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I had the mirena IUD and HATED it - basically every sideaffect listed, I got. I had headaches, weight retention, and a weird out-of-body feeling like my body was not actually my body. Also, it can contribute to ovarian cysts so isn't a good option for those with PCOS. I only know one person who used the nuvaring and she got pregnant the second month she was on it, and the nuvaring made it an ectopic pregnancy. I take the pill now, I'm on one of the ones that helps with PCOS symptoms (acne and facial hair). It's taking a looooong time to see those benefits though! I've been on it for 3 months. I haven't had any weight gain from it though.

I was diagnosed with PCOS around May of this year after 5 years of not know what was happening with my body. I gained 80 lbs in less then 2 years (which felt like a snap of the fingers) and it continued going up and up. I was never overweight so gaining so fast and so much was definitely a shock to my system. I tried and tried to lose weight but couldn't. I was never able to yo-yo diet because I could never lose any weight. I remember right before my sister's wedding in 2007 I worked out with a trainer, went to the gym 5-6 times a week and ate PERFECTLY and lost 4 lbs in 3 months. TALK ABOUT DISCOURAGING!!! Anyway, fast forward to May of this year and I'm sitting at the drs office as she tells me that I have PCOS and it is a major contributor to my weight gain and lack of weight loss (along with the dozen other side affects it comes with) and there's nothing I can do about it. That's when I decided that I needed lap band surgery, not only to repair my self-esteem and confidence but to allow me to live a healthier life. I didn't want to live and feel that way any more. Come October 6th..surgery date. YAY! I can truly say it's the best thing I've ever done. To date I have lost 35 lbs, including preop, slowly but surely. Now I didn't start this post to tell my not so exciting story but to ask a question. I know that I wouldn't have been able to lose the 35 lbs without lap band surgery, but I've noticed that my weight loss has begun to slow down…wayyy down. The dr said I should be losing 1-2 lbs a week, ideally. That's not happening. Of course I've been doing my very best to follow the plan but I'm not perfect. I have my weak moments as everyone. I have been exercising 4 days a week for about 1.5 – 2 hrs a day. The scale barely moves. I'm wondering if any ladies out there with PCOS have noticed that their weight loss has been slower then what seems to be the norm. Of course I am not comparing myself to everyone else but I'm just wondering if it has to do with that, because if it doesn't then I really need to sit down and reevaluate what I'm doing. Thanks for reading guys and I hope to hear from ya'll soon.

Starting this process now with my surgeon after 8 years with my band over 100lb loss and now esophageal dilitation caused me to have to unfill band and have had an o going weight gain. He recommended bypass and we are checking with insurance now. Anyone have issue with insurance not covering a revision due to complications of the band?

