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you're very likely in ketosis. The metallic taste (at the back of the throat and sides of the tongue?) is a result of breaking down and using ketones, the by-product of which is acetyl-CoA and acetate.... dont worry about it it indicates your insulin and blood sugar levels are dropping.. also a good thing. It will resolve through the day then come back periodically. This goes away entirely for most people who enter ketosis and stay there after a few weeks. More info, look up "keto breath"

Yeah, half the bariatric surgery websites I read in the US warn against fast food due to high sodium. Show me the evidence. I also want evidence on saturated fat and cholesterol while you're at it. Nonsense. I understand there's correlation, no ****, but when I was going Keto, often as not I used to rip the bun off two long chilli cheese burgers from Burger King (Swiss thing, awesome) and I was skinny and my blood work was epic. Oh and caffeine too. There's so much nonsense out there and half of it is from people whose names end in MD.

After reading a thread in another forum here, I thought I'd check in and see HOW everyone eats 2+ years post op!! I am 4.5 years post op and currently doing nutritional ketosis but seriously thinking about switching to a more 'bariatric' style eating with higher protein, lower fat and a few more starchy things (like some beans or a bit of squash) every now and again... I have also FINALLY embraced the need to move and get active so have started doing some muscle building. But, in the meantime i'm curious- how are YOU eating these days? Regular diet? Keto? Paleo? Bariatric/low carb? Diabetic diet? Cal controlled? Give your 2 cents!!

After thinking a long time, I believe the issue is this: I came off a liquid diet, and then two weeks later I had fully reintroduced solids (which was around the time this happened). I also therefore was able to put some carbs in, so I came off ketosis. (The protein drinks I was on had ~no carbs.) Also, I've been eating probably a bit more salt than I should. From previous experience, keto makes me lose about 10 lbs of glycogen weight in the starting "whoosh." 10 lbs + solid food in various parts of digestion + some water retention from salt = 15-20 lbs depending on the water retention. So it's probable that I just haven't lost nearly as much actual fat as I think I have, which is extremely depressing, but at least there's an explanation. That said, I'm about 4 inches off both my waist and my hips, so clearly something happened. Though given my consistent weight for the past 2 weeks or so, I'm probably stalled right now. I did just start up a 3x/week strenuous weightlifting program, so hopefully that puts a dent in it. My doctor is horrible at getting back to me on any kind of schedule, so I had to attack this myself. The awful part is that 240 lbs is my normal weight pre-pandemic. All that work to return to the status quo.

Even with a Duodenal Switch, it still comes down to calories in vs. calories out. DS patients can also out-eat their procedures over time. The DS very well may be a great option, along with dietary education and management. I agree that you need to get those tests Fluffy mentioned. Hormonal imbalances can make metabolisms pitifully slow. While you are checking into your options, start tracking. Weigh every morsel of calorie containing food and drink that you consume. See where you are at. It is possible to overeat on keto diets as well, so for some people, they STILL have to count.

I gave this some more thought, Assuming you are not especially fatigued at the end of the day or other days, and you get enough sleep, and your nutrient balance is correct for your post-op diet, and you are of course drinking the more than the minimum amount of water, I would say your exercise regimen is more exercise related and not diet. I wish it was as easy as "eat more carbs, lift more weights," but its far more complicated than that. Nutritionists are not athletic trainers, and neither are athletic trainers nutritionists. If hitting a wall when weightlifting if the only thing of note (no other non-normal post op feelings or notes), then I believe your issue is more directly relate to the gym than an overall carb or calorie intake. Ask the gym operator for someone to get advice from, they either know a knowledgeable trainer that works at the gym (not all trainers are knowledgeable) or a client you can ask questions to. Post-op, you have a heavier than normal protein diet, because you are on a very low calorie diet, and that makes your body want to draw a higher proportion of calories from its ready muscle. So, you should bump up your protein. Post-op unknowingly put myself on a keto diet, low, very low carb and higher fat, because I was very lean meat oriented and string cheese for snacks. I didn't hit such walls. But no one just adds 5 lbs of weights to exercises every week, or even every month. Your body needs water to process, everything. Whatever amount of water you are drinking now, add to it. I was drinking about 80oz a day, and I learned that was not enough for me once I lost alot of weight - 80oz could not support a run every other day without severe shin splints. Now, to your weight lifting. Without knowing what your regiment is, STOP! take a break. Take a 2 week break. Don't worry, your weight loss is far, far more dependent on what you eat than weightlifting. Go for walks instead. Use that time to make sure you lifting right, and lifting with the right form. If you are lifting everyday, it may not be fatigue, it could be pain. You MUST NOT mix up muscle groups back to back. For example, you should not be doing a lat pull down on a monday, and then a deltoid on a tuesday. They share the same muscle group and they are share common muscles. Triceps and biceps are similar, they should be done on the same day, so the shared muscles between those exercises can rest on the off days. You need a rest day for them. Google some suggest workout patterns. I spent 4 months in physical therapy because a "certified" trainer let me do chest press-shoulder-press-incline press everyday. I learned the hard way... not to trust a trainer. I broke my shoulders down, and threw one out fencing, and then later threw the other out trying to grab my dog. If you are lifting every other day, you might need an extra day to recovery. Recovery is super, super important. You do not build muscle mass at the gym, and never will. It happens after you leave the gym, when your muscle fibers go about repairing themselves. Perhaps, being new to lifting, and being older, you just need an extra day. Also, 6 months is TOO LONG to be doing the same thing. Do different exercises in different orders. If you are doing bicep curls, do hammer curls. If you are doing chest presses, do incline chest presses. or more ideally, mix them all up. Doing the same exercises too long will put you into a rut. Make sure you're not doing too many of the same group. Doing 3 sets each of shoulder, incline and chest press on the same day is the same as asking to be admitted for a physical therapist to fix an impinged shoulder. When you leave the gym, that is the best time to eat. Your muscles are craving fuel, and so is the rest of your body, its the best time to absorb food. Also, it wouldn't hurt to have a snack before you go to the gym either. Just also make sure you are hydrated before going to the gym. Back off the weights. Start doing less weights and see how your reps go. When you do sets, you might need a longer rest time between them. Your fatigue might be related to lactic acid, and you need extra time to flush some more of it out. Warm up your muscles before lifting. You might need to stretch, or do a lightweight set before you do your main sets s a warmup.

