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I was on a keto diet months before I had surgery. There are a few forums on reddit dedicated to keto and they are great sources of information. You may want to research cyclical keto which allows for periodic carb increases for those who do heavy lifting. This is something many body builders do.

For me when I noticed how much better I was feeling and looking it became more important than what I love, to eat. Lol. I changed the way I look at food. It is now something to keep me alive and not a crutch. Don’t get me wrong I still like to eat but I’m making better choices and keeping junk food away so I’m not tempted. Look up keto recipes there are tons of them. Plus keep easy meals on hand so if you’re ever in a hurry you don’t grab something bad for you. Hope this helps. Good luck and stay strong!

Just seconding Sosewsue61's comment: I've been told (by nutrition professionals, if not actual doctors) that hormones get stored in small quantities within our fat, and losing a lot of fat quickly can do a real number on our hormonal systems because they're all released at once. It's a little unpredictable. For me, in my early 30s, on a low-fat keto plan, that looked like some skipped periods, some longer-than-average periods, and a few extra cramps--and I'm ready for that again in my late 30s, after the VSG. I don't know what that would look like for me on menopause, or for anyone else, though. The one reassuring thing I can say is that it's temporary. Your body adjusts. The really rapid weight loss tapers off, and you go back to some kind of homeostasis. (I don't want to say "you go back to normal," because it's generally a new and better normal, right? Like you said, there's less inflammation when you weigh less, and that has positive impacts for every body system.)

@@JamGuy I use myfitnesspal to track my intake. I've been doing low carb off and on for about 15 years and tracking calories as well, so I'm pretty familiar with the counts on most foods that I eat. What makes it easier for me is that I eat relatively the same things week after week and I keep my foods as clean as possible. I make most things and rarely go out to eat unless they have nutrition info available. Keto is really the only way I'm able to lose. I thought the sleeve would change that, but nope! Although, I find that I'm able to better manage my cravings for carbs and avoid them. I use net carbs, but I don't worry too much about it since I rarely eat "non-keto" foods. Sometimes my carb intake will be a little higher from things like baby carrots, but again, I don't worry about it much.

There are a few bariatric keto plans out there..... What I've been told is for keto do High protein 60 -80g or whatever your doc recommends. Moderate healthy fats and low carb and lower calories. Just search for bariatric keto truth and groups like that on facebook Sent from my SM-G965U using BariatricPal mobile app

Fluffy has awesome recipe ideas. Particularly, if I were a keto person, I'd watch for her recipes.

I disagree with with Dabeyhive and RickM's comments above. Sure, keto isn't for everyone, but it's great for many people. I love the fact that it gives me some firm rules to follow and it happens to fit my eating preferences. First, I don't believe Keto is a fad diet at all. It's been around in various forms since the 1920's and became the basis of the original Atkin's diet in the early 1970's. It works very well both for weight loss and general health benefits. The problem is that some people don't really understand the diet or follow it correctly--and that's where people into problems. Following a proper Keto diet doesn't mean you should be chowing down on cheeseburgers without the bun eating bacon with every meal. While cheeseburgers and bacon are not prohibited on Keto, those aren't recommended either. You should stick to things like organic eggs, lean organic meats and wild caught fatty fish (like sockeye salmon). Stay away from fatty meats, since the fat is bad things the animals consumed are stored. You then add healthy fats to your food, like avocado, MCT oil, extra virgin olive oil, ghee etc. The idea is to "prime the pump", so you body burns off its excess glycogen stores and then converts stored fats into ketones for energy. This is important, especially if you're insulin resistant. For me, I am really happy with Keto and I can definitely stay on keto long term. My surgeon and nutritionist are on board with my keto choices. I just had my blood work done after 2 months on Keto and everything was perfect. I am no longer diabetic (A1C dropped from 6.3 on multiple meds to 5.1 on no meds). My triglycerides dropped to 54 (they were 450 this past summer on meds). My cholesterol is 190, but my good cholestrol is 97 (which is outstanding)--so that's good. Some of these may be from the surgery, but diet and exercise are equally critical. I suggest that you don't do keto on your own, but you do with with the guidance of a doctor or nutritionist that has a lot of knowledge about keto. I personally keep my net carbs down to approximately 20g a day and close to a 1:1 ration of fat to protein. At this point, I am 14 weeks post op (99 days). I am eating between 1200-1600 calories a day. Those calories are made up of 45% protein, 45% fat and 10% carbs. The carbs I am consuming are mostly from vegetables--even green veggies have some carbs. I don't eat any bread, starches, potatoes, sugar etc. I avoid high carb fruit, but I am allowed berries. I avoid processed foods to the greatest extent I can. I also work out daily--at a high intensity (and have been since I had all physical restrictions removed 1 month after surgery). I have lost 70 pounds since my highest weigh in. My pants size has dropped from a 44 to a 32. My body fat has dropped from 28% to 16.5%. Weight loss surgery is only a tool (a good one), but I would say it gives you a head start and helps prepare balance your body's hormones and stomach so people like me (morbidly obese, with a trifecta of co-morbidities) can lose weight like a normal person without insulin resistance/diabetes and other issues that get in the way. Once I had those issues, in check the rest of it was up to me--with keto and serious exercise making the big difference in getting me to where I want to be. I'll let my pictures speak for themselves: The was me on July 4, 2018 (weighing around 255-260) : This is me on the day of Surgery (weight 235): This is me on March 23, 2019 (weighing 190): As a 45 year old man with diabetes etc., no way I could have done this without VSG. However, I really believe Keto and exercise (45 minutes moderate to high intensity cardio 5-6 times a week and 1 hour of high intensity weight training 4-5 times a week) have changed my health and my life. I can't imagine going back to the life I had before surgery, nor could I imagine not living a keto lifestyle at this point.