Formerly obese personal trainer Kelly Coffey talks turkey about excess skin, and what she did - and continues to do - about hers. Dear Coffey - I’m thinking about having weight loss surgery, but I’m not too keen on living the rest of my life with extra, loose skin. What can I do to keep that from happening? Sincerely, Cecelia in CA Hey there, Cecelia - Congratulations on taking the reigns and exploring your options. I hope you find a good, honest surgeon who can help you figure out if weight loss surgery might be a strong choice for you. As with everything concerning our bodies, the topic of loose skin generates a whole lot of hype. The truth is there are exactly six things you can do to minimize excess, loose skin after weight loss - whether or not you have WLS. The first three are preventative, and apply to the period before weight is lost. The last three apply to the post-weight loss period. First, prevention. 1- Don’t wait. Ask any aesthetician or midwife and they’ll tell you: the younger we are, the more our skin can bounce back from a stretch. If you would be more comfortable weighing less and you’re afraid of having excess skin, the younger you are when you lose weight, the better. But don’t waste precious energy wishing you had lost weight in your early 20s. You have today, and today is where your power is. If there are choices you want to make in service to your health and happiness (whether or not they would result in weight loss) today is the day to make them. 2- Avoid the loss/gain cycle. Imagine how a once-inflated balloon looks and feels after you let the air out. Now imagine the same balloon after 4, 6, or 10 deflations. Much like the balloon, the more times we lose weight and gain it back, the looser our skin gets. Again, now is not the time to berate yourself for all those “successful” stints in Weight Watchers that ended with you gaining the weight back and then some - it happens to all of us, myself included. Today is the day to get yourself stronger, more sustainable tools - tools that support long-term weight loss and minimize the probability of gaining it back. These tools exist, and you can get an introduction to them in my free online workshop, Why We Sabotage Ourselves (with Food) (and What We Can Do About It). 3- Keep weight gain to a minimum. The heavier we get, the more our skin stretches, and the less likely it is to bounce back after we lose weight. You can’t do anything now about your weight history. Feeling badly about it or judging yourself for it will only make you want to numb out (if you’re anything like me, probably with food). If you are reading this at the heaviest weight you’ve ever been, then this is the heaviest you ever need to be. If weight loss is something you want to do for you, your skin will thank you for making caring choices toward that goal starting now. That covers the things you can do to minimize excess skin before you lose weight. Now let’s look at what you can do once the weight is gone. 4- Build muscle. Contrary to popular belief, strength training does not “tone” or “tighten” the skin. Skin elasticity has nothing - NOTHING - to do with exercise. But strength training gives loose skin something hot and firm to lie over - namely biceps, triceps, quads and abdominal muscles. Lots of folks - especially women - shy away from strength-training, or think it’s better to use smaller weights and do more reps. This is a myth that keeps women from ever seeing the results they want and deserve. Assuming you’re being safe and reasonable, the heavier and harder and you train, the more muscle you build, and the better you’re likely to feel about how your skin looks. 5- Have surgery. Even if you’re young, even if you lose weight just once, and even if you strength train like a boss, there’s still a limit to the impact we can have on excess skin after weight-loss. Some consider having skin removal surgery. If this is something you’re thinking about, be warned: Words like “lift,” “nip,” and “tuck” are misleading. Skin removal surgery is no joke. I know that because I had it. The surgery hurts like hell, and can put you out of commision for weeks or months. Also, the medication usually prescribed to manage the post-op pain is highly addictive. If you’ve got a compulsive / addictive relationship to food, you’re way more likely to get hooked on painkillers than someone who doesn’t struggle with the compulsive overeating. 6- Love yourself. Loving your body isn’t going to tighten, lift, or shape your skin after you lose weight, but it can minimize the negative impact that living with loose skin might have on you otherwise. Love is action. Love means making consistently caring choices because you deserve to be cared for, no matter what you weigh or how your body looks. If you struggle to make consistently caring choices, whether you’re pre-op, post-op, or no-op, you’re not alone, and there are practical, usable tools to help you get there. Where will you fall on the loose skin spectrum? You can’t really know unless and until you lose weight. I yo-yo dieted for 10+ years, maxing out at 307 pounds. I had Roux-en Y in my mid-twenties and lost over half my body weight. Eventually I started strength training and became a personal fitness trainer. Two years later, I opted to have abdominoplasty (aka a tummy tuck), because the excess skin on my stomach was beyond anything that could be mediated or improved with exercise. The surgery hurt like a son-of-a-b***h and had me out of work for a month. I’ve made peace with the loose skin on the rest of my body. The muscle I’ve built with regular strength training helps a lot. So has treating my body with care one choice at a time for over a decade. It’s given me self-respect and peace that make my batwings an insignificant afterthought. Loose skin post-weight loss is inevitable for those of us who are or have been obese. But if you would be healthier or more comfortable in your body weighing less, don’t let the fear of loose skin keep you from doing what you need to do to get there. Our bodies will never look like other people’s bodies, and that’s OK. Our bodies tell our stories, and our stories are our strength. All good things, Kelly Coffey PS: Whether or not you decide to have surgery - and even if you've already had it by the time you read this - you can use the tool that's helped me to turn my life and my health around. To learn it, click here to grab a seat in my free online workshop, "Why We Sabotage Ourselves (with Food) (and What We Can Do About It)"

I have such a love/hate (mostly hate) relationship with prednisone. At times, taking it was the only way I could function during a flare. But the weight gain was horrible. I hope I can encourage you. I'm down 40 lbs at 6 weeks post op. My mobility has greatly improved. I'm walking an hour four times a week. I've yet to determine if the flares will be fewer, but I didn't have a working treatment plan for my Ankylosing Spondylitis prior to surgery. First I tried Humira. Now Cimzia. My rheumy is talking Remicade. I'm currently on sick leave. When I'm not, I have to go into the office 10 hrs/wk. I mostly work from home because of my immune system and chronic fatigue. Best of luck to you! Sent from my iPhone using the BariatricPal App

