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Keto Diet After Bariatric Surgery

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Have you been wondering if the Keto diet after bariatric surgery is right for you?

I most certainly have. We know the low carb Keto diet after bariatric surgery is really trending right now, so if you are interested, we want to help you figure out exactly how to start for yourself.

After having a baby and not being able to take off the weight I regained, my husband and I decided to give the Ketogenic diet (aka “Keto”/low carb/LCHF — Low Carb High Fat) a try.  I’m hoping this will be a helpful guide to set you on the right path to losing weight on the Keto diet after bariatric surgery. I’m going to share with you exactly how my husband and I are doing it.

Battling regain post bariatric weight loss surgery? Try our comprehensive guide to effectively lose weight on the low-carb keto diet after bariatric surgery

We chose the Keto diet because we have found this is most similar to what bariatric surgeons are recommending long-term for their patients. The majority recommend low-carb diets, focused on protein, healthy fats, and nutrient-rich vegetables. Granted, the Keto diet is a bit different as it does emphasize lots of healthy fats for the purpose of satiation.

And too much fat in your diet may cause diarrhea, intestinal distress, or other dumping symptoms, if you’re sensitive to it. (Yes, you can dump on fat, it’s not just sugar.)

It feels counter-intuitive to eat so much fat, but the truth is, if you are feeling hungry and deprived, it’s a sign you need more dietary fats in your meals. It’s important to note you probably won’t feel hungry and deprived if you are a newly post-op patient. However, a few years out, your body does regain the ability to have hunger pangs again, so this is a great way to keep yourself from going off the deep end and making those mistakes that pack on regain.

OK, this is my own personal “diet” disclaimer:

I am not a fan of quick weight loss schemes or fads. I’m positive the reason my husband and I were obese is because of the “diet” culture (yes, the kind in quotes, the ones designed with an end date), which is set up to have you lose quickly for the first few weeks, crash and burn, then after months of eating anything and everything, you get back on, repeating the cycle, all of it stemming from a place of shame. Each time messing up your metabolism more and more!

If you are going to do the Keto/low-carb diet, please think of it as a lifestyle change, and not something that is going to give you fast results (although, it probably will). Our healthy-minded vegan friends do not say they are on a diet, no, they live a vegan lifestyle. Don’t rely on the scale, instead, do this for health reasons, and the weight will just come off as a by-product.

We wanted to change to the Keto diet for a lot more than just taking off regained weight post bariatric surgery and post baby; we wanted all of the other numerous benefits of the Keto diet. The neurological health and lifting of mind fog, the restored energy, no more sugar cravings, etc. So go into this knowing this is a forever change, and that you are not going to take the weekends off, otherwise, you negate all of the hard work you put into your week.

If you want to experience the freedom from food addiction, changing to a long-term, sustainable plan, like Keto/low-carb, is a great choice.

The Basics of the Keto / Low-Carb Diet

I feel that I could write pages and pages of what I have learned through my research about the Keto diet, but I want to focus solely on how it relates to people who have had bariatric surgery.

(If you would like a deep dive, in-depth look at how keto works for bariatric patients, please sign up for my free masterclass webinar, “Bio-Hack Your Metabolism; My Secrets to Turning into a Fat-Burning Furnace”. )

Basically, your focus is going to be on getting lots of good fat, moderate protein, and vitamin-rich vegetables, but aiming for no more than 20g net carbs. Once you have reached your goal weight, the one in which your body feels most comfortable, then I recommend raising your carbs, lightly adding back in healthy carbs such as fruits and sweet potatoes. For maintenance, you will want to stay under 50g net carbs maximum, which should keep you fat adapted and remain in ketosis.

I know the idea of adding a lot of fat to your diet is scary for bariatric patient. First, it contradicts the nutrition advice we have had drilled in our heads for decades now. But nutritional science has shown that fat doesn’t make you fat, sugar does. Obesity wasn’t an issue until we were told by the USDA that low-fat diets were the healthiest. Food manufacturers took the fat out of our food, and added sugar to make it taste better, and what happened? We all kept getting fatter and fatter as a society.