I am not at the solid food stage yet, but I'm thinking about a Keto style of eating, trying to make sure that I can get in my 60 grams of protein daily. Have any of you done or are doing this? I'd love your feedback!

October 3 here and day 7 of my pre op diet. I have already lost 12lbs in this 7 days. Crazy. I have been feeling so ready up until this morning when I noticed the keto breath and realized I am full on in ketosis. I keep thinking there are people out there that lose their weight with just a keto diet and exercise not surgery. I know it is just cold feet and I have been expecting this to happen at some point before the actual surgery. Anyway, off to have my Protein shake! Sent from my iPhone using the BariatricPal App

Fortunately, all went well. I lost 29lb in the three and a half months since my first appointment doing a sloppy job of keto and not exercising at all due to my bad back, bad feet and bad shoulders. They'll be submitting my paperwork to Cigna for approval tomorrow, and the staff said it usually takes up to two weeks for Cigna to process everything. Once the approval comes in they'll schedule me for surgery and I'll make an appointment with my PCP for my pre-op physical. My best guess is that I'm looking at mid-June at this point. The good news I got is that I will not be having my procedure done outpatient as I'd previously been told. It turns out that Cigna requires an overnight stay, so I'll be having the surgery at the hospital and will get to spend the night. While I'm sure the doctor would not do it out patient if it wasn't safe, I prefer the idea that I'll be monitored for at least the first 24 hours following surgery. So now I wait. Many people post about their nerves and fears yet I have none. My wife had a knee replacement two weeks ago and I was perfectly calm. I've had two epidurals in the last two months and didn't worry at all. I even took my daughter out driving on Sunday morning, her first time behind the wheel, and even then I was utterly relaxed. I'm really beginning to think that at this point in my life nothing is going to phase me any more.

I was like you. I started with a BMI just barely over 35, had tried keto, crossfit 6x a week, intermittent fasting. I dropped weight, but it was impossible for me to stay consistent. I am a month out from sleeve surgery and have lost a little over 30 lbs. Even in this month alone, there would have been several times when I would have fallen off a diet due to "life" but the sleeve has kept me on track. I'm slowly but surely detoxing from food, and eating for nutrition rather than comfort. It's proving to be a very useful tool. Sent from my SM-N976V using BariatricPal mobile app

Hell everyone 5yr out from Sleeve this month so frustrated gained 30lbs after Neck Surgery 2017 been on Keto lose 13lbs still struggling Ughh

LOL- I guess Ive been Googling the wrong words, here's a new one.... https://www.bariatriceating.com/2017/03/bee-keto-bariatric-plan/

As everyone said, there are as many different eating plans as there are surgeons. My doctor's plan was lowish-carb (not keto low, but controlled). It emphasized protein first, then veggies and not pushing my restriction. He said if I did that calories would take care of themselves and it did work out that way. I tracked (and still do) everything I eat so that I am aware of how many calories I am taking in and what the macros are. I actually also eat about 6 mini-meals per day rather than 3 "big" meals. But if eating that way isn't working for you, try the more traditional 3 meals per day approach. Low-fat has never worked for me as it leaves me hungry, but your body might react well to it. Different bodies thrive on different approaches. At 6 weeks out, you are still very early in the process. Ask your bariatric program what they recommend and then adjust as needed to accommodate your body's needs.