My daughter has alopecia totalis, started when she was about 12. We tried the topical creams and treatments, but I drew the line at systemic steroids and we focused on getting her the best scalp prosthesis we could. She did incredibly well once she moved to a vacuum wig and a couple of years ago her hair started growing back. She ditched the wig about a month ago (she's 19 now) and is growing in a full head of hair with only one thin spot. Now she's been diagnosed with an auto-immune arthritis, so we're heading down the rabbit hole on that one now. Hugs for going through it, it's terribly traumatic. I hope her arthritis isn't too bad. So happy her hair grew back. Mine has been gone for 24 years. I tried an experimental drug last year. I did get some regrowth but also gained the weight. I stopped taking it because of the weight gain. Sent from my SAMSUNG-SM-N920A using the BariatricPal App

Hi there, my name is Lesley, I am starting my journey in the hope that I may get lap band surgery on the NHS. I have just turned 44 and have been a large girl for as long as I can remember, more so in the last 11 years after being diaganosed with clinical depression, in that time, my weight zoomed from 13st to 21-22 stone and I cant do a thing about it. I have tried Orlistat medication through my g.p. I swim frequently, but the weight gain has left me with intollirible lower back pain and crippling leg aches, I have a history of diabetes and heart attacks in my family, so my concern is that I need to get the weight off before I fall victim to the same. In around four weeks I am to go and meet Mr Woodcock at North Tyneside General Hospital (Rake Lane) of whom I have been referred to, if ANYONE PLEASE HAS ANY INFORMATION ON THE PROCEEDURE AT THIS HOSPITAL, PLEASE LET ME KNOW, I guess like everyone else, I just want to know if I will be funded and how long the wait will be, many thanks.

@@shrinkingkimber I had to hold my Cimzia injections 3 weeks before and 3 weeks after. My surgeon wasn't happy either because of the higher risk involved. But everything turned out fine. Btw, I'm going to Remicade next if I fail Cimzia. I've already failed Humira. A lot of my weight gain also came from steroids. Good luck on your surgery! Sent from my iPhone using the BariatricPal App

@@littlered12973 I've been on sick leave since January--also to focus on aggressive treatments, some of which caused a considerable amount of my weight gain. I'm so glad your blood pressure and sleep apnea have normalized! That's quick if your surgery was only on Mar 29. My BP has normalized, too, and my surgery was on Feb 25. I can tell you, being 6 weeks out, that the weight loss has had a significant impact on my chronic pain. WLS has been the best AS "treatment" I've had thus far. I hope the same is true for you and your condition. Good luck! Sent from my iPhone using the BariatricPal App

I kept mine secret until one hour before my surgery. I was worried about all the judgment of people thinking this was and easy out. But it was going to come out eventually and I didn't want to lie about my weight loss when people start noticing the quick drop. I didn't want people to talk behind my back trying to figure it out so I decided to be upfront and made it facebook official. I got way more support than I was expecting. And you know what so what if they talk. If they really care about you they will be supportive. Find out who your true friends are. Everyone has seen me struggle all my life and if it wasn't for all the health issues maybe I wouldn't have done it. Its desperation to be healthy. This was my post to everyone VEVY IMPORTANT ANNOUNCEMENT about My Life. For my Family, Friends and inquiring minds who want to know. Soooo, I have made a huge decision that is going to change my life forever. Hopefully for the better. If all goes well.... Some of you may or may not know that I had a lap band procedure done in 2010 to help with weight loss. It did help for a little while. Eventually the band stopped helping me completely and I fell back into old eating habits. Started the whole yo-yo dieting again. I gained it all back then I lost it all again. Then I gained it all back plus some more. The band has been busted for about 3 years but it's still hanging out in my belly. I have been fighting battle of the bulge since I was 8 yrs old. The older you get the harder it is. The bulge always seems to win. The thing that really makes it hard are the underlying health issues. Like PCOS, thyroid, diabetes, depression and anxiety. Then there is the high cholesterol and blood pressure. With all these health problems comes medication for all. Some of the medication causes weight gain but you need them. So conclusion to this battle. I am having the Lapband removed from my stomach and I will be converting to the gastric sleeve. I am so grateful that I have a wonderful husband who has been with me through all of my struggles. He has seen my ups, downs and all arounds. He sees how hard I do work. How hard I try. How much I beat myself up when I don't lose weight even when I have done all of the right things. He has seen me give up hopes and give in to the unhealthy from my disappointment of not winning the battle. He has stood by me through thick and uh, not so thin. I want to thank him very much for helping me with my journey of becoming a healthier me. Because of my fear of judgement I have kept this to myself. But most people would say not to worry about what others think. A lot of people will say well if you just exercise and eat right you will lose weight. Well I do and it does help but it just isn't enough for me. Exercise has become really hard due to arthritis in my right knee and hip but I will continue to fight through the pain. This is not going to be easy!!!!! I love food!!!!!!!!!!! Sugar is the devil!!!!!!!!!! I am giving up all the tasty favorites for a new me. I am going into surgery at 9:30. Wish me luck. See you when I wake I love you all!!!!❤✌ — feeling optimistic.