So for those of you who may be physically uncomfortable eating so much fat after bariatric surgery as it may cause dumping syndrome, know that at a typical meal, if you were to pick a piece of dark meat chicken, and cook your vegetables in olive oil or avocado oil, that would be plenty of fat, and a great ratio of protein to fat to carbs. No, you will not be drinking jars of fat or eating butter straight from the fridge!

How Long Until I See Results on the Keto Diet After Bariatric Surgery?:

This is going to really depend on your body composition. Every body is different. My husband started dropping inches almost instantly, and by the time we wrapped week two, he was already down fifteen pounds on the scale! For me, not nearly as quickly, and I’m okay with that.

UPDATE: I’m pleased to tell you that it definitely got better as I stuck with it!! After 8 months, I have lost 70 lbs, and my husband about 60! Ladies, don’t worry, it works out in the end! 🙂 

Laurie (that’s me!) after 8 months of keto, and -70 lbs of post-op regain lost. And fat adaptation made it feel effortless!

Scott (my husband) after about 60 lbs of post-op regain lost thanks to keto!

So what to do if you’re stalling like I did in the beginning?

Do you remember after you had weight loss surgery and perhaps you experienced a stall shortly thereafter? You probably wondered, “How could I possibly stop losing weight when I’m only eating a few ounces of pureed food per day?”

First, your body is going to be ridding itself of the water weight it accumulated during your surgery. It just went through a ton of trauma, of course there is going to be swelling. Then as that comes off, your body begins to go through the transformation of dissolving fat and your weight is going to fluctuate as you build muscle instead, changing your entire body composition.

Plus, it takes some people much longer to actually go into ketosis and/ or be fat adapted, which are two different things. Ketosis is when your body is producing ketones and using up fat stores as energy instead of glycogen. Being fat adapted means that you’re to the point where your body is working so well on using up stored fat as energy that you’re feeling so good, and losing those hunger pangs, to where you forget to eat lunch! It’s impossible not to notice, you will feel so amazing! This process may take up to two months or more for some people. This is why keto is a marathon, not a sprint. It is a lifestyle change, not a fad diet.

If this is frustrating to you, as it was to me at first, remember that the scale only gives you a tiny bit of information. Remember the big picture. Don’t narrow-mindedly focus on eating for a smaller number on the scale. Focus on eating for a better LIFE.

Tips for Keto Success:

If you find yourself starting and then stopping after two to three days and just can’t seem to get it down, here are some tips to help make keto much more simple:

Keep it Simple. In the beginning, it is best to just keep a very simple menu. You may even want to repeat the same meals daily until you feel comfortable adding in new foods. There are a million different great keto recipes online, including here on Barivangelist.com, but if having to learn a bunch of new stuff is overwhelming, remember this acronym: JERF. Just Eat Real Food. You can’t go wrong eating real food! For example, bacon and eggs at breakfast, turkey and cheese rollups and a pickle for lunch, and a fatty steak and vegetables in butter for dinner. Now, tell me that isn’t pretty similar to your post-bariatric diet plan already, am I right?? So easy!

Avoid Keto Flu. Cutting out sugar and other carbs can be very shocking to the body and for the first few days you might feel as though you have the flu. You can avoid this by adding in more electrolytes. A sugar-free Gatorade or PowerAde will work fine, but if you are avoiding the fake sugars, you can add pink Himalayan salt to your food for an amazing electrolyte boost! Table salt will not work for electrolytes. In fact, you may be like me and want to ONLY use pink Himalayan salt as it is so delicious, full of trace minerals, and just pretty to look at! Ideally, 2 teaspoons of pink Himalayan salt daily, if possible.

OR

In a lot of low-carb forums, people will tell you to just drink dill pickle juice to get through “keto flu”. I can tell you it works, and it helps if you really, really love pickles.

