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Pretty well. It stayed down, so that's good! I started with cream of wheat; it was OK. Then I tried a tuna pouch pureed with a bit of fat-free mayo and some pickle juice. It was yummy but I could only handle about ¾ of a tablespoon. Next up was fat-free, lactose-free yogurt (Siggi's brand); it was the easiest by far. I ate a whole tablespoon. All of the above made me feel full. I had to cut my protein shakes down to 4 oz. from 8 oz. I find that broth (fat-free, low sodium) gives me a fuller feeling than water and is easier for my stomach to handle than water (not sure why). I am struggling to get enough water/clear liquids in a day. My doc says 48-64 oz. but I've managed at best only 32 oz. in one day. Today (Day 4) is going a bit better so I'm hopeful I get in at least 48 oz.

Calling Dr. Bombay! Calling Dr. Bombay!! @GreenTealael Ok, so you little trickster. How DARE you! How DARRRREEEEEEEE you to get me jacked on cocaine matcha lemon bubble pudding (chia seed pudding)!!! One hit. One hit. That's ALL it took! *sob* In less than 24 hours, I've had 3 tbsp of chia seeds and 1 cup of Silk cashew milk along with the matcha, vanilla, and lemon stevia (plus a few walnuts and frozen blueberries and a little Grk yogurt mixed in). Three (mini meals) desserts...THREE!!! HOLY HOTNESS! HOLY Jehoshaphat Jerusalem! Where's my Wailing Wall now? Where's my Moses now? My chia seed package says 8g carb and 8g fiber for essentially a zero carb experience of nervana. Can this possibly be real? Is this gonna be a colon blow 2000 experience? And more importantly...can I have "tapioca" chia pudding tonight (aka vanilla) after having 3tbsp in <24 hours? And which nut milk is best? Almond milk or cashew milk? Which is thicker and less gritty? Which has better nutrients? And is the unsweetened vanilla version of these nut milks CRAP cuz of ingredients? I need so much. help. SO. MUCH!!!!! kthnxbyecomequickly...

Well before surgery It was Food, Food, got to find my food, got to eat quick before someone else finds it and takes it away! I am an "only,child" but I acted like I hadv6 starving little brothers. Could eat an entire Family-sized bag of Lays Barbeque Chips at one sitting, watching TV, and not even feel like I had eaten. Now, if I feel hungry and that seldom happens, I heat,up,a 1/4 cup,of something, maybe I finish it, but usually don't. Very cautious what I eat, had too much emesis time. I still rely,on soups , broths, protein shakes, stir protein powder, beneficent or Miralax into everything I can for enrichment, Precious pouch, my bossy co-pilot,,, now through. my life, does not trust,protein sources, refuses to consider,meat, cottage cheese, Greek Yogurt, although,i,may try that again, been a month since last attempt. And what she doesn't care for just spews forth. And I dont,vomit like I did when I was "intact", now it sounds more like a cat with a large hairball. Some people say, that their full signal is hiccups, not me, for me it's Emesis coming within 15-20 minutes. Often you can find me curled into a semi-fetal ball over a wastebasket or Washburn. The blessing, if there is one? Good stays down such a short time, it is undigested and has no objectionable odor. Oh,i do manage to,ingest my vitamins, minerals and Zofran still,drink,out of my 2 ounce cuppies, a couple times when I tried to free-style with a normal juice glass? Up she comes because even fluid can choke me . And I was not a habitual vomiter prior to surgery, oh,if I bent at the waist, I could reflexively urp up but I thought my cardiac valve between my esophagus and stomach was weak from GERD. v So I am praying my blood vitamin levels are good, haven't been checked since late Feb/early March, had to,have an Iron INFUSION then. Should be about due for a repeat, but,nobody has ordered one, not my,PCP , not my Bariatric clinic, if the last N.P . is any indication, they are not overly worried or caring for me. Now I had always had an excellent relationship but the last time I spoke to one, she accused me of being a malingerer or Munchausen syndrome, I called only because I had been sick for 18 hours, having trouble even keeping fluids down. And my personality is not bulimic or even similar. Not scheduled for a clinic visit until August, having feeling this person just don't care. Meanwhile I am still losing 3-5 pounds a week,rare for 9 months out, but I guess I can accept,it. Do I grieve food? Not a bit, few times I come close, I just say That Was A Past Life, nothing significant now!. But perhaps I am an outlier, an exception to the Average person. I don't read the threads with pictures of "Look What I Just made and Ate", part of me,just can't relate to,it, the rest a little jealous that they can handle all that! My emotions were pretty settled, resigned to That's the Way,its got to be. Even close to happy, until that little bundle of Nurse-flesh unloaded on me, oh I do remember her name, if she crosses my,path in August, she will regret it, it will be Her Turn to Cry! I might try to forgive, but I do not forget and I am a natural red-head, and the Celtic were warriors, something she may not have taken,into account! But anything I can help with, I will be honored to do so.

