The Definitive Guide to the Bariatric Keto Diet

The Definitive Guide to the Bariatric Keto Diet Bari Life

If you’ve had bariatric surgery and want to know how to use a bariatric keto diet to bust through plateaus and hit your goal weight read this article!

As you know, the Ketogenic Diet is incredibly popular right now and is touted as the Holy Grail of weight loss especially for bariatric patients. A quick google search will show results of dramatic weight loss that is all attributed to swearing off carbs and jumping full-force into the Keto lifestyle.

In case you are unfamiliar, the keto diet has become incredibly popular in bariatric and fitness enthusiast circles alike.

The claims are great:

  • Aids in weight loss. It takes more work to turn fat into energy than it takes to turn carbs into energy
  • Reduces acne
  • May help reduce the risk of cancer
  • Improves heart health
  • May protect brain functioning
  • Potentially reduces seizures

By simply adhering to a very low carbohydrate and high fat (and ideally high protein) diet, you can turn your body into a fat-burning machine. Or so they say…

So if you’re looking to shed serious weight and think that a bariatric keto diet might do the trick, read on.

The Origin of the Ketogenic Diet

The Definitive Guide to the Bariatric Keto Diet Bari Life

Despite it appearing to only splash onto the market in more recent years, the Ketogenic Diet is nothing new.

It’s actually around 90 years old and was not originally created to turn your body into a fat-burning machine…it was a special diet that was designed to help children with epilepsy.

Dr. Russell Wilder of the Mayo Clinic came up with the concept as a treatment for severely epileptic children. Initially, it was a fasting-style diet was used. However, this fasting-style diet proved to be too restrictive for these kids and it did not provide them with enough calories to maintain the right weight for their age.

The keto diet worked well; with research showing that around 50% of the children who tried some form of it, having a significant improvement in the number of seizures they experienced, even when they stopped the diet.

As anticonvulsant medications became more popular and started flooding the market, the classic ketogenic diet lost its appeal.  

However, there were still those that were having serious seizures that not even the best or strongest of these drugs couldn’t prevent.

Jump 70 years into the future, to 1994, where TV’s NBC aired a show called “Dateline” in October of that year, once again sparking interest in the Ketogenic Diet. Based on little Charlie’s life of struggling to control his seizures, it revealed his dad’s effort to find a cure for his son, which led him to dust off the information about the keto diet in the treatment of epilepsy from years before.

The results? By 1997, Charlie was completely seizure-free. Of course, this sparked a national media frenzy, and in 1998, massive interest in the diet amongst the scientific community was sparked. The diet is still used to successfully treat pediatric epilepsy today.

When People Realized it Could Promote Weight Loss…

The Definitive Guide to the Bariatric Keto Diet Bari Life

By the 1960s, with the observation that the ketones produced by the body actually burned fat instead of glucose from carbohydrates, it wasn’t long before weight loss enthusiasts turned the medical Ketogenic Diet into a health and fitness trend.

By depriving the body of dietary glucose as the main energy source, it has to use alternative fuel sources, which become these ketones after a period of 3-4 days of glucose deprivation. Followers of the modern Ketogenic Diet tout it as a means to turn the body into a fat-burning machine, even more so than the earlier low-carb craze diet, the Atkins diet.

The Basics of the Ketogenic Diet

The Definitive Guide to the Bariatric Keto Diet Bari Life

In the classic Ketogenic Diet, the macronutrient breakdown of fats, protein, and carbohydrates is 90%, 6%, and 4% respectively.

Today, the most typical breakdown is 70-80% fats, 20-25% protein, and 5-10% carbohydrates.

There are, however, variations on the diet, having come about as more people have begun to use it as a lifestyle choice.

The more popular modified version of the classic Ketogenic Diet allows for 82% calories from fat, 12% from protein, and 6% from carbs.

There’s also a version of the Ketogenic Diet that incorporates more medium-chain triglycerides, which allows for 73% of your calories from fat, 10% from protein, and 17% from carbs.

