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My doctor recommended 60 grams per day of protein, which seems low for my height. I probably need about 75 based on what I have read. It is all I can do to make it to 60. I feel like I am on a low fat keto diet, lol. Thank goodness for the vitamins! I still have not had any labs ordered so who knows. I received a packet from the dietitian recommending 5 small meals (1/4-1/2 cup each) each day. I have noticed that the recommendations differ vastly between different providers. I am supposed to be having regular appointments with my dietician but the appointments are always full so I have had no dietician contact post operatively. She doesn’t even respond to my emails (okay, she did once, two months after I asked a question). In some ways I am relieved that no one has noticed the weight loss, but at the same time I want it to be noticeable, too. I guess 229 looks as huge to the average observer as 289. I look forward to passing from an obese BMI into just an overweight BMI. For my height that will be at 205. Maybe it will be noticeable at that point. But you’re right, you tend to overlook changes on someone you see on a daily basis.

Ahh that is such a shame! I am sorry! But at least the pizza was extra good! Its good to hear your experiences with it all post-surgery, and that keto banana cookie sounds yummy! Would you mind sharing the recipe? The rice is amazing with it all...ugh I will miss it!

In case this helps, I'll show you what one of my typical days looks like at 4 months post-op. Keep in mind I have had the DS so I eat more. My personal macro goal is 120-150 grams of protein a day, under 50 total carbs, and 100 grams of fat. Also, I can't tolerate any raw fruit at the moment. And calories are not relevant for DS patients because we malabsorb most fat and a good chunk of our protein... 8 am: Premier Protein Cafe Latte Shake 9 am: Ratio Keto Vanilla Yogurt with 2 tablespoons of toasted coconut chips, 1 tablespoon of keto nut granola, and 1 tablespoon freeze dried strawberries 12 noon: 1/4 cup roasted Spaghetti Squash, 1/4 cup of ricotta cheese, 1/4 cup of a beef bolognese sauce 2 pm: Cafe Macchiato with espresso and 4 oz Fairlife Protein Milk 3 pm: 2 mozzarella cheese sticks, 2 mini baby cucumbers and 4 cherry tomatoes 6 pm: Roasted chicken leg and thigh quarter, 1/3 cup of vegetable soup 9 pm: Homemade Keto Banana Walnut Dark Chocolate Muffin Total Macros: 150 grams of protein (yay!!), 43 grams total carbs, 97 grams of fat, 1634 calories.

I didn't really get a chance to do this because my surgery date changed and I had to immediately start the pre-op diet. So the only thing I had was 2 slices of a really, really good pizza and a few wings. Oh, and a mixed drink! And that was it... I've found post op that I can still eat a lot of what I loved before with modifications. I can have pho, but without the rice noodles, the sweet little lady at our local shop makes it with veggies for me! I can have korean bbq (which is my favorite meal) but we order ala carte now instead of all-you-can-eat and have leftovers for days. I can have thai curries but I get them to go and put them on heart of palm noodles and have several meals of it. I can't have the carbs I used to have and some days I miss them, but not for too long. I do miss a pastry with my coffee, but I'm working on finding a few decent keto cookie recipes and I recently made keto banana nut chocolate chip muffins that were wicked good and scratched that itch... My partner loves to eat out so I've found a variety of ways to adapt what I get, how to optimize for things that will be good as leftovers, or how to get a smaller portion or leave off what I can't eat... Enjoy your katsu curry!! I do kind of miss that with a steaming bowl of rice... Mmmm...

