Day 5 - Calling all the Vets - questions for you all

Hi everyone. I decided to ask people on the RNY menu thread last Monday if they had a question for an OH Vet (Veteran) here what would they ask? I got great feedback and have 16 great questions that some of our regular posters wanted to ask the Vets here.

Here on OH if you are 5 yrs post op you are considered a "Vet." So everyone who is 5 yrs post op or more are welcome to chime in (RNYers, VSGers, DSers etc). I will ask two questions per day per post, today is Day 5. I hope that all the Vets out there will help us by giving us your experience, insight, knowledge & expertise to all of the pre ops, newbies, anyone post op who is struggling, anyone who is a lurker but does not post and for any Vet out there who may have had regain and is fuzzy about the "rules" and needs help.

Thanks in advance to all the awesome Vets!

When you reply to make it easy please just say "Response to Q1" or "Response to Q2" hope that works! Can you also include in your response how many years post you are, thanks

Question #1 (Q1):

So much talk around about doing "Keto." What are your thoughts on Keto and how do you feel about "diets" like that?

Question #2 (Q2):

Is weigh gain inevitable? Does everyone get "regain" and/or "bounce-back." Do you feel this is totally up to the individual and not necessarily a givn?

Lets talk!

Question #1 (Q1):

So much talk around about doing "Keto." What are your thoughts on Keto and how do you feel about "diets" like that?

Well this is a hot button for me right now so forgive my TL:DR reply! (MY OPINIONS ONLY FYI)

As I said a few days ago, I have had some regain over the past 2 years (25-30 lbs) due to uncontrollable life stresses. Keto caught my eye and I've followed some online Keto groups. As far as Keto specifically goes here is what I am learning and thinking: Keto is like many other very low carb diets including paleo, atkins, and (surprise!) yes even our post op eating plans. It is a higher fat plan than I am comfortable with, but following it loosely has gotten the carbs under control for me and reminded me of some basics. Potatoes are not my friend. I don't even LIKE rice.

Sugar: no.

Protein first.

High quality complex carbs (veggies) next.

A little fruit.

Be done.

Drink a lot of water.

Eat clean.

What I have noticed on the Keto boards/pages I follow is this: many many people are seeking a magic pill. There's even a Keto video out there entitled "The Magic Pill" proclaiming that Keto is a cure for serious medical conditions. We know here that there is no magic pill.

I see people wanting to over complicate what is at the core a very simple eating plan with buying a ton of "special keto friendly" ingredients rather than simply shopping the edges of the grocery store, celebrating the simplicity of healthy eating. Various companies (south beach, slim fast, and more) are marketing Keto heavily with highly processed products. Follow the $$$$$.

News flash: green veggies are keto friendly. Salmon and a nice steak or pork loin are keto friendly. And Atkins friendly. And bariatric friendly.

Keto is often combined with intermittent fasting, which my own primary care doc mentioned in passing a while ago. The idea there is that you fast for some set # of hours every day (16 or so) and do all your eating in the remaining 8 hours. Some claim this is the magic ingredient. For me it would throw my post op blood sugar into a tizzy and I'd likely end up on the floor somewhere. Besides that, I don't like being hungry - it makes me anxious. And we know there is no magic ingredient.

In the Keto community, you'll also hear of extremes like total fasting....egg fasts....and it sounds kind of creepy and extreme. Who wants to live on eggs? We know the answer. It's desperation, for some extremely obese people. And a lot of this extreme stuff happens without individuals touching base with a real live doctor.

We know how the story ends, don't we?

The larger issue, though, is diets. Maybe for those with 10 lbs or so to lose, diets can be the answer. But for those of us who stared morbid obesity in the eye, a diet is a ticket to another failure. I read that "Keto is a way of life!" but a diet is rarely a way of life. We can name dozens of diets, and collectively I dare say that we have tried them all.

Ultimately, we have the most powerful tool there is in our surgery. Ultimately, we have made the hardest decision. And ultimately, the answer for our success and health and well being is to live the way of life set forth by a surgeon, by a nutritionist, by tons of valid research.

Question #2 (Q2):

Is weigh gain inevitable? Does everyone get "regain" and/or "bounce-back." Do you feel this is totally up to the individual and not necessarily a given?

I don't think it's inevitable. But it is common.

Bounce back is different from regain. I reached my "goal" and stayed there for about 12 minutes. My body fought every effort to stay there, even with a lot of exercise and perfect adherence to my eating plan. My body told me that I needed about 7 lbs more to maintain, and I had to listen. Indeed, that's where I maintained for 8 years, with that little bit of bounce back.

