Keto After a Hysterectomy: When to Start and What Changes

Last updated on May 25th, 2023 at 06:09 pm

Six weeks out, and the grocery list is already written. Eggs, bacon, a bag of cauliflower you’re told will turn into rice if you believe hard enough. You’ve read that keto is the fast lane to losing weight after a hysterectomy, and you’d like to start Monday.

Then you hover over the list. Is Monday too soon? Everyone seems sure you need carbs to heal. Somebody online says keto flu knocked her out for a week, and you’ve only just stopped feeling knocked out by the surgery.

Keto, short for ketogenic, cuts carbs so low that your body switches to burning mostly fat. Your liver turns some of that fat into ketones, a backup fuel your brain and muscles can run on when sugar is scarce. That’s where the name comes from. You eat meat, fish, eggs, vegetables, cheese and fat, and give up bread, pasta, sugar, potatoes, rice and most fruit.

Trying keto for the first time since your hysterectomy? Read on. Already on keto before the operation? Jump to going back to keto after surgery.

Is keto safe after a hysterectomy?

The bigger risk after a hysterectomy sits in the healing weeks, and it isn’t the missing bread. It’s eating too little while your body is trying to heal.

Surgical nutrition guidelines push for getting food in within hours of an operation, because skipping it after major surgery risks underfeeding. A 2026 review of who should be careful with keto puts the weeks after surgery on its list.

Keto makes under-eating easy. It cuts out whole food groups, and in the first weeks your appetite may already be missing in action.

So, the “you need carbs to heal” line? Not quite. What you need to heal is enough food, protein especially. Carbs are one way to get it. If you’re not eating enough of anything yet, keto can wait.

Once you’re healed and eating well, it’s a diet like any other, with its own rules and side effects.

When can I start keto after a hysterectomy?

There’s no official date. Most women are up and about again within three to eight weeks, depending on how the surgery was done. The healing on the inside keeps going well past that.

“Cleared” at your follow-up usually means cleared for activity. Starting a diet is a separate question, so ask it directly: am I healed enough to start cutting back on food?

Signs you’re ready

These are the signs to look for on top of your surgeon’s go-ahead:

• You’re eating full meals again.
• Your appetite has come back.
• Your bowels are working without a daily negotiation.

If most are still a no, keto can wait.

Starting keto before a hysterectomy

Some women start keto before the operation to hit a weight target before surgery. Tell your surgical team you’re doing it. When the day-before instructions arrive, follow them, even if they ask you to drink juice.

Who should check with a doctor before starting keto?

Talk to your doctor first if any of these apply:

• Diabetes medicine. Cutting carbs can change how much of it you need.
• A pill ending in “-flozin,” taken for diabetes, heart failure or kidney disease. A 2023 kidney guideline suggests people taking them be advised against keto. Case reports describe a dangerous acid buildup in the blood, in one case after a single week of keto.
• Blood pressure pills or water pills. Keto can add to what they do, and your dose may need to come down.
• Kidney disease, or certain blood pressure pills. Either can push potassium too high even from food.
• Advanced liver disease.
• Gallbladder trouble, or a gallbladder that’s already out. Your gallbladder stores bile, which helps you digest fat. Without it, bile trickles out in smaller amounts, so a high-fat diet can take some adjusting.
• Heart failure.
• A weight-loss drug, like Ozempic, Wegovy, Mounjaro or Zepbound.

How many carbs is keto?

Many keto plans say to stay under 20 grams of net carbs a day. Studies usually draw the line higher, at 20 to 50 grams a day, which is under a tenth of your calories. The two are closer than they sound. Net carbs leave out the fibre, and vegetables carry a lot of it, so a vegetable-heavy day at 20 grams net can easily come to 35 or 40 grams in total.

That switch puts your body in a state called ketosis. In one trial that put healthy adults on three carb levels, the lowest reliably kept people in ketosis, and the middle one, about three times as many carbs, usually did. The classic keto weight-loss trial started people under 20 grams, which is why so many plans start there.

Getting into ketosis usually takes two to four days of eating this way, sometimes longer.

You may have heard of ketoacidosis, and it sounds alarmingly close. It’s an emergency that happens mostly in people with diabetes: without enough insulin, ketones build up until the blood turns acidic. In ketosis from a diet, there are ketones in your blood, but not enough to do that.

Net carbs or total carbs?