Out of Control Cravings and Hunger? You may need more dietary fat, aka in the keto world, fat bombs. My husband would go CRAZY without his fat bombs! I personally don’t like them as much because I’m super sensitive to dumping syndrome, especially the addition of any sugar alcohols/sugar substitutes. But if you need to be kept from going into a tailspin, I recommend looking up “keto fat bomb” recipes on Pinterest! My husband’s personal favorite are these Keto Mini Pizzas. I like them, too, because they don’t have any added sugar. But he eats them literally every day, and remember, he is dropping inches like crazy!

Take Measurements and “Before” Pics. As I mentioned earlier, the scale doesn’t mean much, so only step on it once a week at MOST. Have someone hide it if necessary! But go by body measurements, not weight.

Lazy Keto — To Be or Not To Be. Many people who are following the keto diet feel they need to track their macros. Macros are fat, protein, and carbs. You can use MyFitnessPal for free on your phone for this purpose.

If you are interested in calculating how many macros and calories your body needs, this is my favorite macro calculator.

But if counting macros complicates things  in the beginning too much making it hard to stay on, then I encourage you to do “lazy keto” and not track for now. One thing you can’t afford to be lazy about, though, is reading labels to check for hidden sugars and carbs. You will still want to only consume 20 grams of net carbs or less per day. The foods we used to think were healthy, wheat, corn, starchy veggies, most fruit, are going to need to be eliminated for now.

Seriously, guys, if tracking your macros makes your eye twitch because it brings back bad memories of that “diet” culture mentality, skip it. If you’re eating real food, three times a day, in pouch-sized and sleeve-sized portions (about 1 cup), you are going to be FINE.

For the record, neither my husband nor I track our macros.

Mental Preparation is Your Best Weapon. Getting your mind right is key to success. Decide now that you are not going to let temporary desires sabotage you from getting what you want in the long term. Give yourself permission to be successful.

One thing that helps us is to put a sticker on a the calendar for every day we stay under our net carb goal. I definitely don’t want to miss a day of putting my sticker up!  If it works for my kids, I figured it would work for me, too. We also have assigned a monetary value to that sticker, so at the end of the week or month, if I so choose, I can use that money to purchase something off my Amazon wish list. I put every little thing on that list before purchasing it, because I will usually change my mind after a few months. So the things that have been on there long-term are the ones I will eventually purchase. It’s a great motivator to reward yourself with a tangible item, and not with food!

I hope this answers your questions about how keto works after bariatric surgery!

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Reader Interactions

Comments

  1. I am curious if you go by the macros on the keto macro calculator you shared? It seems like more calories than what I should be consuming, but then again maybe I am not losing because I am not eating enough. For example, I try to stay around 1,000 calories however the keto macro calculator suggests about 1600. What are you thoughts?

    • Hi Tamra! Yeah, that’s definitely the problem with these online calculators. 🙁 They really do estimate too high. Here is a link to my Keto Hack ebook where I explain that a good rule of thumb for bariatric keto for now is to always hit your protein macros, definitely don’t eat as much fat is needed (just until you are comfortable and satiated withe each meal), and that should help with the calories as well, because per gram fat is 2X as many calories as protein and carbs. So if you’ve been good around 1000 calories, I think that’s a great goal. 🙂 Here is the link: http://bit.ly/keto-hacks-bariatric-patients

  2. I have been on Keto for two weeks and the problem I have is that I can’t eat enough food to get all of my macros in each day. Had GBS approx 8 years ago and while I’ve only put on about 15 lbs, I know I’m on a slippery slope. Any ideas?

  3. I saw one person asked but didn’t get the answer, can we still have protein shakes? I don’t like eating in the morning so protein shakes are my go to. I also eat a lot of light and fit Greek yogurt and the triple zero ones. I had ryn last year and my stoma stretched when the doctor went in to close an ulcer so I lost feeling. I’m still down 117lbs but I still have s lot to lose and haven’t lost much since November.

