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I have never been so anxious about anything. My last visit to surgeons office I was told not to lose any more wt. Like wtf?? Isn't this the whole purpose, but before my financial counselor could respond it clicked.. Oh wait... My BMI may not qualify me. Got it.. So the struggle lately has been maintaining my weight. I've done keto diet for 30 days and lost 17 lbs. I have another 80lbs to go. I'm currently at 235 and now apparently I'm 5'4 and not 5'5 anymore. ☹️ I'm a bit nervous that the insurance will have me do these classes and then I won't qualify for the surgery. Everything else had failed for me with dieting. I don't do much exercise because I'm in tons of pain from knees and hips. Forgot to mention had a total hysterectomy and not on hormone replacement which can cause early osteoporosis. I'm only 40 and about to be a "Glamma". I need the strength and prayers. Anyone have this issue at all?

Can you try to satisfy your cravings with healthier options? I've been having cauliflower mash and cauliflower risotto, just from the frozen food section, and it tastes sooo good. Or have the pasta sauce you want, but over zucchini noodles? There are a ton of recipes online for oven fried this and that. When I was doing keto (low carb) a few years ago, we used crushed pork rinds as breading for chicken fingers and it was delicious. Then bake in the oven or air fry. I know how hard it is to kick cravings though! It sucks! Sent from my SM-N976V using BariatricPal mobile app

This is probably due to ketosis. You're not taking in carbs, and so you're in keto mode -- I had HORRIBLE dry mouth during keto, and also the weirdest smell (my body, my spit, my mouth...everything smelled weirdly sweet). Once my calorie intake went up a bit, it chilled out again.