Keto guides argue about whether to count net or total carbs, and your label decides half the argument before you do.

In Canada and the US, the carbohydrate number on a label includes the fibre. Subtract the fibre and you’ve got net. In the UK and the EU, fibre isn’t counted in the carbohydrate line at all, so the number is already close to net. Subtract fibre again and you’ll count it twice.

Sugar alcohols are sweeteners, like erythritol, xylitol and maltitol, that your body can’t fully use for energy. You’ll find them in “keto” and sugar-free products. On a label they often get their own line under carbohydrate, and those grams are already counted in the carbohydrate total above them. Some keto guides subtract erythritol completely and only part of the others.

And the “net carbs” on the front of a package? Canada doesn’t allow the wording on labels at all, because nobody agrees on how to define it. US labelling rules don’t define it either, so a US package’s net carbs use whatever formula the maker picked. Always read the nutrition label.

To hit your number, log what you eat for the first few weeks. A carb-tracking app does the math for you, and it’s the fastest way to learn which foods eat up your carbs.

Keto vs low carb

People use the words interchangeably, and they aren’t the same diet.

Vegetables stay in on both. Keto drops the starchy ones, like potatoes and corn, and keeps the leafy and crunchy ones.

Dirty keto and lazy keto

Lazy keto means counting carbs and nothing else. You keep net carbs to about 20 to 50 grams a day and don’t track calories, fat or protein.

For a lot of people it’s the only version they’ll stick with, and cutting carbs that low can cut calories without trying. In a small two-week study, people with type 2 diabetes ate about 1,000 fewer calories a day on average once their carbs dropped, without counting a thing.

Where it goes wrong is protein. Nobody’s counting it, so it’s easy to come up short, and that’s a bad trade while you’re healing.

Dirty keto means the carb number is the only rule for what you eat, too. Fast-food burgers without the bun, hot dogs, deli meat, packaged keto snacks and diet pop all count, as long as they fit under your limit.

The appeal is easy to see. No cooking, and the scale can still move.

But processed food makes it easy to overeat. In a month-long hospital trial, people ate about 500 more calories a day on ultra-processed meals than on unprocessed ones, even though both menus offered the same carbs, fat and fibre. That trial wasn’t keto, but a bunless burger and a bag of keto snacks are exactly that kind of food.

Fewer vegetables also means less fibre, the last thing your bowels need after surgery. And processed meat is classed as a known cause of bowel cancer.

If you go the easy route, keep two rules: protein at every meal, and vegetables every day. And pay attention to how the packaged stuff treats you. If it leaves you hungry, bloated or craving carbs, swap it for whole food.

A bunless burger on a busy night is fine. As the base of your diet while you’re healing, it’s a lousy way to eat.

What do you eat on keto after a hysterectomy?

Meat, fish, eggs, certain vegetables, some dairy and the fat to cook them in. The shopping is simpler than the rules make it sound.

Foods to eat

• Meat and poultry: beef, pork, chicken, turkey, lamb
• Fish and seafood: salmon, tuna, sardines, trout, shrimp, including canned
• Eggs
• Leafy greens: lettuce, spinach, kale, arugula, Swiss chard
• Other low-carb vegetables: broccoli, cauliflower, cabbage, Brussels sprouts, zucchini, cucumber, celery, asparagus, green beans, peppers, mushrooms, radishes
• Fruit: avocado, olives, raspberries, blackberries, strawberries, rhubarb and starfruit
• Dairy: cheese, cream, butter, unsweetened Greek yogurt
• Nuts and seeds: almonds, pecans, walnuts, macadamias, unsweetened coconut, chia, flax, pumpkin and hemp seeds
• Fats and oils: olive oil, avocado oil, butter
• Drinks: water, coffee, tea, unsweetened almond or soy milk
• Flavour: herbs, spices, mustard, vinegar, lemon

Go easy on carrots, onions, tomatoes, beets, winter squash like butternut, and fruit like blueberries and melon. They’re fine in small amounts, but the carbs add up fast.

Foods to skip

• Bread and grains: bread, pasta, rice, oats, cereal, crackers, tortillas, quinoa
• Starchy vegetables: potatoes, sweet potatoes, corn, peas, parsnips, plantains
• Beans and lentils: kidney beans, black beans, chickpeas, lentils, hummus
• Most fruit: bananas, apples, grapes, mangoes, pineapple, oranges, dried fruit
• Sugar in any form: candy, baking, honey, maple syrup, jam
• Sweet drinks: regular pop, juice, sweetened coffee drinks, regular beer
• Hidden carbs: milk, sweetened yogurt, ketchup, barbecue sauce, many salad dressings and store-bought sauces

A medium baked potato alone carries about 37 grams of carbs, more than a whole day at 20 grams net.

