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I'm 4 years post VSG and also looking at a RNY revision. I had significant GERD all my life. With my surgery I lost about 90 lbs, regained 40. have lost the majority of that using Keto but still, the GERD remains. Surgeon says RNY revision will cure the GERD. I want off of meds, which I've been on for 15 years. I understand the decision to consider a revision. There are many vets who have revisions for various reasons.

Keto is (was) not a fad diet. It's effective for children and some adults with seizures and other health issues. People assume it is a fad, all the new low carb diets are based on it. My nutritionist said if you wanted to do keto at stage 4 it's fine, but I'm not keen on giving up dairy and I'm growing green beans lol!

Did you experience "keto flu"? Sent from my SM-G925P using BariatricPal mobile app

It’s always best to follow the diet you were given as it will be to follow their post surgical plan. As @liveaboard15 said different surgeons require different diets. My surgeon would put different patients on different diets based on the amount of weight they had to lose, their weight loss history & their medical history. So my friend was on all shakes, her friend was on two shakes & a meal & I was on keto. You can always ask your surgeon why he requires you to follow the all shake diet. The first five or so days are the hardest as you break some addictions & dependencies. You may headaches, low energy, etc. almost like withdrawal symptoms but better to get past this before surgery than after. Some people slip on their pre surgical diet. A slip is okay but regularly going off plan isn’t. The diet is required so you lose some weight to improve your health, reduce fat around your liver so your tummy can be seen more easily during surgery &, as above, break some habits & food dependencies. You can do it. It’s only two weeks. Some have to do it for three or more weeks.

This is a reply I gave someone about the food loss portion of their post I think it might help you with the being depressed over food. I was a 36 BMI so I’m considered not part of the high club and most people would say I shouldn’t have gotten it which is why only about 5 people know about it and I won’t tell anyone else. I don’t need the Criticism while I recover. “ I’m only one week post op but I can tell you this if you are reading this. The food restrictions how we overthink them aren’t really all that I know we think we will never eat certain foods but there are so many options for those of those that love food. Health is number one but if you google, Pinterest or even just ask there are so many good recipes and substitutes for meals that you can still enjoy the same. Yes we are eating less and not binge eating but it shouldn’t be like that regardless first week has been hard for me but I have spent the time I have no work planning out and researching basically a lifetime of changes. I follow people on social media that have been 1,2,3,4 even 10 years post op and they have their journeys up and what they eat and how they feel and it made me feel great. Even BariatricPal has items that resemble the real thing but are tailored to us. I know it’s not the post you all want to see it is more tailored to the part in your post were you might think you will suffer over food. Honestly I love penne vodka and Pasta and I know I can’t eat a whole plate how I used to but I found ways to replicate good recipes with low carb Keto or no sugar items.”

It looks like there have been a lot of ppl who don't read. I eat 1000 calories or less and weigh 280. I was bulimic for years. I got the band and list then regained even though I was under 1000 caliries a day. I'm considering the surgery because the doctor says it changes your body's set point. My fear isn't that I won't lose, but that once again I'll regain because my body really wants to stick at this weight. I eat a whole foods diet, not a SAD. I do keto. I just don't lose. Sent from my SM-G935P using the BariatricPal App With a condition as unusual/clearly medical/atypical as yours, a public WLS forum where most of us got fat from overeating junk is probably not going to get you the responses you need and desire. Definitely come here for support and love as you go through the process, but as far as factual scientific advice? Your situation is so far out there in the atypical range, I'm sure there are very few here that are qualified to answer. Best to you!! I'm sure with your desire to succeed, you can make it happen. I wasn't the OP. I was just letting her know she's not alone and that there are said to be benefits for those who are not eating 2 meals at McDonalds for dinner and still unable to lose weight. However, I'm not really sure where else one would look if they were in my situation and looking for answers. I can't possibly be the only one in my situation. And doctors assume I'm showing them my food diary that shows whole foods and then running thru to get a milkshake. No one believes me. I don't care and im not offended. But when I do start a thread with questions it's because of can't possibly be the only one in my situation and I need help too. As far as the doctors are concerned there is no reason and I just need to exercise harder. I did that. 2 hours a day. Where else can I turn? Like I said I wasn't asking questions originally, but where else would I go? Sent from my SM-G935P using the BariatricPal App Hugs. That's why I added the OP part late in the game.

