This is really for sleeves who are far enough out that are eating actual meals.... have you ever tried the keto diet? Good? Bad?

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No - I followed a very strict no-fad-diet regimen (and still do) so I concentrated on developing/maintaining healthy and sustainable dietary habits for the long term rather than short term miracle diets that fail after a few months. Skipping major food groups and the nutrition that they provide doesn't do it. Besides, keto wasn't a "thing" when I got started.

While losing, I just concentrated on getting my requisite protein, and then getting the best nutritional bang for the buck with the remaining calories in my allotment, be it from fats, carbohydrates or whatever.

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 had my sleeve May 2013. I still have restriction, but have not been successful in losing all the weight I wanted to. I had the sleeve surgery in order to reduce the amount of insulin I was taking, and to be healthier, not thinner. At least, that's what I told myself. I did reduce insulin from U500 to U100, via pump, and my bp evened out. However, I am about to have bypass surgery, in order to get skinny and live healthier for the next 40 years! I realize nothing will change though, unless I change my habits for the better.

My dear friend has been in every diet out there, but has had the most luck with Keto. She even just had all-over body plastic surgery to remove her excess skin. She says shes had the most energy in her life, and can think so much more clearly than ever before. For her, it's her new way of life.

Yes, keto has been around for a long time, as has most of the popular diets that have gone in and out of fashion - there really isn't all that many things that can be done in a weight loss diet that hasn't been tried before and found wanting, often multiple times. Keto has some apparent benefit in the treatment of epilepsy but beyond that it is fundamentally just a fail safe or backup mode for our bodies in time of famine - we can get by but the body really doesn't like it (that's why if provides you with the bad breath and BO, telling you that this really isn't a great idea....)

Over the short to intermediate term, it can work well - as most diets do - but in the longer term for the morbidly obese, beyond a year or so, it shows the same 95+% failure rate as any other diet effort (though WLS tends to extend that years' grace period some.) Indeed, if you go back 20-30 years in the WLS world, many were often told to simply eat as they did before, but just less (courtesy of their WLS) and it overall worked well for the first year or so, but obviously since they never learned to eat sustainably and correct the habits that caused them to need WLS in the first place, they typically regained. So, from a strictly weightloss perspective (as opposed to longer term weight control), almost any diet will work with your WLS for the first year or so. What really counts is how well you adapt to a sustainable weight maintenance life in the long term. If keto works for you to do that - great; if going vegetarian or vegan does it, that is also great. Balanced diet, South Beach, Zone, Atkins, low fat, Mediterranean or whatever - go for it, and don't worry about what others do because if it doesn't make sense to you, then is isn't right for you.

Clinically, high fat, low carb diets such as keto or paleo (or at least the current commercial interpretation of paleo) are used for minimizing or avoiding weight loss after a gastrectomy (such as when done for cancer or gastroparesis) owing to its high caloric density - one needs lots of calories in a small volume to maintain weight, which is just what such diets provide. This isn't to say that they can't be used for losing weight, but the odds are more stacked against one in doing so, and one needs to be aware that just because a food or recipe is labelled as keto (or paleo, vegetarian, vegan, etc.) doesn't mean that it is appropriate for weight loss or contol - one still needs to watch what one eats.

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. [emoji4] 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.

Wow!!! Thank you for such a detailed explanation, I really appreciate it! I am only two weeks out from surgery so I still have a loooong way to go before I start my normal meal plan.

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Yes, keto has been around for a long time, as has most of the popular diets that have gone in and out of fashion - there really isn't all that many things that can be done in a weight loss diet that hasn't been tried before and found wanting, often multiple times. Keto has some apparent benefit in the treatment of epilepsy but beyond that it is fundamentally just a fail safe or backup mode for our bodies in time of famine - we can get by but the body really doesn't like it (that's why if provides you with the bad breath and BO, telling you that this really isn't a great idea....)
Over the short to intermediate term, it can work well - as most diets do - but in the longer term for the morbidly obese, beyond a year or so, it shows the same 95+% failure rate as any other diet effort (though WLS tends to extend that years' grace period some.) Indeed, if you go back 20-30 years in the WLS world, many were often told to simply eat as they did before, but just less (courtesy of their WLS) and it overall worked well for the first year or so, but obviously since they never learned to eat sustainably and correct the habits that caused them to need WLS in the first place, they typically regained. So, from a strictly weightloss perspective (as opposed to longer term weight control), almost any diet will work with your WLS for the first year or so. What really counts is how well you adapt to a sustainable weight maintenance life in the long term. If keto works for you to do that - great; if going vegetarian or vegan does it, that is also great. Balanced diet, South Beach, Zone, Atkins, low fat, Mediterranean or whatever - go for it, and don't worry about what others do because if it doesn't make sense to you, then is isn't right for you.
Clinically, high fat, low carb diets such as keto or paleo (or at least the current commercial interpretation of paleo) are used for minimizing or avoiding weight loss after a gastrectomy (such as when done for cancer or gastroparesis) owing to its high caloric density - one needs lots of calories in a small volume to maintain weight, which is just what such diets provide. This isn't to say that they can't be used for losing weight, but the odds are more stacked against one in doing so, and one needs to be aware that just because a food or recipe is labelled as keto (or paleo, vegetarian, vegan, etc.) doesn't mean that it is appropriate for weight loss or contol - one still needs to watch what one eats.

Thanks for the response. I agree with most of your comments. Keto definitely is not for everyone. Although Keto does not require calorie counting, it also isn't a license to ear as much as you want as long as it's on the diet. I track my calories daily and stay at or below 1500 a day at this point. I will eventually go up closer to 2000, but this is working for now and I am only 14 weeks post-OP. I will sit down with my nutritionist in three months after I have my next round of bloodwork to see if I need to make any changes.

I will say one thing that should apply to any health diet---stay away from commercial, processed foods and beverages. Don't eat anything that l, when you look at the ingredients, sounds like it was invented in a lab. Stay away from simple carbs and sugar. We don't need them. You can't go wrong with a whole foods diet, with or without keto.

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Wow!!! Thank you for such a detailed explanation, I really appreciate it! I am only two weeks out from surgery so I still have a loooong way to go before I start my normal meal plan.

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It's not that long. My doc had me eating solids in 4 weeks. I still follow all my doctor's instructions, but I choose to eat keto foods and skip the carbs. That said, my macros are not really keto because I am 45 percent of my calories come from protein. That's way too high for keto. I am more of an extreme low carb diet if I want to get technical. I am not consuming enough calories for a true therapeutic keto diet nor can I do intermittent fasting. However, my blood glucose levels are very stable now. I am never over 120 even after eating. I am generally under 100. My BP is normal. If I ever see adverse effects on my health, I would change my diet. So far so good though!

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