That second list is where keto lost me. I had some success on it early on. But I like a wide range of fruit, and some of the vegetables I cook with were on the no list too. The no list looks short on day one. It isn’t.

A day of keto meals

Here’s a day with around 25 to 35 grams of protein at each meal:

• Breakfast: three eggs scrambled in butter, with a handful of spinach and a slice and a half of cheddar.
• Lunch: a can of tuna over salad greens, with a whole avocado and an olive oil dressing.
• Dinner: one roasted chicken thigh with a heaping cup of broccoli and olive oil.
• Snack: three-quarters of a cup of unsweetened Greek yogurt with a few raspberries, plus a small handful of almonds.

That day comes to about 1,800 calories, 115 grams of protein and 26 grams of net carbs, with 24 grams of fibre.

Use it as a starting point. How much you need depends on your size, age and how much you move. Start with your maintenance number, the calories your body burns in a day, also called your TDEE (total daily energy expenditure). An online body weight planner will estimate it for you.

To lose weight, the usual guidance is to eat 500 to 1,000 calories a day under that number, which works out to about one to two pounds a week. While you’re still healing, eat to your maintenance number, not under it. Then scale the day up or down to fit, and keep the protein where it is.

Eating out works the same way. Order the protein, ask for extra vegetables in place of the potato or the bun, and skip the bread basket. Most menus can do that without anyone blinking.

Gassy vegetables in the early weeks

Keto leans hard on cabbage-family vegetables: broccoli, cauliflower, Brussels sprouts, cabbage. They’re great for fibre. They can also add gas, at a time when trapped gas after surgery may already be your least favourite thing.

If gas is still a problem, go easy on those and lean on spinach, zucchini and peppers until your digestion settles.

How much fat do you eat?

Enough to feel full. In the textbook version of keto, fat makes up 70 to 80 percent of your calories, because it fills the space carbs used to. Most keto plans don’t have you count it. Keep carbs low, protein up, and cook with enough fat that you’re not hungry an hour later.

Some of that fuel comes from your own body fat, which is the whole point if you’re trying to lose weight. Eating extra fat won’t burn more of it.

Which fats to choose

Butter, olive oil, avocado oil, and the fat in nuts, seeds and fish all fit on keto. Butter is a keto staple, and there’s no need to give it up. If you want to go easy on your cholesterol, lean on the others a little more than on butter.

The evidence for that is one very small five-day trial, where a keto diet built mostly on polyunsaturated fat didn’t raise LDL, the cholesterol you want lower, and a version built on saturated fat did. Across dozens of trials, though, the amount of saturated fat didn’t predict whose LDL went up.

Sweeteners and “keto” products

Erythritol is the easiest sugar alcohol on the stomach. In a single-dose trial in young adults, a big dose of erythritol caused no symptoms, and the same dose of xylitol gave people watery stools. The more you take, and the more kinds you mix, the likelier the trouble. Keto bars and cookies often mix several.

Erythritol has also been tied to heart trouble. In people being checked for heart disease, higher blood erythritol went with more heart attacks and strokes. Your body makes some erythritol on its own, though, and in a large study of women, the link mostly disappeared once diabetes was taken into account. Unsettled is the fair word for it.

A low carb number doesn’t make a cookie full of sweeteners a health food. Keto works fine on regular groceries, and the “keto” products are optional.

What to drink

Water is the main drink, still or sparkling. Coffee and tea are fine black or with a splash of cream, and unsweetened almond or soy milk works in both. Salted bone broth counts too. When carbs drop, your kidneys flush out salt and water, which may be behind a lot of keto flu, and a cup of broth puts some of that salt back.

Watch the rest. Regular milk has about 12 grams of carbs a cup, so keep it to a splash. Juice, regular pop and sweetened coffee drinks are out. Diet pop is fine.