Thank you. It was early last year when I was diagnosed with this. I was starting to pick up a lot of symptoms due to obesity and multiple comorbidities. My blood pressure was at peak in 2016 175/115, heart rate was 100-110, liver function tests were in the red and indicating severe inflammation and irritation. hba1c indicated newly diagnosed and quickly progressing diabetes (peak 7.9). A few notable side effects that should worry anyone.. - Severe edema on the legs. I'd push into the middle of my legs with my thumb and it would leave a pit indentation that would last like a full minute and the skin would return to normal. This is one indication of progressing liver dysfunction, along with other things. - Darkening of skin pigmentation (acanthosis nigricans) on my neck and armpits with a velvety texture (to the touch) as a result of extremely quickly progressing diabetes and insulin in the blood (plus insulin resistance). - Extreme accumulation of fat deposits in abdominal region resulting in distention (this is far more common with males -- females tend to distribute it around other areas, but they can accumulate it the same way as men generally indicating far worsening condition) -- my stomach was 61 inches at peak last year, pant sizes were too small at 50+ - Sleep apnea. This one's pretty obvious. On the sleep study I had roughly 55 apneas per hour, normal people have 5 or less. While I started to understand these conditions, I noticed I wasn't losing weight enough. It wasn't until my extensive pre-op diet that i learned anything significant. Normally I notice people in our WM program get 2-4 week pre-op diets like people here. Because of my weight, abdominal distention, and because I'm a male and male adipose tissue tends to be a lot more solid than females, they gave me a 3 month pre-op diet. I was given Glucerna as my pre-op diet drink that went from Feb 1st to April 20th. I tried for the first week to tolerate the stuff, changing flavors, adding cinnamon, trying to dilute the taste by having broth with drinks of it. None of it worked, I couldn't have more than 2 a day. My RD (dietitian) demanded 6 a day. I told her a few days into it that I had trouble consuming these, I was regurgitating them because the taste was so terrible and no attempts to mask the taste worked for me. She freaked out to holy hell. I saw her a few days later at my surgery prep class, she was teaching it along side a bariatric RN. I told her in person that she cannot freak out like that, and if she does, I will just lie to her.. that it isn't conducive to our relationship for her to go nuts. She apologized and it seemed she understood. Fast forward a week after that, she does a follow up call, I'm still having troubles getting up to 6 Glucerna a day, but because I'm suspicious of her now I say I'm up to 4 out of 6. She freaks out again, but this time she threatens to talk to my surgeon and halt my surgery. She wants to do a follow-up call with a new case manager the following week.. I make sure to lie to this person, and to the RD when she follows up a few weeks later. But not even a week after that last convo where she threatened my surgery I immediately started researching on these forums as well as other bariatric programs what pre-op diets they use, and why. They all pretty much turn out to be a modified keto diet, so I start this a few weeks into February and continue it all the way to surgery day, losing nearly 80 pounds from the pre-op alone. In the meantime, only a month into the pre-op and a lot has drastically changed with my body. My March 1st bloodwork shows for the first time in over a year perfectly normal liver function. My hepatologist smiles for the first time ever in an appointment, she sees those results, does a Fibroscan, which reveals at least 50% improvement in my liver stiffness (stiffness is associated with advancing liver disease, normal livers are soft), sees I've lost tons of weight already, and is thrilled with my progress. Likewise, my blood workups from early March (I have a revolving 3 month diagnostic/panel) show significantly improving blood sugar (hba1c) from 7.9 to 6.3 to 5.7 (right at the stage between diabetes and pre-diabetes, except I'm taking Metformin and Forxiga at the time). Repeated fasting glucose shows perfectly normal levels at 4.4-4.6 but because of the hba1c (which is a 3 month average given the period your red blood cells carry around the sugar) being 5.7 they elect to keep me on both them. Before surgery all my medications were as follows: - 1000mg metformin (fast acting) 2 times a day (2 tablets, each one 500mg, they're huge), for diabetes - 10mg Forxiga, fast acting, also for diabetes - 10mg hydrochlorathiazide (HCTZ), first-line treatment for blood pressure, is a water pill - 75mg metoprolol 2 times a day (beta blocker, reduces HR and blood pressure) - Prevacid and generic lansoprazole, 30mg once per day, although I preferred it every other day or every third day, PPI for reducing stomach acid - Cipralex/Escitalopram, latter being the generic and Cipralex being brand name, treatment of extreme night time anxiety caused by sleep apnea ... Post-surgery the changes to my medications were: - 1000mg metformin (fast acting) 2 times a day (2 tablets, each one 500mg, they're huge), for diabetes - 10mg Forxiga, fast acting, also for diabetes (off this completely) - 10mg hydrochlorathiazide (HCTZ), first-line treatment for blood pressure, is a water pill (off this completely) - 75mg metoprolol 2 times a day (beta blocker, reduces HR and blood pressure) - Prevacid and generic lansoprazole, 30mg once per day, although I preferred it every other day or every third day, PPI for reducing stomach acid Prescribed Pantoloc (pantoprazole) 40mg for 6 months due to surgery and prior EGD/barium pre-op showing moderate reflux - Cipralex/Escitalopram, latter being the generic and Cipralex being brand name, treatment of extreme night time anxiety caused by sleep apnea Down to 4 medications as of April 20th. Regarding the symptoms: - Edema in my legs have completely disappeared. I used to not be able to see my ankles either before pre-op, now they're back to their normal bony self, and my legs are clearly defined now by my muscles again. Pushing a thumb into my leg reveals no pits. - The darkening pigmentation on armpits and neck have receded significantly and are almost completely gone, nobody but me notices them anymore. - Sleep apnea has significantly improved. This leads to promise in terms of getting off Cipralex, but the doctors asked me if I wanted off it and I said not until my apnea is 100% gone. - My first visit to a doctor post-op last week and without hydro had a RHR (resting heart rate) of 50-60, and a normal pulse of 77 (from 100-110), blood pressure was 103/81, which is an enormous improvement. I have a blood workup (ie blood sugar/liver panel) in a little over a week from now, and I think that might decide if I stay on Metformin or if I'm off it (I expect another great improvement).. likewise with metoprolol, but because my weight is still high as of today (back and forth between 265 and 266, about 100 pounds down from my weight early this year), and second number of blood pressure still being moderately high, I might still be on it for a while, will likely be off it by the end of the year. I kind of thought against this but here is a picture of my liver on surgery day (April 20th) following my pre-op diet that I already showed another member in PM when I was discharged: The white spots I want to follow up with my hepatologist on to see if thats fatty (very good news if so, means liver is very much on its way to being completely healed) or fibrosis (not terrible but would mean I've still got improvement just not as much/fast). Nonetheless all the nurses and my surgeon on surgery day who saw my liver mentioned the livers form looks great, the color is nearly normal. What matters to me now is what my hepatologist thinks. I'll prob make an appt with her tomorrow to see her sometime shortly after my blood workup.

