Ketogenic Diet and Duodenal Switch ( DS ) weight loss journey

Tonya_me

I am 6 years out from having had duodenal switch surgery. I dropped a bit more than 100 lbs, which was not all the wt I had to lose. I've since regained about 40 lbs and I want to turn that around and begin my wt loss journey again. I am exploring doing a keto diet to achieve that wt loss, and I'm going to take my transition into a ketogenic diet slowly. I'm focusing on life changes and identifying small things that I can change long term and will let those small changes layer into an overall significant change to the way I eat.

I would LOVE to hear from anyone else who has had DS wt loss surgery who is doing a ketogenic diet. One of the challenges ahead of me, as I see it, will be how to get in enough fat to make the high fat lifestyle work. I'm not sure how much fat I absorb now, but the figure I've been able to find is 21%. And, I recall reading somewhere that our fat mal-absorption remains pretty stable in the years to come after the surgery. So, with the low carb and moderate protein, getting in enough cals via fat, I suspect will be a bit of a challenge. In truth, I tried this before (but didn't know about "ketogenic diets" then but was ending up that direction on my own) and it worked well, but I had to really, really, Really push fat to get in enough calories that my body didn't think it was being starved. But, that was several years ago and I'm back to try it again.

JulieMeserve

I just started Keto about 2 weeks ago and feel great, I have not gone through any surgeries, but have been overweight for a long time. It can be challenging to get all your fat in with Keto , but it gets easier, also the other challenge when beginning is dumping the bread, etc. The carb count will be low on keto , but you get your carbs from whole foods. I wish you luck with your journey!

macchiatto

I've been on keto most of the time since Nov (tried a higher carb diet for a while this spring but went back to keto because it had so many benefits for me) but I haven't had the surgery. I hope you're able to find the support and resources you need though! There's a keto group and a Low Carbers Daily Forum here on MFP with a lot of keto'ers if you want to check those out.

Tonya_me

Thanks guys! I did a search but had trouble finding people who both had the DS and were trying keto. I know that my fat push will be HUGE compared to yours because of my malabsorption of fat, but please do drop in and let me know how things are going for you.

I am still doing very, very badly with regard to carbs. I only started tracking myself a couple of days ago, and my macros are surprising me. I eat a lot more than I thought I did! lol My biggest carb downfall is my coffee, that I load up with sugar and milk. I've got some erythritol ordered, though, and I'm going to give that a try. I'm a major, serious carb addict, so I'm going to take this transition slow and just whittle my carb load down. I'll identify a spot and figure out how to address it and then move onto the next adjustment.

Tonya_me

Fat bomb

I don't know many fat bomb recipes, but this is nothing like what I've seen out there so I'll share. I ordered in some raw pumpkin seeds, and I just fried them up in some butter. So, lots of fat, some protein and not many net carbs (although some). Just throwing that out there as a non-traditional fat bomb.

flawlessreflection

14 day on keto..so far I've lost 12.5lb... still learning this new lifestyle change...

Tonya_me

flawless, first off I'd just like to say that you are gorgeous!!!

Second, congrads on the wt loss! That is fantastic! Do you feel that any of it is water weight? I know that on keto that you can have a lot of water leave you very fast. With having just started it two weeks ago, have you experienced that? Any nausea? I've heard that you actually need to up your salt intake to offset the loss of salt (or electrolytes?) as your body dumps water and that that helps nausea.

Were you big into carbs before you started? Did you face any challenges to transitioning into going keto?

Tonya_me

I am very, very, very new to exploring keto in terms of just moving in that direction right now. I only started tracking my food again a few days ago. It's been a bit of an eye opener!

I'd like to have my protein intake at about 100 grams. Because of my DS, I really need to not go less than 100. I am surprised to find out that I am exceeding that 100 grams rather handily! So, not overdoing protein will actually need to be on my radar. I wasn't expecting that.

As I get my carb load down, I'm going to have to increase my fat -- a lot. Because of the DS, I think it will need to be between 600 and 700 grams a day. DS'ers (theoretically) absorb about only 21% of the fat they take in. When I did this once before, I didn't know about keto. But, I had figured out that if I were dropping carbs for the sake of going low carb, then I needed to push fat super duper hard or else my calorie intake for the day was WAY below 1000 cals. So, as I move forward, other than managing my addiction to carbs, how to get in enough fat is the thing I see as my biggest hurdle.