Alcohol

Alcohol can fit, if you pick the right drinks. Counts are per drink, from the food tables:

• Fits: spirits like vodka, gin, rum and whisky have no carbs, served straight, on the rocks, or with club soda or a diet mixer. Dry red or white wine runs about 4 grams a glass, and low-carb light beer about 3 grams a can.
• Go easy: regular light beer, at about 6 grams a can.
• Skip: regular beer, at about 13 grams a can. Also sweet and dessert wines, liqueurs, most ciders and coolers, and cocktails made with juice, regular pop or syrup. A single piña colada can carry more carbs than your whole day.

Calories from alcohol still count, and it’s easy to drink a few hundred without noticing.

While it hasn’t been studied in people, those on keto say drinks hit harder when you’re in ketosis. The only data is in rats, whose blood alcohol ran higher on keto. If you drink, go slower than you used to until you know how it affects you.

Your first week, step by step

1. Get your surgeon’s go-ahead, and check with your doctor if you take diabetes, blood pressure or weight-loss medicine.
2. Stock your kitchen with keto foods, and clear out the ones you’re skipping.
3. Pick your carb number, under 20 grams net or 20 to 50 total, and set up a tracking app.
4. Build every meal around protein, add vegetables, and cook with enough fat to stay full.
5. Expect keto flu in the first days. Extra salt is the usual fix.
6. Weigh yourself once a week, and don’t read much into the first week’s drop.

How much protein do you need on keto while healing?

Enough, and on keto the risk is more often too little than too much.

“I learned that the hard way after the first few days when I wasn’t feeling hunger cues and was drastically under-eating,” one woman wrote. Another, nine days out, only worked out she was under-eating after days of feeling shaky and sick.

The everyday baseline for adults is 0.8 grams per kilogram of body weight. Expert guidance for older adults puts the floor higher, at 1.0 to 1.2 grams per kilogram, about 70 to 85 grams a day for a 70-kilogram woman. It was written for people over 65, but it’s the nearest guidance for a woman in midlife trying to hold on to her muscle while she loses fat.

You’ll also see 1.5 grams per kilogram quoted for surgery. That figure is one guideline’s estimate, per kilogram of ideal body weight, for patients who need nutrition support because they can’t eat enough. It was never meant for a woman eating well at home.

And the idea that too much protein kicks you out of ketosis? In one small study, a meal’s protein added only a few grams of sugar to the blood. In another, men eating a keto diet with 30 percent of calories from protein stayed firmly in ketosis. Eat the chicken.

Carb cravings

Plenty of women in the weeks after surgery find their body wants the exact opposite of keto. “All I want is bread. That’s it. I want to live bread.” One woman two years into keto couldn’t stop thinking about cake the week after her surgery.

Women who’ve been there say protein at every meal takes the edge off. Starting keto while cravings are at their worst is a hard way to begin. If they don’t ease up, there may be other reasons your cravings have changed since your hysterectomy.

How do I avoid keto flu?

Keto flu is the rough patch some people hit when they first cut carbs. It usually starts within the first few days, is worst in week one, and is mostly gone within two to four weeks.

The usual list:

• Headache
• Tiredness and fuzzy thinking
• Crankiness
• Light-headedness
• Muscle cramps and weakness
• Constipation, or the opposite
• Bad breath, which comes from ketones on your breath

When carbs drop, insulin drops, and your kidneys let go of salt and water. The loss is biggest in the first four days and eases off after about two weeks.

Notice how much of that list overlaps with week three of recovery? Tiredness, headaches, sore and sluggish. It’s one more reason to let the surgery symptoms settle first, so you can tell what’s causing what.

Salt, potassium and magnesium

Salt. It’s the fix people reach for most. The only figure with names on it, an extra 1 to 2 grams of sodium a day (a cup or two of salty broth), comes from keto researchers Jeff Volek and Stephen Phinney’s clinical experience. For comparison, most adults are told to keep sodium under 2,300 milligrams a day. If you take blood pressure pills or water pills, or have heart failure or kidney disease, don’t add salt unless your doctor agrees.

Potassium. Most people can get it from food: avocado, spinach, salmon, mushrooms. Potassium pills, and salt substitutes, which are often potassium, are a question for your doctor first.

Magnesium. The upper limit for magnesium from supplements is 350 milligrams a day. Food doesn’t count toward it. Some keto sellers suggest 300 to 500 milligrams, which can put you over from the pills alone. Too much tends to bring on diarrhea, and it’s riskier if your kidneys don’t work well.

Leg cramps

Magnesium is the go-to advice for cramps on keto, and plenty of people say it works for them.