Prior to my surgery, I had to attend one general informational session, one support group, one psychological assessment, got clearances from a heart doctor, a pulmonologist, and my PCP, and attended a 3-hour seminar on what to eat during each phase of the process. I started my pre-op diet on May 15, and follow the diet to a "T" -- twelve days of the following (no more, no less): 1 cup low-fat soup (cream or tomato) 1 cup veggies (carrots, cucumbers, tomatoes, or iceberg lettuce), with optional 1-2 tbsp fat-free dressing ½ cup of each of the following: sugar-free pudding, sugar-free applesauce, fat-free yogurt, and oatmeal. 3 protein shakes 48-64 oz. water The doctor said the pre-op diet was to reduce the fat around my liver, but it had some great psychological benefits as well. I savored every bite I took, took my time to eat and enjoy it, used smaller utensils and plates. Surprisingly this filled me up, thanks to the protein shakes and yogurt. I went to a restaurant with family and ordered only water, I brought my own meals to barbecues with friends and did not cheat once. It felt very empowering! Also a bit frustrating as my friends tried to push their food on me -- "Are you sure you don't want to try this? It's really good. One bite won't mess up your diet." I sat there very happy with my soup and salad, and finally shut them up by asking if they wanted to try my delicious iceberg lettuce and cream of tomato soup. The final day of pre-op (the day before surgery) was clear liquids only. I drank a gallon+ of water, and ate about 4 sugar-free jello cups. I did go to bed hungry that night but happy to do so because I knew what was coming next. My husband and I are avid boaters with lots of friends in the boating community who we spend most evenings and weekends with. Two days before my surgery, we had 7 of my girlfriends on our boat and one of them took a group photo. There they all were looking cute in their bikinis, and there I was looking fat and frumpy in my t-shirt and jean shorts. Any nerves or qualms I felt about the surgery were instantly gone when I saw the photo. I was ready! The surgery itself on May 28 went well. It took about 2 hours, and my surgeon also repaired a hiatal hernia. I did have one problem in the recovery room. Apparently my body can't handle opioids very well, and every time I pushed the pump for more pain medicine I would fall asleep and then quit breathing. I had a dedicated nurse who was closely monitoring this. She quickly contacted my surgeon who recommended a dose of Narcan to reverse the effects of the opioids, and then ordered only manual doses of pain meds. If it weren't for the constant care of the recovery nurse, it could have been a bad situation. I spent one night in the hospital, where they encouraged me to walk the halls, and even refused to discharge me until I did so. I took and passed a second leak test the 2nd day. They sent me home with an abdominal binder (#gamechanger), a pill crusher, and prescriptions for pain, nausea, cramps, and reflux. I have 6 purple incisions on my belly -- they aren't bruised, the glue they used is purple. It feels like a scab, and will fall off on their own in 1-2 weeks. I am up and walking around, even up and down stairs, although more than about 8 minutes at a time is exhausting and painful. But each time gets easier. Tomorrow I start the puree phase of my post-op diet. Protein shakes, applesauce, pudding, cream of wheat, yogurt. Nothing with anything but a smooth consistency, so I can puree canned fruits & veggies, fish, etc. Twenty days of that, then on to soft foods. At 6 weeks I will no longer have restrictions but plan to eat most of the same (eggs, fish, lean chicken, veggies, etc.). Thanks to everyone here who have shared their stories, challenges and victories. It really has been helpful for me, and I'm sure many others.

I never drank one protein drink post-op. I ate high protein yogurt and fairlife milk. I ate a few protein bars 3 weeks post-op and had no problems. I'm 3 months post-op and get all my protein from food. No shakes or protein bars. Good luck!!

I lost 50-60lbs those first two months, then had an 8 week stall, and have consistently lost 10lbs per month since then. I am seven months out and it seems like this month weight loss has sped up a bit. I have lost 7lbs in 2 weeks. This is not me complaining at all, lol. Does your body just *know* when it is at an equilibrium? If you keep doing the same thing, will you just keep losing and end up looking sickly? I eat roughly 700cals a day and about 40g carbs. Sometimes a little more, sometimes less. I did stop tracking because I literally eat pretty much identical meals every single day. Yogurt, a protein snack, turkey meatballs and cauli tots with salsa, another protein snack or maybe some berries, and then cottage cheese or a turkey patty for dinner during the week. Occasional diet icecream bar. On the weekends I inadvertently eat less, or will eat out and get a salad with a protein in it. And I plan on exercising vigorously a minimum of 4 days per week indefinitely.

