Reducing the size of your liver before bariatric surgery

This leaflet will give you information on the recommended diet to follow in the weeks leading up to your bariatric surgery.

It is not intended for use at any other time and must only be following under supervision from a Registered Dietician.

Why is my diet important leading up to my surgery?

To perform bariatric surgery, your liver will need to be lifted up and out of the way in order to operate on your stomach underneath. Making your liver smaller and more flexible will reduce the risk of any damage being caused.

If your liver is too large or fatty and is too difficult to move, your surgeon may have to switch to open surgery. Open surgery is higher risk, leaving a larger abdominal scar and a longer recovery time.

The aim of this diet is to reduce the size of your liver, making it lighter and more flexible. To achieve this, a low carbohydrate and low fat diet must be followed. You will lose weight, but more importantly, your liver will shrink which will increase your chance of having a safe operation.

What will my diet consist of?

Your diet will be low in carbohydrates; both starchy and sugary foods, as well as fatty foods as these will affect the size of your liver.

You will need to eat foods high in protein (lean meat, poultry, fish, low fat milk, and eggs) which will stop you feeling very hungry and help your body cope better with the very low intake of energy.

How long should I follow the diet?

It is necessary to follow the diet for 2 weeks immediately before you are due for your surgery.

You may be advised to follow this diet for longer than 2 weeks if the surgeon suspects your liver is particularly large. As this diet is not well balanced, following it for longer than recommended will mean you are not getting the nutrition your body needs which may slow down your recovery after surgery.

Your dietary allowance

You should eat the full number of portions of the allowance each day:

Your daily allowance:

It may be tempting to have a special or large meal just before having your surgery. This will reverse all the benefits of following the diet. If the risk of performing the operation is too high, the surgeon will abandon your surgery.

Other foods allowed – Salt/pepper/mixed herbs/ground spices – chili, ginger, paprika etc. gravy using stock cube and no thickener, soy sauce, low fat vinaigrette, sugar free jelly or chewing gum, artificial sweetners.

You should not eat the following food as they are too high in far and/or carbohydrates. Any sauces such as mayonnaise, salad cream, chili sauce, BBQ sauce, chutney, pickle, piccalilli, ketchup, brown sauce, balsamic vinegar, horseradish sauce, tartar sauce, mint sauce, stuffing, butter, margarine, oils, jam, lemon curd, marmalade, peanut butter, sweets, chocolate, cake, ice cream, biscuits, crisps, sugar.

Remember:

• No other food should be eaten.
• Alcohol is not allowed.
• It it is not on the list then do not eat it.

Example meal plan

*Rest of milk from 200ml can be used for cups of tea or coffee that day or drank separately.

Can I still drink alcohol?

It is very important that you do not drink any alcohol while following the diet. Alcoholic drinks contain a lot of energy. Also, it may undo any efforts to reduce the size of your liver. Instead, select drinks from the fluids section of the diet plan.

Do I need to take vitamin and mineral supplements?

Due to this diet being very restrictive, it is recommended to take an A to Z multivitamin and mineral supplement each day. At this stage it can be any general A to Z multivitamin and mineral tablet.

For particular supplements that are recommended after surgery, please refer to patient information leaflet ‘Dietary advice following bariatric surgery’.

Will my bowel habits change?

It is quite normal to have less frequent bowel movements while following the diet. Drinking the recommended amount of fluid will help keep your bowel movements regular. Exercise such as walking and swimming may also help.

Are there any risks of the diet?

The diet is very low in calories and carbohydrates (starchy and sugary foods). You may feel more tired than usual. Some people can feel light-headed. Others can lose concentration more easily. If you feel like this, check that you are eating everything in the portions recommended.

If you have been doing extra exercise to help you lose weight, you may need to do a little less while following the diet. Always drink a minimum of 1.5 to 2 litres of fluid each day. Check with your Bariatric Dietician if you are unsure.

If you have suffered from gout, symptoms may reappear or worsen.

Remember, you should only follow the diet for the time specified.

Contact your Bariatric Dietician if you have any concerns. Taking your vitamin and mineral supplements and making sure you drink the recommended minimum fluid intake of 1.5 to 2 litres every day will help.

What if I have diabetes?

If you take medication (insulin or tablets) to treat diabetes, you may need to alter the amounts while following this diet to ensure that your blood sugar levels do not drop too low.

This will need to be reviewed by the Diabetes Team that care for you. If you monitor your blood sugar levels, you should continue to do this. You must consult your Diabetes Specialist Nurse/Practice Nurse/GP before starting the diet.

If you are concerned at any point while following the diet, contact your Diabetes Team.

When should I stop the diet?

You should continue to eat on the diet until midnight before your surgery. You should not eat or drink then until after your surgery. Your Dietician will advise you on what foods are best to eat after your surgery.

Helpful Tips

We would recommend that you design your own meal plan for the duration of the liver reducing diet. This will allow you to eat meals and snacks that you enjoy; taking into account your likes, dislikes, and any allergies or intolerances you may have.

What should I do after surgery?

Some people find it helpful to prepare meals and snacks in advance for when you are discharged home following your surgery.

For the first 2 to 3 weeks after your surgery you will need to follow a liquid/pureed diet and therefore you may find it useful to have a hand blender or liquidiser.

It is recommended to have the following ready at home:

• Instant porridge oat cereal.
• Smooth diet yoghurts/custard pots.
• Pureed vegetables.
• Puree or stewed fruit.
• Skimmed/semi skimmed milk.

To make mealtimes easier, prepare small meals (1 to 2 tablespoons in size) in advance and freeze in small pots/yoghurt pots to eat once you get home.

Contact numbers

If you need further help or advice please contact:

North Tees and Hartlepool NHS Foundation Trust

Specialist Services Admin Hub

Telephone: 01429 522 471

Monday to Friday, 8:30am to 4:30pm (excluding Bank Holidays).

Information used in the development of this leaflet:

https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13087 – BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery, September 2020, Mary O’Kane, Jonathan Pinkney, Erlend Aasheim, Julian Barth, Rachel Batterham, Richard Welbourn.

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