Ultimate Guide for Getting Into Ketosis After Bariatric Surgery

Hamburger Cooking on the Grill
Get the Ultimate Guide for Getting Into Ketosis
After Having Bariatric Surgery
(Includes a 3-Day Quick-Start Menu!)

Have you recently had bariatric surgery?

Has it been a few months, but you've hit a stall?

Keto is a great way to move forward, but your small stomach might have you baffled about how to proceed. Here's what you need to know to get into ketosis fast and stay there.

Whether your doctor has suggested that you go Keto, or you're thinking about doing carb restriction all on your own, post-bariatric surgery challenges can leave you wondering if Keto is even possible.

No need to worry.

As long as you've given your stomach and/or intestinal tract time to heal, it's easy to get into ketosis and stay there, even if you can't eat lots of fat or salad.

In fact, most pre-op diets put you into the state of ketosis before surgery because low carb is the fastest way to reverse liver inflammation, making weight-loss surgery safer.

After-surgery, bariatric diets may or may not promote ketosis, depending on how closely you followed your doctor's guidelines.

In those first few days after surgery, your stomach wasn't able to handle much food, but liquid, pureed, and especially soft-foods diets can still be too high in sugars and starches to promote ketosis.

Tuna and Noodles
Tuna and Noodles are easy to digest,
but are very high in carbs.

If you've been reaching for the:
  • gelatin
  • Popsicles
  • soft pasta
  • milk shakes
  • mashed potatoes
  • sugary yogurt
  • hot cereals
  • ice cream
  • applesauce
  • bananas
  • rice
  • bread
  • pancakes
instead of easy-to-digest meats, eggs, cottage cheese, and soft vegetables, your adventure into the low-carb lifestyle will be a pleasant surprise.

If you haven't been reaching for high-carb goodies, don't expect to see the massive weight loss that occurs during the first week or two.

This period of a low-carb diet is designed to deplete glycogen stores. Glycogen is how your body stores carbohydrates, so when you're no longer eating them, your body will use its storage first.

The body also stores the water needed to process glycogen, so as it's turned into glucose, you'll lose a lot of water weight.

The first two weeks on a Keto Diet can be very deceiving.

Most of what you lose on the scale is not body fat. It's just water, which can leave you dehydrated.

The body often tries to fix the lack of hydration by stuffing what little water it has into your adipose tissue. Your fat cells. While this can still happen if you're already in some degree of carb restriction, your body won't be as spooked as those who are brand new to low carb because your glycogen stores will already be partially depleted.

Instead of massive water losses, you'll actually be ahead of the game because what you'll lose from the very beginning of going Keto will be body fat, especially if you are already in a mild state of ketosis, or are consistently moving in and out of ketosis, but don't know it.

Weight loss will be slower, but more of what you lose will be fat.

Plus, getting stricter with your diet will enable you to comfortably eat at your new caloric deficit because ketosis will kill your appetite.

When combined with the reduced hunger that comes with surgery, ketosis can be a powerful weight-loss tool, so if you're stuck partway to goal weight, and you want to give the Keto Diet a whirl, here's the best way to get into ketosis after having bariatric surgery.

Pinterest Image: Chicken Legs and Bits of Salad

What Triggers Ketosis?

The state of ketosis is always triggered by carbohydrate restriction. Despite what bloggers and some low-carb experts might say, ketosis has nothing to do with how much dietary fat you eat.

When carbohydrate foods are limited, no matter what the fat content of the diet is, the lack of carbohydrate forces the liver to use its glycogen stores, the storage form of carbohydrates.

Carbohydrates are not stored as glucose. They are stored as glycogen, which takes up less space, and then the glycogen is broken down into glucose, as needed.

The liver can only hold about 80 to 100 grams of carbohydrate, at any one time, so at 4 calories per gram, you'll burn through those 360 to 400 calories worth of glycogen stores fairly quickly.

Muscles also store glycogen, but muscle glycogen is a closed system and not shared with the liver. Increasing your activity during the first few days will increase the need for your muscles to replenish their own glycogen supply. This can hurry the adaption process along a little quicker.