It looks like there have been a lot of ppl who don't read. I eat 1000 calories or less and weigh 280. I was bulimic for years. I got the band and list then regained even though I was under 1000 caliries a day. I'm considering the surgery because the doctor says it changes your body's set point. My fear isn't that I won't lose, but that once again I'll regain because my body really wants to stick at this weight. I eat a whole foods diet, not a SAD. I do keto. I just don't lose. Sent from my SM-G935P using the BariatricPal App With a condition as unusual/clearly medical/atypical as yours, a public WLS forum where most of us got fat from overeating junk is probably not going to get you the responses you need and desire. Definitely come here for support and love as you go through the process, but as far as factual scientific advice? Your situation is so far out there in the atypical range, I'm sure there are very few here that are qualified to answer. Best to you!! I'm sure with your desire to succeed, you can make it happen. I wasn't the OP. I was just letting her know she's not alone and that there are said to be benefits for those who are not eating 2 meals at McDonalds for dinner and still unable to lose weight. However, I'm not really sure where else one would look if they were in my situation and looking for answers. I can't possibly be the only one in my situation. And doctors assume I'm showing them my food diary that shows whole foods and then running thru to get a milkshake. No one believes me. I don't care and im not offended. But when I do start a thread with questions it's because of can't possibly be the only one in my situation and I need help too. As far as the doctors are concerned there is no reason and I just need to exercise harder. I did that. 2 hours a day. Where else can I turn? Like I said I wasn't asking questions originally, but where else would I go? Sent from my SM-G935P using the BariatricPal App

It looks like there have been a lot of ppl who don't read. I eat 1000 calories or less and weigh 280. I was bulimic for years. I got the band and list then regained even though I was under 1000 caliries a day. I'm considering the surgery because the doctor says it changes your body's set point. My fear isn't that I won't lose, but that once again I'll regain because my body really wants to stick at this weight. I eat a whole foods diet, not a SAD. I do keto. I just don't lose. Sent from my SM-G935P using the BariatricPal App One thing I learned through this process is that my obesity is at least partly due to under eating as much as to overeating. Overeating is my bodies response to under eating (skipping meals, restricting, etc.). One of the biggest gifts of this program for me so far is a deeper understanding of nutrition and what my body really needs. Eating under 1000 calories in a day is no longer an option for me. Of I go over 1000, even on slow small increments, I gain. Ive been on many diets with many "coaches". I've been through different nutrition classes while in training for holistic health, while in college, and with docs. I understand the metabolic system. My doctor recently ran labs and told me how surprised she was to see sugars, and everything else perfect. I realize that for most people 1000 is not enough. I apparently have a really efficient metabolism. It doesn't take much to make me go. Sent from my SM-G935P using the BariatricPal App What is your resting metabolic rate? Have you ever had it tested?

It looks like there have been a lot of ppl who don't read. I eat 1000 calories or less and weigh 280. I was bulimic for years. I got the band and list then regained even though I was under 1000 caliries a day. I'm considering the surgery because the doctor says it changes your body's set point. My fear isn't that I won't lose, but that once again I'll regain because my body really wants to stick at this weight. I eat a whole foods diet, not a SAD. I do keto. I just don't lose. Sent from my SM-G935P using the BariatricPal App One thing I learned through this process is that my obesity is at least partly due to under eating as much as to overeating. Overeating is my bodies response to under eating (skipping meals, restricting, etc.). One of the biggest gifts of this program for me so far is a deeper understanding of nutrition and what my body really needs. Eating under 1000 calories in a day is no longer an option for me. Of I go over 1000, even on slow small increments, I gain. Ive been on many diets with many "coaches". I've been through different nutrition classes while in training for holistic health, while in college, and with docs. I understand the metabolic system. My doctor recently ran labs and told me how surprised she was to see sugars, and everything else perfect. I realize that for most people 1000 is not enough. I apparently have a really efficient metabolism. It doesn't take much to make me go. Sent from my SM-G935P using the BariatricPal App