Tonya_me

My carb addiction

Right now, I see my habit of sweet coffee as my greatest downfall with regard to carbs and carb control. I load it up with sugar and milk, and I often have multiple coffees every day.

What will be changing with that is that I ordered some erythritol, a sugar alcohol that isn't suppose to impact your glucose levels (I think). In order to give myself a chance to get used to erythritol, I figure I'll mix up a batch of half erythritol and half sugar and I'll use it in my coffee. I'll then continue to increase the erythritol in mixture until I'm just using erythritol and no sugar.

I know that what would serve me best is to give up coffee. I've tried before and I never stick with it. So, I'll make small adjustments and work toward making them the new norm before moving on to more adjustments. I know that milk adds a lot of carbs. So, I need to change that too.

For now, I'll work on holding myself down to 2 coffees a day. Maybe once I get ready to go full keto, maybe I'll be ready to kick my coffee addiction to the curb. I've tried the butter/coconut butter coffee..... No. Maybe it will be better with erythritol added in.

ladipoet

macchiatto wrote: »

I hope you're able to find the support and resources you need though! There's a keto group and a Low Carbers Daily Forum here on MFP with a lot of keto'ers if you want to check those out.

Here's the link to the group @macchiato mentioned:

http://community.myfitnesspal.com/en/group/discussions/394-low-carber-daily-forum-the-lcd-group

Erfw7471

I used to work with a woman who had the DS and had terrible side effects from higher fat & refined carb intake, and apparently those were to be life-long issues. Have you checked for advice on WLS forums?

*edited to add: she had terrible diarrhea with higher fat and had extreme gas with the refined carbs, but this may just have been her reaction.
**edited again: still asleep, not enough coffee, lol

Tonya_me

Erfw7471 wrote: »

I used to work with a woman who had the DS and had terrible side effects from higher fat & refined carb intake, and apparently those were to be life-long issues. Have you checked for advice on WLS forums?

*edited to add: she had terrible diarrhea with higher fat and had extreme gas with the refined carbs, but this may just have been her reaction.
**edited again: still asleep, not enough coffee, lol

If I eat bread, especially whole wheat bread, be careful. The stink of my gas can clear a room! It's BAD!!! But, I don't do much in the way of bread. If I were to eat crackers, I suspect I'd struggle. And, I notice a gut-gas reaction when I eat potato chips. But, I tend to be able to eat fruits without much issue. And, I could eat sugar all day long without it producing stinky gas.

As for fat and diarrhea, eating too much fat can trigger diarrhea for me, but it's short lived diarrhea as the fat is passing through. Other than that, I struggle quite a bit with constipation. Occasionally, I'll eat something besides fat that triggers some diarrhea for me, but more than anything else, it's constipation that's my problem. It really makes me taking iron (and I take heme iron which tends to be easier to pass) and calcium a real struggle. I take far, far less than what I should. But, wow, I like to be able to poop! (DS'ers are famous for talking about poop -- my apologies). I do take Miralax and it does help, but when I take my calcium and/or iron, constipation becomes an issue even with the Miralax.

But, with regard to the prospect of eventually having to get in possibly as much as 600+ grams of fat (because of the presumed 80% malabsorption of fats) as I lower my carbs, I'll take it a day at a time and slowly increase my amounts. I'll take it slow in figuring out what my limits are and what things work and what things don't.

For the lady you worked with, I hope her situation got better. I've got a friend with DS who had similar issues and she slowly increased the amount of fiber she eats by making beans a staple in her diet. It helped a lot. Now about 7 years out from surgery, she doesn't have the issues she did early on. The gut tends to heal itself and adjust over time.

Tonya_me

ladipoet wrote: »

macchiatto wrote: »

I hope you're able to find the support and resources you need though! There's a keto group and a Low Carbers Daily Forum here on MFP with a lot of keto'ers if you want to check those out.

Here's the link to the group @macchiato mentioned:

http://community.myfitnesspal.com/en/group/discussions/394-low-carber-daily-forum-the-lcd-group

Thanks! I'll check that forum out. I wanted to start one specific for DS'ers because of the unique challenge of trying to get in a tremendous amount of fat to offset the low carb plus the malabsorption of fat. But, I am sure that forum has a lot of information that would come in very handy for me.