To store glycogen, muscles remove glucose from the bloodstream and convert that glucose back into glycogen. This lowers your blood glucose level in the blood, which triggers the liver into converting glycogen into glucose to raise your blood sugar back up.

Warnings About Exercise and Elevated Cortisol

If you're already fairly active, you don't want to up your activity more than it is because you can actually go too far.

Ketosis uses the starvation pathway, which forces the body to burn fatty acids for fuel instead of glucose. When the body isn't adapted to burning fats, when it can't burn fats effectively, too much exercise can actually trigger the body into starvation mode and cause your weight loss to stall.

There's a fine balance between getting enough exercise and exercising too much, but mostly, it depends on how your body physically responds to the exercise.

When stressed, your cortisol levels will rise.

Cortisol is a stress hormone that directs how energy is used by the body during stress.

When cortisol is high, insulin is secreted to clear the bloodstream of fatty acids, paving the way for the liver to dump it's glycogen-converted glucose into the bloodstream. Glucose gives you quick energy, such as during a sprint, but if you have insulin resistance, elevated cortisol levels will make it worse.

All forms of stress cause the body to elevate stress hormones, not just exercise.

The surgery, dieting, and even worry all play a role in your hormonal state. If you over-exercise, on top of everything else, or you're prone to worry and fret about your weight, fat loss can come to a halt.

Man Swimming Under Water
Pick something you enjoy doing, like swimming,
weight-bearing exercises, or walking.

Being active is fine, and encouraged, but use a little common sense when planning your day. Weight-bearing exercises, swimming, and walking are less stressful on the body than aerobics, so you don't want to do anything that is too intense. At least, at first.

Also, try not to worry too much about what your weight is doing. Focus on getting into ketosis instead.

How Long Does it Take to Get Into Ketosis?

Many people consider the starting point of ketosis to be when ketones start spilling over into the urine, but the state of ketosis actually begins much quicker than that. As soon as the liver mobilizes fats to handle the lack of glycogen, you are in some degree of ketosis.

Most people go into mild ketosis every single night, unless you're in the habit of eating something just before you go to bed, but the aim here is to encourage the body to make more ketones than it already does.

You can reasonably get into ketosis in less than 24 hours, even though it takes 2 to 7 days for acetoacetone ketones to start showing up in the urine.

This is because ketones are a by-product of triglycerides being broken down into fatty acids, and the body always burns amino acids first. Creating free fatty acids requires the liver to remove the glycerol backbone from triglyceride, so it can be converted into glucose. During this breakdown process, ketones are also produced.

These ketones are actually partially burned fat fragments. They are released into the bloodstream to help fuel the brain, organs, and other body systems. The brain can cover up to 70 or 80 percent of its fuel needs with these ketones, and initially, all of your body cells that have mitochondria will be using ketones, as well.

As carbohydrate restriction continues, the liver keeps pumping out ketones to take up the slack. The production of ketones slows down protein oxidation and reduces the need for the liver to convert amino acids into glucose, sparing muscle tissue.

This is why you don't have to worry about eating too much protein. Within a week or two, protein needs go down and the body begins to shift from predominantly burning glucose to predominantly burning fats.

For Keto beginners, the body often makes an overabundance of ketones because it doesn't know how many to make. This is why pre-opt diets work so well. Your body is brand new to ketosis. But after surgery, your body will be slightly wiser and not make so many when you first go into ketosis again.

The ketosis process takes a few days, and it will be several weeks before your body is using ketones and fatty acids efficiently, because as carb restriction continues, the muscles will begin to burn fatty acids for fuel instead of ketones.

Ketosis isn't the end-goal.

Becoming fat adapted is the aim.

But, by the end of the first week, you'll be making plenty of ketones to fuel the body and will begin to burn body fat.

What's the Best Way for a Bariatric Surgery Patient to Get Into Ketosis Quickly?

One of the biggest challenges that a bariatric surgery patient has is their small stomach size.

Most patients by the end of six months can handle about one cup of food at a single sitting. A few people can eat a bit more, but if you push the limits, you can end up stretching out your stomach permanently. That would be counter-productive to your aim.

