Visit with Nutritionist: Big food restrictions starting ... now! Plus, no caffeine!

I had my second visit with my surgeon yesterday (technically more because she did my VSG 7 years ago). She has a new nutritionist in the office and I met with her as well. She basically described and prescribed a Keto diet for me. Animal protein, veggies, no more than 2 fruits per day. Is this what most of you eat pre-op? And why is caffeine so bad? I've never heard of that being forbidden and it's a problem because the only protein drink I like is Click and it's loaded w/ caffeine. Help!

The postop DS diet is a lot like keto but I would revise that down to NO fruit and very few carbs of any kind till you are under goal. As far as the caffeine goes, as long as you are drinking enough there is no real reason to avoid it.

The rationale for a low carb diet is to make sure when you have surgery that your liver is glycogen deprived and therefore, smaller. Easier to move out of the way. But that is only necessary a few days before the big event.

A ketogenic diet is less than 20g of carbs a day, ideally with the majority of your calories (65-85%) coming from fat. Very few of us eat fruit, actually, and in fact most of us do not. The biggest difference is that protein is much lower than someone with a DS should get, probably 60-90 for most, which is going to be way too low. Many of us are zero carb too, so we only eat animal products. I'm about 95% zero carb, myself.

Low carb diets also stabilize insulin far better and reduce inflammation in general. So, low glycogen stores are a bonus, but the lack of systemic inflammation is very helpful both during surgery and post-op as well, as it helps with healing considerably. Since most people who are obese are insulin resistant it's beneficial to be on it probably longer than a few days.

It also reduces fatty deposits in the liver to stay on a low carb diet. When I had the VSG I weighed 440. My highest weight had been over 750 pounds. My liver was smaller and better-looking than most people who had never been obese, and I had almost no inflammation despite having three autoimmune disorders. I didn't have fatty liver at all, which is highly unusual. The surgeon said it was due to having been on a low carb diet for many years.

A few months pre-op, I gave up carbonated beverages, caffeine, alcohol, artificial sweeteners, sugar and desserts. I also limited processed food and simple carbohydrates, and started eating more vegetables. This "detox" helped me prepare for the post-op lifestyle I wanted to implement, which went very smoothly. It would have been harder for me to give up these things AND recover from bariatric surgery at the same time. It wasn't easy to do and I felt lousy for a couple of weeks but then it got easier and I lost weight. This approach also made the strict diet right before surgery a non-event. Good luck!

Some of this i**** or miss for nutritionists. Most are just giving information that may have been
helpful in certain instances.

I guess my view on the diet is how close you are to actual surgery and if you are shooting for some weight
loss pre-op to meet either surgeon or insurance requirements. Keto is pretty close to a post-op diet so it might be a good start. I just think your life is so different post-op that pre-op isn't really much help.

Personally, I would just nod and agree with the no caffeine while continuing on. Caffeine is a big
issue for Nuts post-op because the big worry is dehydration. Even if they tighten your VSG while
they do the switch you may not have the restriction you initially had so it might be less of an issue. In hindsight I think if you are used to caffeine then continuing on isn't a big dehydration issue but it wouldn't hurt for the first 4 to 6 weeks to try and keep clear of caffeine.

Congrats and have a safe surgery,

Pete

My surgeon also had "no caffeine" which I did follow for about 4-5 months post-op. Definitely NO to the "no more than 2 fruit per day". Fruit is incredibly high in sugar, which equals carbs. Maybe a bite or two of apple sauce or something like that in the first couple of weeks but that's it.

High protein, low to no carbs.

I'm almost 15 years post-op and would never consider eating fruit twice a day ;)

Caffeine can dehydrate, but the effect is minimal according to research. A bigger issue is that many beverages that contain it happen to be acidic or astringent (coffee and tea, but more so coffee) which can inflame the already irritated (from surgery) stomach and intestines. The more inflammation you have, the harder that healing is, and the more likely leaks or bleeds can occur. Also, coffee in particular is hard on the stomach even without surgery. You still have parietal cells with a sleeve, and these are what create acid. Some people get gastritis and ulcers from coffee because a compound in it (not caffeine) can overstimulate these cells.

In the case of coffee, it can also act as a laxative which may be beneficial, I found it beneficial after my VSG anyway, heh, but I don't know if that is part of why it's usually contraindicated right after intestinal surgery.

Keto is a reasonable guideline to follow. Just don't try to do it low-fat. Go for full fats the way that nature intended. I think keto is without cheese, and I ain't gonna lie, I cannot make my protein totals without cheese.

Caffeine slows the healing process, so you want to go without while recovering.

You can have cheese on Keto, you just need to shred your own as they at flour to keep it from sticking together. Paleo in no cheese.