I went to one bariatric surgeon who said I'd have to go on the keto diet after surgery. I'm a vegetarian, and I have no desire to go on a diet that doesn't allow beans, complex carb grains, and minimally sweetened yogurt (the kind recommended by bariatric surgeons).

If I tell another surgeon that I will not go on a keto diet after surgery, are they likely to deny my surgery?

Not all programs are alike. I’d suggest looking for a program/doctor who has a flexible nutrition plan that’s more inline with your eating plan.

My program takes a balanced approach and there really aren’t foods I can’t have - but I can’t have them all at every stage.

I am allowed beans, complex carbs and minimally sweetened yogurts. So check around with different programs to see who might be a better fit for you.

It might be helpful to remember what a true keto diet is vs. what diet culture makes it out to be. A TRUE keto diet simply means eating few enough carbohydrates that your body enters ketosis where it is no longer using glucose as its primary fuel source. It is NOT inherently a high fat, meat only diet. That is what diet culture has turned it into. There are lots of vegetarians who follow a healthy, whole foods based ketogenic diet. Additionally, the amount of carbs that allow ketosis will vary WIDELY from person to person so unless you are testing regularly, you won't really even know if you are truly in ketosis or not.

Now, that being said, most surgeons will say that WLS patients eat a keto diet simply because your primary focus will be protein and your intake will be so low that by virtue of the volume and type of foods you'll be eating you'll be in ketosis. Immediately post-op, you won't be able to eat enough beans (or anything else for that matter) to get in your full protein requirement, let alone extra grains & veggies on top. That is not, however, a requirement (generally speaking) nor is it permanent. Over time, as you're able to eat more food and a wider variety, you'll very likely see your carbohydrate intake increase.

I would say, it may be helpful to revisit the conversation with the surgeon and/or dietitian to ensure they understand your needs as a vegetarian and that they are able to support you and tailor the post-op diet to your needs. If they can't or won't then it may be helpful to consult with another surgeon. Ultimately, being HEALTHY post-op is the primary concern and that requires eating a metric crap ton of protein. Can you do that as a vegetarian? Absolutely! But it will require extra support and possibly some creativity and flexibility on your part. Best of luck to you!

I would talk to other surgeons. My surgeon is a major vegetable and fruit fan. As soon as I could fit it in my diet, his goal for me was 7 to 14 servings of vegetable/fruits a day. "No matter what. Just make it happen." It is great for weight loss and health.

He isn't specific about the type of protein, just as long as I get 65 to 100g a day.

2 hours ago, imaginegirl said:

I went to one bariatric surgeon who said I'd have to go on the Keto diet after surgery. I'm a vegetarian, and I have no desire to go on a diet that doesn't allow Beans, complex carb grains, and minimally sweetened yogurt (the kind recommended by bariatric surgeons).

If I tell another surgeon that I will not go on a keto diet after surgery, are they likely to deny my surgery?

i have two options - 50 total carbs a day or meal replacement shakes and one small meal a day.

talk to your nutritional consultant to have a vegetarian preop diet to shrink your liver.

16 minutes ago, KimA-GA said:

i have two options - 50 total carbs a day or Meal Replacement shakes and one small meal a day.

talk to your nutritional consultant to have a vegetarian preop diet to shrink your liver.

Her issue isn't with the pre-op diet. It's with the post-op program.

I would explain to them what parts do not work with your current diet and see if there is any flexibility. If not, I would smile and nod to get out of there but see a different surgeon to see if they have a more diverse plan.

May I add a suggestion that you just call around and ask if you can pick up a copy of the post op diet rather than making appointments and going there just to see if that part works. They may not agree to give it to you but if you explain why they may?? Just a thought.

Have a look at Dr Matthew Weiner’s Pound of Cure book & his you tube videos. He’s a bariatric surgeon who supports a low animal protein diet. It may not be anything all that new but may make you more comfortable about how to manage your weight loss post surgery.

A good dietician should help you devise a way of eating that is best for you, your health requirements & your eating preferences. The biggest ficus post surgery is your prirein intake (& fluids) but I’ve never heard anyone say they were restricted to getting their protein only from animal sources. Plenty of plant based protein shakes & powders, yoghurts, milk, etc. as you know you can eat to meet the goals you’ll be given.