  4. I am wondering if it easier for bariatric patients to achieve and maintain Ketosis? I use urine strips, though I am thinking about monitoring with a blood monitor but I feel like I am able to stay in Ketosis pretty easily. For example my birthday was last week and I ate some carbs for sure but the next day I was a little lower on my ketones but still in Ketosis. And when I started about 3 weeks ago it took 3 days to get into Ketosis and I haven’t really been out of it since. I’m just curious honestly.

  5. I had Gastric Sleeve surgery in June of 2015. My surgery weight was 287 and I lost about 50 lbs. I have never been able to lose more and have tried regular keto but ended up starting and stopping several times. I pretty much resigned myself to the fact that I won’t be able to lose more but I want to change that. I am hoping this plan for bariatric patients will help. Feeling discouraged for sometime now. And I have sugar cravings which set me up to fail.

    • Hello Barbara, everything you described is what a lot of our community goes through and people who have already taken the course have had results but the best part is kicking that sugar addiction to the curb !!!

      sign up for our SO! LONG SUGAR! course you will be put in the waiting list then we will grant you entrance soon (: https://pages.convertkit.com/c62308c6eb/a820adec35

  6. Hi after having the bariatric sleeve procedure the and amount of volume we eat . How do you eat the amount of protein, fat etc.. when on keto ?

  7. Hello
    I had Gastric Bypass in 8/2018 I was 324 lbs, I started Keto diet about 2 weeks ago and zi feel great I have lost about 8 lbs in the last 2 weeks i am now 245 lbs, so in about 7 months I have lost 79 lbs and feel great.
    about a month ago i started to feel more hungry so I researched the keto diet. I consulted with my surgeon and made a few changes but is working I have not experience dumping at all.
    good luck to all of you.

  8. I had the Roun Y in 2004 and gained back some of the weight. I have been on this Keto for 5 to 6 weeks and been going to the gym 3 times a week during this time as well and only have lost 6 pounds. I am feeling very discouraged. I am reading why more weight is not dropping and there are so many keto calculations with a large difference in intake of fat, protein and calories. What do I choose? How do I calculate myself?

  9. I had Gastric Bypass in May 2013 and have been struggling with regain. My husband and son are researching Keto and want to start at the beginning of the New Year. My husband is hoping it will help with joint inflammation and pain. I was researching to see if I can do it too.

    I have two concerns:
    The first is my protein shake. I love it and have one every morning. I have always been haphazard with my vitamins and credit my protein shake for my good labs. Would I still be able to have it daily? It is called Chike High Protein Coffee, if you care to look up the nutrition info.
    The second is dumping syndrome. I’m a dumper and I dump on fatty foods every time. A slice of bacon, a sausage, a chicken wing, all will make me dump. Is it still possible to do Keto?

    • Hi Terry!

      Does cheese make you dump as well? There’s a lot of protein and some fat in cheese, but not sure how your body responds to that. Have you talked with your surgeon (or some other nutritionist) about your dumping syndrome and asked for advice there? We don’t have problems with cheese over here – it is a great snack to have a stick of string cheese or some “pizza”.

      If your husband and son are looking to do keto for the health benefits I don’t see why it couldn’t help. If your body goes into ketosis it’s going to start breaking down the stored fat and reduce the weight, and that should help with the inflammation.

      Anyone else have any advice for Terry here?

  10. Hi, I had the sleeve done 5 years ago and almost gain all weight back. Started keto in May lost 42lbs but have getting sick lately. My hair is falling out like crazy, lost about half so far. I started looking for answers. I think I’ve been so sick to my stomach is because I’ve been doing to much fat? I think I need to switch to bariatric keto diet? Any advice?

  11. I tried the Keto and for me I got super sick. It did not agree with me and I had GBS 4 years ago. What am I doing wrong??

  12. I completely agree with the LCHF Keto style eating.
    But fat does not cause dumping syndrome. Dumping is due to refined (usually sugar) carbohydrates entering the intestines to quickly.