Congratulations on a successful surgery. I have no incite on lactose shakes but wanted to say that drinking will get easier. Yesterday was one month after sleeve and my surgery went well no complications. Glad to say that I've added spinning to my workout regimen as of yesterday. Right now my foods are limited as I am in the soft food stage and my meal consist mainly of yogurt, bean soups, egg and cheese, spinach and protein shakes. Water intake can be challenging at times but I do my best. Best of luck to a healthy you!

Our plan was for liquids, mushes, purees and soft proteins like fish. eggs, beans, etc. from the hospital on out for the first month, and then everything else after that. The primary rule was to try new foods one at a time to test for tolerance and if a small amount went down OK, then great; if not, go back to known foods and try it again in a week or two. You likely won't be doing much solid food yet as protein still is a priority and you probably can't get enough protein with solid food yet, so there will still be a lot of protein shakes, yogurt, etc for a while as you experiment with more advanced foods. Some people will be able to progress more quickly than others - that would be normal so don't worry if you can't take some things yet.

You are worried about doing things because they make you look like an idiot , maybe you should worry less about what other people think and do what is good for you. One could also say that posting for the first time on a site like this about how bad things are and trying to put other people off could make one look like an idiot. A much better first post would have had a backstory and if a person is struggling asked for help! I don’t have a bunch of rules and restrictions, I eat like a “ normal” person just in much smaller quantities. If you follow the 20/20/20 rule for eating and drinking then there aren’t hours in a day where you can’t drink. I don’t see what is wrong with carrying a water bottle as it is something a lot of people do these days, however unless you are going bushwalking it’s not really necessary. Most of the time we are not that far away from somewhere we can get a drink. Having to carry a lunchbox everywhere you go is also not normal. Generally there is always something available that is suitable to eat. Even at unhealthy fast food restaurants if you focus on protein you will find something. Eat some ribs, or the burger without the bun or some chicken or go to a 7/11 or supermarket and buy a yogurt or some cheese or............. I have just been on a months holiday to the USA, UK, Asia. Not once did I need to carry a lunchbox, I didn’t starve and I didn’t feel like an idiot. At the end of the trip I had lost weight with very little effort on my part. Sorry that you feel you weren’t given any info but there is a lot of info available for the taking for those that are happy to do thorough research. I think that maybe you need to see a food psychologist as it sounds as though you have an emotional attachment to food that you are struggling with. I hope that you are able to overcome your issues and that you can start using this tool to it’s full advantage and eat in a normal happy way

I'm not sure how these people managed this. I was by far not perfect, but I could hardly get a but of yogurt down starting my 3rd week.

I’ve been drinking carbmaster milk in between meals since I developed lactose intolerance and can’t drink the protein shakes or eat Greek yogurt anymore (which were my go to meals to increase protein). This was my nutritionists recommendation and I’ve found it really ads up. I have 2-3 1/2 cup meals (soft food until next week) but without the milk I can’t get more than 25-30 grams with just food. Sometimes I steep tea bags directly in the milk to mix it up.

Embrace this stage. It's there for a purpose. It's there to help you break the old ties to eating for any other reason other than fueling your body. Relax into it. Cuz all too soon, you will have the opposite problem. You are going through a very normal reaction. Embrace! Reframe. Be positive. Do not grieve. BE AMBIVALENT! So how do you get your protein in? Treat it like a prescription. You have 1 job. And that job is that you need 60-80g of protein per day. For now at 3 weeks. Here's what you do. You split it into meals. Your job is to have 6 mini meals divided roughly 2-3 hours apart. Meal 1 - 5oz protein shake (15g protein) Meal 2 - 1 egg + 14g turkey sausage crumbles (by weight) + 1/2oz part skim mozzarella or a light cheese wedge (11g prot) Meal 3 - 5oz protein shake (15g protein) Meal 4 - 1/4 c ricotta bake (15g protein) Meal 5 - 2oz foil wrapped swai + 1/2oz well cooked broccol + 1/2oz grape tomatoes (15g protein) Meal 6 - 1/4c Greek yogurt thinned with protein drink + canned peaches (no sugar added) (9g protein) Here's the meal plan sample. This was a typical day for me at your stage. So something like this. Click to enlarge image: And don't worry if you can't eat it all! Don't worry if you can meet your protein goals here or there. The average over time will be fine! Try to get your 60g minimum in as a dude and for now, you'll be fine. Too soon, you will be able to get it all in and will try not to get too much protein. LOL. Your food desire WILL return. Learn new things...