I was on Trileptal as a mood stabilizer for a while and it worked wonders for me, and didn't add any weight. I will definitely say, that being on keto did almost as much for me as my mood meds though.

Thank you so much for the encouraging words. I think I have to let go of the comparison of people dropping 100 lbs in almost 3 months.. so it’s a little frustrating. I was thinking of going back to strict Keto

Total carbs - Fiber+ Sugar = Net Carbs... I am Type 2 Diabetic 5 years...I take my Metformin from a PEZ dispenser...I'm hoping my Sleeve August 10, will get rid of the type 2 altogether... I also plan on doing keto diet when I'm back to real food... er

Same. My dietician said to eat higher levels of protein, but other than that, watch my portion sizes and how often I eat and make sure my meals are balanced (so so many fruits and vegs aren't allowed with keto, and I'm excited to learn how to "properly" eat balanced meals again)

isnt Keto diet basically what most people go on after bariatric surgery? Basically we cant do carbs anymore so we do the healthy proteins like Chicken, Fish, eggs ect...

I love doing keto. I think it gives you more food options and you feel satisfied longer. You could lower your calories eating fish instead of steak. I eat baked fish with ghee a lot.

You might Trump my answer because I am in a stall. If cutting calories for me the next week doesn’t help, I will try cutting fat too. I love that I didn’t have to cut fat so far, but maybe that could help break the stall. I don’t do straight up keto but I do low carb.

But I think you’re onto something with Keto flu. I googled description and that sounds about right excluding cramps.

@Joann454 I started researching this today after your post and I found this article with links to other literature http://www.ketotic.org/2014/12/the-effect-of-ketogenic-diets-on.html?m=1 It may be that lower T3 while on. Keto diet is a good thing. I am still researching, but I wanted to share this with you.

Hi everyone! I had sleeve surgery in May 2013. Initially I lost about 140lbs, but then about a year and half post op I got pregnant. I gained some weight during and after pregnancy, and then lost some weight as well, and now I'm having a complication of some esophageal issues where I'm not able to swallow correctly. I have an appointment with a really great surgeon at an exceptional hospital in the Chicago area. I will have my first visit with them in April. I was hospitalized in January for Fluid build up and severe infection of my right lung. This was caused by aspirating food and fluid due to my esophageal problem. They did an esophogram and upper GI while I was in the hospital, and the gastroenterologist who was treating me in the hospital informed me that my sleeve had stretched, my stomach was nearly the size of a normal stomach. Additionally, the lower part of my esophagus where it connects to the stomach is dilated, as if my lower esophagus has been acting as a food pouch for quite some time. I was really shocked by this, as I had no issues post op from my sleeve and only stopped losing weight when I became pregnant, which I figured was to be expected. But since I had my baby in May 2015, I have struggled to lose anything. I was doing a keto diet at the end of last year and that was working, until I got sick in January. Now that my esophageal issues have been diagnosed, I have trouble eating anything solid. My weight has maintained since I was admitted in January but I haven't had any significant loss since then. Long story short, my primary focus is to get my esophagus issues figured out and fixed, but they referred me to two different docs - one that specializes in swallowing disorders, and the other is a GI/bariatric surgeon to address my stretched pouch. Since I'll likely need surgery to fix my esophagus, it would make sense to do any revision to my sleeve at the same time. I feel like I have 2 options (maybe 3) to discuss with regard to fixing the sleeve. Either re-sleeve, DS, or revise to gastric bypass. I should note that my highest weight was around 460, so even when I was at my lowest weight before getting pregnant, I was still at 306ish. I'm currently around 340-345 putting my BMI around 48. When I first started thinking of going the surgical route for WLS, something about the gastric bypass didn't appeal to me. So now I am struggling with if I should re-sleeve or go for the DS. I'm thinking since I still have so much to lose, the DS might be a better choice, but I honestly don't know enough about it to make a decision. I've read the limited info I could find about DS, I realize it's not a particularly popular surgical choice, but I want to hear from people who've had it, possibly people who had it after having a sleeve. I'd love to hear your stories and thoughts on the DS!