    “Dumping syndrome occurs when food, especially sugar, moves too fast from the stomach to the duodenum—the first part of the small intestine—in the upper gastrointestinal (GI) tract. This condition is also called rapid gastric emptying”

    • Hi Candy!

      Dumping syndrome (whether it be early- or late-onset) can be caused from the rapid passage of ANY food, not just sugar / carbs.

      Read that definition you pasted again.

      Yes, sugar is going to trigger those symptoms far quicker than any other macros, however, gastric bypass and duodenal switch patients know when they’ve had too much fat. I know all too well that as a gastric bypass patient myself, I will have true dumping syndrome symptoms with too much fat, even in the absence of carbs. (Which is a giant bummer, because heaven knows I love a really marbly rib eye! 😉 )

      https://www.obesityaction.org/community/article-library/what-is-dumping-and-why-am-i-experiencing-it/

      • Laurie, I agree with you. Too much fat can also cause dumping. I am one that can get mild dumping from too much fat and/or sugar. I am 5 years post op RNY so it has faded some but it is the days that I forget about it that catch me off guard and my body reminds me of my new anatomy.

  13. I am so gladI found this site. I had the gastric bypass surgery over 10 years ago and have gained 25 pounds. I’m very uncomfortable and can’t seem to take the weight off. My gall bladder is gone too. I need help in guidelines to following the ketogenic diet. My family started on Monday. I’ve lost 5 pounds, but for me it’s different because of the gastric bypass and gall bladder removal. I really need help on this.

  14. Hi Laurie, my name is Trudy, am very interested in doing the Keto diet. I have some health issues that if I may ask you some questions. I have had GBS in 1990

  15. I’m a year out from GSV (Sleeve) but have been in a stall for 3 months. I am starting this keto lifestyle change to jump start my weightloss.

  16. Do you know the ratio of macros for bariatric keto? I am 3 years post-op for Sleeve Gastrectomy and have had no luck finding an accurate macro calculator! Any guidance would be much appreciated. I have regained about 35lbs and would like to get back down to my goal weight.

  17. So very interested in the meal plan and following you. i had Gastric Bypass surgery oct 17 2016 and i need to stay focus and on track i have seen how amazing friends of mine are doing on the Keto diet but did not think i would be able to go on since having surgery.. So thrilled to see i can go on it also get my husband on as well

  18. I had gastric bypass surgery in 2003 and lost over half of my body weight and was about 125lbs. I leveled off around 135-145lbs and kept it off for years. Then, then the food and lbs started easing up and I was 185lbs. I refused to get near the 200lb mark! I started keto and lost down to 145. I’ve made keto/low carb my lifestyle and love it. I stalled at 145lbs and want to be around 135lbs. My weight jumps over the smallest things! I can eat 50 carbs for a couple of days and BOOM I’ve gained 4 to 5 lbs and have to go back to under 20 carbs and it comes back in line. The real pro lem is that I can’t get down any further and I really don’t feel that well on keto. Everyone talks about the energy, clarity, etc. I don’t feel it. I feel like maybe my body isn’t breaking down the fat that is needed for energy. I take digestive enzymes and a probiotic. I’ve been reading about lipase (there’s a small amount in my digestive enzymes) and wondering if it may help? Any thought you or anyone else has are welcomed.

    • Hi Sherry!

      I don’t know if you’ve talked to your surgeon or GP but I would suggest you do that to see what’s possible. We all get to a stall and it means that your body has reached a point where it’s entered its comfort zone, but you can break out of that. I have been at what I’ll call a “set point” for about a month but I did finally break through and dropped about 5 lbs since then. You can do it!

  19. After revision surgery a year ago I am having difficulty with late dumping syndrome reactive hypoglycemia that causes weakness and fatigue. Do you have any information that was helpful to you?
    Thank you

    • Hi Rhonda!