Hearty Helping of Smoked Turkey Breast and Scoop of Cole Slaw
Bariatric patients can not eat traditional Atkins portions.
They can only eat about 1 cup of food per meal.

The small amount of food doesn't leave a lot of room for extras.

But it doesn't leave a lot of room for fatty protein foods either.

When you consider that Atkins requires you to eat 12 to 18 ounces of meat per day (1-1/2 cups to 2-1/4 cups) PLUS salad and/or vegetables, Atkins Induction is the uppermost limit that a bariatric patient can handle without making themselves ill.

Realistically, you'll have an easier time eating low carb if you set your diet up with 3 small one-cup meals and 2 mini snacks a day, right from the start.

This will give you ample room to meet all of the requirements for Atkins Induction, and give you something to work with like dropping a snack later on, should you stall again above your weight-loss goal.

The biggest problem with using a huge caloric deficit, like bariatric surgery requires, is that the body tends to adapt to what you're doing much quicker than it does for dieters who use a smaller deficit.

For that reason, you always want to leave yourself somewhere to go, or you'll end up eating at starvation rations for the rest of your life.

Due to the limitations and protein requirements, Atkins 92 or The Keto Diet that's promoted at Reddit will be the best to get you into ketosis quickly and help you stay there because they are versatile, don't put unnecessary restrictions on you during the first two weeks, and can be easily adapted to your needs.

In fact, the Atkins 92 Do-It-Yourself plan, an alternative low-carb diet that Dr. Atkins offered in 1992, and Keto are exactly the same thing, except that the Keto folks over at Reddit like to keep a close eye on their protein, carb, and calorie counts for the day.

What the low-carb community refers to as Keto is actually Nutritional Ketosis, as coined by Dr. Phinney, and sometimes called LCHF (Low-Carb High-Fat). This particular diet is quite confusing, however.

Originally designed for endurance athletes on maintenance, a popular low-carb blogger decided to try it out as a weight-loss diet. His tweaks got confused with the actual Nutritional Ketosis Diet, so how to do LCHF properly has gotten quite twisted along the way.

People believe all sorts of crazy things about that plan, so going with Atkins 92 will be a better fit. Plus, Atkins 92 fits nicely within the real Nutritional Ketosis framework.

Just divide what Dr. Atkins recommended across three meals into three meals and a couple of snacks, so you won't struggle with the volume of food you need to eat. Before 2002, snack recommendations for the Atkins Diets were optional, so as long as you eat what's required for meals, you'll be fine.

Why Choose Atkins 92 Over Atkins 72?

For most people, I recommend Atkins 72, so why am I switching gears here and recommending Atkins 92 instead?

In 1972, protein powders were not available to the public. If you read our instructions on how to do Atkins 72 Induction, you'll notice that protein shakes are not on the menu. Neither is cream cheese, coconut milk, coconut oil, or even avocado. Atkins 72 is strictly:
  • meat, poultry, and fish
  • eggs cooked any style
  • hard cheese, like cheddar (4 ounces maximum)
  • 2 cups of salad (lettuce, cucumber, radishes, celery only)
  • oil-and-vinegar dressing only
  • juice of 1 lemon or lime
  • sugar-free spices
  • bouillon cube or diet soda
  • sugar-free gelatin
  • and up to 4 teaspoons heavy cream
This is a hard-core low-carb plan designed to last one week. It's biologically zero carbs, which means your body treats it as if you hadn't eaten any carbs at all. After the first week, you return foods to your diet in 5 to 8 carb portions, ONE at a time.

In 1992, Dr. Atkins loosened up the restrictions a bit, after many of his patients confessed that they were cheating on the diet. They were not cheating with carbs, however. They were simply staying under the 20 carb limit, and eating more vegetables than the 72 plan allowed.

For that reason, Dr. Atkins changed the main Induction Plan by adding 2/3 cup of vegetables to the menu, and keeping everything else the same.

Protein powders were still not on the market yet. However, since his cheating patients had no trouble getting into ketosis at less than 20 carbs a day, and ate whatever they wanted to within that restriction, Dr. Atkins offered the same method to his readers.