@TheRealSergio I felt pretty overwhelmed by the idea of being dependent on drinks/powders and not having room for anything but protein when I was your stage post-op. I'm currently 8 months out. I assure you it got easier once I was released to full foods and was able to experiment more. My husband is diabetic and decided to clean up his eating to accomodate my dietary needs as well. We've had to figure out the best ways to make the main portion of our dishes as high in protein as possible, and that has meant experimenting with spices, rubs, etc. It has been fun. I regularly hit keto, paleo, and bariatric foodie sites and message boards to explore my options. I do eat vegetables, just not very large portions, but try to combine them with a protein rich item. I don't eat bread by choice as I am one of the unfortunate sleevers who has dumping syndrome. I don't miss it and even at 8 months out, I am amazed at what I don't miss and how much my tastes have changed. There are days that I don't meet my protein goal, but I just try to do better then next day. I have had a ready to drink shake here and there while traveling as it was the most convenient and healthier option at the convenience store. Congratulations on your weight loss. I hope you'll be able to find something that works for you. Best wishes to you.

I had a headache for a week after starting my pre-op diet. It was hard to get through but finally stopped. I was dizzy too and just out of it overall. I had numerous people tell me it was carb withdrawal. I did a bunch of research and there is all sorts of info online about it. Some names of it are ‘ keto flu’ and ‘ carb withdrawal’. I am 7 days into my month long pre-op and my biggest problem is that i am soooo hungry. It is making me soooo nervous that if I have this surgery and am still hungry I don’t know how I will do it! I need some advice for sure.

I follow a Keto/LCHF plan too so I keep carbs to under 20g. According to some of the books I've perused (The Obesity Code, Good Calories-Bad Calories, etc), protein also raises insulin, just not to the same extent as carbs. My protein intake is around 50-60 g, which is on the low end of what WLS dieticians recommend. I realize that most forum members eat much more protein than that with excellent results so I might not be the best example to follow.

Even if you were gaining muscle weight, you would notice a change in the way your clothes fit. When my nutritionist told me to eat carbs pre-op, my Keto mind screamed no. I did it though and lost weight. But I highly limited them. If you are not tracking on an app like Bariastic. you can easily consume way more carbs or calories than what you need. Some people can drink their calories for the day before ever eating any food. I would limit those carbs and be mindful of how much you are eating in a day. I know before surgery, I told everyone I didn't eat that much till I started tracking my food intake and was shocked to find out I was overeating. Also..not sure what surgery you had but my doc told me of a sleeve patient/friend of hers that did everything right and lost only 30 pounds within the first year. She ended up putting her on Ozempic to help. So there are some people who simply don't respond as well to the surgery based on age, meds etc. But before going that route, I would examine the food intake amounts first. Good luck!!!

I just google to find recipes. Here are some of the sites I like. http://www.ibreatheimhungry.com/ https://www.ruled.me/keto-recipes/ https://www.dietdoctor.com/low-carb/recipes/best-keto-recipes I also found that many of my normal recipes worked with minor substitutions. e.g Use zucchini noodles instead of pasta, choose higher fat beef, add cheese / butter.

I had my op 5 years ago and have regained more pounds than I expected  and feel very down, which makes me eat emotionally! Never a good thing! Well I have just decided to lose the pounds and have started eating low carb and started listening to podcasts all about weight loss, Keto and healthy ways , I find it really helps listening to 1 podcast a day to help keep me focused and motivated!

