Guide to Going Keto After Bariatric Surgery

Medically Reviewed by Katelyn J. Mock, US-Registered Dietician (R.D.)

Low carb diet has been at the receiving end of fat-phobic health professionals. Many of them give it a bad rap, citing increased bad cholesterol levels and greater risk of cardiovascular diseases. However, people are now warming up to the idea of fat not being Queen Cersei of “the Game of Diets.”  Ketogenic diet – or simply “keto” – is essentially a high-fat, moderate protein, low carb diet that has a long list of positives.

A research study by Nicholas J Krilanovich1 published in the American Journal of Nutrition states that reducing carbohydrates and switching over to a fat-rich ketogenic diet allows for drastically cutting down calories without feeling rapaciously hungry.

Logically, consumption of more fat would mean elevated cholesterol levels; however, there are numerous research studies2 pointing that the logic-defying ketogenic diet actually results in reduced bad cholesterol (LDL) levels and elevated good cholesterol (HDL) levels. This is achieved by forcing your carb-deprived body to convert fat into fatty acids and ketones, and utilize them for energy. So carbs get replaced with fat as the main source of energy for the body. In other words, your body is practically running on (read burning) fat.

How Ketogenic diet works - infographic

The Ketogenic Cheat Sheet

What to Eat? What Not to Eat?
Meat Sugar Laden Foods (soda, cakes, cookies)
Chicken Cereals
Turkey Pasta and Bread
Fish Beans and Legumes
Eggs Processed Vegetable Oils
Good Fats (olive, avocado, ghee, butter ) Alcohol
Veggies Sugar-Free and Low-Fat Products
Minimal Amounts of Fruits Starchy Vegetables

To Keto or Not to Keto After Weight Loss Surgery?

With all the buzz around it, you have to modify your approach to ketogenic diet in case you have had weight loss surgery. The basic premise of keto – high fat-low carb – has to marry the high protein-low carb bariatric philosophy. And the result – a low carb, high fat, higher protein diet suiting your altered stomach and digestive system.

Ketogenic diet has many benefits, some of which are:

  • Low Carbs = Lower Appetite
  • More Weight Loss
  • Loss of Pesky Belly Fat
  • Lowered Blood Triglycerides
  • More Good Cholesterol
  • Less Bad Cholesterol
  • Improvement in Type 2 Diabetes
  • Lowered Blood Pressure Levels

Keto Diet Benefits - Infographic

Typical Bariatric-Friendly Keto Meals

Here are some sample ketogenic menus suitable for those who’ve had bariatric surgery:

Day 1 Day 2 Day 3
Breakfast ·         Bacon/eggs
·         1/2 grapefruit		 ·         Bacon
·         1/2 cup diced papaya		 Sausage with slices of apple
Lunch Chicken/green salad with avocados ·         Tuna salad
·         Green salad with sliced apple		 Shrimps with avocados
Dinner ·         Baked salmon with spinach sautéed in butter
·         1/2 cup fresh berries		 ·         Baked chicken
·         1/2 sweet potato with butter or eggplant with parmesan cheese and green salad		 Flank steak with asparagus
Snack Guacamole with veggies /cottage cheese Whole-milk plain yogurt with berries Protein shake/string cheese

* Adapted from St Louis, Betty Wedman. “Appendix 1 – Ketogenic  (Low Carbohydrate ) Diet.” Bariatric Surgery Patients: A Nutritional Guide. CRC, 2017.

What to Look Out for?

  • Not more than 1 teaspoon butter/ghee per meal
  • No full fat whole milk
  • No heavy cream
  • No cream cheese, including the low fat variety
  • No skinny lattes
  • No eating till you feel stuffed or till the point your are uncomfortable

Some Keto-Friendly Swaps

  • Zoodles (made of zucchini using a spiralizer) instead of pasta or noodles
  • Cauliflower pearls instead of rice
  • Low fat cheese in place of cheddar cheese
  • Unsweetened tea or coffee instead of the non-fat milk variety laden with artificial sweeteners

The Pre-Op Keto Bonus

There are some research studies pointing at the positive effects of ketogenic diet on pre-operative bariatric patients. According to Frida Leonetti and colleagues3, low carb-ketogenic diet results in reduction of body mass index (BMI), waist circumference and neck circumference, and even decreased diabetic medication after following a pre-operative ketogenic dietary regimen.

We want to reiterate that bariatric surgery is no magic pill. The onus of its success is primarily on you – the eating habits and commitment to lifestyle changes. A modified keto diet can be a great way to eat well while feeling sated at the same time.

Just make sure you consult your bariatric surgeon as well as the nutritionist before you take the plunge, as they will rightfully help with the modifications to suit your new stomach and digestive system. Go Keto!

Sources:

1) Nicholas J Krilanovich. Benefits of ketogenic diets. Am J Clin Nutr  January 2007 vol. 85 no. 1 238-239

2) Hussein M. Dashti, Naji S. Al-Zaid, Thazhumpal C. Mathew, Mahdi Al-Mousawi, Hussain Talib, Sami K. Asfar and Abdulla I. Behbahani. Long term effects of ketogenic diet in obese subjects with high cholesterol level. Molecular and Cellular Biochemistry 286: 1–9, 2006. DOI: 10.1007/s11010-005-9001-x

3) Frida Leonetti, Fabio Cesare Campanile, Federica Coccia, Danila Capoccia, Laura Alessandroni, Alessandro Puzziello, Ilenia Coluzzi, Gianfranco Silecchia. Very Low Carbohydrate Ketogenic Diet Before Bariatric Surgery: Prospective Evaluation of a Sequential Diet. Obesity Surgery > Issue 1/2015