It's this alternative method of doing Atkins 92 Induction, where you are free to create your own low-carb plan, provided you don't eat more than 20 carbs a day, that fits nicely within post-bariatric surgery requirements. You can use protein shakes to help you hit your protein target, leaving you room for a little vegetable nutrition.

The freedom of Atkins 92 makes low-carb bariatric meals easier to design, and since you're not required to eat 20 carbs a day, you can just eat to satiety.

Let's Talk Protein

Asian Shrimp
Protein is the foundation for all low-carb diets.
If you've had any type of bariatric surgery,
you need to eat protein foods first.

Protein foods are the backbone of a low-carb diet. They will take up the largest volume of foods you're allowed to eat.

Since volume is your number one concern, it's best to go with foods that have a high protein-to-food-volume ratio. This will make it easier to hit your personal protein target.

In general, the protein recommendation for low carbers is to eat 0.8 grams of protein per pound of lean body mass. Lean body mass is everything in your body that isn't fat. This includes:
  • body organs
  • water and other fluids like blood
  • undigested food
  • bone structure
  • muscle tissue
  • nails
  • hair
  • skin
  • and even your fat cells
Some low-carb experts, like Dr. Phinney, recommend you eat 15 to 20 percent of your maintenance calories in protein. For the average person, this is a bit tricky to figure out.

Obese individuals will have a higher lean body mass ratio than those who are overweight because your muscle mass, bone structure, and connective tissues will be designed to support your extra weight.

Those extra structures won't still be around by the time you get down to your ideal weight, as your body will consume what it doesn't need.

Also, those who eat low-carb diets tend to weigh more on the scale than their body size suggests, making it difficult to set a number weight-loss goal. You can actually end up being heavier than your original weight-loss aim suggests by the time you trim down.

For example, when I dieted down to 160 pounds using the old Weight Watchers Exchange Plan, as a young mother, I wore a size 16. When I finally dieted down to 160 pounds doing low carb I wore a size 14. Same weight, much older, but I was a smaller size.

In 2007, the prevailing thought on protein was that you needed to eat 1 gram of protein per kilogram of current weight.

For me, right now, at 202 pounds (the last time I weighed myself), that would be 202 divided by 2.2 (how you find your weight in killograms), which is 91.8, or 92 grams of protein rounded up.

It seems that no matter which system I use, my protein needs always come out the same, so today, I'm more inclined to just tell you to eat between 72 and 90 and then adjust it upward if you're still hungry. Your body will let you know if you are protein deficient.

Here are the symptoms of protein deficiency.

What 72 to 90 Grams of Protein Looks Like in Real Life

If you're only eating lean protein sources, like chicken breast or tuna, you can simplify the process by counting 7 grams of protein per ounce of meat.

Flaked Tuna
Lean meats are 7 grams of
protein per ounce.
This is only a rough estimate but works out very well.

Cheese fits into this category, as it's 7 grams per ounce.

If you're only eating fatty protein sources, you can count 6 grams of protein per ounce of meat.

Whole eggs fit into the fatty protein category, as eggs are 6 grams each.

If you're eating a combination of lean protein sources and fatty meats, such as bacon or ground beef, throughout the day, you can count your protein for the entire day by multiplying the total ounces you plan to eat by 6.5.

This is what I do now. It's easier.

At 6.5 grams per ounce, 72 to 90 grams of protein comes to 11 to 14 ounces a day. On average, I eat between 12 ounces and 16 ounces right now.

Lean sources, like chicken breast and tuna, will require you to eat less volume, about 10 to 13 ounces, but your diet will be lower in fat. You'll want to make sure that you add healthy fats to your protein meals if you go this route.

For instance, 1/2 cup of chopped chicken (about 4 ounces) made into a chicken salad will give you 22 grams of protein for your meal or snack, while 2 scrambled eggs will give you only 12 and take up more volume in your stomach.

One egg and 2 strips of thick bacon is even worse. It only comes to 11 grams of protein.

This doesn't mean you need to ditch the bacon and eggs.