I'm curious... did you all discover these changes gradually? I haven't noticed any real changes yet, but then I'm still on full fluids and have only tried a few things (oatmeal, cottage cheese, Greek yogurt, refried beans, pudding, and soup). Meat and raw cabbage (where did that come from??) are the only things I'm craving. Sent from my SM-G960W using BariatricPal mobile app

Sweet things are even sweeter to me. I do still use some Splenda Or stevia in my coffee - depending which I have handy- but even flavored yogurts were awful at first. As I get farther out I have been able to tolerate the taste a little more. Water some days tastes funny and I have to put something in it to help the taste. But that could be just being sick of water lol cottage cheese still tastes like the best thing ever to me though. Pre surgery it was tolerable - now it’s the most amazing treat and red peppers- they are the perfect food to me. Too bad they don’t have protein but they are just the crispness and sweetness. So yeah there are definitely changes in tastes- textures too but that is a whole other conversation

And I still, after nearly 9 months, cannot eat banana, peanut butter, cottage cheese or even Greek yogurt, all of these were pre- surgery friends but my Precious Pouch, the little ruler of my life , will not accept them. Maybe someday, maybe never, the jury is still out there. And water,for me, has gone from being sweet-tasting to bitter, and I have not a clue why!

You are a sleeve about a year out? (looked up your past posts) I’m guessing your asking about pouch reset because of a regain? For some pouch reset works to reboot and get back on plan again. Some find it too restrictive. Another option is simply going back to real food stage basics. Activity/exercise, hydrate diet plan. Log your food, stay within your weight loss calories and macros (Calorie and macro range may have to be dialed in specifically to where your body loses weight) Years out its not realistic for me to eat 800-900 calories. It’s a common experience to have less sleeve restriction years out.(it’s not back to full size) There are strategies to ty to fill the space and help with hunger. (make sure examples are on your plan) Get rid of temptation in your house Log your food in a food app.*keep within your weight loss calories and macros* Dense protein sources will keep you feeling more satisfied than soft foods. – Get rid of shakes and bars.(use only as emergency food) Real whole food will keep hunger at bay. Eat your protein and other items on your plan. Eat as much wonderful low-calorie veggies until full. Real sugar and extra carbs make you crave them more and cause hunger*detox off them* If you deprive cravings you want them more – Keep healthy options for sweet and salty on hand EXAMPLES Salty: chicken fajitas, jerky Sweet: Dannon light n fit Greek yogurt, strawberries dipped in sugar free chocolate, sugar free popsicles.

I’ve had like an oz of eggs and yogurt only . I’m able to do my protein shake but takes me about 2-3 hours but I get it in but them with other fluids I can’t it so Weird

Healthy_life2 and Fluffy gave some great advice. They are very knowledgeable, and a treasure to this board. I’m only a month out, but the memories of the first couple of weeks are very fresh. It was rough. I felt like getting my liquids and some protein in was a full time job. Drinking is a lot easier now. By week 3 I could eat very soft cheese (like laughing cow), eggface’s ricotta bake (that recipe is LEGIT), high-protein low-carb yogurt, soft scrambled eggs, puréed salmon spread. Week 4, last week, I was able to add in some softly cooked brown meat chicken (I have a Sous vide, so it’s easy to keep it soft and not overcook it, I highly recommend that gadget) and softly cooked salmon. I could get in about 1/8 - 1/4 cup in. I have to go very slowly, like taking 20-30 minutes to eat it, and chew the daylights out of it. I’ve progressed to being able to try little bits of most types of meats. I’m still learning to listen to my body’s signals that it’s full, so I go by measurements. 1/4 cup of food per meal, 3 meals per day, and 1 protein shake for a snack (half in the afternoon, half in the evening/night). I can add bits of salsa, etc. for flavor, which keeps down the monotony. I’m still going to be chewing for a long long time, and may forever. It’s not a bad thing. I enjoy my meals a lot more. I can add in non-starchy veggies in at the 3 month mark, as long as I’m getting the protein in. The chewing a ton and not drinking water 1/2 hour before and 1/2 hour after a meal were some of the behaviors that I had to develop prior to surgery. My program was pretty rigorous, but I think it prepared me fairly well. You’ll get used to this new way of being. There are so many wonderful proteins and non starchy veggies out there. I’m still going to indulge in fruit here and there, but it will be a bite of fresh strawberry, or a blackberry off a vine or a huckleberry or two while I’m hiking. And I will enjoy the hell out of it.