I'm glad you are feeling better!! Learning to eat slow is definitely a challenge. I still catch myself sometimes. I get food bored too so I try to eat a variety of things. I don't usually weigh out my food, but I do portion it out/estimate the portion and log it to make sure my macros are on target. It is crucial for DS patients to get enough protein in and if you aren't tracking it you might not be getting enough. It'll eventually show in your labs, but once your protein level drops in labs it is a huge pain to get back up. So it is best to just track it... You don't have to be as exact as weighing, but a good estimation is worthwhile and will also teach you how to understand what correct bariatric portions are for you. My surgeon likes his patients to stay in ketosis for a while so I aim for 120 grams of protein, less than 50 total carbs (usually less than 40 total carbs for me to be safe), and I aim for about 100 grams of fat for good brain health. I don't eat at specific times. That's too much planning. LOL I drink a protein shake as soon as I wake up, then eat a meal about an hour later, and eat every 3 hours after that until I go to bed! I usually end up eating about 5 times a day. I ascribe to the "eat less more often" method and so does my surgeon. I discovered soon after surgery that I need to eat within 3 hours, anything past that and I start to feel exhausted and have no energy and get moody. I feel my best if I eat within 3 hours of my last meal throughout the day... Sometimes eating is a protein snack like a bag of protein chips and a few pickles. Sometimes eating is more meal-like like keto chicken tenders with steamed asparagus. But I always eat by that mark or I pay for it. I also pay for it if I don't get enough fluids in a day, so I watch that. Monitoring your food and water can feel triggering for some people due to past diet attempts. But it is important to reframe it as a caretaking behavior as much as possible, especially for DS patients because our dietary needs are so important to be on target with.

I don’t tell a lot of people either. Just stick to the facts like many others: saw a dietician, did a lot of research, changed the way I ate & had my doctor’s support. If they ask what diet (still get asked occasionally) I say keto to kick start (was my pre surgery diet so true too) but then no diet just made changes that are good for me. I don’t tell them I exercised because I didn’t & anyone who knows me would know I was lying if I said I did. LOL! I agree with @GreenTealael. The quick turn about to redirect them to themselves or a new topic is a good tactic:

I had surgery during the Keto/intermittent fasting boom and I relied heavily on that excuse. Was I really fooling anyone? In retrospect, I doubt it. Now with the rise of highly effective weight loss medication and it’s media coverage, people will think whatever they want anyway, despite your well thought out excuse. You can always remain vague and say your health is improving and then immediately switch the conversation to focus on something else. I absolutely love the “enough about me, what about you?” pivot.

I had surgery during the Keto/intermittent fasting boom and I relied heavily on that excuse. Was I really fooling anyone? In retrospect, I doubt it. Now with the rise of highly effective weight loss medication and it’s media coverage, people will think whatever they want anyway, despite your well thought out excuse. You can always remain vague and say your health is improving and then immediately switch the conversation to focus on something else. I absolutely love the “enough about me, what about you?” pivot.

PROGRESS UPDATE I had my gastric sleeve surgery on December 18th, 2023. I was nervous going into the procedure as I had never had any surgical procedures before, but it went relatively smooth. I was in a lot of pain while in recovery, to the point where the team had to push oxy and fentanyl simultaneously to help with the pain. Once the team was able to help me manage the pain I was in pretty good shape. It has certainly been an adjustment but it wasn't as daunting as I was expecting it to be. Its been about 2.5 months since the surgery and I've lost almost 60 pounds; I weighed in on at the hospital at 366 and yesterday weighed in at 308. My highest weight was 475lbs so all-in-all I've lost 167lbs utilizing diet, exercise and the sleeve. I found it fairly easy to comply with the post-op diet and have moved on to solid foods. I'm not hungry often but I make sure to eat at mealtimes to continue meeting my goals. I consume, on average, between 80g and 100g of protein a day and consume less than 900 calories a day. I don't consume very many carbs as a) they tend to contain more sugars and b) they tend to make me not feel very good. I do still have a bit of a sweet tooth but that has been easy to manage with the occasional chocolate chip. I've also completely kicked sugar and have switched to monk fruit sweetener with erythritol. I also dabble with keto recipes, mainly deserts as I find that some "entree" recipes contain way too much fat for my liking. My family, friends, and coworkers notice the weight loss more than I do. I'll see it a little bit here and there but not to the extent that others do. I still see myself as that 475lb guy that struggles with his weight and his health. I know that it isn't true, but that is still how I view myself. My clothes are fitting me much looser and I think I see some weight loss in my face and neck. I still have a lot of excess fat and tissue around my midsection and especially the "love handle" region. I definitely suffer from body dysmorphia as I only ever see the overweight me. My overall goal weight is 250lbs, which is only 58 pounds away which sounds crazy. That said, I would throw a party if I reach 225lbs as that is my "best case scenario" goal. I genuinely believe I will achieve both goals but there's always that part of me that doubts it. This has been the best decision I've ever made for my health and I wish I had made this choice earlier.