it really depends on what ur goals are... rapid weight loss? sustained weight loss? maintenance? muscle building? fat loss? carb reduction? fats loading? anyway...i used the following calculator to determine my optimal macros based on a modified keto diet (kinda like Atkins II, sorta). it worked for me until it didn't...the macros i was aiming to maintain was really not sustainable (for me) in the long run. im 5+years post op now and don't look at macros anymore (haven't done so since year 2)...now i just keep an eye on total calories (no matter how they are comprised). i've been able to maintain below goal weight this entire time just on maintaining a caloric limit alone....but thats just me...ymmv. but anyway, here is the calculator: https://www.ruled.me/keto-calculator/ good luck! ❤️

Well let me chime in here- I am 4 years post op!!!! I had pretty significant GERD way BEFORE my surgery, and in fact it was a huge mitigating factor in my surgery. my surgeon told me that the reduction we both expected in weight would easily eliminate my GERD, so either surgery was an option. I chose VSG in 2014. I lost about 70 lbs total and felt great. I took the occasional PPI for the first 4-6 months during that huge weight loss. Then...well about 2 years post op I regained a lot of my weight and GERD returned. I went back on a PPI. last fall I made an appointment with my surgeon who said that I REALLY had to lose all of the regain, and that if the GERD didn't resolve, I would probably face a revision. Around the same time I had an EGD and got some ugly news from my GI doc. That sparked a huge drive in me, I went full on Keto and have re-lost all of my regain!!! BUT...my GERD is still present and not getting any better. I know that I DO have a sliding hiatal hernia that may be reacting to the fat in Keto, so I just keep pushing and hope that by the time I see my GI doc in fall, it will be gone.. So yes, reflux after surgery can be and IS a real issue. for me, I honestly wish I would have just had the bypass 4 years ago, because I STILL face that option, even 4 years out!! EDITED TO ADD: I was formally diagnosed with Barrett's Esophagus in 2012 but thankfully, no other positive screens since that year.

You have to kind of figure it out for yourself, because everyone is different. However you nutritionist should be able to give you a meal plan. If you are paying them, fire them, they are useless. Most long term successful people eat low carb. I eat keto. I use a calculator to set my macro requirements. I eat foods I like that fit my macros and the keto way of eating. Once you are healed how you eat is up to you. Still your nutritionist really makes me angry. They should be able to give you real suggestions. That is their job

There are a few ways to accomplish this: 1. Eat some type of stewed meat, where it naturally has taken on moisture. 2. Find some low sugar or sugar free sauces (i.e. use a little bit of keto bbq sauce) 3. A little bit of gravy, all things considered, should be ok. Don't douse your food in gravy, but use just enough to add moisture. 4. If the meat is a good fit for it (like chicken), some avocado mash makes a nice sauce. Really, just find something that adds moisture, so you aren't relying totally on your own saliva to help it breakdown and become mush in your mouth.

OK guys!!!! I started Keto 2 weeks ago and would love to have a forum of just Fellow Ketoers!! We can trade recipes, stories, question, concerns etc. Keto stuff is all over the internet...but nothing about doing it after WLS. I use My Fitness Pal to track all food/drink, calories, carbs, fats. I currently stay until 12g carbs per day, 60g protein and 27g fat. I use Ketostix every morning to make sure I stay in Ketosis ( usually a 4) but I don't feel I'm losing quick enough. What is your experience so far with Keto and your daily intake of foods? It's just so hard for me to get in enough calories and protein.

Intuitive eating for food addicts is like saying heroin in moderation. In my keto groups people say eat until you are satisfied, and I have to speak up and remind people that some people are never satisfied because they are food addicts and they just need to portion control. If WLS could be successful at eating intuitive, they would not be WLS patients in the first place. Everyone isn't a food addict, I don't really think I was, I am just very carb sensitive and a glutton. I like to indulge and pamper myself. Post-op I switch how I do that pampering and treating myself.