Regain, on the other hand, is closely tied to denial. We have surgery. We lose weight. We feel great. And we are lulled into the false notion that people who look like we do can eat anything they want. It's not true, but it's an appealing thought isn't it? We gain a few lbs. and we can ignore that. Our jeans get snug again, and we decide to wear the yoga pants every day. Pretty soon a special occasion comes around and we need a new dress because the cute "LBD" won't pull up over our hips. That's why my advice on an earlier question was to pay attention to regain and be ALL OVER it. Don't deny it when it's 5 lbs. You can tackle 5 lbs. 30 gets harder. And so so often, I am saddened to see WLS patients proclaim that they have failed yet again and regained everything and more. Regain isn't a choice, but the sum total of a lot of small choices.

Bounce back is the result of our body adjusting. Regain happens because of our thinking.

I think that is a good way of looking at it... bounce back vs regain. Bodies have normal fluctuations- even bodies that weren't morbidly obese.

Question #1 (Q1):

So much talk around about doing "Keto." What are your thoughts on Keto and how do you feel about "diets" like that?

I don't generally subscribe to "diets" of any kind. Personally, the "diet" mindset is negative and counterproductive for me. So I prefer to think of my eating as making choices that promote my good health and longevity...not any kind of fad of the month.

That said, you do you. I think people should do what works for them. The common denominator among successful people is that they make intentional choices and stick to them. They don't necessarily make identical choices.

Question #2 (Q2):

Is weigh gain inevitable? Does everyone get "regain" and/or "bounce-back." Do you feel this is totally up to the individual and not necessarily a given?

Its inevitable that your body will eventually adjust to your new anatomy. Whether or not that equals re-gain is up to the individual. It will get harder, and maintenance is far more difficult than losing, but regain is not guaranteed.

Q1: I think people should follow whatever eating "plan" works for THEM! I don't knock ANY plan. I tried Keto, but it was a bit too hard core, for me. Most days I follow High Protein/Low Carb/With one fruit/Lots of coffee/Intermittent Fasting, with a 6-8 hour eating window

Q2: No, I don't think anything HAS to be...It's like being told 75% weight loss is a "success"...I call BS...That still leaves lots of folks Obese, and I don't think that's where they WANT to be

TL:DR I agree with both Chris and Lynn.

Q1: I think keto is being made into the next "big" thing and as a result, it's become *******ized and polluted by the diet industry. It will sadly end up being a parody of itself. For bariatric post-ops, I think it's close to what we need, but I think we need higher protein than keto generally prescribes.

Q2: I think it happens to a lot of us, but not a given. I think it's human nature to want to start relaxing our rules after a while and that can come back and bite us in the ass in the form of regain-even if it doesn't necessarily involve letting sugar/carby foods back into our lives.

Off topic: I'm bouncing off the damn walls over here. I think I made my coffee too strong this morning. Wheeeee!

Hi Daisy and Friends!

More interesting questions...this is such a good "series" Daisy :) Interesting that many of us seem to agree on the answers...

Time since surgery: 5 years 3 months

Q1 (keto): I have seen my brother lose 100 lbs without surgery probably 3 times. And always gains it back :( He's currently doing "keto" and it's working for him. He drinks coffee with cream and butter in it and is just on a super high fat high protein diet. I am sad though, because I know once he gets to a comfortable weight, as always happens, he will start having two pieces of pizza here, a piece of cake at a party there...and then gain it back. I have seen him do paleo and a few others, and sadly, like most of us experienced before WLS, once you go back to the normal way of eating the weight comes back on. But I know some people like the structure and support (soooo many online forums and recipes!) that something like keto provides, so hey, if that works for you, go for it!

Q2: ugh, the bane of my existence. I think many people get bounce back, simply because as time goes by and your pouch matures, and diet fatigue sets in, it's typical to gain a few pounds. I see regain as something else - more than just being 6 lbs above your goal weight. I had a bit of bounce back in year 3, and then regain in year 4. Like Lynn above said, the jeans get tight so you start to wear yoga pants, and then there is a wedding and you need a new dress and all of a sudden you realize your clothes don't fit! When I was over 300 lbs, I could lose 20 lbs and it wouldn't affect the fit, but now 20 lbs is a full size and then some. I am fighting the regain and need to lose 25 lbs and it sucks. Like others have said, try to nip it in the bud when it's 5 lbs, not when it's 30!!!

I think question 1 would be good for everyone. It would be interesting to see vets versus newbies also. So many jump on the keto bandwagon and I guess it really isn't a big jump from low carb, high protein we are recommended to do after surgery.

I think keto is fine. I don't buy into all the shakes and supplements that are sold to help with keto, nor am I interested in the weird zombie recipes for making everything keto.

Weight gain is not inevitable. I am once again losing a 15 pound regain. It was entirely my fault. There was no outside force responsible for it.

Q#1: Keto? Living in Europe I am spared a lot of American fads. I have no opinion in this except to say find an eating pattern that works for you and don't deviate from it.

Q#2: IMO there exists a sweet spot that is easier to maintain than the lowest weight achieved. It's reslly up to you how hard you want to work to stay there.

I have been too low and worked to stay in my comfort zone. I don't consider it regain or bouncback so much as finding the right zone and allowing myself a 3kg wiggle zone.