Initially after the surgery you will be on a staged return to eating diet. This is support your healing tummy & not put undue stress on your digestive system. There are some foods we’re not advised to eat during this period. But again a good dietician should be able to advise you of alternatives. Mind you many have refried beans on their list of recommended foods during the staged return to eating stages.

While I was on keto for my pre surgery diet, I was not encouraged to follow it long term by my dietician: good for kickstarting a diet but not long term she advised. I had my own doubts about it so I was glad. Many of us use the weight loss stage to devise a way of eating that best suits our needs & preferences & don’t follow any specific ‘diet’. I mean if there was a diet that worked for everyone none of us would have been obese & needed surgery. Personally I’m a low fat, low carb (2 serves of whole/multigrain carbs a day), low sugar & high protein (absorption issue).

Many vegetarians successfully have surgery so your eating preferences should not be a deterrent to you either once you find a supportive surgeon & dietician.

Most any sensible diet works post op and can be adapted for the immediate post op transition period as well. Vegetarian/vegan is tricky for a while because of the low protein density of most foods and the small amount that can be consumed for a while, but there are some veg protein drinks out there that can be used.

Does this surgeon have an RD associated with the practice? They would be the most helpful in tailoring a diet for your needs - most understand that for a diet to be successful, it has to work for the individual. Some surgeons will jump on the latest fad diet, like keto, as a way of "tailoring" their program to the greatest number of potential patients while keeping it "one size fits all".

When I went through this, there was a clique of patients on these forums who were all gaga about their surgeon because he was a strict low carb fan and they were all hooked on the low carb fad and many chose him specifically for his diet (Keto wasn't a thing then, more classic Atkins was the then current fad). A great marketing tool for the surgeon, and an OK diet for many patients, but hardly a necessity.

Our program was quite flexible, aiming mostly to get maximum tolerance while keeping to the protein levels and textures required early on, Right out of the hospital we could have eggs, oatmeal, cream of wheat, sloppy mashed potatoes, refried beans, yogurt, etc. and it was quite successful for most everyone. So no need to get into any of those fad diets, or put up with docs who do.

It's good to hear that my diet will be flexible. The surgeon I'm thinking about does have a dietician, so I can talk to them about it. They're more informed than a surgeon about food choices anyway.

Thanks to everyone for your feedback!

Check out Heavenly fan on youtube. She is vegan based keto.

Should have also mentioned a consideration is that losing weight is pretty hard on the liver. Plus as we lose weight cholesterol is released into your blood stream from your fat. It is quite common to have poor liver function results & to see your cholesterol levels rise while you are losing weight. (It settles again once your weight settles.) A high fat diet would put even more stress on your liver & increase your cholesterol levels further. Just something to consider & discuss with your surgeon & dietician.

When I was in nursing school in the late 90s, during my pediatric clinicals, I took care of a baby that had hundreds of seizures a day, and they put her on the keto diet to try to help. THAT'S what the keto diet was originally for, but some fad to lose weight. I wouldn't go to any surgeon who recommended ANY type of strict diet to me that left out whole food groups. Now, my surgeon did recommended very low carbs at first, but gradually adding them in. It is a very balanced approach and no food is completely off limits, in moderation, of course. I eat mostly vegetarian so that was important to me. Now, I am not a complete vegetarian and I was willing to eat some chicken and fish to get more protein after my surgery.
Anyway. All surgeons are different. If you're not happy with their plan, find another doctor who is more aligned with the way you want to eat. This has to be permanent lifestyle change, and to be successful it's important to find something you can stick with long term.
Some of my family does keto and it's always all or nothing with them. One minute they're totally strict, the next minute they're living on processed carbs.. It's a total diet mentality which I don't believe in.
I don't want to get on my soapbox here. Just wanted to tell you that not all surgeons are gonna say you have to do keto.

And also, it's one thing if they recommend it in the early stages when you can't eat much. I'm just saying long term.

On 8/23/2022 at 2:36 PM, imaginegirl said:

I went to one bariatric surgeon who said I'd have to go on the Keto diet after surgery. I'm a vegetarian, and I have no desire to go on a diet that doesn't allow Beans, complex carb grains, and minimally sweetened yogurt (the kind recommended by bariatric surgeons).

If I tell another surgeon that I will not go on a keto diet after surgery, are they likely to deny my surgery?

I did not have to do Keto. you just need to get good protein, which is not a problem since you can get plant based protein powders.