Eggs can really help you hit your target, especially if you use them for snacks or breakfast. You'll just need to be aware of the protein content of the foods you're eating. Keep track. Don't guess, so you can combine them and juggle them in the best way possible.

What you don't want to do is fill up on vegetables and then have little to no room for your meat, cheese, eggs, and protein shakes. Protein foods should always be consumed first, and then vegetables and salads eaten to satiety.

Think of vegetables as a way to make your food look more colorful and appetizing, rather than being the center of attention.

Protein Shakes

Strawberry Protein Shake
Protein shakes make it easy to hit your protein target
on the Atkins Diet.

Protein shakes are a must-have for those with a small stomach. If you make your own at home, you can control both the amount of protein powder you use in the shake and how much liquid you add.

This gives you the freedom of making a shake that is the perfect size for breakfast or a snack.

Make sure the protein powder is low in carbs.

Many powders add sweeteners that will raise the carb count. A plain whey powder or something artificially sweetened should only cost you a carb or two per scoop. Maybe three. Watch out for powders that have been sweetened with fructose or other carby sweeteners.

The type of liquid can be easily adjusted to fit your calorie requirements. While 4 tablespoons of heavy cream and 1/2 cup of water, plus ice, is a standard low-carb recipe, the heavy cream will cost you 50 calories per tablespoon.

In 2007 and 2008, I was eating lower fat, so the basic shake recipe in our archives reflects that.

If you've stalled before going Keto, heavy cream might not be the best option.

Lengthy weight-loss stalls almost always mean that what you're currently doing is maintenance, so something has to be changed. For a lot of individuals, that something is consuming less fat and calories. However, keep in mind that if you're not eating enough food, or if you're getting too little fat, you can also stall.

A better alternative to heavy cream in your shakes is coconut milk or low-fat cottage cheese. These ingredients are what I turned to when I tried to push my body to go below 160 pounds by using a Protein-Sparing Modified Fast (PSMF Diet). However, you don't have to go as extreme as I did.

Canned coconut milk is low in carbs, but extremely creamy, so it tastes very high in fat. Make sure you shake it well before using. At 30 calories per tablespoon, it can help you shave your calorie intake without feeling deprived. I used the basic shake recipe above, and just switched out the coconut milk for the heavy cream.

A 1/4 cup of low-fat cottage cheese, on the other hand, contains only 40 calories, slightly more than a single tablespoon of coconut milk, so if you're cutting way back on calories, switching out the cream for cottage cheese can offer a great option. In addition, the cottage cheese will add another 7 grams of protein to your shake. Once blended, you'll never know that cottage cheese is in there. You'll think it's cream.

Healthy Fats

A Keto Diet is higher in fat than a well-balanced diet. This is because you're using fatty acids for energy. If you don't eat enough fat, you'll feel tired and your weight loss will stall. With 20 carbs a day being your upper limit, and 72 to 90 grams of protein a firm aim, the only macro you have to play with in terms of calories is your dietary fats.

The average Keto Diet is about 60 to 65 percent fat.

While that might sound like a lot of fat, it's not as bad as you think. Most protein sources are not just protein, but a combination of protein and fat. An egg, for instance, is 65 percent fat, which is why it's relatively low in protein. Higher protein meats, like chicken breast, are super low in fat.

When you eat lean sources, to cut down on volume, you'll need to add a bit of healthy fat to your meals. Coconut oil, coconut milk, real butter, heavy cream, olive oil, nut oils, and avocados will help you keep your calories within your target range, while supplying your body with the energy it needs to get through the day.

Keep in mind that most low carbers are overeating fats.

This is why they are struggling to lose weight. They've bought into the idea that because fats have no carbs, they can eat all of the fat they want and still lose weight.

You can't.

Part of your daily fat percentage must come from your body fat. This is the concept that's been the most difficult for the low-carb world as a whole to accept.

If you get this right from the start, you won't have to relearn it later:

If you eat all of the fat your body needs to function, it will have no need to go into your fat stores for more.