Is the Keto Diet the Best Way to Lose Weight?

While the Ketogenic Diet, when done correctly, can shift the body’s dependence on insulin secretion and glucose metabolism as a source of fuel, there’s really only one way to get that extra fat to shift from the areas it’s hanging onto the body:

Burn more energy than you consume

Calorie restriction has been shown to be one of the best methods for weight loss, without too much of a focus on macronutrient breakdown, which is what the Ketogenic Diet focuses on.

In fact, when researchers have looked into which diet is best for weight lossand the overall improvement of obesity and its markers – the difference between low fat and low carbohydrates provide no significant findings.

This confirms our notion that the number of calories consumed in general, is the key to successful weight loss.

Research has also proposed that the benefits of a low-carb diet are more about calorie restriction than about cutting the carbs. When you eat more fat or more protein, it increases your levels of satiety, which means you’re less likely to be hungry and want to eat than when you eat more carbs.

Because of this, and because some bodies of research have found that inflammatory markers in the body are increased during a ketogenic low-carb diet, it appears that there is really no reason to follow such a radical diet like the Ketogenic Diet, when other calorierestricted diets can work just as well for weight loss, without the potential health hazards attached to them.

That’s not to say that there is no place for the Ketogenic Diet…

The Ketogenic Diet Works Well in Certain Cases

While the ketogenic diet is not inherently superior for weight loss purposes, evidence shows that it can be preferential in special use cases.

Specifically for people who struggle with:

  • Insulin resistance (a condition when insulin becomes less able to lower the level of glucose (sugar) in the blood)
  • Type 2 Diabetes
  • Metabolic Syndrome

A ketogenic diet can be very useful in managing not only weight, but general health.

All three of these disorders are related. The developmental progression begins with Insulin Resistance (least severe) ending with Metabolic Syndrome (most severe).

Insulin is a hormone produced by the body that cells use to transfer sugar in the blood (blood sugar) to the inside of cells where it is stored and can later be used for energy.

So insulin resistance means the cells require more insulin to “get the signal” to open up and let the glucose. This causes a roadblock at the cells causing blood sugar levels to rise since it can’t successfully enter the cells.

Once insulin resistance progresses Type 2 Diabetes can develop and later progress to Metabolic Syndrome.

Understanding that higher carbohydrate intake causes a spike in blood sugar, it makes sense that a low-carbohydrate diet would benefit individuals with any of these three disorders.

In fact, research supports this theory. In fact, studies show that restricting carbohydrate intake for people with Type 2 Diabetes symptoms improve significantly.

Taking this into consideration we now understand that people with disorders relating to the metabolism of carbohydrates like Insulin Resistance, Type 2 Diabetes, and Metabolic Syndrome can benefit greatly from a low carbohydrate diet.

However, you should notice that these benefits do not mention anything regarding weight loss. This is purely from the standpoint of managing weight and genetic-related conditions.

You see, insulin is the hormone that the cells need to open their channels to allow sugar or glucose into their inner environments in order to be used as a source of fuel. Imbalances in insulin mean this process happens ineffectively and so blood sugar remains high, the body uses stored glucose as a source of fuel, and then it begins to use protein as the next available source.

You guessed it! This is when your muscle mass starts to decrease and you feel fatigued and generally unwell.

Provide a higher proponent of fat in the diet, enough protein to maintain muscle mass and protein-related functions, and significantly reduce the need for sugar and insulin, and this problem can be solved.

The body transitions from predominantly using glucose as energy and instead will use fat. This can significantly reduce the risk of developing disorders like diabetes.

Other Benefits to the Ketogenic Diet

Another reason for following a bariatric keto diet, which ties into metabolic syndrome, is the effect that it has on a person’s triglyceride levels.

Triglycerides are the fatty acids that are observed in the blood, and they are higher in those who consume a higher carbohydrate diet. Research has shown that when compared to a low-fat diet (higher carbohydrate diet), a low carb diet can reduce these triglycerides, which has a significant and positive effect on heart disease risk.