The trials looked at a different kind: sudden, painful calf cramps that wake you at night with no clear cause. In a review of eleven trials, mostly in older adults, magnesium was unlikely to help those. A 2026 trial in people 50 and over, most of them women, found the same. Compression stockings, in that same trial, did cut them.

None of those trials were in people on keto, where cramps may come from the salt and water your kidneys let go of. If magnesium helps you, keep supplements under 350 milligrams a day.

Easing in or cutting carbs overnight

The standard advice is to ease in to dodge keto flu. It sounds sensible, but the closest trial found people on moderate carb levels had about the same symptoms as people on strict keto. So pick the pace you can stick with.

A fever after surgery isn’t keto flu

Fever isn’t one of the usual keto flu symptoms. After surgery, a fever means call your doctor, whatever you’re eating.

Will keto make constipation worse after surgery?

It can, and the timing isn’t great.

The surgery slows your bowels for a while, and that part passes. In one study that followed women for three years, only about 2 in 100 who weren’t constipated before their hysterectomy were afterward.

Keto brings its own risk. Depending on the study, anywhere from 1 to 68 percent of adults got constipated on it. So, somewhere between hardly anyone and two out of three. Some women already on keto say their bowels have never been better, so you may be one of the lucky ones.

If not:

• Fibre from low-carb food. Volek and Phinney suggest 15 to 20 grams a day on keto. Chia, ground flax, avocado, raspberries and leafy greens all bring fibre without many carbs.
• Fluid. Up to two litres a day, mostly water.
• Walking. Every day, as far as feels comfortable.
• Your stool softener. Keep following the bowel instructions you went home with.

How fast will I lose weight on keto?

Faster than usual in week one, and then about the same as any diet you stick to.

The first week’s drop is mostly water, the salt and water your kidneys let go of. Nice to see. It just isn’t fat. And if your stomach looks bigger than the scale suggests, swelling and fat are different things this soon after surgery.

Over that classic 24-week keto trial, people lost about half a percent of their body weight a week on average, first week included. That’s my arithmetic from the trial’s total, and nobody loses in a straight line. At 200 pounds, it’s roughly a pound a week.

In trials that ran a year or more, keto came out about two pounds ahead of low-fat diets. Its real strength is that many people find it easier to eat less without counting calories.

Do you need ketone strips?

No. They can tell you whether you’re in ketosis, but not how fast you’re losing. In one small study of women, ketone levels didn’t track weight loss week to week.

If you want to check anyway, ketosis means blood ketones over 0.5 millimoles per litre on a blood meter. Urine strips are cheaper. They still work after the first weeks if you test first thing in the morning or late in the evening. Mid-morning and mid-afternoon strips missed about half the time.

Why did keto stop working?

“Keto made me gain weight!” It happens, and the reasons are mostly the usual ones.

Keto doesn’t burn fat by magic. In a tightly controlled study where men ate the same calories on keto and on a high-carb diet, keto didn’t speed up fat loss. Calories still count.

So the usual suspects:

• Carbs creeping back. Sauces, dressings, “keto” snacks, a few extra berries a day.
• Sugar alcohols like maltitol. Your body absorbs part of it, so a “keto” bar that subtracts it all from net carbs is counting low.
• More food than you think. Fat is filling, and it’s also calorie-dense. Nuts and cheese add up fast.
• Sleep. Night sweats and broken sleep can make everything harder.
• Medication changes since surgery.
• A smaller you. As you lose weight, your TDEE drops, because a smaller body burns fewer calories. The deficit you started with shrinks until it’s gone. Put your new weight into the body weight planner now and then, and set your deficit from the new number.

If you’ve been on it a few months and nothing has moved, take your food log and your medication list to your doctor.

Does keto work if your ovaries were removed?

Keto hasn’t been tested in women whose ovaries were removed. The closest is a small 2025 study of women past menopause with obesity and high blood pressure, and it wasn’t randomised. The ones on a supervised very-low-calorie keto diet, a few hundred calories a day, lost weight and body fat over six months, and their blood pressure and cholesterol improved. That’s a long way from keto in your own kitchen.

In a 25-day study of the same diet, women past menopause lost less weight than women before menopause, but their blood sugar improved and the younger women’s didn’t.

Hot flashes on keto are anyone’s guess. One woman with both ovaries out found hers definitely got worse on keto. Another, on a low-carb diet, wrote that “the fewer carbs I eat, the fewer hot flashes I seem to experience.”