I haven’t but I would be interested in coordinating to do that. Nice to know that it would be helpful! Welcome to to the forum - I would love to discuss the intersection of sexuality and weight gain.

Did you make a LGBTQ community here?👀😍🥰  I would love to be part of it. My weight gain was partially due to challenges I faced in my sexual orientation journey in my early 20s for sure.

Hi Kristie, i think your comment is for me, please forgive my responding if not. Thank you, for your kindness; this whole thread has frankly made me quite sad tonight and your post was a ray of hope. I felt pretty misunderstood. I really appreciate you reaching out and taking the time to post; affinity groups have been very helpful to me in the past and I did hope that I would be able to discuss these intersections of experiences/backgrounds as it relates to my original weight gain, my decision to have WLS, and my plan to keep on track with weight loss and weight stability. Thanks again. Look forward to reading more posts in this forum and trust that I will learn a lot from those who are further in their health paths than I. Good night.

I often wonder if I should consider removal. I had my band placed in Oct 2010. Last April I had an issue and had all the fluid removed. Apparently I had learned nothing about food consumption and that resulted in about a 50 lb weight gain. Almost a year later, I have some restriction but the weight is barely falling off. I am afraid that if I got a revision, I would just gain more weight again.

OK ladies, prepare to feel tall: I'm 4'11", so quit complaining, LOL! I used to be a tall 5 foot, but with the weight gain (to 203 lbs) came the "degenerative disc" back problems and I lost an inch in height. :frusty: BUT in Oct I get my band, things are gonna change! I can't wait to buy clothes I actually like. Imagine not having to hem everything you purchase. And high heels will be so much fun again!

Update from a previous post: I got really swollen, they actually brought me in for a problem OB expecting pre-eclampsia because of how swollen I was, and that I was going up about a pound a day. But my BP and everything else was fine so I was sent home with advice to wear support hose from the moment I get out of the shower until I go to bed (no thanks). I've now lost the fluid (and the weight, I'm back to being about 15 pounds below my conception weight, so no weight gain yet - I'm just bouncing back and forth between the same 4 pounds), and have found that I only swell when I'm sitting. I haven't done that since I lost the weight to begin with. Bad flashback. If I can remember to get up and walk every hour or so, I do fine. I've also cut way back on my sodium, just to be careful.

There is a YouTube video I posted in a thread not too long ago with Dr Wiener explaining that although it may stretch a little, it will never be back to its pre surgery size volume. I beleive it would take a considerable amount of constantly overeating to stretch it out. But I also understand any amount of stretching will lead to eating too many calories and weight gain, even just a little stretching. Good article!

Thanks for the replys. My insurance covers the band or the bypass so I have to choose between the two. I have a choice between two brands of lapband but that's it. I was originally going to go with the band but then some people who had the bypass said they knew people with the band who have had problems with infections and or weight gain. They said they were happy with the bypass even though they both had gallbladder failure a year after the surgery. After reading comments on "this" forum, I'm now back to considering the lap band. It's not an easy decision.

I had my IUD (Mirena) placed prior to my sleeve, but I did notice the increased weight gain like so many others. Almost to the point where I contemplated having it taken out.

