Carbs after bariatric surgery…quite the controversial topic. 

Some say you should consume very low carbs.  Others say your body needs carbs. And I get it.  You just want to be successful after bariatric surgery.  Yet you’re confused, scared and unsure what the right answer is.  Especially if you’re noticing changes in your appetite, cravings, hunger or how your clothes fit.  The fear escalates.  

Not to mention, thoughts of restricting fill your head because your friend has been so successful following a very low carb diet(aka keto).  So you question if you shouldn’t lower your carbs.  Creating more confusion and fear.

So here’s the thing, there is no one formula that works for everyone.  In fact, I recently covered this in “Why you shouldn’t follow your friend’s successful diet.”

This is why it’s important to work with a practitioner like myself who can help personalize your intake.  Because in reality, some of you need to increase your carbs.  A lot!

So hear me out on why some of you may need to increase your carbs after bariatric surgery. 

But, I’d like to preface this with I’m not against low-carb or ketogenic diets.  I’m just against the idea that mass populations of people think they’re suppose to follow a low-carb or keto diet for life.  When that may not be the case. 

So to me, understanding your genes that influence your ability to manage carbs seems more sustainable. 

Again, to me this is a personal decision.  For example, my mom has Dementia/Alzheimers disease.  A disease directly related to blood sugar and insulin.  I know my genetics and I want to minimize my risks for developing this later in life.  

Although I don’t have the APOE high risk variants, it’s important to me to adopt a prevention lifestyle when it comes to my brain & metabolic health.  Because it’s what I do now that will help delay the onset.  Instead of waiting until I show symptoms or signs. 

And if I did have the APOE high risk variants, you bet I’d be diligent at following a genetic guided diet to slow the process. 

So, I applaud you for wanting to improve your health.  But unless you truly know your genetics, following a low-carb diet may not be necessary.  And not to mention the impact restricting food has on your overall relationship with food. 

You see, understanding your genetics can improve your relationship with food.  As it will uncover what your body truly needs.  Minimizing your desire to follow the next fad diet that comes along.  You wouldn’t get tripped up on thinking it would even be an option.

What is a normal carb intake?

The dietary guidelines for Americans recommend that carbohydrates make up 45-65% of total calories.  For example, if you consume 2000 calories daily 900-1300 calories should be from carbs.  Which translates to 225-325 grams of carbs per day. 

How did low-carb become a thing?

First off, low-carb diets have been promoted as a primary focus on weight loss.  However, a significant rise in popularity for low-carb diets resulted after decades of focus on low-fat diets and a parallel rise in national obesity rates. 

The quest began to determine if the recommendation to consume twelve servings of carb sources daily to counter the lowered fat intake was at the root of our obesity crisis.

What’s considered low-carb?

The studies show it’s somewhere between 20-150 grams of carbs per day is considered a “low-carb” intake.   

So essentially, a low-carb diet of 20-50 grams of carbs would be considered a very low carb diet.  And 50-150 grams of carbs would considered low carb.

Again, variables that should be determined by working with a practitioner like myself to prevent missed nutrients.  That could lead to malnutrition. 

What are the positives to following a low-carb diet?

A recent study published in 2022 found those following a low-carb high protein diet had better blood sugar balance and overall weight loss. 

Low-carb approaches stem primarily from the hypothesis that lowering insulin, a critical hormone that produces an anabolic, fat-storing state, improves cardio-metabolic function and induces weight loss.  As shown in this 2018 study. 

This approach has been recently called the carbohydrate-insulin model.    Studies have shown low-carb approaches to be superior to other dietary methods in producing rapid weight loss for the first 6 to 12 months.  

And to clarify further, I discuss more about insulin in this “Why bariatric patients should care about blood sugar”.  And in this “Why insulin levels matter for appetite and weight”

Additionally, when lowering carbs from the diet, the macronutrient intake of fat and protein generally increases to compensate for the reduction of carbs.

The ketogenic (keto) diet, a specific low-carb version, deserves mention. Keto diets restrict carbohydrates to induce nutritional ketosis and typically limit carbs to 20 to 50 grams daily. Restricting carbs to under 50 gms induces glycogen depletion and ketone production from the mobilization of fat stored in adipose tissue.

The keto diet has been found to lower the risk of Alzheimers and dementia, diabetes and insulin resistance, and improve weight loss to name a few. 

So there is compelling evidence around following a low-carb lifestyle.  But what are the negatives?

What are the negatives of a low-carb diet?

Typically, I find that all or nothing mindset around carbs creates a unique environment when making food choices.  I’ll have people afraid of eating whole real food choices(aka fruit, potatoes, beans, lentils) because of the sugar/carb content, but will have no problem eating a weight watcher ice cream bar because it’s “low-carb”.  Or a bag of Quest chips because it high-protein, low-carb.  This is mind boggling to me.  And is exactly what the food industry LOVES!!

I mean I do understand the rationale, but it comes from a lack of education around carbs and how your body works.  As well as knowing the tips and tricks around minimizing the glucose/insulin spikes when consuming higher-carb foods. 

But outside of impacting your food relationship, there’s additional considerations when choosing to follow a low-carb lifestyle.

1. Getting adequate fiber requires intentionality and is rarely accomplish.
2. Can increase cortisol levels in some individuals when carbs are too low. 
3. Can impact sleep, by causing a 2-4 am wake up.
4. Doesn’t always work well in those with thyroid dysfunction.
5. Short-chain fatty acid production will be influence from the lack of fiber.
6. Difficult for some peri-menopausal/menopausal females without impacting hormones negatively.
7. May be difficult in those with no gallbladder.
8. Liver support may be needed for those following a keto diet that have a fatty liver.

So even it does produce great weight loss for you, it doesn’t mean it won’t impact other areas of your health negatively. 

What are the genetics influencing a choice to follow a low-carb diet?

Although your genes are not your destiny, you still may need to manipulate their expression in order to manage your health.   In fact, there’s over nineteen genetic SNPs that can influence how your body regulates glucose and insulin.  And for some, it may take a very specific combination of these variants that would require you to follow a very low carb diet(keto). 

For example, the SLC2A2 genetic SNP is involve in the first step of glucose-induced insulin secretion.  It is associate with increased insulin response to sugar and refined carbohydrate consumption.  Therefore, compounding sugar intake and cravings, especially for sweets. 

Another example, ADIPOQ, the GG genotype was associate with high insulin and triglyceride levels, compare to A allele carries and is associate with a higher risk of insulin resistance and metabolic syndrome.

Lastly, a very recent study published in 2022 on “How the timing of dinner and genetics affect individuals blood sugar control” . They found eating dinner close to bedtime, when melatonin levels are high, disturbs blood sugar control.  Especially in individuals with a genetic variant in the melatonin receptor MTNR1B.  Which has been link to an elevate risk of type 2 diabetes.

The high melatonin levels and food intake associated with late eating, impairs blood sugar control in carriers of the MTNR1B genetic risk variant through a defect in insulin secretion. So as you can see, your genes can make you more susceptible to more imbalances in your blood sugar. But here’s the thing, having genetics SNPs that predispose you to imbalance blood sugars is not a death sentence or a guarantee they will be express.  

So as you can see, your genetics can play a role in whether or not you should truly follow a low-carb lifestyle. 

Conclusion

So as you can see, the intake of carbs is very individual.  No two people will respond the same as there is only one you.  So when choosing how many carbs your body needs, don’t just look at weight loss.  You have to consider how it influences your hormones, stress response, sleep, gut health, thyroid and liver.  This is why working with a practitioner like myself can be so beneficial to determining the amount of carbs your body needs to flourish.