When Keto Doesn’t Work After Gastric Sleeve Surgery

The diet we typically recommend for our vertical sleeve gastrectomy patients is a high-protein, low-carb regimen. Why? In a nutshell: it offers foods most people like and it works. The ketogenic diet—which is high in fat, moderate in protein, and very low in carbs—is a cousin of our generally prescribed diet and popular among bariatric patients in general. Lots of my patients love it. But for some, it doesn’t prove effective or sustainable. Here’s why.

Keto Basics
The high-protein, low-carb way of eating is pretty familiar to our VSG group, and many believe keto is essentially the same thing. It’s not—at least, not exactly. Instead of focusing on mostly protein, this diet targets mostly fat and virtually eliminates carbs so the body enters ketosis, a metabolic state where fat is used for energy rather than glucose. Sounds great, right? After all, burning fat is the name of the game in weight loss. But a segment of people don’t react well to keto, for any number of reasons.

Keto Obstacles
Replacing carbs with fat seems like a dream come true, and for many people who’ve experienced gastric sleeve in Mexico with Endobariatric, it is. But you know it’s not for you when:

• You find it too difficult long-term. The keto diet commonly consists of things like meats, eggs, sausages, cheeses, fish, nuts, butter, oils, and seeds. There’s virtually no room for plant foods or, for that matter, deviation from a fairly tight list of foods. Maintaining a state of ketosis is why the keto diet works, and it doesn’t take much of a slip for your body to say “bye-bye” to ketosis. Dining out can be tough, and some find it too restrictive over the long haul.

• Other conditions interfere. Lots of my vertical sleeve gastrectomy patients have a long list of ailments when they come to me. Many of those conditions (Type II diabetes, high blood pressure) can be mitigated or even resolved entirely by losing weight with the sleeve. But some can’t. And if you deal with something like Hashimoto’s or another autoimmune disorder where a certain diet prevents flare-ups, keto might not be the best idea. Hashimoto’s patients, who have a hard time losing weight anyway because their immune system attacks their thyroid, tend to avoid things like dairy, nuts and seeds, and oils. Some doctors even recommend a vegetarian or vegan diet for autoimmune patients. You can see where it would be tough to do keto with those parameters.

• You don’t feel good. Here’s my standard disclaimer: everybody is different. And every body is different. Some keto lovers swear they’ve never felt better or had more energy. Others, like my patient, Dawn, say that keto makes her sluggish and didn’t help her lose weight at all. Christine, a Hashimoto’s patient who tried keto after she was sleeved, didn’t lose weight even though she was in ketosis the whole time. The point of VSG is to look, feel, and be better. So if your diet isn’t helping you with those goals, it’s not the right diet for you.

Keto Alternatives
Rather than feel discouraged if keto doesn’t fit your body, I encourage you to feel relieved that there are so many other options! It might be as simple as going the high-protein, low-carb route that so many Endobariatric patients find successful. Rather than fats, most of your calories will come from protein sources, of which there are many. Boredom typically isn’t a problem there. And non-starchy produce is also encouraged on a high-protein, low-carb plan. Still not for you? There’s also paleo, plant-based, low-GI, and many, many other options that will work with your sleeve. Tap into the expertise of our on-staff dietitian (did you know we had one?) to help discover find what’s right for you!

The bottom line, as always, is that the right gastric sleeve diet is the one that works for you, whether that’s keto, high-protein, or something else.

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“Changing lives…one sleeve at a time”.