The OP stated that she does not overeat, that she doesn't eat 1000 calories a day, but chooses the wrong foods to eat (junk food, fried food, pizza, etc.). Just wanted to clarify that. Also, there are many reasons people cannot lose weight. I was one of them. I am diabetic, and severely insulin resistant. This surgery helped to reset my body and my blood sugar is coming down nicely. Yes, I'm still using insulin, but not nearly as much as I was. Hopefully as more weight comes off, the need for the insulin will continue to decrease and eventually I can be without it. I ate keto for a few years, exercised until I continually kept hurting myself, and didn't lose any weight. However, my blood sugar did respond for a bit, but then it just kept going higher and higher. I cannot afford for damage to occur to my organs, so I finally saw WLS as my last option. Now I wish I would have done it years ago. I do have metabolic syndrome, and you can do everything right and still not lose weight. Then it is just frustrating and depressing, to say the least.

Ah I haven't gone to any support groups yet, don't know if I will. I told quite a few of my close friends before doing this and so far all have been very supportive. Because I had like weird eating (keto) before my surgery, everyone is kind of use to me and my having to order stuff a specific/special way I guess. Also my husband has been so supportive too. So I mean I guess with the help of the online community here too, I feel like I'm good. If that makes sense? How's it going you're only a week out. I was hating life still at a week out. Now however I am feeling great.

I'm sure they are very tasty, but they are junk food. Keto junk food is still junk food and should be avoided.

LOVE this! So what did you say when the guy said that in the full room? Were you embarrassed or did you own it? Oh, I "get" anonymity! Ok, we'll let you slide on pics of the body parts ROFLMAO! My sissies and niece who are super supportive keep calling me skinny minny and the incredible shrinking woman. They tell me how proud they are of me. But no one else has commented until yesterday. My PCP came in and apologized for entering the wrong room. He said he didn't recognize me until he looked down at my chart. LOL. That felt good! So I'm loosely letting my whole carbs fall somewhere between 30 and 40g right now. They net out to anywhere from about 20g net to 30g net. I'm not averse to pushing them up to 60g per day total carbs. I don't want to add a lot of sugar into my life even in the form of naturally occurring ones because I feel better without them. I'm definitely still in ketosis. My sugars are generally falling less than 15g total for the day. I don't know the study. Will have to look it up. But my question would be whether the study is a good one. Are they using newly ketogenic peeps? Or are they using people who've been keto adapted for a long time? It can take up to 3-6months of continual keto to become completely keto adapted. And the brain chemistry and body chemistry of those folks is completely different than in other folks specifically because the amounts and types of different ketones circulating. Brains actually run preferentially and "better" on ketones rather than glucose as fuel--or so MANY studies support. A brain is either going to be a sugar burner or a fat burner. If it's a sugar burner, it has the BARE minimum need of about 60g of carbs per day baseline. If it's a completely adapted fat burner, it has theoretically, unlimited supply of the specific ketones it needs to run very precisely. Any sugars needed to maintain the body are adequately provided for by gluconeogenesis that comes from dietary protein (in the presence of adequate protein intake) or in breaking down muscle in the absense of adequate dietary protein. A ketogenic diet is actually a muscle-sparing diet. But, I do believe that we as post ops are suffering silent lows, or even lower than our usual bgs due to small volume of food and small amounts of carbs in general. I am terribly flash irritable. Not grumpy all day. But little things make me flash. That has gotten better this week--extremely so--since I upped my calories to between 700-800. So that's why I'm thinking it's low bgs. My lowest readings have historically been in the late afternoon. And that is when I have the greatest propensity towards hanger. Otherwise, I'm pretty mellow really.