While you don't want to go down to super low levels of fat, unless you have no other alternative, you do need to eat less than your body needs. I lost weight at a good pace eating about 50 percent fat, rather than the more typical 65, but I don't burn fats for energy very well.

Genetically, I am not built to burn fat.

Salads and Vegetables

In 1972, oil-and-vinegar dressing was the only salad dressing allowed, unless you preferred lemon juice, but using the Atkins 92 do-it-yourself rules lets you take advantage of today's low-carb foods. Look for salad dressings that don't contain sugar, or make your own, and don't forget to add the carb count into your daily total.

Sugar-free oil-and-vinegar dressings are generally carb free, supplying only calories and healthy fats, while Ranch and other modern dressings are not.

If raw vegetables in your salad won't work for you, due to their digestibility, pick something else that is super low in carbs, such as sliced green onion, or garnish your salad greens with crispy bacon, grated cheese, and chopped hard-boiled eggs.

The key is to keep your carbohydrates as low as possible, so you can get into ketosis fast and easy.

With Atkins 92, you'll need a carbohydrate counter to look up the carbohydrate content of the vegetables you want to eat. I personally use The Complete Book of Food Counts by Corinne T. Netzer. It gives you values for:
  • calories
  • carbohydrates
  • protein
  • fat
  • cholesterol
  • sodium
  • fiber
But you can use an online data tracker like Fitday or My Fitness Pal if that's easier for you. I don't have a Smart Phone, so I do things the old fashioned way, but feel free to use any phone app you like.

A search engine will also bring up the carb count from one of the data tracker sites if you ask it to search for the carbs in the vegetable you want to use. I sometimes do it that way too, if I'm only looking for a single value.

How Many Carbs Should You Eat Per Day?

If you want to get into ketosis as fast as you can, try to stay below 10 carbs per day, and eat mostly protein foods for the first three days.

This 10-carb limit includes the incidental carbs that are in spices, cheese, salad dressing, and eggs, as well as salad greens and/or vegetables. It will require you to eat mostly meat.

The fewer carbs you eat, the faster you'll get into ketosis.

Also, keep in mind that the number of calories you eat have nothing to do with ketosis, so eat a comfortable amount of food for the first three days. Don't place more stress on yourself than you need to.

Give your body time to get into ketosis, adapt to burning fats, and then worry about how to lower your calories to get the scale moving.

Most low-carb newbies do not understand that training your body to burn fats for fuel is what low carb is all about.

It's really not a quick weight-loss diet.

Keto is about switching metabolic pathways, which can improve diabetes, high blood pressure, cholesterol, and other health concerns, but it takes a few weeks to implement correctly.

Weight loss is a side effect of improving your hormonal state in combo with eating at a caloric deficit.

If you're not in a rush to get into ketosis, and just want to give the Keto Diet a try, you can go with 20 carbs a day, instead of 10. Going with 20 carbs will make meal prep a bit easier and less repetitive.

You could also opt for 15 carbs a day, or juggle your carbs from low to high to keep the body guessing at how many carbs will be coming in, as the sample menu below does. While getting into ketosis fast is a good idea, you don't want to sacrifice comfort, especially if you're uncertain about how to eat low carb correctly.

Expect hunger reduction to occur within 2 to 5 days.

Weight-loss surgery lowers your body's ability to produce ghrelin, the hunger hormone, so you might experience this reduction in hunger by getting full faster than you did before, rather than actually feeling hungry between meals. You might also have to eat according to the clock, rather than how you feel.

However, when the body runs out of glycogen, it might start screaming at you to eat.

This is the turning point in the ketosis process and tells you that you are on the verge of making the switch into the alternative metabolic pathway. If you suddenly start craving sweets or other carby foods, thinking about food a lot, feed your body a tuna salad.

I know that sounds odd, but honest-to-goodness, it really works!

I don't know what it is about mixing tuna and mayonnaise together, but it quiets the cravings for sugar.

Once the switch into ketosis occurs, cravings will quiet down tremendously, and you'll often forget to eat. Don't let this rattle you. You don't have to eat everything you've planned to eat for the day. Just make sure you hit your minimum protein target. Lots of people are happy, content, and healthy eating a zero-carb diet.