Hello. I’ve had some success on keto and Atkins type diets in the past and I am curious how they work post op and more than a little nervous to start it up again now since they are basically higher fat and my past probs there...plus I’m only two months + post op. Lil backstory- I had my gallbladder taken out 11/2016 and a year later my body still hasn’t made up its mind on how to process fats (mainly dairy, meat based fats are tolerable) Some days I can totally tolerate minimal dairy (like in my morning coffee or some meat wrapped cheese/pickle meals). Other days I take one sip of my AM coffee and I bolt straight to the bathroom & for the rest of the day- this is low fat, whole milk, half and half or even full on heavy cream. I literally can drink/eat FULL fat one day and get the intestinal freak outs the next! I don’t get it! I had VSG on 10/31/2017 (2.5 mos) and still struggle having dairy back into my diet since I’m pretty much experiencing the same thing. Now I make my one morning coffee with chocolate Premier Protein shake and do OK but still struggle with any other dairy...cheese, low fat sour cream, yogurt...but I WANT TO COOK WITH THIS STUFF! PLUS I NEED THE CALCIUM. Ricotta bake- HELLO! I want to be able to eat that without excusing myself from the table after one bite. Can I do a modified Keto and/or Atkins type eating program that allows me to eat lower fat (mostly dairy) type foods and still be satisfied and lose weight? Maybe less fat and more protein? Is there something like that- toss in some whole greens maybe? I’m earnestly trying and reaching out for help so please don’t give me arrogant attitude. I enjoy most of you but geez the power trips here are sometimes too much...kinda like the trots I get lately many thanks and so much love and appreciation to all of you that offer kind supportive suggestions...Tess

Healthy_Life2 is giving some really solid advice and feedback. I appreciate her comments. I am only 2 months out so can't comment on weight regain. I can say that I have made a complete 180 in my lifestyle choices. I am extremely diligent in following my post-op dietary plan. I track daily caloric intake using the MyFitnessPal App and then go over my macros in the evening to make sure I am on target. I wouldn't even call it a diet--because that's such a temporary thing. I am looking at this as a new lifestyle. I have deviated from the standard plan provided by my doctor (I did discuss it with him and my nutritionist) and I am following a very low carb keto style plan (although too high in protein intake to be a true keto diet). This type of lifestyle provides me with very clear guidelines of what I can and cannot eat--which makes choosing foods easy, I do track calories too and set a limit to how many calories I can consume in a day, but this isn't hard since I am usually very satisfied sticking to my plan. Even if my ability to eat more increases, I feel like I can make good choices that may increase the volume of food that I eat without causing me to over-consume. When they say the sleeve is only a tool, they do mean it. Losing weight post-op is still a lot of work and requires a lot of discipline. The big difference is you are no longer fighting against your high set point, so instead of heating a plateau and suffering terrible hunger and cravings, you don't have that set point fight against you. The volume restriction is also helpful, but as Healthy_Life2 said, you can eat more frequently and undermine this process. I also now get up early in the morning to hit the gym before work and I love that "me" time. Even though this new and still "exciting" for me, it's a lifestyle that I can be happy with for the long term. I do not miss sleeping in late or eating carb heavy foods. I hope I still feel this way 2 or 5 or 10 years from now, but I am definitely happy right now. I can say that you need to be mentally prepared to make major lifestyle changes after you have the surgery (before as well!!). You need to have a healthy lifestyle plan in place and be 100% committed to following it through after surgery. I think the people that commit to following a healthy lifestyle plan will be successful long term. The people that only follow the post-op plan "most of the time" and "only cheat a little" are probably not following the plan very much at all and are cheating a lot!! I have gone to a few support group meetings and there are so many people that show up that can't understand why the weight isn't coming off them, while their friends lost so much. After talking more, it turns out that, as a result of surgery, they cut down their portions of crappy processed fast foods and other junk foods, but they continue to eat the same crap they ate before surgery (just less of it). That's not how you get down to a 25 BMI!!! You have to use this opportunity not only to cut down on your portions, but change your food and lifestyle choices. The people that make these changes and stick to it don't seem to have issues with regain (other than the normal 5-10 pound fluctuations that should be expected).

My wife is 5'3" and was 180 at her heaviest sometime last year. She was around 175 when we started, and hopes to get down to 115-120 (we both lost a significant amount of weight 4 years ago, and that's where her weight stayed on a keto diet with regular weight lifting). Her mom has a BMI of 50, type II diabetes and some hyper tension issues, so she was concerned that the constant up and down weight struggle would ultimately lead her down that path. Her BMI was 32 starting preop, 30 the day of surgery.