Calories are not the only thing to watch out for. Fruit is high in sugar and carb. The nutrition binder I got from my nutritionist says the most fruit at the soft food stage is a 1/4 c of unsweetened apple sauce or a 1/4 of a a mashed banana. That's total per day and they recommend mixing it with plain unsweetened yogurt or cottage cheese for the protein. I'm extremely carb sensitive and can only tolerate berries pre op so not sure I will eat any fruit.

Look. Eating right now IS supposed to be sufficiently hard in order to deter you from over-eating and to provide a negative feedback. Purposely going for "easy" soft to digest food is synonymous with "eating around your tool." You are looking for ways to make it easy on yourself to get food in so that you don't feel that negative response. But the reality is...the SOONER you can advance to solid dense lean protein, the better! Honestly. It's the stuff that will get you and keep you satiated longer and will keep the food in your tool longer which means you also absorb the nutrients better!!! (Edited to add: And of course you MUST follow your prescribed food progression plan from your doctor!!! Do not try to advance more than appropriate for your stage and level of healing!!!) So keep working at soft foods: soft boiled eggs, soft scrambled eggs, canned tuna, canned salmon, canned chicken, poached white fish, poached salmon, liverwurst, cottage cheese, Greek yogurt (but not too much), EggFace ricotta bake, green bean casserole with lots of canned chicken in it. Try chilis, soups, stews with slowly cooked meats and only tiny bits of veg... Drop the lentils and beans for now...

alright i will stop buying fruit salads, too bad the lentils, beans and tuna all make me feel nauseated after 1-2 spoons maybe i'll stick to liquid protein (shakes and Greek yogurt) for 1 more week.

the guidelines most of us get are that we should focus on protein first, then non-starchy vegetables. If there's room after that (which there often isn't early out), then an occasional small serving of fruit or whole grain carb (although whole grains can be tough on your stomach early out - so I'd wait on those). Some people, esp those who are carb sensitive, never or rarely eat fruit at all during the weight loss phase, given the sugar. I'm not particularly carb sensitive, but early out, a fruit serving for me meant maybe six or eight berries on my Greek yogurt. I still don't eat a ton of it because of the calories - and even though fruit is packed with vitamins, there's still a lot of sugar in it, so I limit it.

First and foremost it is all about the volume. At about 4 weeks here is your VOLUME rec. Liquids = 4oz at one meal (4 oz of anything liquid) Soft Foods = 1/8-1/4c (that means 1-2oz by WEIGHT) maximum per meal. That means at THIS time? It's ALL about the protein. Until the time when you get ALL your protein in from food. Protein first. Then if room, a bite or two of well cooked, soft veggie at 4 weeks. The ONLY time you might add a little frozen or canned fruit (ie fruit without peel and low or no added sugar) would be with a tiny bit of yogurt. But emphasis is on a bite or two--not a whole bowl. For one it's WAY too much sugar/fructose at 1 meal and for two, you MUST get your protein in. At 4 weeks, you MUST get your protein in!!!!!!!!!!!!!!!!!!!!! Non-negotiable.