I am just starting Zepbound tomorrow! Ihave had a long journey. I was lapbanded in 2002. I lost 130lbs. In 2014, after not seeing any doctors for 5 years, I went to a local bariatric surgeon just for a checkup. He found my esophagus had expanded. My band was too tight and I was packing my esophagus..didn't even know..no pain. Immediately unfilled and gained 30lbs in a month..eating NOTHING! LIke almost! I was refilled after about 3-4 months and then developed an infection..and to cut to the chase..band was removed in 2018 and revised to sleeve. By then I was up 50lbs. Since then I gained another 50lbs..so the sleeve did nothing. Between covid, bad eating habits and menopause, I cannot get this weight off..I tried keto..lost a few lbs..tried intermittent fasting..lost a few more..but my body just won't move the weight down..so broke down last week and saw my new primary doctor and she prescrived Zepbound..well orginally Wegovy but that is harder to find and Costco had Zepbound. I will start this Saturday.

If you are counting total carbs you need to be under 50 grams total carbs to maintain ketosis. If you are counting net carbs you need to be under 30 grams net carbs to maintain ketosis. They aren't interchangeable. Some believe fiber and sugar alcohols don't impact blood sugar so they can be subtracted and net carbs followed, but that doesn't apply to everyone. I can't eat any of the high fiber "keto" products like breads. For me, carbs are carbs and keto bread will knock me out of ketosis just as fast as a chocolate bar. 🤣 I am not the norm, but it is incredibly annoying!! And I know others like me. Regardless, my dietician said we should count total carbs because net carbs are not a recognized measurement by whatever association decides these things. LOL Most fruit is high in carbs, yes, and so most people watching their carb count choose coconut and berries as opposed to citrus or bananas. Same with veggies, green beans would be a better choice than a sweet potato. Keep in mind this state of ketosis is not intended to last forever, so what might not be the best item to eat right now will fit perfectly later on in your nutritional picture when you can increase your carb count.

Apparently they called the first week of the pre surgery shake diet hell week at my surgeon’s office. There’s a lot of withdrawal symptoms associated with it (sugar, carbs, caffeine). Your cravings go crazy - you always want more the things you can’t have. Your emotions are all over the place which often makes you want to comfort yourself with food. On & on. Round & round. I was vey relieved I was placed on keto for the pre surgery diet. I had done the shake diet before. Two shakes & one small portion meal of steamed vegetables & plain cooked protein. Did it for 8 weeks & then again for 6 weeks a couple of years later as another diet I was trying. It ain’t easy even with one meal. Check with your dietician regarding swapping out a shake for a broth/soup. Some companies do offer them as well as shakes but they’re still going to be low calorie & go through you quickly being liquids. You’ve got this. You can do it.

Its quite normal to go off foods. I think its the Keto diet that changes the foods tastes. Two years on, I still am unable to stomach cooked salmon, mussels and lamb. Strangely enough, they were my most favourite foods pre surgery. It does get better once real foods are back on your menu, I promise. Just eat what you can now because this stage of having little appetite doesn't last for everyone. What you are doing is great