I only told two people (in case of emergency) Everyone else appeared too judgemental to me so I decided not telling them was best Other than that when people ask I tell them I eat a lot less and low carb/keto

yes - it is. They have a Keto version, too, but the protein level in that one isn't as high.

@Joann454 I started researching this today after your post and I found this article with links to other literature http://www.ketotic.org/2014/12/the-effect-of-ketogenic-diets-on.html?m=1 It may be that lower T3 while on. Keto diet is a good thing. I am still researching, but I wanted to share this with you.

Hi all. I was sleeved 4/4/17 and have plateaued and just upset w myself. I do the protein first but maybe not enough water. I don’t know. I would like to figure out my macros and try the keto diet. mi75 or Biloxigirl any suggestions? Please and Thanks

Oh wow - I've never heard of Keto Rash before so I looked it up - here is a quick YouTube to watch...totally makes sense! Thanks!

Oh wow - I've never heard of Keto Rash before so I looked it up - here is a quick YouTube to watch...totally makes sense! Thanks!

If you're in to low carb eating...like Keto...you can make some cheese chips. Sent from my SM-S908U using BariatricPal mobile app

Hello, I'm Tracy age 45 mom of 7, ages 30 to 1½. I'm originally from southern California and now reside in Alabama. I had the Roux en Y procedure 12/26/2001 almost 18 years ago in Whittier California at age 28, my weight skyrocketed to 407lbs at 5'2"..! Luckily with no other conditions i.e. diabetes, high blood pressure etc so I was a great candidate. My lowest weight was 148. I maintained for many years until 2006 after my 5th child and a nasty divorce and with that came my depression & over eating. In 2007, I moved to Alabama and weighed 189, got remarried in 08' and had 2 more children. After having my 6th child in 2011 my weight got up to 203 & there it stayed until January 2018, after giving birth to (my 7th baby) our precious full term daughter who sadly was stillborn at 41 weeks, and 10 months later in October, I lost my best friend/my momma to liver cancer at age 66. After the devastation, I no longer cared about anything, I didn't even care if I lived or died. I turned to eating and was on a lot of medication for anxiety, depression and a mood stabilizer which added another 57 lbs. After going to therapy, getting off all my meds, returning to my faith/church I decided 2019 would be my year!! I made that promise to my momma on her death bed! I went ahead and had my oral surgeries, another back surgery, another mammo/biopsy (I also lost ¾ of my left breast last Aug) saw my cardiologist, changed my diet to all Keto. But the 19 lbs I lost in 5 months came right back. So on June 7th I met with a local Bariatric Dr, June 27th did my pre-op tests and just 6 days ago July 2, I had my revision done to a gastric sleeve. I was 251 day of surgery and I'm at 142 lbs as of yesterday. I had zero pain except for the horrific gas pain in my upper chest, shoulders & back because once they got in there, they discovered a huge hernia behind my liver & fixed that. My first gastric bypass I was cut open 16" so having it done by laparoscope was amazing just 9 little incisions. I feel great and I'm excited for my new life & 2nd chance! Thank you for reading and God bless! Sent from my DL7006 using BariatricPal mobile app