First off, what is a ketogenic diet? The ketogenic diet is a very low carbohydrate, very high fat, low-moderate protein diet. Historically, it has been used to control epilepsy in children. When you don’t give your body carbohydrates (your body’s preferred fuel source), it begins to use and break down body fat as a source of energy, which is called ketosis. The breakdown of fat leads to the production of ketones, and the ketones are what begin to fuel your body (instead of the carbohydrates you were feeding it before). This process can take a few days to achieve, and when done correctly, can be tested by measuring the ketones in your urine with a dipstick. If ketones are present, this means you’re in ketosis. What does the macronutrient profile look like? FAT – A ketogenic diet should include healthy fats such as fats from fish, seafood, eggs, nuts, vegetable oils, dairy, and some meats. There is a lot of poor information on the internet that encourages people to have the majority of their fats in the form of cream, lard, bacon, and fried foods, which are not good for our heart. CARBOHYDRATES – The ketogenic diet is described differently depending on the source, but on average it means limiting your carbohydrates to 5-10% of total daily calories. For bariatric patients eating around 1200, 1500, or 1800 calories/day, this works out to 22, 28, or 34 g of carbohydrates/day, respectively. That’s very little! Foods rich in carbohydrates that are limited/eliminated in a ketogenic diet include: grain products (e.g. pasta, rice, bread, etc.), fruit, many vegetables (e.g. potatoes, corn, carrots, squash, etc.), some dairy products (e.g. milk, yogurt), legumes (e.g. chickpeas, beans, lentils), and sweets and sweetened beverages (e.g. chocolate, ice cream, pastries, juice, soda, etc.). That’s a lot of food groups being restricted! PROTEIN – On a ketogenic diet, protein is considered low-moderate (depending on your protein requirement), or around 15-20% of total calories. For bariatric patients eating around 1200, 1500, or 1800 calories/day, this works out to 52, 65, or 78 g of protein/day, respectively. Are these protein targets in the range that your dietitian has recommended for you? For many of you, likely not. FIBRE – Fibre falls under the umbrella of carbohydrates. Because you now know that carbohydrates are very limited on a ketogenic diet, you can guess that fibre will also be very limited. A diet very low in grain products, fruits, most vegetables, and legumes means that constipation is going to be a real issue! I heard that a ketogenic diet leads to rapid weight loss. It’s true in the beginning, but the important factor here is to understand what kind of weight loss this is. Yes, it’s true that reducing carbohydrates leads to weight loss, however the weight that’s initially lost is mainly water weight, not fat. Here’s a behind the scenes look at what’s going on: Your body always wants to keep your blood sugar well controlled, so it stores some sugar (or glycogen) in your liver. When you’re sleeping, or fasting, your body uses this stored glycogen to send some sugar into your blood, to be sure that your blood sugar doesn’t drop too low. Glycogen is stored in your body by attaching glucose to water. So when we empty our glycogen stores, we’re actually losing a fair bit of water as well, and that’s the initial weight loss that you see. The weight loss that follows from there is partly muscle loss if you’re not meeting your protein needs (which as discussed above, might be the case) and fat. While ketogenic diets have been shown to be better for weight loss than other low fat diets, the results are only true in the short term. In the long-term, there doesn’t appear to be any difference. You’re also more prone to rebound weight regain on a ketogenic diet once you re-introduce carbohydrates again (whether by choice, by cravings, or by obligation because you feel unwell without them). But I thought that the ketogenic diet was proven to be effective? The ketogenic diet isn’t a new diet at all. It’s actually been used for almost 100 years to treat children with severe epilepsy who don’t respond to medication. However, even these children don’t stay on the ketogenic diet their whole lives, they only do so for a temporary amount of time. These children are followed very closely by their doctor and dietitian to very slowly bring carbohydrates back into their diet. Despite what you dietitians say, I want to try the ketogenic diet! Ultimately, it’s entirely your decision to try what you want. We (as dietitians) are only here to guide you through the evidence that’s out there, and as of now, there’s no research on the ketogenic diet after bariatric surgery. There’s also not enough long-term research to know and understand if the ketogenic diet is safe for your heart in the long-term (i.e. more than 12 months of being on the diet). Three of our biggest concerns as dietitians are: 1) Are you meeting your protein needs? 