Is keto safe long term?

Nobody can say yet. Most keto trials run for weeks or months, and there’s little data past two years.

Cholesterol

Across 62 trials, LDL went up a little on keto on average, while triglycerides (a blood fat) fell and HDL, the protective kind of cholesterol, rose.

Which way yours goes depends a lot on your weight going in. A 2024 analysis by Norwitz and colleagues found LDL rose sharply in trials of lean people, didn’t change in trials of people with a BMI (body mass index, a weight-for-height score) of 25 to 35, and dipped a little above that. The scary rises in the headlines come mostly from lean people.

Your own numbers could go either way. After a few months on keto, get your cholesterol checked and compare it with before.

Hair loss

Hair loss on keto is usually shedding, called telogen effluvium: a shock to your body pushes extra hairs into a resting phase, and they fall out together a few months later. You’ll see more hair in your brush and the shower drain, thinning all over.

Major surgery is one of those shocks. So is fast weight loss, and so is a diet short on protein. Shedding starts two to three months after the trigger, so a hysterectomy alone can bring it on right around the time you start keto. Shedding a month or two into keto could be from the operation, the diet, or both.

In one study of people who shed after losing weight, women had been losing about 7 pounds a month on average when it started. Keep protein at every meal.

Shedding usually stops within three to six months, and the hair grows back.

Kidney stones and bones

Kidney stones are the long-term risk with the clearest numbers. In pooled studies of children and adults on keto, roughly 1 in 17 developed them, usually months or years into the diet. About half were uric acid stones.

Keto changes your urine in ways that make stones easier to form. Ketones make it more acidic. Eating less fruit and fewer vegetables lowers citrate, a substance in urine that keeps stones from forming. Lots of meat adds purines, which your body turns into uric acid. And with less water coming in from fruit and vegetables, there’s less urine to flush it all out.

So drink plenty of water, and keep vegetables on every plate.

Bones come up as a worry in a lot of keto guides. So far, the few trials that checked found no change in bone density, though none ran long, and there was a hint of faster bone breakdown in women. If your ovaries were removed, your bones already need looking after, keto or not.

Nutrients keto can run short on

Cutting grains, beans and most fruit can leave you short on fibre, B vitamins, iron, magnesium and zinc. Eat a wide range of vegetables, nuts, seeds, meat, fish and eggs. If your diet has shrunk to eggs and cheese, that’s the gap to fix.

Exercise and keeping muscle

Keto doesn’t make you fitter. In studies of people who already train regularly, it didn’t improve performance, and during weeks of heavier training, performance dropped.

Like any diet, keto can cost you muscle along with fat. Strength training is the best way to hold on to it, with enough protein alongside. Once you’re cleared, start exercising and build up to lifting weights.

How do you come off keto?

Slowly, with a plan, because regain is common.

About half the people in one low-carb study regained at least a quarter of the weight they’d lost within three years. People who slept six to eight hours a night were far more likely to keep it off.

The usual advice is to add carbs back gradually, starting with vegetables, beans, fruit and whole grains. In one small study, women who reintroduced carbs over four weeks after a supervised keto phase kept losing for months, and most then held steady or regained some.

I was already on keto before surgery. What now?

Expect a break around the surgery. It won’t undo months of work.

Some hospitals give a carb drink or juice before surgery. One woman who’d kept under 50 grams of sugar a day for years was handed two cups of juice for the night before. By the end of the thread she called it “a blip in an overall eating pattern.” Follow the hospital’s instructions. If you’re diabetic, ask your team how they want you to handle it.

After surgery, hospital food probably won’t be keto, and for a day or two crackers and ginger ale may be all you can face. Eat what you can. Getting food in early beats staying in ketosis.

Women who were keto before describe going back once their appetite returned, some within days, others after their follow-up. Start by eating enough, then cut the carbs. If keto flu comes back, a little extra salt and plenty of water help. If you’re on keto for diabetes, tell your diabetes team the surgery date.

Heal first. Eat enough. Then cut the carbs. Keto will still be there at eight weeks, or twelve, once you’re eating full meals and your bowels have stopped being the main topic of your day.

Bring these to your follow-up:

• Am I healed enough to start cutting back on food?
• Do any of my medications change if I cut carbs?
• Should I check my cholesterol before I start?