• Reference Number: HEY1471-2024
• Departments: Dietetics
• Last Updated: 30 August 2024

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your dietitian, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

This information sheet will explain:

• The aim of the diet
• How long you will have to follow this diet
• How many carbohydrates are allowed
• Provide 2 diet options.

What is the aim of the diet?

To reduce the size of the liver, it is necessary to follow a diet that is low in carbohydrate, low in fat and moderate in protein.

Following this diet achieves changes to the liver, it ‘shrinks’ in size and softens, making it easier to move during surgery.

During laparoscopic or ‘keyhole’ bariatric surgery, the liver has to be lifted out of the way to access the stomach lying beneath it. If the liver is heavy, fatty and immobile, it is harder for the surgeon to see and gain access to the stomach underneath. This could be a reason for changing to open surgery.

Open surgery means a larger abdominal scar, which results in longer recovery and increased risks.

You will lose weight by following this diet, but more importantly, your liver will shrink and you increase your chances of having a safe operation.

How long will I have to follow this diet?

Before your weight loss surgery, it is essential that you follow this special pre-operative diet for a full two weeks for the diet to be successful.

There may be a temptation to have a special or larger meal prior to surgery; however, if you do this, this will reverse the liver-reducing effects of the diet.

Please note this diet is not optional and is only intended for you to follow before your surgery. It should not be followed after surgery or by anyone else.

How much carbohydrate am I allowed?

The diet is designed to give you approximately 60 to 90 grams (g) of carbohydrate per day. It is moderate in protein and low in fat although the extent will depend on the foods chosen and the way in which they are cooked. The energy value of the diet is approximately 600 to  800 kcal.

Diet options

The following diet option 1 is the recommended diet for liver shrinkage:

Diet Option 1

Each day you will need to have:

• 3 pints, approximately 1800 millilitres (mls) or 9 glasses, of skimmed milk. Please check the label.
• Sugar free jelly. This can be made with water or you can use some of the milk from your allowance. You can have as much sugar free jelly as you would like however the sweeteners can cause you to have abdominal cramps and loose stools.
• Unlimited water, tea, coffee, no added sugar, squashes. Milk used in tea and coffee is part of the required 3 pints of skimmed milk a day.

Ensure you take one A-Z complete multivitamin and mineral supplement as this will make sure you get all the vitamins and minerals required before your operation because this is a very restrictive short term diet.

Diet Option 2

This is an alternative liver shrinkage diet, you may be advised to follow this diet or you can chose this if you cannot do option 1.

Each day you will need to have:

• 2 pints of skimmed milk. Please check the label.
• Sugar free jelly made with water. You can include some of the required 2 pints of skimmed milk a day. You can have as much sugar free jelly as you would like however the sweeteners can cause you to have abdominal cramps and loose stools.
• Unlimited water, tea, coffee, no added sugar squashes. Milk used in tea and coffee is part of the required 2 pints of skimmed milk a day.

•  One Meal – Options include:
  •  75 grams of grilled or oven baked skinless chicken and green leafy vegetables such as cabbage, kale, sprouts or salad (this includes lettuce, onion, tomato, peppers, cucumber and should not include potato or sweetcorn)
  • Or 120 grams of grilled or oven baked white fish and green leafy vegetables such as cabbage, kale, sprouts or salad (this includes lettuce, onion, tomato, peppers, cucumber and should not include potato or sweetcorn)
  • If using a dressing ensure it is a small drizzle and is a low fat option.

Ensure you take one A-Z complete vitamin and mineral supplement as this will make sure you get all vitamins and minerals required before your operation because this is a very restrictive short term diet.

Special note for patients with diabetes:

 If you have diabetes and are treated with medication, you may need to adjust your insulin or medication whilst following this diet.

You will be provided with a personalised plan from the bariatric endocrinologist to manage your diabetes. If you have not received this, please contact the bariatric team.

If you have questions or concerns, please ask at clinic appointments.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of Nutrition and Dietetics on tel: 01482 674490.