I have accepted tgat my future eating habits will never look anything like my old eating and tgats how I got to 313 in the first place. Tge surgery really is just 1 tool to help you reach your weightloss goals. I don't eat a lot of carbs at all, less than 60-65 grams a day 70-75 if I exercise that day. I don't really do keto as we can't have all that high fat and its not healthy long term. I just find creative ways to satisfy my favorite food cravings and whatever I "think" I can eat I put half that on my plate. If you eat sugary starchy foods more & more gradually on the regular you will decrease the amt that tgey bother you or cause dumping thus making it easier to incorporate them daily and putting weight back on. I lose 2.7 lbs a week on avg on about 600-800 cal a day but my day is mostly Protien then veggies with healthy fats and a small amt of fruits and carbs. I have been speaking with a councelor ev 2 weeks and my Nutritionist every month to make sure I stay focused, satisfied and don't make the wrong choices destroying my chances of success. Snacking is my biggest issue, Sugar free candies, Skinny Pop corn, popsicles, beef jerky, cheese sticks etc. I had to get all snacks out of my room, car and severely limit the amt I buy myself. I can easily stall if I snack on the wrong foods.. I had an eating disorder in my 20s and I had to totally rebuild my relationship with food, its still hard but being disabled and in pain daily was harder.

- if both surgeries are just as easy to fail as they are to succeed, why do the research charts show this difference? Research is based on averages. The numbers you are quoting do not apply to everyone in exactly the same way....it is an aggregate of those who reach goal AND those who don’t. 1 person loses 100 lbs. Another loses 40 lbs. Average weight loss of this “control group” is 70lbs...which is no where near what each person actually lost. @catwoman7 probably explained this better than me In her earlier post, lol Second, if you need to rely on averages for your peace of mind, it may be worth your while then to look into the makeup of the studied. Age, gender, starting weight, lifestyle habits, medical conditions, genetics, etc. Daunting, yes, but more informative and contextual. But really, wanna beat the average? Stick to plan more consistently than the “average” person (barring any medical conditions of course). Also, I wanted to ask, did you get to choose the size boujie you wanted for your sleeve or know what size Dr used for you?? Doc just did his thing with no input from me. I have no idea how what size he used! Also, did you cravings and hunger completely return after 6 months or it does but slightly? My hunger levels and occurrences has not returned to pre-op levels. I can’t remember when I first felt hungry though (it was months in)...but I do remember it was a rare occurrence. Even now at 2+ years out, i still have days of just not wanting/forgetting to eat. When i do get hungry, it isn’t the ravenous kind of hunger though. And it doesn’t take much to satisfy it. Lastly, can you just do complete Keto during the first year after surgery so you stay under 20 net carbs and in ketosis? Or our body doesn't need to be in fat burning mode because of the surgery? I didnt do full-on Keto during weight-loss phase because there was no way I could get in the percentage of fat required...but I did do ultra-low carb (20 net carbs max) during that time. But number of grams of carbs consumed is no where near as important as total calories consumed for weight loss. Though going low carb does tend to make me look lean. For my body this is good, cuz i can see more muscle definition, but for my face, not so good, as I look Skelator-ish. Since I have been consuming a higher number of net carbs (anywhere in the 100-175 range) my face looks much nicer, but the bod looks “soft” P.S. sorry this was so long

Fluffy has awesome recipe ideas. Particularly, if I were a keto person, I'd watch for her recipes.

October 3 here and day 7 of my pre op diet. I have already lost 12lbs in this 7 days. Crazy. I have been feeling so ready up until this morning when I noticed the keto breath and realized I am full on in ketosis. I keep thinking there are people out there that lose their weight with just a keto diet and exercise not surgery. I know it is just cold feet and I have been expecting this to happen at some point before the actual surgery. Anyway, off to have my Protein shake! Sent from my iPhone using the BariatricPal App

I saw my doctor today and got weighed just to see if the scale is different there than at home. I am 380, which of course I am happy about - but like I said, much of that was from the Optifast prior to surgery. I am not going to focus on the scale, but like I said before I was expecting a bit more of a woosh of weight loss since having the surgery. As I said before, I lost 20 ponds in two weeks just doing keto and moving a bit more - again I know that is water weight and also that wouldn't continue, but it was a great feeling nonetheless at the time. I agree with your points about nonscale victories and a month from now, I may be singing an entirely different tune on here. I was just thinking outloud and giving my initial thoughts per this thread. Thanks for the support. HM