Thanks for responding, Fluffy, especially with such a well-thought out post. I understand now that I may be 'too early' in the process. I'm such a slow loser and am hitting multiple stalls...that I was looking for anything I could do that would help. I have started tracking my food/water/liquids intake in the myfitness tool now that I was given macros by my dr's office but their plan has me consuming more carbs than I am comfortable with as I'm a big keto devotee and I lose better when I keep carbs low as a general rule. I did 'Atkin's' way back in the day and lost 80 lbs and kept it off for a decade. I restarted a keto WOL 15 months before having surgery as this way of eating helps my body feel better. Now I'm wondering should I follow dr's plan & not attempt to modify to be lower carb...unsure if only being 2 mos post op if my body would prefer that...but having had this body for a number of yrs (lol), I have such a difficult time losing weight...period. Usually it comes off much faster when I keep carbs below 20 ideally...or 30 for a stretch. Below is your list and I just wanted to put my responses in but I get what you are saying about it being too early for me to do IF. I'm hoping some of the things on your list that I'm already doing will have me better prepared should I go down the IF route later in this process: 1. FOLLOW your doc's and RD's plan for you and the stage you're eating at. You MUST be able to easily get the required protein in per day that they prescribe for you. And the amount of fluids you're told to consume. 2. Follow the rules of WLS. No eating drinking 15/30 or 30/30 depending your doc's plan. 3. Get ALL of your daily Vitamins in without skipping a single dose. I've been fortunate that I haven't had an issue with this even directly after surgery 4. Get to walking. And maybe even get to doing core strengthening exercises. Started hiking with youngest daughter several weeks ago. We've been consistent to this day. We currently do 2 x's a week and are looking to increase this but waiting for temperatures to cool down so we can do so..I also swim in my pool a couple times a week. 5. Protein first at every meal/snack >> al dente veggies >> a tiny bit of healthy fats (and that's it). Protein always first, especially since I'm only 2 mos post-op. If protein goes down ok, then I eat whatever veggie if i have one. 6. Cut out ALL C.R.A.P. (google it)--that means no sugar, grains, starchy root veg, starches, refined products, fake stuff, "treats" such as Protein Bars or Water drops. Severely limit the use of sugar substitutes. Did this 17 mos ago when I embraced keto WOL although I never believed in enormous intake of fat so my version had fats limited to ones that are healthier. I tended during this time to stay away from protein bars but if in a desperate pinch as I had a bad habit of not eating regularly (working so much I'd forget to eat, etc.) I might have one. I was a big user of artificial sweeteners during this period although I kept an eye on the research about them possibly causing hunger and many other things about them. Currently my limitation is 2 to 3 packets of splenda (or another fake sugar) a day in my post-op world. 7. Start drinking green tea now (I use decaff) and look into Earl Grey Tea. Ironically I just got a tea brew bottle and a pack of..I think it is green tea in a subscription box that I get. 8. Try to keep your carbs to <30g net per day (subtract Fiber grams of carbs from the total carb count to get net carbs. Yes, I'm a big believer in this! Trying to figure out how to fight myfitness pal as it does not have food listed in its DB, from what little I've seen, with net carb count. I may have to hand add all my stuff 9. No "snacking". Eat 3 meals + 1-3 small mini meals per day in order to limit meal portions to the volume recommended by your doctor and to reach your protein totals each day. A mini meal is an organized, orderly, planned event. Snacking is not. Snacking is hedonistic and reckless and it's possible to do a lot of damage with a single snack event. Since I'm 2 months post-op..this is usually covered although I am not yet this structured as I'm still having occasional issues at mealtime. My mini-meals are not yet planned, thought out events. Well, it's more like I know I will have a carbmaster yogurt in between my breakfast premier protein shake and my next 'meal' which is always an intake of real protein (i.e. meat that I can tolerate and is not a fatty meat). I also will parse out 7 almonds, etc. I think where I'm at is more like 'practicing for where I need to be'? I DID find myself recently..and it is always late at night as often don't eat my 1st meal of the day until almost 11 AM...going to get sugar free jello, sugar free popsicles but I was NOT hungry. It is old habits trying to creep back in. Was really upset that I started to 'go there'..this is a very slippery slope for me! 10. Aim to get 2-3oz of protein per meal (lean dense protein, no casseroles, no deeply satisfying gooey cheesy high reward meals. Keep is simple: grilled chicken, sauteed chicken, poached or sauteed fish, etc. No meat lube or stuff that adds to the pleasure of the food experience. My protein meals are much like what you said. Haven't had a casserole yet...wait, I did. It was shredded chicken I made in crockpot with chicken broth,fat free cream cheese and salsa..but no cheese involved. It is one of the few ways I can get 'moist' chicken. The macros do fit into my keto version including keeping the fat down more than most keto plans.

Hi Jessica! Great job with your weight loss! I think carbs might have a little to do with my stall. I also think that my working out has something to do with it, oddly enough. We have a new gym in town that does some pretty intense workouts and I go Mon, Weds, and Fri. I can't help but wonder if this sudden change in workout might be causing a little bit of the stall, as well as maybe building muscle. I am going to try the Keto diet to limit my carbs and hope that that, combined with my inability to eat a lot and working out break my stall! Good luck to you on breaking yours!