Tonya_me

I got the erythritol I'd ordered in. I haven't done well with alternative sweeteners in the past, so I'm taking it slow by cutting it half with sugar and half with erythritol while I get used to it. But, I'm super excited to see how it impacts lowering my daily carbs. Sweet coffee is a huge habit for me, but I'm eager to see how this helps. One step at a time.

Tonya_me

I got in the erythritol I'd ordered today, mid morning. I started using it after I'd had my first cup of sugar sweetened coffee, and when I did use the erythritol, I mixed it half and half with sugar. It's going fine with the taste. I can tell a difference with my tummy in that it's wanting to go the diarrhea direction, but I'm hoping that means that I'll be able to take my calcium and iron more often.

But, the thing that really has my attention is that my sinuses started draining. I've got chronic sinusitis (or more specifically, non-allergy rhinitis). I can take a nasal decongestant and it do nothing for me. But yet, since I started using the erythritol this morning, I've had sinus drainage. For me, this is astounding and amazing. I'm super happy with this turn of events.

Tonya_me

I haven't been able to find much activity by DS'ers, and I haven't found anything DS specific to going LCHF, so I'll continue to post here in case someone goes looking to read about a DS'ers experience going low carb.

Yesterday I went for a long, slow walk (with a slow walking companion) for about a little over an hour. I got in 55 net carbs, 100 fat, but only 43 grams protein. And, the scale dropped another 1.6 lbs today, taking me to 217.4.

I'm going to assume my wt loss is mostly water wt until it either slows down or gets to 210 or below.

I don't feel that I got in enough calories yesterday. I definitely didn't get in enough protein. I'll try to do better today -- but I also know from what's in my fridge that it might be just a so-so day on protein.

Also, I didn't have much of an apatite yesterday. I felt a little shaky at time during the second half of the day, but I attribute that to the low calories. I got some more to eat and felt a bit renewed.

For any non-DS'ers reading this, the figures I've seen on absorption for a DS'er is 60% protein, 21% fat, and 60-100% carbs (simple carbs at 100%). I don't know what my absorption rates are, but I keep these #'s in mind as a guideline regarding how many calories I'm potentially taking in.

Tonya_me

Some low carb foods that are working out well for me so far:

green olives
mushrooms
pumpkin seeds (a fantastic substitute for popcorn)
erythritol (alcohol sugar)
butter
sweet bell peppers (colorful ones, red and yellow)
coconut butter (different than coconut oil)
coconut oil
cucumbers
feta cheese
chicken liver (often coated with a dusting of corn starch & fried in butter)
dark (86% ?) chocolate (wonderful when combined with the coconut butter. Does great things for a sweet tooth.)

I sometimes have a sweet treat of a prune and drinking a big glass of whole milk tends to be a bit of a carb fix for me.

Korreltjie

@Tonya_me MEEEE!!! You seem like a copy of me! I've had DS 6 years ago and now following LCHF/keto. Looking for correct ratios for fat/prot. Seems like 700g fat! So much! Please contact me.

skhoward1969

I am a DSer 9 years out and am trting Keto to get back on track. Would love to hear how things are going and how youve adjusted your macros to accommodate out malabsorbtion.

dixd84

I just got the DS 6 weeks ago and I'm thinking I really want to do a Keto diet because I have a hard time with Carbs... I have had really bad diarrhea almost since day 1 with DS though so I'm very scared what Keto would do to me... please feel free to add me as a Fitness Pal contact or contact me if you have any suggestions. Like some of you DSers have said... there aren't very many of us out there!

Miss_Hattie

dixd84 wrote: »

I just got the DS 6 weeks ago and I'm thinking I really want to do a Keto diet because I have a hard time with Carbs... I have had really bad diarrhea almost since day 1 with DS though so I'm very scared what Keto would do to me... please feel free to add me as a Fitness Pal contact or contact me if you have any suggestions. Like some of you DSers have said... there aren't very many of us out there!

Hi. I am prepping for the duodenal switch to have in June. I've really been worried about the possibility of diarrhea and the bad gas. Almost wonder if I'll be afraid to get together in social circles. The bariatric clinic told me they think I'm the first DS patient they've had. Guess I'm a guinea pig?