I have to eat every 2-3 hours and have since I was post op, so I eat 5-6 small meals a day. I prefer this because it keeps me from mindless snacking, provides a rhythm to my day, and allows me to get in a variety of flavors and textures. I'm only 3 months post op, there is no way I'd get my daily macros in with just 3 meals a day. My stomach doesn't have that capacity and if I go past 3 hours without eating my energy crashes, I feel light headed, nauseous, shaky, and irritable. Each person's body is different, but by necessity I ascribe to the "eat less more often" method and I'm not alone in that need. My target macros are 120 grams of protein, 100 grams of fat, 40 grams of total carbs, calories don't matter because I malabsorb a good percentage of fat and a moderate percentage of protein. 8:00 am Premier Protein Vanilla Shake 9:30 am 3 tablespoons hashbrowns, 4 cherry tomatoes, 1 1/2 scrambled eggs 12:00 Ratio Coconut Keto Yogurt and 2 tablespoons Diabetic Kitchen Granola 3:00 pm Espresso with 1/2 cup Fairlife Whole Milk, Quest Spicy Sweet Chili Protein Chips 6:00 pm 1 grilled chicken thigh, no skin, 3 tablespoons green beans 9:00 pm 14 Wasabi Soy Roasted Almonds, 1 Choxo Dark Chocolate Coconut Cup Total Macros: 116 grams of Protein, 40 total grams of carbs, 78 grams of fat, 1305 calories. This is pretty typical for me. I don't always eat the protein chips, I was just in a hurry and they are one of my go-to snacks when I can't have something perishable. Normally they'd be a protein and veggie.

Hi I am 3 months out and I am experiencing hair loss, but honestly, even people that do Keto or Code Red where you basically only eat protein (btw hard on the kidneys) lose hair, so I think it's unavoidable. Things will get much easier once you can eat actual food (you'll learn by trial and error what works for you.)

it really depends on what ur goals are... rapid weight loss? sustained weight loss? maintenance? muscle building? fat loss? carb reduction? fats loading? anyway...i used the following calculator to determine my optimal macros based on a modified keto diet (kinda like Atkins II, sorta). it worked for me until it didn't...the macros i was aiming to maintain was really not sustainable (for me) in the long run. im 5+years post op now and don't look at macros anymore (haven't done so since year 2)...now i just keep an eye on total calories (no matter how they are comprised). i've been able to maintain below goal weight this entire time just on maintaining a caloric limit alone....but thats just me...ymmv. but anyway, here is the calculator: https://www.ruled.me/keto-calculator/ good luck! ❤️

Sorry if I'm repeating myself, I've lost track of which threads I've posted on. My doctor said to keep it under 10g total carbohydrates per serving, and target 50-60g total max per day. Not low enough to go into Keto, unless that's your intent, but low enough for the body to prioritize burning fat first. I know on days that I've blown past this, I'll feel more irritable a few hours later and I'll crave more bread and sugar for 2-3 days afterwards, so go lightly on it! Personally, I've had trouble with some artificial sugars causing cravings and irritability. Not everyone will have this intolerance, but pay close attention to any sugar alcohols or substitutes in ingredients and see which ones affect you. I've had luck tolerating monk fruit and stevia, but Sorbitol and Xylitol hit me as hard as normal sugar.

Were you given a diet & list of what you can & cannot drink/eat before & post surgery? If you didn’t ask for one. It’s really important to follow the plan you’re given. Surgeons can have different plans with different requirements. For example the pre surgery diet could be three protein shakes a day, or it might be 4 shakes a day. It could be two shakes & one meal of meat & vegetables (low fat, low carbs). Some even specify what brand of shakes to drink. I was on keto so lots of differences. Generally post surgery it’s protein shakes, bone broths, cream soups, consumes so protein, protein, protein. Some are allowed sugar free jello but again you should follow your surgeon’s plan. All the best.

