. Buy a ‘time stamped’ water bottle or simply recreate one by writing the hours of your work day down the side of your bottle with a permanent marker. For example, evenly space 9 a.m., 10 a.m., 11 a.m., and 12 a.m. down one side of the bottle and 1 p.m., 2 p.m., 3 p.m., and 4 p.m. down the opposite side of the bottle. This strategy will also help you to pace yourself throughout the day.

– Lisa & Monica, your bariatric surgery dietitians

Regardless of how marijuana is taken (i.e. smoked, inhaled or eaten) the effects are the same. The majority of people who use marijuana describe a sensation of relaxation and euphoria (the “high”). Some people however react badly to the drug which can result in a state of panic, anxiousness and fear, or in some cases even hallucinations if they take too much.
Of particular relevance to bariatric or weight loss surgery, is the fact that marijuana impacts the part of your brain that controls appetite. Have you heard of the “munchies”? Yep, that’s right, the “munchies” are a real thing! Marijuana can increase your appetite, causing you to eat more, which obviously is not great if your goal is weight loss.
Interestingly, a recent study on weight and marijuana use actually showed that marijuana use may very slightly (and we mean VERY slightly) reduce body weight (about a 0.5% reduction in BMI) (1). This study however was conducted on a group of people with an average BMI of 27 kg/m2, which is way below the average bariatric or weight loss surgery patients’ BMI pre-surgery. This unfortunately means that this mild weight loss effect cannot be applied to the typical bariatric or weight loss surgery patient.
We did however find one recent study done in 2016 that is more relevant to the bariatric or weight loss surgery population (2). The study was run on a group of 50 patients (62% being RYGB patients) all 2 years after surgery. The results of the study showed that the patients who had smoked marijuana within the last 30 days and the patients who had started smoking more since surgery, were all more likely to have disordered eating habits, specifically “loss of controlled food intake” (2). Although the study did not look at weight outcomes related to marijuana use, we know that disordered eating habits such as grazing and bingeing are risk factors for weight regain after bariatric or weight loss surgery.
In conclusion, we do not yet fully understand the effects of marijuana use after surgery with respect to weight loss and longer term weight maintenance outcomes. The field of research is still very young (3). Regular marijuana use however may pose medical risks after surgery, therefore speak with your surgeon if you have been prescribed marijuana for medical reasons. Furthermore, if you choose to use marijuana for recreational reasons on a regular basis, it is worth discussing this habit with your bariatric nurse and dietitian.
– Monica & Lisa
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References:
1. http://onlinelibrary.wiley.com/doi/10.1002/hec.3267/full
2. http://www.sciencedirect.com/science/article/pii/S1550728915002063
3. https://www.ncbi.nlm.nih.gov/pubmed/24913244