      I’m not sure what your diet has been like but when I dump it’s mainly because I had something like bread or high sugar content, and it makes me have to lie down and sleep it off. It’s no fun! A personal weakness of mine was Dunkin’ Donuts. Luckily, ever since starting this no sugar no grain thing I haven’t dumped at all!

      Bottom line, I would keep careful track of your diet and check with a dietician or your GP to see if there are some clues to what’s going on.

  20. Thank you so much for this! Not much out there about keto and gastric bypass. My NUT says “no” and wants me to stick to single digits fat and sugar. I am 12 years out!!
    The bottom line for me is that when I’ve done keto before I had amazing mental clarity and energy coupled with low sweet cravings. Sadly, I succumbed to eating poorly again due to lack of boredom and meal prep time.
    I will give this a try again . . . I’ve read that it takes 2-4 weeks to become keto adapted.
    I LOVE your explanation of a fat woosh. I never was able to wait for that. . .
    P.S. Do you have a facebook page?
    Fondly,
    Denise

  21. I had GBS in 2017, and lost 163 lbs…sadly, about 100 have shown back up! My daughter is doing Keto and losing weight like crazy, but I have been concerned about all of the restrictions I have as a result of the GBS (don’t tolerate meat well, dumping, no tolerance of sugar alcohols, etc.). I am planning on giving it a shot, and after finding your site, I am anxious to see how it goes. Good luck to everyone doing or about to do Keto post GBS!

  22. I had gastric bypass (good ol’ scar straight down my middle) back in 2005. I have regained and lost during the years since surgery, never going above 230 but never going below 165. I really want to give this a try. My cousin who has never had a weight issue is currently eating keto and lifting weights and she looks fabulous. My husband retired from the Army after 20 yrs and has gained a little tummy, I think he would benefit from this lifestyle change as well. Any books we should get? Do you lift weights as part of your routine?

    • Hey Jamie,

      Scott here – Laurie’s husband. I LOVE this lifestyle and I think he would benefit as well, but only if he has the mindset for it. Laurie does do weightlifting as well on Tuesdays and Thursdays and loves it, but I do not personally lift weights at this time. I’m still dropping pounds too.

      As far as books go – what are you looking to do? If you need recipes and meal planning, Laurie can help you there with the recipes on this site and the Empowered Members club. If you’re looking for strategies for living on the diet then I don’t know if there’s anything out there for that – perhaps we can find something in Amazon?

      Whatever you choose, GOOD LUCK!!! Congratulations on keeping the weight off and letting your tool work for you!

  23. How accurate do you think the macros calculator is for our reshaped tummy? 1300 calories seems pretty high as I am doing roughly 800-1000 now… should the calculated figure be adjusted for bariatric patients?

    • Hi Danelle,

      Laurie’s husband Scott here – also the developer of the app.

      We are adding a feature to the app to adjust for the recommended nutritional needs for our community, so yes, when we release you will be able to see things targeted to the bariatric community as well as a normal person by changing a setting.

      I hope that is what you were looking for. If that didn’t answer the question let me know here or on Facebook and we’ll get back to you.

  24. I just found your blog and I am over the moon that you have created this. I thank you from the bottom of my heart for it. Fantastic information!

  25. I had a revision in 2015 and just started eating this way. I can’t believe how the weight I’s coming off. I used to drink protein shakes all day and not lose any weight. Now that I’m back to eating human food I am dropping the pounds.

  27. I had gastric bypass in 2015. I lost 110 lbs and I have gained back 60. I am researching the keto lifestyle and plan on starting it in the next 2 weeks after cleaning out my cupboards and re-organizing my kitchen. I am starting it with a co-worker so we can support each other and try out different recipes together. I stumbled onto your site while researching and you have so much information. Thank you for sharing your knowledge, ideas, and encouragement for others to learn from.

    • Thanks for sharing all this. Had Gastric Sleeve in February 2018 so am new to all this. “keto” has not been mentioned by my nutritionist thus far.

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