Agreeing with the others, stick with the plan. The first couple months you definitely do not want to put pressure on those staples and risk a leak. That's a rough surgery compared to what you just had. Infections from that can get nasty and lead to sepsis. I struggled with overdoing it myself early on, but had to remind myself that its to prevent burst staples, and that I can give it 30-60 minutes and resume eating to give it room. I've noticed I can do 8 fl oz easily if I'm not careful before my stomach starts pushing back. As for the hunger, I'm one of the unlucky few that still has the obsessive head-hunger. It takes practice, but look for signs that your stomach and body are telling you that you are full, despite part of you saying "I have to keep eating!" It took a lifetime to train that reflex, and it won't go away overnight. I'm still fighting mine daily. I've noticed I'll feel a little pressure if I'm approaching the limit, but if I keep going, I start to get a runny nose, which is my final warning before making myself sick. My goal is to prevent it from getting to that point. One thing I did to throttle my eating speed is to get disposable mini / baby spoons and forks from amazon. They're only like 1/4 of a teaspoon so you get a smaller portion per bite, which helped me a lot! It takes longer to eat, which gives your stomach more time to send the full response to the rest of your body, since that is delayed. I've had to use the disposable ones since its mentally easier for me to walk away from the food if I throw the little cheap spoon in the trash. I'd rather use the reusable ones, but I know the limits on my discipline haha. This is just anecdotal, but as a recovering Type 2 diabetic, I have to be careful with sugar and starch hidden in foods. I've eaten some over the holidays, which tasted great, but realized it made me crave more. If I went a meal without it, I would get actually angry, and I'm sure I wasn't any fun to be around. Eating desserts over Christmas would send me into constant snack cravings for 2-3 days. I told my doctor, and he said you have to power through those couple of days, but by focussing on low carb (not necessarily keto) and prioritize protein, unsaturated fats and water, those cravings go way down. I've had to use "filler foods" to hold me over between meals. My wife says its gross, but I've been eating Fage plain greek yogurt to hold me over. Single Digit carbs and 17g of Protein per serving and its more savory rather than sweet. Mentally, I've used it as a substitute for cheese, mayo, sour cream, and other things to just pretend that its a more substantial food. That and it does seem to fill me up as long as I don't have anything sweet with it. Similar with 2% fat cottage cheese. Also, some artificial sweeteners can set off a sugar craving or insulin response, which just compounds the cravings. I'm not sure which ones do, but I know the ones in the Fairlife brand protein shakes do not set it off for me, while MuscleMilk does make me crave it. Fairlife has Monk Fruit, Stevia, and Sucralose, and don't seem to set that off for me. You may want to experiment to see which ones may bother you.

Try an electrolyte powder in your water. It is common for the liquid diets to trigger "keto flu" from the lack of minerals and nutrients compared to a normal diet. I found a packet of electrolytes a day really helped keep my energy up and the muscle cramps and headaches at bay. Good luck! ❤️

That does sound like the basis for the diet I'm on. They told me to work on getting 64oz of water per day as top priority, then around 60-80g of protein next. Next it was to prioritize some unsaturated fats (fish, poultry, and lower carb veggie protein options). From there, they told me to keep carbs under 10g per serving, and under 55g total for the day (not quite as low as keto). Then try to keep saturated fats low where possible. I'm a 6'1" male, so they had me try to target 800-1000 calories per day during the weight loss phase, and work toward 1200 after about 6 months. You may want to check with your doctor or nutritionist to see if they have a recommended range to target. I learned the hard way while I was sick with Covid over the holidays that its really easy for excess calories to be hiding in small things. But overall, just keep up with what you are doing. There will be a stall within the first couple months, and a second stall a couple months after that, so just mentally prepare for it. Both will last 2-4 weeks and will likely have a slight regain in the middle of it. It doesn't take much fluid retention to make the number on the scale go back up. Remember that a 16oz bottle of water is literally 1lb. It's not fat, so it doesn't count. if you're drinking a half gallon / 2L of water a day, that's 4 lbs sitting there, but it doesn't count as "fat weight". It is jarring to see a 4lb fluctuation on the scale, but you're not losing progress, it's just water that your body isn't done processing yet. Think of the weight loss more like stair steps rather than a straight line. You can push through it!

