People talk about how they gain weight immediately after surgery (not everyone, but some folks). People talk about how, when they switch from liquids to purees they gain weight (again, not everyone, and I doubt many people fall into both groups). And everyone just nods their heads and says "yes, that does happen, don't freak out, stalls are normal at this point." I think some folks even have said "that's water weight, chill." (Usually more nicely.)

I think the difference has to do with whether or not your body enters ketosis before surgery -- those of us on protein drinks and no juice or anything else with sugar will almost certainly be there after a week or more of that diet* -- and when you leave it. Switching from glycolysis to ketosis comes with a steep drop in water weight. (It takes more stored water for the body to perform glycolysis.) Don't get me wrong: you also lose fat, but not all of the miraculously fast loss you see is fat; anywhere from 3-8 pounds is water. Those pounds will come back as soon as you leave ketosis. Sorry. I know that's a bummer.

The upshot is, if your IV bags have any kinds of sugars in them, or if the nurses give you juice in the hospital, you'll see that regain immediately after surgery, even if you were fully hydrated beforehand. (Maybe you would, a little, anyway, as your body does what it needs to do to heal from surgery.) If that doesn't happen, but you get home and start drinking juice or normal Gatorade or something, 1) that's probably not the best possible habit for the long term, and 2) you'll get that water weight back then. Or, box number three: if you are only drinking broths and protein shakes and not getting any carbs to speak of, it'll happen when you transition to purees -- refried beans, apple sauce, yogurts, etc. will have more carbohydrates in them, and you'll get your water weight back then.

In my experience with coming out of ketosis (pre-WLS), my body only actually gains a tiny bit, but it "stalls" for 2-3 weeks before it goes back to losing normally.

So, I think that's at least part of what is happening with the weird post-surgical gains.

Before I stop writing this already very long post, I want to point out that ketosis is NOT the same thing as ketoacidosis, and you are not in danger if you go into ketosis. The transition is unpleasant (though making sure you're extremely well hydrated and you've got enough electrolytes, including especially sodium, when you cut out the carbs will help ease it somewhat), but once you make it, you should find you aren't as hungry anymore. I don't know whether there's any special benefit to staying in ketosis for the week(s) after surgery, before transitioning to purees, but speaking only for myself, I'm inclined to try, in the hopes that I don't end up super hungry while I'm only taking in liquids. (I don't get much say about what goes in my IV bags or what the hospital tells me to eat, so it may not be up to me. We'll see.)

Public Service Announcement: Please do not buy ketone measuring strips unless you need them for your diabetes. They are getting harder for diabetics to find, because keto nuts are using them up. You don't need to measure the ketones in your pee if you're dieting. It is unnecessary. (Is your breath disgusting? Great, you're in ketosis.) Spread the word to your keto friends, please.

*I only say "almost," because there are apparently a lot of people who get their broth by straining chicken noodle soup and not eating the noodles or the chicken. I don't know how many starches end up in a broth that had noodles cooked in it. Also, strained cream soups are allowed on my pre-op diet, and those will have a higher carb content than your average protein shake. We're allowed to use milk in our protein shakes, too, which could be enough to stave off ketosis. Also, I think the nutritionist allows G2, and that has some sugar. So it's not definite? But it's likely.

Nice, post!

I think though, one thing that is missing, is that ketosis just means your body is burning fat for energy. So you don't need to be ultra low carb to be in ketosis. You just have to have a significant enough calorie deficient that your body has no option than to use your fat stores.

Yeah, great stuff! So it's different for some of us...I was in ketosis before surgery and am keto adapted (long term since basically 2000 with a little time off for surgeries and poor behaviors through that time).

And you make a great point about the IV fluids having sugar in them. I don't know of too many surgeons who want to risk putting you under while in deep ketosis. Maybe bariatric surgeons are different? Dunno. But my PS who did all of my breast recon work could smell it on my breath and skin and would say, that he would just give me some "juice in my iv" to bring me back into glycolosis before putting me under. He did explain why and said there weren't enough hours in his world for that risk on a daily basis with all his patients.

But I do know that I also routinely come out of the hospital 5-15lbs heavier than when I went in and part of it is optimized hydration from the ivs, extra surgical inflammation in the tissues themselves, any extra stuff they put in (like my implants which may be about 1lb each lol). Plus the crap food that seems to have sugar in everything!!! (Even though i never ate anything knowingly that had sugar -- ie reg jello, juice of any kind, reg Gatoraide, high carb protein drinks, mashed taters, VERY little mashed beans, etc.)

So I think there may be more to the hospital part than ketosis/glycolosis and water weight. I also know I had the 3 week, 6week, 3 month, and 6 month stalls. GAH!!! So hard and frustrating. LOL. And I was deep into ketosis at those times from each stage. So I just think stalls happen. Weight loss is non-linear. LOL. It just isn't. I lose, get to a new low, then bounce up and around for a few days before resuming going back to a new low...

7 minutes ago, sillykitty said:

Nice, post!

I think though, one thing that is missing, is that ketosis just means your body is burning fat for energy. So you don't need to be ultra low carb to be in ketosis. You just have to have a significant enough calorie deficient that your body has no option than to use your fat stores.

Agreed! Great point. We can get to ketosis by either carb restriction or caloric restriction!!

Oh, yeah, sorry, I definitely seemed to hand-wave away stalls as if they all have an explanation, there. Definitely, there are just normal stalls in weight loss, too. In my experience, they usually map to my body re-configuring where its inches are, but that may not be universal.

And ketosis-while-also-taking-in-carbs is definitely a thing I know less about than I should, @sillykitty -- I mean, I know it's a thing? Long distance backpackers experience it, as do bariatric patients. But I don't know anything else besides "it's a thing."

Thanks for the additional info about ketosis, too, @FluffyChix!

And thank you Cranky Magpie for this post, some information we surely can use.

Soo I confirmed at least part of my theory about all this to myself: I split a can of low-sodium Campbell's chicken noodle soup with my spouse last night (he got the solids; I got the broth) and this morning my weight is up, despite staying true to the liquid diet. Some of the noodle starches definitely get into the broth, and that appears to lead to water weight.

Even the "low sodium" broth tasted salty. ... OK, friends, I won't lie to you: it tasted like heaven. But I really don't think it was the salt, in this case.

And it had calories, but nowhere near enough to get me within shouting distance of my BMR, let alone enough for me to gain anything.

It's water weight from switching (at least partially) back to glycolysis!

I bet I'll be hungrier today than I was in previous days, too. ? Guess it's good I did that experiment with one more day of full liquids to go, instead of doing it tonight, when I'm on clear liquids all day tomorrow.

(I'm going to eat so much sugar-free jello. So much.)