Hey there! I was wondering if I could get some feedback from individuals who have combined bariatric surgery with the ketogenic diet, and what your progress has been with it. Specifically wondering if you've seen it maximize your weight loss.

Always a good idea to get feedback from others.

I was put on keto for the 2.5 weeks before surgery but that was all I did. Some will likely swear by it but personally I wouldn’t go back to it. Good to kick start a diet but not long term. Your surgery is the best kickstart you’ll ever find. The high fat intake on keto is the real issue for me. I’ve never enjoyed high fat foods & now I don’t have a gall bladder to help process all that fat.

You may find your cholesterol temporarily increases while you are losing (it’s released from your fat). I believe it’s one of the reasons most surgeons & dieticians recommend low fat while you’re losing so you’re not adding to the risk. Losing large amounts of weight & high cholesterol levels also put you had a higher risk of developing gall stones. It’s why many of us end up having issues & have our galls removed post weight loss surgery. I’ve read keto can also screw with your blood sugar levels so if you have issues with diabetes it may not be your best option.

Usually best to stick to your surgeon’s plan & dietician’s recommendations while you are losing. Slowing adding in new foods as you go. You’ll lose doing that & you will go into ketosis as well - bad breath & a smelly body awaits you ?.

You may find you end up developing your own eating plan which works for you & which incorporates aspects of many eating styles once you’re close to or in maintenance: keto, vegan, vegetarian, Atkins, intermittent fasting, etc. Whatever way you go it has to be sustainable & complement how to want to live your life.

Good luck whatever you choose to do.

I also was told to eat low fat after surgery, although I've found that higher fat foods keep me a bit fuller longer (I've had a lot of hunger, which isn't common). I didn't realize that was putting me at higher risk of gallbladder issues, but I don't know what else to do. I'm trying to maximize low fat protein, but while also eating low carb, there's not much in the way of flavor options. Plus, due to my job involving lots of travel, I eat out a lot, and I know eating out involves higher fat foods.

I'm curious to see what answers you get from people who've tried keto.

I had RNY, not sleeve, but I find too much fat at one time makes me nauseous. My husband eats keto and I literally make two meals (when I cook), because I eat carbs and can’t tolerate the high fat in his food. The post op diet is usually pretty much a high protein, reduced carb, low/reduced fat diet, which worked well for me. In maintenance, I eat more carbs.

the first few weeks/months you should follow your clinic's food plan. I do know people who've done keto once they're a few months out, though (or in maintenance - if they're dealing with a few lbs of regain).

My nutritionist said no to keto. Honestly, my doc's office is about eating balanced with a focus on plant-based - more Mediterranean than anything else. I don't know if Keto is good for the long-term. I do use a lot of Keto recipes because then I can add in my own healthy carbs in a controlled manner, but I try to modify the recipes so they're not so high fat.

I did a keto-ish diet pre-op and low carb off and on for years. Obviously they weren’t the answer for me as I did have VSG! I wanted to stop fearing carbs and have a more balanced diet. At almost 8 mo out, I have found that I can’t tolerate the higher fat foods as well. They make me feel nauseous. I do ok with butter, cream and full fat cheese so in weighed and measured amounts I still have those.

DISCLAIMER: The following is what *I* did based on my own research and trial end error on how things affected *MY* body. I am NOT advocating to NOT listen to your team without educating yourself.

With that said:

Edited to add: I didn't realize this post would be so long, sorry!

My program was to consume pre-defined "portions": each meal was supposed to consist of 25% protein, 25% starch and 50% non-starchy vegetables, and to work my way up to 1200 calories per day total with a min 60-70g protein. They also said to avoid added sugar. The didn't specifically mention to go low fat, but I mean if I followed the guidelines listed above, it would naturally be low-ish fat.

Needless to say, I didn't do that. First, I couldn't get that amount of food in, Second, I tried it out, saw a swoosh in weight, and figured that going low-carb was very effective in weight loss for ME. I kept losing weight, so I just kept doing it. Why fix what ain't broke, right? More on this later...

So for the majority of my weight loss phase I went ultra-low carb...was averaging less than 20 NET g of carbohydrates per day (i don't count fibre nor sugar alcohols), aimed to reach 60g protein per day, and let the fat fall where it may. My cals were about 300-400 in the first couple months, and by the time I reached goal, I was at about 800 (yes, I know this is on the low end compared to most, but it worked for ME). P.S. I feel the need to add that my nutritionist was made aware of what I was doing. And while she tut-tutted me about it, she didn't overly object. Also, all my labs came back satisfactorily during this period (and still does), and my surgeon was pleased.

***WARNING, MATH TIME...***

Given the total calories I was achieving, I wasn't truly doing KETO proper, as my fat consumption did not reach the levels required for my protein intake. True KETO is 70-80% fat, 10-20% protein & 5-10% carbs. Since I was doing 60g of protein, I would have needed to do ~75g of fat, which would have put me in the 1100 cal range...and I wasn't even coming close to that level.

****

So really, I was probably doing more a version of Atkins Phase 1 (ultra-low carb).

Now that I'm 3 years out, I am no longer so strict about my macros. I still *kinda* limit carbs, but not really. I eat bread on occasion, and sugar pretty regularly (in small amounts)...but i very rarely eat pasta or rice. I think its just habit now?

Looking back, here is my take/opinion on going this route:

• TRUE Keto is very difficult to achieve in weight loss phase while keeping cals low.
• There is a relatively big drop in weight in the beginning of each period of going low carb. There is a bunch of science to explain this, you can google it.
• Going low carb makes a difference in how my face and body looks. While it looks good on my body, cuz you can see more muscle definition, its not so great on my face cuz I look gaunt.
• I've come to the conclusion that FOR ME, in terms of weight loss/maintenance ONLY, the ingestion of carbs has much, much less impact (if any) than calories consumed. It doesn't seem to matter if 1000 calories is made up 5% carbs or 50% carbs, I'll lose weight on it either way.

Good Luck! ❤️

Edited October 26, 20214 yr by ms.sss

16 hours ago, deardarkling said:

Hey there! I was wondering if I could get some feedback from individuals who have combined bariatric surgery with the ketogenic diet, and what your progress has been with it. Specifically wondering if you've seen it maximize your weight loss.

I did keto for a good bit of my weight loss period (with the full support of my Surgeon). His plan was low-carb anyway, so he didn't mind when I took it to keto levels.

I definitely wouldn’t recommend it for at least 6 months after surgery or more. The higher fat content generally won’t be tolerated as well and you’re putting yourself at a much higher risk for gallstones. Just doing lower carb is definitely effective after surgery since your cals are so low to begin with. It’s also hard to fit in certain nutrients because of the calorie restriction combined with the diet restrictions on keto.

My surgeon's plan was very low-carb but also low-fat. It wasn't working for me, and my weight loss slowed and then stalled. My new NUT and I put together a plan that was a little higher in carbs, and it worked—apparently my body needs carbs to prepare for working in the beet fields of the gulag or whatever. Added in about 100 calories of carbs a day (that's 25g, math people) and the weight loss resumed its 3-4 lbs. a week swoosh.

Every body is different.