The Week 3 stall is real! I stalled and gained 6lbs back between weeks 3 and 5, and just now lost it back in the last week. I've had several people tell me weeks 3-6 will generally have a stall and a slight regain due to your body panicking over the rapid weight loss, and readjusting its baseline, so it is part of the process. I've also been told a second stall/regain will occur around the 3-month mark, and last up to 4 weeks, so prepare yourself for that. I'm bracing for that coming up soon. Keep in mind the weight loss won't be like a straight line, more like stair steps with the occasional bump back up before dropping again. Just stick to the diet, and switch to weighting weekly to prevent obsessing over it (like I did haha). Also, several months from now, as you approach your goal weight, remember that gaining muscle through exercise will make the number on the scale go up, but that's a good thing. Muscle weights 1.5x as much as fat, so as you gain it, you will continue burning off fat, which is the "bad weight". About 1 year out, you won't worry as much about the scale, and will celebrate the wins in smaller clothing sizes, more energy, and better endurance/stamina! Regarding the caloric intake, my surgeon and team recommended I keep aiming for 800-1000 calories per day, but I am a 6'1" male, so my base caloric rate may be higher than yours. I would check back with your doctor or nutritionist to be sure, but I think 1200 is closer to the target after 1 year. Also prioritize water and protein first, followed by unsaturated fats, then try for any carbs/sweets/starches/breads and saturated fats last. My plan has me targeting less than 50g of carbohydrates per day, not low enough for keto, but enough to keep the sugar cravings and fat retention down. You may need to check your macros as well. Best of luck to you on your journey!

Congrats on the 16 years of success! As we get older, our metabolism likes to mess with us, haha, but this is common. My surgeon told me that after a while, some weight regain will occur, but the best way to restart things is to redo your pre-op diet for 2 weeks, just to jumpstart things. His plan is at least try to get 64oz of water a day, start with 2 protein shakes for the two meals a day where you typically eat less. On the "big meal" each day, try to get in 6 oz of meat/protein of your choice along with as much leafy greens/broccoli, cauliflower, celery, cucumbers as you can. Cut out breads, starchy veggies (potatoes, carrots, etc) for the 2 week duration. Target 60g-80g of protein, and under 50g of carbs per day (not quite keto levels, just reduced). Calorie target was around 600-1000 per day, but it is meant to be temporary and not long term, just a jump start. From my personal experience, sugar/starchy carbs tend to send my cravings off the deep end for up to 3 days after eating them. I'm having to avoid bread, cookies, cake, candy, tortillas, wraps, potatoes, carrots, rice, and oatmeal whenever I start to regain. Some artificial sweeteners seems to set me off too, but I am a recovering Type 2 diabetic. I haven't isolated which ones affect me yet, but I can drink Fairlife protein shakes without having that sugar craving, and it has Monk Fruit, Stevia, and Sucralose. First day is absolute hell, but after 3 days it eases up considerably. Give that a try for 2-3 weeks and see if that helps with the weight loss. After that time, start working in your normal foods again, but give them a few days to see if any are triggering the new weight gain to happen again to see what's worth keeping. Slowly increase your calories to find the amount that works best for you long term. You want the range that lets you have the energy you need without weight gain. Some people may be only 1000 calories, others 1200, and others may be closer to 1800, so there's no exact number that works for every single person. Good luck, and I wish you well on your journey!

I had the same experience as NickelChip on the GLP-1 meds. Saxenda I lost about 15 lbs on, when insurance decided I didn't lose that fast enough they stopped covering it. I gained the 15 back plus another 10 almost immediately. I then went on Victoza, no weight loss. I did Ozempic for two years, also no weight loss. And on both of them I actually gained weight until my highest weight of 320lbs. They did help my A1C levels but that was it. They all had unpleasant side effects and cost a ton. I'm 7 weeks out from a duodenal switch. I've lost 26 lbs since the surgery and while there have been tough moments I'm so glad I decided to go with surgery instead of trying more medication... I've lost 40 lbs since my highest weight! I've never lost that much weight with anything, ever, not even with keto plus the meds. Usually if I have issues with a doctor's office not returning my calls or responding to my messages, I eventually go in there and talk to the office staff in person and wait until they send a nurse out to deal with my issue. 😂 It is quite effective! I'm super nice about it, but still... I had a LOT of scheduling issues with my surgery and in the middle of it they lost their scheduler and I had to deal with some really rude staff on the phone. But it all got sorted out in the end! Hang in there!!

I only had to do 2 weeks of keto - I had mine in Mexico. My insurance denied me. They required BMI and THREE co-morbs 😩