Eat high protein...almost like a keto diet. Protein decreases hunger. It'll take a little bit to detox off of carbs and sugar but it's a must if you want to drop the weight. The sleeve is our tool not a magic fix. Excersize too if you can. Walking a couple miles total a day helps. HW = 360 SW = 292 GW = 220 reached 3/7/18 CW = 210 @ 6'5" 150 pounds lost! [emoji106]

Yes, I am pre-op. The weight I've lost was a result of 2 years strict keto....you probably saw that in my other post. I don't believe there's a set expectation for weight loss. The lady at my surgeon's office said with the meds, they expect me to lose approx. 25lbs which should put my BMI around 38.5. I gained a good 5lbs during the holidays which they're unaware of. I can lose 13.5lbs at this point and be right at a BMI of 40. I just need to get to that appointment and find out what they're wanting me to take. I'm guessing it's phentermine which I highly doubt will effect me since I used to pop Adderall like Skittles. No matter what, I'm going to make sure this surgery happens...

Think I am going to have a look at this KETO diet. Sent from my iPhone using Tapatalk

I gosh I don’tdo Keto! Just lower carb. I didn’t do it during the loss phase or now at maintenance. Way to hard to maintain the chemistry of keto... and the fat.

I am just now at 3 months. Everyone is really different with this honestly. I had a tough time-just passing Thanksgiving, I am getting a bit more used to foods I can handle but I will be honest and say there are a lot of limits. Some days are still worse then others-Doc said that's normal for the first year. I try to eat my normal keto diet from before but still have to add Atkins shakes. Cold does better for me then hot so I will sometimes freeze a drink in a bowl for lunch and have that. It definitely helps. Turkey meatballs are my staple these days if I can mix it with a little sauce. They say bread is difficult but I will have at least one or two slices of Aldi zero carb bread- it gives me a lot of fiber and some protein. I toast it then put either the turkey meatballs (smushed and mixed) onto the bread then let it get a bit moist or, if it's a good day, I can try some egg and then chicken that's been boiled with keto barbecue sauce (just a tad-it has about 3 net carbs). Sometimes I can handle deli meat and cheese seems to be fine for me if I really chew well and take tiny bites. I also have my tablespoon or two of genepro for the missing protein. Veggies are still really hard for me but I do take a v8 green and I have been trying little bits of apple. Banana was pretty hard and other fruits can be a toss-up depending on the day. I started to mix a bit of sweet potato mashed with almond milk and some of my boiled chicken together for some meals and peas mashed can be ok if I can handle it. Popcorn that's air-popped is doable for me and seeming the easiest to take down in small amounts (no butter or salt-just plain). I will take it as a treat- a cup or so. I also live on the sugar-free popsicles with 15 calories when my store has it in stock. Tillapia works for me some days as well if it's not baked or fried but boiled in the bag. My calories are still only at around 800 on good days but I'm exercising well and labs are showing the genepro is doing well with the protein. Probably not the best example for you as you can be better able to handle varieties then I am right now but it's where I'm at. Had bypass Sept 1.

I like to see everyone getting a minimum of 700 calories after the first month or so. That would be 80g protein, 33g fat, 20g net carbs. This still results in ketosis, but provides the minimum fatty and amino acids required. (I set protein a bit higher to offset the low carbs and fat. More calories (1000) allows less protein.. but never drop below 60g protein). A true ketogenic diet provides a lot more fat and calories than 700. Personally I was over 800 at 4 weeks, and 1000 at 8 weeks (non-keto), but some people can't lose well on a thousand. 700-800 is a sweet spot for maximal losses while still hitting nutrient goals.

Biohacking? Not really my kind of beef since I managed to jump off the self-optimization wagon. Anyway... I think you're missing my point that a lot people associate insulin release only with carbohydrate intake and this is simply not true and I'm not sure why you're answer seems to be so over the top because this is all I wanted to say. If you want to live a keto-life and enjoy that and there is even research to back you up, that's absolutely fine However, in the end what this guy has to say is just another opinion, based on his research. Other researchers have other things to say, based on their research and we're all back to square one again.