Bert99, based on your own unfortunate experience I can see where you might take a jaundiced view of the whole Lapband thing, but jumping on poor Hummingbird who offered understanding, concern, and a logical suggestion was a bit harsh. And as for lap band surgery being the easy way out- well, I reckon you've discovered it isn't easy at all. We still have to take responsibility for what we eat and how we eat it. On the chance my own experience will help, I'll share it. If it doesn't help, ignore it. I am not paid by a surgeon to write nice things about the band and I am not in the "wonderful" phase of the band. It has taken me two years and three months to lose 84 pounds. I've had ups and downs and looong plateaus. It has not been easy. I don't expect it to be much easier in the future, but I have learned some things that help me through the rough Patches. My band invariably feels tight during the early part of the day. I struggle with this, some times more than others. This week has been a particular challenge because I long for the emotional comfort of freely eating whatever I want. Of course, eating for emotional comfort eventually packed a hundred extra pounds on me. If I insist on eating early in the day when my band is tight, the food will come right back up. If I eat too much, up comes the food. If I don't chew well enough, same thing. If I wait until I am relaxed, actually hungry (and not just wanting to eat), and then eat a controlled portion of easily chewable food- well, life is golden. Most of all I have to guard against overeating, which means something quite different back in the days before the band. Overeating now can mean two bites. I know that feeling of too much food in the pouch- it is miserable until it is gone, one way or the other. It is a pain to have to pass up invitations to lunch because I know I am not going to be able to eat, but I've discovered my friends and family are quite understanding about my dietary limitations. We go for walks instead or get together to sew or garden or ride the horses. It is a continuing pain in the neck to not chew well enough, overeat, eat when I'm not hungry and end up having to walk around to let the food settle or actually go get rid of it in worst case scenarios. Sometimes I am better off just going back on liquids for a day or two and letting my stomach relax. Easy way out? Not on your life. But I can live with it because it is working for me. If the band is too much of a problem for you, by all means have it removed. But the weight gain you report is not a side effect of the band; it is the result of too many calories. That's not going to change once the band is gone. Overeating is an eating disorder, just like bulemia and anorexia. Hummingbird's suggestion to find a counselor to help you deal with that particular eating disorder is a good one. Please don't discount it. Good luck to you.

My last in weigh in is in 2 weeks and I need to loose 10lbs. This is really stressing me out because I gained 3lbs on my 2nd weigh in. If I don’t loose then I will be denied and have to start all over. I recently quit smoking and that contributed to my weight gain. OMG !!!!!!!

I think many of us feel the same way! I think it is common for the band fills to kick in, even 1-2 weeks after the fill. Also, I think it is common that once you PB a few times, the stomach is swollen, thus tightening our band. Not to mention, hormones, time of day, etc. My motto with fills is...if more often than not you are too tight, then you may need a slight unfill. I HATE being too tight. Also, with the quick weight gain. Sometimes, if I am too tight (low calories) over time, then bamm I am loose and can eat more, my weight loss slows or I even gain a pound or two. I attribute this to my metabolism slowing, due to low calories/starvation mode. Then, once I can eat more my metabolism is still on "slow speed" and takes a while to speed up. Your body want to conserve the food (energy) it is receiving. Give it awhile, those pounds will come off. Shawn

So I was watching these videos by one of the WLS Surgeons and he isn't pro-sweeterners! He thinks it can also spike Insulin by your body responding to the sweet taste in the mouth. And can also cause weight gain! I do have medical knowledge and Insulin is only secreted in response to Glucose molecules attaching to the receptors in your Pancreas, so him extrapolating Insulin release to the taste itself kinda doesn't make sense to me! May be Slpenda, aspartame etc may not be the best alternatives but natural sweeteners seem safe so far especially how Keto diet is revolves a lot around such natural sweeteners! Thoughts? Are you a fan? Whether or not sweeteners are safe to be used in your weight loss journey esp cause many of us may not tolerate sugar well for life! https://youtu.be/DTIK8n0WTBU

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!

I know this is controversial but the nurse practitioner at my practice says that there is a lot of research correlating diet soda with weight gain. They can’t figure out the exact relationship. They just know that they are related. Just a heads up if you start gaining and don’t know why it could be the culprit. They told me that medically I can have soda but they recommend that I do not.