Guest blog by: Lillian Craggs-Dino, DHA, RDN, LDN, CLT, FASMBS-IH Many patients wonder if they can adopt the ketogenic diet after undergoing metabolic and bariatric surgery. However, there is widespread confusion regarding its specifics. Some believe it involves a high-protein approach, while others confuse it with a carnivore diet. This lack of clarity emphasizes the importance of understanding dietary options post-surgery.In this blog, we delve into what the ketogenic diet entails, its macronutrient composition, and discuss the pros and cons of this popular dietary trend. What Is the Keto Diet? The keto diet is a restrictive dietary regimen originally developed as a therapeutic approach to reduce the severity and frequency of seizures in children with epilepsy that are not adequately controlled by antiepileptic medications.In recent years, the keto diet has gained popularity as a weight loss diet due to its appetite-suppressing effects and its ability to aid in weight loss. The keto diet breaks down body fat into ketones, causing ketosis, which serves as an alternative energy source.Recent research suggests that the keto diet may also benefit cardiovascular health by lowering cholesterol, triglycerides, and blood sugar levels.1 The Keto Diet: Macros and Restrictions The keto diet is notably restrictive, typically consisting of approximately 75-80% fat, 5% carbohydrates, and 15% protein. For example, on a daily intake of 1,000 calories, this translates to about 89 grams of fat, 12.5 grams of carbohydrates, and 37.5 grams of protein. This diet restricts certain food categories, including whole grains, fruits, and some vegetables, while favoring high-fat meats like liver and bacon, as well as full-fat dairy products. Why the Keto Diet May Not Be Appropriate After Bariatric Surgery There are several reasons that the keto diet may not be suitable for individuals with metabolic and bariatric surgery. Firstly, the dietary recommendation after surgery is to prioritize lean protein sources while emphasizing "good" fats, such as monounsaturated fats over saturated fats. Additionally, although starchy carbohydrates and fruits may be limited initially in the bariatric weight loss journey, the ultimate goal is to encourage a balanced diet that includes all food groups.Secondly, long-term restriction of specific food groups is not considered healthy or sustainable. Thirdly, the Academy of Nutrition and Dietetics (AND) advises against the keto diet for individuals with pancreatic disease, liver conditions, thyroid problems, eating disorders or a history of eating disorders, gallbladder disease, or those who have had their gallbladders removed.2 Given the medical histories often associated with metabolic and bariatric patients, these conditions may be relevant considerations. Embracing a Balanced Dietary Approach After Bariatric Surgery Patients who have undergone metabolic and bariatric surgery have made a significant commitment to their health. Post-surgery, it's crucial to adopt a diverse, nutritious diet that emphasizes protein intake, adequate hydration, and consumption of low-sugar foods and beverages. Daily vitamin and mineral supplements and regular physical activity are recommended. Instead of adhering to restrictive diets like the ketogenic diet, prioritize a balanced intake across all food categories while staying mindful of your body's metabolic needs. Regular follow-up visits and participation in support groups are essential for achieving and maintaining a healthy weight after metabolic and bariatric surgery. Summary While the ketogenic diet may appeal to some seeking weight loss or health benefits, it isn’t fitting after metabolic and bariatric surgery. The emphasis post-surgery should be on adopting a diverse and nutritious diet that supports long-term health and weight management. Prioritizing lean proteins, "good" fats, and a variety of wholesome foods, alongside regular medical supervision and community support, offers a sustainable path to achieving and maintaining a healthy weight after surgery. Understanding and embracing these dietary principles can empower patients to make informed choices that optimize their well-being in the long term. References 1. Kosinski C et al. Nutrients. 2017;9(5):517.2. Academy of Nutrition and Dietetics. https://www.eatright.org/health/wellness/diet-trends/what-is-the-ketogenic-diet. Accessed June 27, 2024. *These statements have not been evaluated by the Food & Drug Administration (FDA). These products are not intended to diagnose, treat, cure, or prevent any disease.This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regard to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.