This no-hunger condition is a result of Leptin being able to communicate with the brain. You have plenty of fat stores your body can use for its energy needs. As your body fat goes down, your hunger will return, so just go with the flow, and let ketosis work as it was designed to.

You are now predominantly burning fatty acids for fuel, rather than glucose, so you won't feel those "I've run out of glucose, feed me right now" urges you used to get when it was almost time to eat.

Additional signs of ketosis can be found here.

Three Day Sample Menu to Help You Get Into Ketosis

This is a simple three-day quick-start menu to show you how to eat when your stomach is small. It contains 90 grams of protein and less than 20 carbs to get you into ketosis quick and easy:

Day 1: (1,200 calories, 93 grams protein, 9 carbs)

Breakfast: (11 grams protein; 1 carb)

1 fried egg
2 slices bacon
coffee, tea, chicken broth

Lunch: (33 grams of protein; 1 carb)

3/4 cup cooked chicken breast with mayo
1/4 cup sliced green onion mixed in

Dinner: (17 grams protein; 2 carbs)

4-ounce hamburger patty
salad with full-fat dressing to satiety


Protein Shake (20 grams protein)
2 ounces cheddar cheese (12 grams protein)

Day 2: (1,035 calories, 89 grams protein, 11 carbs)

Breakfast: (20 grams protein)

Protein Shake


2 ounces of tuna
1 tablespoons mayonnaise
over 1/2 cup shredded lettuce


2 roasted chicken legs, with skin
1/2 cup green beans with butter


2 ounces cheese
2 ounces tuna with 1 tablespoon mayonnaise

Day 3: (1,200 calories, 88 grams protein, 14 carbs)


1 scrambled egg
2 slices bacon
coffee, tea, chicken broth


2 roasted chicken legs, with skin
1/2 cup salad with full-fat dressing


hamburger patty
1/2 cup green beans with butter


Protein Shake
2 ounces cheese

These menus are lower in overall calories than a typical low-carb diet, but higher in fat than you might be used to eating. They are tailored to fit the volume of food that a bariatric patient can eat, as well as the number of calories you might be already eating 6 to 12 months after your surgery.

They are meant to show you how to get your protein in and include enough fat calories to make getting into ketosis comfortable.

Your actual carb budget is 20 a day, so there is room for larger portions of salad or vegetables if you need them. To raise your calories on Day 2, for example, you could have some avocado on your tuna salad. You could also munch on bacon for an extra snack in the morning.

Okay. You're In Ketosis. Now What?

If you're doing Keto after bariatric surgery, your small stomach size means you'll have to do an extended Induction, and include a broader choice of foods, rather than a standard Atkins Diet.

This is another reason why Old School Atkins would be a better fit for you. Older plans let you tailor the diet to fit your own situation and fitness goals, so keeping the food volume small won't be a problem. Many people stay at 20 carbs a day for months or even years at a time with no ill effects.

Everyone doesn't have to move to a higher carbohydrate level after Induction, or use the Atkins Carbohydrate Ladder as a guide, though you can if you want to.

The key to making the Atkins Diet work, and how you stay in ketosis, is to stay below 20 to 25 carbs a day. While most people can actually eat more than 25 carbs and maintain ketosis, your situation is unique.

Protein foods must always take precedence over carbs, so make sure that you use your carb budget to improve your protein-based meals, instead of replace them.

Fashion your menus to fit your macros, and you'll do just fine.

Notice that having a protein shake for breakfast on Day 2, instead of for a snack in the afternoon or evening, lowers the overall calories quite a bit. This can be helpful information to know if you need to severely reduce calories, after getting into ketosis and becoming fat adapted, like I did.

Look for ways to trim the fat, if needed, like removing the skin from your chicken, or eating baked chicken instead of mixing it with mayo. Switch to Canadian-style bacon, instead of pork, lean ham, or cook your chicken breast in a skillet with a little butter and herbs, instead of eating legs and thighs.

There are literally hundreds of ways you can easily trim calories to get the scales moving again, without a lot of pain. You just have to be willing to personally experiment on yourself and take the time you need to discover what works and what doesn't.