2) Are you emphasizing healthy fats; 3) Are you just looking for a quick fix? If you’re using the ketogenic diet as a “reset” just like the last fad diet you tried, you’re only feeding the yo-yo dieting pattern (just playing devil’s advocate here!). Can I be on a ketogenic diet my whole life? The honest answer is we don’t know. We don’t have research on the long-term effects of following a ketogenic diet. It’s suspected that it may lead to higher cholesterol levels which may lead to heart disease, but more research is needed to conclude this. Does being on a ketogenic diet guarantee that I’ll keep the weight off? While more research is needed, one study showed that the participants who were very strict about following the ketogenic diet were able to keep off the initial weight loss for up to 56 weeks (or a little more than one year). We don’t have the research to say if in 10 or 20 years that their weight will still be stable or not. We do know however, that if you don’t find the ketogenic diet realistic for your lifestyle and you end up coming off of it, you will regain the weight (if not more), as with any temporary diet. Is the ketogenic diet safe? While it may be generally safe (meaning you’re not going to die) for most people, you should always check with your doctor, especially if you have heart disease, liver disease, and diabetes, as this diet may put your health at risk. The ketogenic diet is not considered safe for those who have chronic kidney disease. The ketogenic diet has received a lot of criticism because it’s a very restrictive diet, eliminating many foods and therefore many nutrients that are important for health. Following this diet puts you at high risk for micronutrient deficiencies. Make sure you discuss additional vitamin supplementation with your family doctor or dietitian. What are the benefits of a ketogenic diet? Aside from weight loss, following a ketogenic diet has been shown to improve blood sugar control in those with type 2 diabetes, lower triglycerides, lower LDL cholesterol (the ‘bad’ cholesterol), and raise HDL cholesterol (the ‘good’ cholesterol). Although these benefits sound attractive, know that other low fat diets have produced similar results, and would be safer in the long-term since they’ve been better studied and are less restrictive overall. What are the risks of following a ketogenic diet? Liver disease? – More research is needed, but several rat studies have shown an increased risk of developing liver disease. While results from rat studies don’t 100% translate into humans, animal studies often give an indication or at least a starting point for how something will affect the human body. More research is needed in human subjects. Muscle loss. – Another risk of following a ketogenic diet is muscle loss, because most patients aren’t able to meet their protein goals. Losing muscle may put you at risk of weight gain. Working with a dietitian while following a ketogenic diet can help you be sure you’re meeting your protein needs. Earlier death? – Like we’ve mentioned, there isn’t enough research yet on the long-term risks of following a ketogenic diet, but a recent study found that low carbohydrate diets (less than 40% of calories from carbohydrates) was linked to earlier death, compared to having a moderate-carbohydrate diet (50-55% of calories from carbohydrates). Remember that a ketogenic diet has around 5-10% of calories coming from carbohydrates. How did they explain this increased risk? The risk with a low carbohydrate diet seems to be because the carbohydrate calories are often replaced with more animal protein and unhealthy fats, rather than plant-based protein and healthy fats. Note that this study was not on bariatric patients, but again, the findings are interesting. What are the side effects of a ketogenic diet? Side effects during the adaptation period (i.e. in the beginning of following a ketogenic diet) include: brain fog, fatigue, headaches, nausea, strong smelling sweat and urine, constipation or diarrhea, and poorer exercise performance. Long-term side effects include: bad breath, micronutrient deficiencies, and muscle loss. What are common misconceptions of the ketogenic diet? Many people believe that it’s a carbohydrate-free diet, meaning no carbohydrates at all. This isn’t the case. You can have in the range of 20-50 g of carbohydrates per day (depending on how many calories you’re eating). If you don’t know what this looks like in terms of food, speak with your dietitian. Another misconception is that a ketogenic diet is high in protein. This also isn’t the case. A ketogenic diet is moderate in protein for the average person (who hasn’t had bariatric surgery), and is therefore typically low in protein for a bariatric patient. As you likely know, low protein puts you at risk of losing muscle which will affect your overall weight loss, and put you at higher risk of weight regain in the future. Other than muscle loss, what are other negative nutrition consequences of following a ketogenic diet after bariatric surgery? Low in fibre – The smaller food intake that you have after surgery already makes getting in enough fibre difficult. This partly explains why so many people are constipated after surgery. A ketogenic diet significantly limits most fibre-containing foods including fruit, most vegetables, grain products, and legumes, so your fibre intake decreases even more. Constipation is therefore even more of an issue! High in unhealthy fats – Many people don’t follow a ketogenic diet correctly and include too much saturated fats (or unhealthy fats) in their diet. For example, they may choose bacon, sausages, and lard, over fish, nuts, and vegetable oils. A diet high in saturated fats has been linked to heart disease. Low in many micronutrients – A ketogenic diet is also low in important vitamins and minerals such as thiamine, folate, vitamin A, calcium, magnesium, iron, and potassium. While you’re prescribed vitamins and minerals supplements after bariatric surgery, these standard prescriptions don’t account for you following a ketogenic diet. If you do decide to follow a ketogenic diet, it’s important to have your doctor or dietitian re-assess your vitamin and mineral supplements and for you to continue doing blood work regularly. Will I be able to exercise just as much while on a ketogenic diet? The downside to following a ketogenic diet is that it may actually reduce your exercise performance (across anaerobic, aerobic, and strength related exercises) in the short-term. If you’re doing low intensity exercises such as walking or a leisure bike ride however, you shouldn’t notice a difference. More research is needed to understand how a ketogenic