In general, however, it is worthwhile to note that the benefits of a keto diet completely depend on the ability of the individual to utilize glucose, and that is based solely on each person’s metabolism.

If you do fall into this insulin resistance or diabetes category and have had (or are planning on having) bariatric surgery, it’s important to speak to your doctor before starting a ketogenic diet as the benefits are conflicting.

Some studies have found there to be marked improvement in cholesterol levels of patients waiting for bariatric surgery and following a keto diet, along with improvements in blood glucose and insulin level control. What’s more is that fatty liver conditions in these patients are significantly affected, which poses a huge benefit before surgery.

Evidence has also been gathered to suggest that a keto diet may actually pose greater risk prior to the procedure as the state in which ketosis is achieved increases oxidative stress, which has been found to have negative consequences post-surgery.

The bottom line is that bariatric surgery is an entirely effective method to reduce insulin imbalances and glucose intolerances, particularly in those diagnosed with morbid obesity and diabetes. It is very rare to require further extreme intervention to maintain insulin and glucose levels in post-surgery patients.

Ketosis: You’re Probably Not Getting There

The Definitive Guide to the Bariatric Keto Diet Bari Life

Look at many of the different websites explaining the keto diet and you’ll likely come away with an understanding that if you follow a low carb diet for 2-3 days, you’ll be in ketosis and your body will start burning fat.

This isn’t entirely true.

Ketone production and build-up to a level where the body can start using them as a fuel source depends on a number of factors. This includes current body fat percentage, BMI and resting metabolic rate.

If you’re not getting into a state of ketosis, which is typically because your body is still using the supply of glucose (from carbohydrates), there are consequences. First, while you are still working on glucose, your increased fat intake is likely going to go to storage instead of being used as fuel.

The second, is that you’re likely attempting to seriously restrict your carb intake, albeit not by enough to get into ketosis. This not only means that you’re not “doing the keto diet ‘right,'” but it will leave your brain in a spin, you’ll end up fatigued, irritable and moody.

The Wrong Way to Do Keto

The Definitive Guide to the Bariatric Keto Diet Bari Life

Three of the biggest Ketogenic Diet mistakes are those involving the three macronutrients: Carbs, fats and protein.

    1. Carbs.

If you don’t track what you’re eating, you’re not doing keto right. You need to use a diet intake tracker to determine the ratio of your macronutrients to have a real gauge on how many carbs you’re eating.

You may think that because you’ve cut out bread, pasta and fruit that you’re automatically doing it right, but you don’t think about all of those additional carbs in other everyday food like milk, beans, and vegetables.

    1. Fats.

When the Ketogenic Diet first hit the public space in a big way, everyone was rushing out to buy bacon and butter.

Of course, these are high fat foods, but are they the best for you and your health? Not really. Animal sources of fat are higher in the more inflammatory form of omega fatty acids, called omega 6s, while bacon and other processed meat is high in sodium and can also contain preservatives and other chemicals you don’t want to put in your body.

    1. Protein.

Many people don’t really know where protein falls in importance in Ketogenic Diet. When it comes to how your body functions, protein and its amino acid building blocks are essential.

Getting enough of these compounds to allow your body to make enzymes, hormones and all of the other aspects that allow it to run optimally, is a critical part of the success on any diet.

The healthy way to do the bariatric keto diet

The Definitive Guide to the Bariatric Keto Diet Bari Life

To achieve the success that you want to on a bariatric keto diet, there are a few considerations to make before you start:

1. Determine your calorie requirements.

Depending on your individual needs, you may need to start off with a modified 2000 calorie diet, or if you have already undergone weight loss surgery, for example, you may need as little as 1000 calories.

Your doctor or dietitian is the best person to speak to with regards to your personal needs.