You might find our latest series on How I Lost Over 100 Pounds by Tweaking the Atkins Diet useful. Since I don't burn fats for fuel very easily, I had to take my calories down to only 950 a day to make a low-carb diet work for me.

The series contains menus, tips, and everything I did to lose the weight, but it also shares exactly what I did wrong.

If you happen to be lucky enough to have the genetics for fat burning, you might actually have to increase your fat budget instead of lower it.

Many lower carbers feel better and have more energy eating higher fat and lower carbs than I do. There is no reason why you have to eat 20 to 25 carbs a day. The body can manufacture all of the glucose it needs for the brain from the protein you eat.

The key is to find the correct amount of protein, fats, and carbs that will optimize performance for YOU. This isn't something that I can tell you how to do. It just takes a willingness to experiment with various levels of protein, fats, carbs, and calories, to discover what works best.

This strong personalization is what allows you to make your low-carb diet your own. Once you know what's best for you, the only thing left is to just go out and do it!

Are you a bariatric patient that is thinking about going Keto? If so, we'd love to hear from you. How well did Atkins work? 

New to Low Carb? 

Check out our Beginner's Guide for lots of tips and advice! We also have a Beginner's Page with links to lots of basic articles designed just for newbies! If you found us because you've stalled on your bariatric diet, we have a page devoted to weight loss stalls and plateaus, as well.

Feel free to ask a question in the comments, share your experiences, or just say "Hi!" We'd LOVE to hear from you!


  1. Hi there! I wanted to follow up with you as I was the original one asking about what I should do to get out of a stall after bariatric surgery! I lost 73 pounds in 60 days after surgery without any effort...and then I hit a wall. Hard. Three months later I had gained 4 lbs even only eating 800 calories a day if that! My metabolism had tanked and I had bad insulin resistance as I am diabetic but off meds since surgery. So my doctor said to try Keto to help me break the stall and fight back against the insulin resistance. I then googled Keto and found you and you published this! So on June 29th after our summer vacation I started induction. I have been eating low carb the keto way since. I am sooo happy to say as of this morning I have lost 15 pounds since I started on June 29th! It broke my three month stall and my sugars are under 100 always and I feel fabulous!!! Thank you thank you thank you! I am making this a lifestyle so I can get to goal and then maintain for life!!!

    1. Thank you so much for coming back and sharing that! I hardly ever hear back from the people I talk to, and always wonder how they've made out. 15 pounds in a month is terrific! Congratulations for breaking your stall. Keep up the good work!

    2. Hi Vickie! I am 30 pounds down now since starting keto in late June and 25 to my goal! After bariatric surgery my insulin resistance was bad..but the keto diet stopped it in its tracks and broke my stall! I have added intermittent fasting and made my body a far burning machine! I am down 90.pounds since 12/09/16 and can not say enough about your blog! Thank you for educating me!!

    3. You are very welcome. Thank you so much for sharing your results with us. I'm glad to know you've found the blog helpful.

    4. @Branleonhardt I had my surgery December 13th 2016. I dropped a alot of weight by April I stopped losing. I'm done a hundred and nine pounds. And I feel like I've gotten nowhere. before my surgery everybody told me by year I dropped 200 lbs because I was so heavy but no one ever told me the struggle that I would have having a thyroid disorder. My doctor made comment about me trying to keto diet so that's what I'm going to try to do and hopefully that will work for me. Congratulations on your progress

    5. The Keto diet really is the answer to disrupt the insulin resistance your body is going through. Vickie'd blog here is a wealth of information and she is always posting helpful information! I have adopted this way of eating as a lifestyle now. I finally made it to my goal weight and keto is helping me to maintain the weight loss! I have no more diabetes and even my thyroid disorder has gotten better! Insulin resistance causes a multitude of health issues so once you go low carb high fat you will see that stall come to an end and everything else within your body starts following!! Good luck to you! The struggle is real but you can do it!!

  2. Keto Diet is popularly known as a low carb diet, where the ketones produced in the human liver are used as energy and this is perfect for weight loss.


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