I count everything. I was diagnosed with congestive heart failure in 2022 and was put on a sodium restriction. Just two months before my projected VSG surgery date my A1C was 9.6% and I was put on diabetic meds(Metformin and Semaglutide), given a blood sugar meter with instructions to check my blood sugar twice daily, and told to cut out all sugars in my diet. Around the same time as my Type-2 Diabetes diagnosis my Bariatric Surgeon had me go on a Keto/Atkins very low carb diet prior to the liver shrinking diet due to my extremely high 71.5 BMI.
That was my first time on a 'low carb' diet since I tried South Beach in 2004, and I really liked it for how it made me feel and how much easier it has become to find low-carb substitutions for common foods. So I decided to stick with it post-surgery. I am two weeks out from my surgery and I am at the point where I can eat 800-1000 calories a day, where 50% is from protein, 40% fat, 10% Net Carb, and sodium between 1,500mg and 2,000mg. I track my Daily Food Intake in an Excel Spreadsheet, listing Calories, Total Fat, Protein, Net Carbs, Fiber, and Sodium of each. I also track my fluids, noting if the beverage has any sodium. I avoid sugars like the Plague, except when it comes to fruits. I will on occasion eat fresh strawberries, raspberries, or some honeydew melon.
I don't feel the Keto diet is suitable for Post-op due to the high reliance on Fats. I like a more even distribution favoring protein over fat, but still keeping enough healthy fats in my system so entering Ketosis is a possibility. My carbs are always under 25g a day, most of the time between 15g and 20g. I was only in Ketosis once for a brief few days, and it was right after surgery. I check my ketone level regularly with those over the counter 'pee' strips.
I like my method of tracking my nutrition manually instead of using an App or Website, although there is a lot more work looking up nutritional labels for everything I eat, or general nutritional information for those items without labels. The plus side of it is I am amassing a database of my frequently eaten food items so logging is becoming easier.
I agree with the general consensus that 'Diet' is an ill-fitting word for what we are doing. I like the term 'Lifestyle Change' much better. A diet, to me, is finite in its duration. It has a beginning and an end. A Lifestyle Change goes on indefinitely.