2. Think about your macros.

Often, bariatric patients need higher protein intakes as they don’t tolerate high fat in the period following their surgery. A typical recommendation is at least 60g of protein per day. While your carb intake may be advised to be in the range of 20g of carbs a day, you may have a slightly higher protein requirement than fat requirement to begin with.

3. Figure out your fat.

Typically, fat intake on the Ketogenic Diet ranges from 60-75%, and can be based on your individual needs. In most cases, a fat intake of above 80% like that used in the medically induced Ketogenic Diets is not necessary to get into a state of ketosis or benefit from ketosis.

Next, it’s on to selecting your food!

Keto-friendly foods

Here are foods we recommend for the bariatric keto diet:

1. Fats

Given the nature of the ketogenic diet, dietary fat is a major component. It’s important to prioritize fat sources that are rich in nutrients, not highly processed “junk food.”

Great sources for keto dieters are:

  • Olive Oil
  • Nuts, seeds and nut butters
  • Whole fat dairy products like cheeses and kinds of milk
  • Coconut oil
  • Butter
  • Higher fat protein sources like fish, red meats and fattier cuts of white meat also contain significant amounts of fat

Healthy sources of fat to include in your meal plans include those that the majority that come from plants. Olives and their oils, avocados and their oils, coconut and coconut oil, MCT oil, nuts, seeds, and cacao butter. Animal fat should be eaten in moderation, and saturated fat content kept a close eye on.

2. Protein

As you read earlier, the traditional ketogenic diet includes lower amounts of protein. Recent beneficial adaptations of the diet include higher levels of protein to maintain muscle mass and increase satiety.

  • Chicken
  • Turkey
  • Salmon
  • Fattier cuts of red meat
  • Eggs
  • Nuts and Nut Butters

You will get protein from some of the vegetables you consume as well, from beans, lentils, chickpeas and quinoa.

Fatty fish such as salmon, tuna, mackerel and herring not only add fat to your diet, they contribute a special nutrient called omega 3 fatty acids, which are anti-inflammatory and good for your overall health.

3. Carbohydrates

Vegetables can contain a surprisingly high amount of carbohydrates, specifically starchy vegetables like potatoes, peas, and corn. These simply contain too many carbohydrates to fit into a ketogenic diet.

So you’ll want to stick with low-carb vegetables like:

  • Cucumbers
  • Iceberg lettuce
  • Mushrooms
  • Leafy greens like spinach and swiss chard
  • Bell peppers
  • Zucchini
  • Cauliflower
  • Asparagus
  • Tomatoes

Since vegetables are still made up of carbs it’s important to choose these low-carb options to maintain a state of ketosis.

In Conclusion

While the Ketogenic Diet is made out to be a simple and effective means to lose weight and improve your health, there is much more than whether you’ll have bacon, avocado or both for breakfast!

The most important thing you must consider when choosing a diet protocol is “what can I stick to in the long-term?” This is vital to your weight loss success because extreme or limiting diets that interfere too much with a happy lifestyle tend to fall by the wayside.

Just remember that the first component of a diet that results in successful weight loss is calorie restriction. You can do a bariatric keto diet all day long, but if you’re not eating less than your body is burning, no keto magic will cause weight loss.

Before you start a bariatric keto diet, it’s best to speak to a suitable healthcare professional, if not your treating doctor, about how it could help or hamper your health as an individual. In the end, whether you go ahead and try the Ketogenic Diet or any another form of dietary change to bring your body systems into balance by losing weight, remember that it’s a step in the right direction and will be to the benefit of your body and overall well being.

What’s your take on the bariatric keto diet? Let us know in the comments below!


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  1. What book is best for the Ketogenic Diet. I had the sleeve surgery in 2012 and I’ve gained 10 pounds and I can’t seem to get it off.

  2. I found this article very informative and it helped me to understand some of the things I was doing wrong and the things I need to do to be successful in my weightless journey. I have be really confused and puzzled as to why I wasn’t losing weight. Thank you

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