diet affects exercise performance, especially in the long-term. I’ve been having episodes of low blood sugar after bariatric surgery. Can I follow the ketogenic diet? If you’ve been experiencing low blood sugar after surgery, it’s not recommended to start a ketogenic diet. It’s important to understand why you are experiencing low blood sugar as soon as possible. Here are some of the most common reasons for low blood sugar after bariatric surgery: Dumping syndrome due to high sugar intake Going long periods of time without eating Not eating enough carbohydrates or not spacing your carbohydrates out during the day Excess exercise An overactive pancreas Diabetic medication that is not adjusted properly Speak with your dietitian to figure out why your blood sugar keeps dropping. I plan to try the ketogenic diet for a few weeks and then come off of it. If that’s the case, then don’t bother. The reason this diet works for weight loss is because you are in ketosis (which in itself takes a couple of days to achieve because you need to use up your glycogen stores). If you come out of ketosis, you will no longer see the effects, and thus begins the yo-yo dieting effect. Always remember – Temporary changes yield temporary results! I’m already on the ketogenic diet, how can I come off of it safely? If you’ve already started the diet, reintroducing carbohydrates can lead to bloating, unstable blood sugars, and weight regain. To minimize these effects, begin by including whole grain products, rather than refined processed carbohydrates (e.g. white bread, breakfast cereals, pretzels, etc.). Whole grain foods include quinoa, brown or wild rice, oatmeal, bulgur, and barley. Sweet potatoes would also be appropriate. Include 1 to 2 tablespoons at only one meal per day for up to one week. If you’re feeling okay, begin including one fruit at one snack for a few days, and then try reintroducing yogurt and milk. But aren’t there doctors and health gurus out there promoting the ketogenic diet? Yes, there are, but there also were doctors and health gurus promoting the Atkins diet, the Pritikin diet, and the Dukan diet back in the day. There will always be people out there trying to capitalize on the newest fad diet to sell you on the weight loss dream and to take your money. It’s easy to point fingers and put the blame on specific foods or food groups, but ultimately the only way of eating that has been proven effective time and time again, is moderation. As dietitians, we know very well that ‘moderation’ (which means something different for each of our clients) isn’t sexy, but it’s key to having a healthy long-term relationship with food. I’m pregnant and I want to follow a ketogenic diet. Following a ketogenic diet during pregnancy is not recommended. While your body can handle being in ketosis, the production of ketones is harmful to your baby’s development, particularly their brain development. SUMMARY… – A ketogenic diet is very low carbohydrate, very high fat, low-moderate protein diet. – A ketogenic diet should emphasize healthy fats, but many sources online emphasize online unhealthy fats (e.g. bacon, sausage, lard, cream, etc.). – A ketogenic diet is very low in carbohydrates. This means that it’s not only grain products that are limited (e.g. pasta, rice, bread, etc.), but also fruit, many vegetables, some dairy products, legumes, and sweets. – By default, a ketogenic diet is also low in fibre which results in constipation in many patients. – A ketogenic diet is considered low-moderate in protein. Most bariatric patients aren’t able to meet their protein needs on ketogenic diet which results in muscle loss. – We don’t know the effects of a very high fat diet on health long-term, but it likely isn’t good for heart health. – Many of the benefits of a ketogenic diet (e.g. weight loss, improved blood sugars, lower triglycerides, lower LDL cholesterol, increased HDL cholesterol, etc.), are similarly seen in low-fat diets (while being way less restrictive overall). – There are many unpleasant side effects to following a ketogenic diet including constipation, poorer exercise performance (at least short-term, no research on long-term performance), muscle loss, bad breath, and micronutrient deficiencies. – You likely need to take additional vitamin and mineral supplements while following a ketogenic diet. Regular blood tests are still very important. – A ketogenic diet is not recommended in a variety of health conditions, and is even considered dangerous for some (e.g. patients with chronic kidney disease and pregnant women). Always check with your family doctor and dietitian before making drastic changes to your diet. – The ketogenic diet has not been studied in people who have had bariatric surgery, so the short-term and long-term effects are unknown. – The ketogenic diet is very restrictive and is therefore not sustainable for the majority of people. Eating out and socializing around food become almost impossible. Our final thoughts… Many patients are quick to blame carbohydrates for weight regain. Instead of jumping to a ketogenic diet, we recommend reviewing the bariatric basics and booking an appointment with your bariatric dietitian. If you absolutely insist on trying a ketogenic diet, we suggest a “modified keto diet” that consists of more plant-based protein and healthy fats, with enough protein to be sure you’re maintaining your muscle mass. What are your thoughts on the ketogenic diet? Have you been tempted? Are you currently following a ketogenic diet? – Lisa & Monica, your bariatric dietitians P.S. For more tips on healthy living after bariatric surgery, follow us on Facebook (@bariatricsurgerynutrition) or check out our highly praised book HERE!

are you on solid foods yet? Dense protein is pretty filling - way more so than stuff like cottage cheese and yogurt.