64 oz. of Water for WLS - Fact or Fiction?

Sharon SW-267
GW-165 CW-167 S.

on 4/24/16 11:02 am, edited 4/24/16 4:03 am - PA
RNY on 12/22/14

You are prob getting in more fluids than you think, esp if you are exercising or else your urine would be darker.  At first it is easy to measure because you are only taking in mainly fluids.  But as you get further out, you are eating more foods -ie veggies - that also contain water so it is more difficult to track your total fluid intake.

As I understand it, because we are on hi-prot diets that can be hard on the kidneys* that you want to keep up your fluids.    If you're getting in 48oz in actual drinks, you are prob getting more from your food - like yogurt, etc, and are closer to the recommended 64 oz than you may think.

You had surgery recently so it's OK that you are still ramping up to 64oz - you do not want to stretch your pouch, but as people get further out, many start to eat more food and forget about the fluid rule until they gain 10-20 pounds and decide to return to the post-op diet. Getting in the fluids (rather food) helps people feel full and keep their calories low.  If people respond forcefully about getting in the fluids it is because it is a good way to make sure you get to and stay at your goal weight.  This becomes more of a challenge after a few years post WLS, so it is good to start this habit early.


*The research I've seen shows that if you already have kidney probs then a hi-prot diet can be bad, but if your kidneys are OK they can prob withstand the added stress.

http://www.livestrong.com/article/517469-does-eating-too-muc h-protein-affect-your-kidneys/



Donna L.
on 4/24/16 12:46 pm - Chicago, IL
Revision on 02/19/18

Actually, if you're in metabolic ketosis, many of the ketones are removed from the body via urine.  They are also excreted through the lungs, but urine also contributes considerably.  Normally, ketones are metabolized so few show up in the urine, but since many of us are in ketosis during our rapid weight loss phase (this just means we're using fat for fuel versus only glucose), we do flush quite a bit out via that route.  Drinking helps with this process considerably.

I follow a ketogenic diet post-op. I also have a diagnosis of binge eating disorder. Feel free to ask me about either!

It is not that we have so little time but that we lose so much...the life we receive is not short but we make it so; we are not ill provided but use what we have wastefully. -- Seneca, On the Shortness of Life

on 4/24/16 12:50 pm
RNY on 02/29/16

Thanks, Meep.  That makes a lot of sense!  My recent UA's have shown mild ketones.

Age: 55.  5' 8" SW 345 lbs.  RNY on 2/29/16 at UVA w/ Dr. Hallowell.     
Month 1 - 3/29/16: 319 (25 lbs. lost) | Month 2 - 4/27/16: 314 (5 lbs. lost) | 
Month 3 - 5/29/16: 303 (12 lbs. lost) | Month 4 - 6/28/16:  293 (10 lbs. lost)
Month 5 - 7/28/16: 289 (4 lbs lost) | Month 6 - 8/28/16: 282 (7 lbs. lost) |
Month 7 - 9/27/16: 278 (4 lbs lost)

on 4/24/16 2:03 pm
RNY on 08/13/14

What Holly Kim said...my thought is what could possibly be wrong with drinking at least that...?  

Lanie; Age: 43; Surgery Date (VSG): 8/12/14 w/complications resulting in RNY next day;

Height: 5' 6" SW: 249 Comfort Zone: 135-140 CW: 138 (10/13/17)

M1: -25 lbs M2: -12 M3: -13 M4: -7 M5: -11 M6: -10 M7: -7 M8: -7 M9: -3 M10: -8 M11: -4 M12: -4

5K PR - 24:15 (4/23/16) First 10K - 53:30 (10/18/15)

on 4/24/16 2:25 pm - Philadelphia, PA
RNY on 04/28/15

While I think it definetley a good practice for general health- my goal has never been 64oz of water daily. In my youth I was a bed wetter... That explains a lot of my mindset. Being taunted by family to drink less, not drink after x time already set my mind towards less is better. Then years being SMO gave me a horribly overactive bladder. Again- you drink less to try and manage it. I've had 30+ years of conditioned thoughts towards liquid intake. Knowing that drinking calories was a huge part of my obesity-- my focus is on NOT doing that now. 