So I'm 2 years out from gastric sleeve surgery. Last year I started eating carbs again and got way off track. I posted about this back at the end of December and I'm still trying to work the kinks out, since I have been on-and-off doing well with getting back into the healthy lifestyle that I LIVED BY before reintroducing carbs. I know that I can do it I've just been having trouble keeping myself from falling back into old habits. I've recently noticed that I almost always get sick when I drink/eat anything dairy-based AND sweetened. Whether the sweetener is artificial (no sugar added hot chocolate or protein shakes) or real (like one serving of ice cream on a cheat day). I get the sweats, that feeling of shakiness or general unease, and finally unignorable nausea until I just have to just run to the bathroom and give up. This is not something I've ALWAYS suffered from. Especially with the protein shakes since I drank them regularly for at least the first six moths or so. I think this happens more often with powdered protein mixes than it does with the pre-made premier protein shakes though, for whatever that's worth. I keep telling myself it may because I just drink it too fast, but I am not so sure anymore. I have almost a full case of premiere protein (which I think I'll TRY keep and just drink verrrry slowly) and a brand new container of EAS Lean 15 protein powder. Not sure I'll ever be able to finish that if every time I make a shake I get sick. At this point, I'm just ready to give up on protein supplements period. I am trying to maintain a high fat/protein and low carb diet (basically keto, but modified for WLS and my protein requirements) so I definitely feel like I get enough protein anyway without the supplements. I don't know. I'm really just writing this because I'm curious if anyone else has experienced the same thing.

My Foods were: Chicken - I could not wait to have baked chicken that was not in broth. Tomatoes - I did not like tomatoes before surgery and then all of a sudden, I was craving them. Pears - I love pears Corn - I do not know why but I wanted corn on a cob with some butter. Watermelon - I love them but the seeds were a no go. I did not have watermelon until I was about 3 - 4 months out. Turkey - I missed having a turkey sandwich Less Healthy: Pork Bacon and Red Meat. I have not been one for bacon and red meat in general but after surgery, I wanted it like crazy. I got my fill when I tried Keto and now I am back to barely eating it.

Thank you so much for your response. So I did the 6 month process last year and did great. Lost like 40-50lbs and did everything right. Was given a surgery date and didn't follow through. Because of the weight I lost on my own I thought I could do it on my own and didn't want to take the risk at surgery. Well over the last year I gained 15 or so of those pounds back and realized I cant do it all on my own, no matter how good I was eating. So i jumped back on the train to surgery. This go round though i dont know if it's the fear I won't go through again if I lose the weight or that I'm so positive about the surgery I'm scared of not getting to eat the stuff I do now that I'm having a food funeral. I know that I already have a fatty liver so that does scare me and I do want to be in the best shape before surgery. I see a counselor and all though I wanted to keep my surgery somewhat of a secret I think I will talk to her. I'm suppose to be doing the south beach diet. Which for the last year I have been on a diet that has been some what the same as the keto diet, but sense starting back up with the surgery all the progress I made with that diet has gone out the window Sent from my SM-G960U using BariatricPal mobile app

Take a look at the Mayo Clinic Diet. It's based on the Mediterranean diet....which is the diet eaten by the people who have the best longevity in the world...lowest heart disease and cancer rates, too. I have never felt better in my life or enjoyed my diet more....than when I started eating the Mayo Clinic Diet. (have been on it since June of last year) My nutritionist is fully supportive of my continuing this diet. I have no problem hitting my 60+ g of protein goal, and I keep my calories between 1000-1200 a day. Some nutritionists will really push keto after bariatric surgery....but my office serves a population of people from all over the world...many vegans, some following very different cultural eating habits...so they're more open to different paths up the mountain so to speak:) Best wishes to you on your journey.

I was doing a Keto like diet (was not hitting the fat goals) then I went on vacation and it was shot to hell So I'm doing a low carb plan but nothing like before. I didn't notice any gained weight as a result of the switch however I am in the early months of post surgery my body seems to enjoy the fruits and vegetables more than the proteins (I was a vegetarian prior to surgery anyways) but I'm still being careful to keep rice bread and the likes out of my diet.