I'm 5 weeks out and I get hungry. Not to the point I'm dying or anything but if I go too long between Protein shakes I get dizzy and tired. I have carb cravings still now that I'm eating real food even though I'm eating less than 15 grams a day. I try to stay in keto but I've been ready for food since week 2 of surgery. I'm losing weight, so that's the important thing. I get really hungry when working out or walking long distances. Every one is different but this is my experience. Sent from my iPhone using the BariatricPal App

No there is no norm or standard plan for before or after surgery. Much like there is no standard for how you will recover, how much weight you’ll lose, what ‘fun’ side effects you’ll experience, etc. There’s just generalisations & averages. There will be similarities across plans & differences. Like in the pre surgery eating plan. Some don’t have any. Some do three shakes a day while others do two shakes & one meal. Me I had to do keto. Same with the post surgery stages. Differences can be around how long each stage is or even what foods you can or can’t have at each stage. For example potatoes are allowed on many plans but were a big no in my plan. I do know my surgeon adjusts his plan depending on the individual patient & their specific needs & situation. My friend who saw him was on the 2 shakes one meal plan. Her friend, also same surgeon was all shakes. Our ages, starting weight & general health were different. It’s why we say it’s always best to follow the plan you were given and if you are having difficulties to contact your team to see if & how you can tweak it to better suit you & your needs & experiences.

Yes, I had what is called the Keto Flu. Electrolytes help to curb this. I drank the broth of Progresso soup (strained out the rest) and that helped significantly. Good luck and this will get better shortly.

When I finally convinced my Dietitian to give me some sort of macros to follow, they actually said "150g per day" for carbs! I thought that sounded WAY too high, and even 100g seems like a lot to me. I've done keto before (and that was the only way I lost any weight at all, prior to VSG), so it's not too difficult for me to cut back there. Thank you for weighing in - I really appreciate it! :)

Not sure which diet you're on, but super low carb can result in "Keto flu". I don't have a fat restriction on my pre-op diet and found that good fats + grey Celtic sea salt really helped me. Like, coconut oil and a pinch of salt in my shake. Or just a grass-fed burger with no bun. My headaches got better when I flipped into full ketosis around day 4. Sent from my iPad using the BariatricPal App

So I am required by my insurance to get with my doc and go on a restrictive diet for 6 months, meeting with her once a month for weight-ins and evaluations. I am curious if anyone who went through a similar thing has a particular diet recommendation. I had some success on Adkins back 13 years ago. I was able to stick to it more than others. I went back to eating normally though and put it back on and then some. Looking at Keto or another carb restriction diet to hopefully train me to get away from that junk before and after the sleeve. Suggestions? Sent from my iPhone using the BariatricPal App

I began keto the Monday after my surgery info session at the end of Feb. I have lost 65 lbs since then following the keto diet. My nutritionist didn't recommend it but she said as long as it was working I could do it. She wanted me to follow a high protein low fat diet. I stayed keto up until the start of my liquid diet, which was Monday 8/21. My surgery is 8/31. I questioned whether or not I wanted to have surgery since I was so successful with the keto diet... but I still have 100+ lbs to lose and I'm not getting any younger. I plan to stay low carb following surgery, eventually transitioning to keto if my body allows it. My labs have improved dramatically and I'm no longer pre-diabetic thanks to keto.

You don't seem to need any advice, you've got this. I'll admit I got lucky in that my nutritionist told me at my first consult for the first month (of three) to just avoid carbs after breakfast, and that was it. I kind of took it upon myself to go full keto, keeping myself under 15g of carbs a day and it's working great, down 23 in two months. Due to what amounts to head-to-toe injuries exercise is not an option for me right now, so I can literally say I'm doing all this without breaking a sweat. I haven't felt hungry a single minute since I started and I'm chomping on a hard boiled egg right now. Like you I have no pre-op liquid diet requirement, so that certainly makes life easier. As for protein shakes, I found a giant barrel of cookies and cream flavored something or other at Costco that I mix with unsweetened almond mile. Search the boards and you'll find lots of recommendations for both powdered and pre-mixed shakes. Good luck with everything.

Did the nutritionist lay out a dietary plan for you? Granted, all my nutritionist told me on the first visit was to cut out carbonated beverages and avoid carbs after breakfast. I also had to meet with a dietician at the hospital who basically said I had to meet a certain number of grams of per day pre- and post-surgery, so I took it upon myself to just go full keto. The advantages of doing keto are no calorie counting and little portion measuring, plus with all of the meat, eggs and I cheese I get, I haven't felt hungry in several weeks. So I suggest calling the nutritionist again and asking if he/she has any specific recommendations for you other than "eat less".

Ever heard of Keto!? That’s what I did and it helped me loose all my pre op weight! Some of my family and friends even tried it with similar success stories

I heard trying a keto diet. It helps break a stall. God bless.