So I don't get 64oz in... I aim for 50. If I get more fine-- if not-- it's better then me chugging soda or high fructose corn syrup like I used to. 

5'6.5" High weight:337 Lowest weight:193/31 BMI: Goal: 195-205/31-32 BMI

on 4/24/16 4:22 pm - WI

Don't forget that we are more inclined to get kidney stones from our vitamin supplementation.  Most multi vitamins have calcium carbonate which can cause kidney stones.  Drinking lots of fluids helps prevent the formation of stones.

I have to drink 120 ounces to avoid constipation.  Most of us struggle with constipation from the high protein diet.  The best way to stay "regular" is to drink a lot of fluid. I would be a mess if I drank only 48 ounces  daily.

As for your "not being one to blindly follow rules"... I think that you are setting yourself up for problems.  Following the WLS rules to the letter is essential for success.  We became obese by "doing it our own way".  

HW 270 SW 236 GW 160 CW 145 (15 pounds below goal!)

VBG Aug. 7, 1986, Revised to RNY Nov. 18, 2010

Sharon SW-267
GW-165 CW-167 S.

on 4/25/16 11:01 pm - PA
RNY on 12/22/14

Yes - I'm glad so many are saying - Stick to the straight and narrow ****il you reach your goal weight) and then you will want to stick to the straight and narrow because you made it to (or below) your goal weight.


Oxford Comma Hag
on 4/24/16 4:37 pm

64Oz seems like a lot at first, but I can drink 20 oz of water in about five minutes. I drink 100+ounces of water a day. I find I get dehydrated more quickly now than presurgery. 

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255


T Hagalicious Rebel

on 4/24/16 5:21 pm - Brooklyn
VSG on 04/25/14 with

It's probably feels harder now to get the 64oz in, but as you get further out it shouldn't be a problem. Getting in 64 oz of water is not a belief system, you can easily look up why medical professionals think that you should get in the minimum of 64oz, mind you, you can get that from a variety of foods & drinks, but people try to get it from just plain water too.

Gauging your hydration needs by how thirsty you are is a bad idea, usually you're already starting to get dehydrated at that point. Besides what if you weren't paying any attention to how your body feels that day? Remember the old saying an ounce of prevention is worth a pound of cure, at least I think that's how it goes. 

No one surgery is better than the other, what works for one may not work for another. T-Rebel


on 4/25/16 4:47 am
RNY on 08/21/12

Post WLS a much higher perceetage of our diet should be made up of protein. FOREVER. Protein consists of amino acids. On a molecular level each amino acid contains an amino group, an acid group, a hydrogen atom and a distinctive side group all attached to a central carbon atom (amino means containing nitrogen). When an amino acid is broken down (this occurs when they are used for energy or to make glucose or fat), they are first deaminated or stripped of their nitrogen containing amino groups.

Two products are created as a result: ammonia and a keto acid.

Ammonia is a base and in excess it will upset the blood's critical acid-base balance. To prevent this from happening your liver combines the ammonia with carbon dioxide to make urea which is much less toxic. So the more protein you eat, the more urea your body produces. 

To get rid of the urea your liver cells release it into the blood, then your kidneys filter it out of the blood for excretion in the urine. To keep urea in solution, the body needs water so a person who consumes a high protein diet must drink plenty of water to dilute and excrete urea from the body. Without the extra water a person on a high protein diet runs extra risk of dehydration because the body uses its water to rid itself of the urea.

You can also see that the liver and kidneys are working extra hard in this scenario, which is one of the many reasons alcohol should be avoided after WLS.

Is 64 ounces a myth? No, but it is just a guideline. How could it be a firm rule, when one person could be 5 feet tall and sedentary, and another be 6 foot tall and a runner? Guidelines are there to help figure things out. But they exist because so many people do things poorly. Your average person doesn't drink enough. They likely have mild symptoms every day, and don't even realize it. It's their "normal." 

This is the time to create new habits. Raise the bar. Stop aiming for minimums, or trying to create some logic where you can avoid minimums altogether. Instead of 64 ounces, aim for 100 instead. Youll be healthier, without question. And it will be a good lifetime habit.

Drinking more is the simplest path we could possibly take toward better health. Just drink.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

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