Pre-operative liver shrinkage diet

Pre-operative liver shrinking diet 

When you are preparing for surgery, your surgeon may ask you to have a special diet known as a liver shrinkage diet in order to aid your operation. This may be appropriate for surgeries such as laparoscopic (keyhole) or robotic cholecystectomies (gallbladder removal), fundoplication (anti reflux surgeries) and bariatric (weight loss) surgeries.

A liver shrinkage diet involves a specific dietary plan that aims to shrink the liver down by having a diet low in calories, carbohydrates (starches and sugars) and fat for 2 weeks prior to the surgery.

The diet is only recommended for 2 weeks prior to the operation is not to be followed long term or afterwards.

What is the purpose?

A liver shrinkage diet allows a reduction in fat and size of the liver to ensure that an operation can be performed in a minimally invasive manner safely. If your liver is too big, it may make an operation more technically challenging for certain procedures named above and increases the risk of having an open operation or having a procedure abandoned.

By following a strict diet, your body reduces its carbohydrate stores, specifically its glycogen stores (glycogen is a form of sugar stored in the liver and muscles used for energy). As a result of following the liver shrinkage diet, the liver holds less glycogen stores and water and so shrinks as a result. This makes the liver smaller, softer and more flexible to allow easier operation. This is relevant as in certain operations, the liver needs to be lifted up or out of the way to access the stomach or the gallbladder.

You will be counselled on this diet by your surgeon and with the help of a dietician if necessary.

N.B. for some people who have or have had difficulties with food, diets and other challenging experiences, this will be taken into consideration and support can be available. Furthermore, people with other underlying medical conditions such as diabetes who take specific medications to control their condition will also have adjustments made.

Does everyone need to have it?

If your BMI is over 35 you will be counselled during pre-operative clinics by your surgeon and you will be invited to proceed with a liver shrinkage diet. You will be supported in your diet and have specific information provided for you.

If your BMI is less than 35, you will not be routinely receiving liver shrinkage diet information and is likely you will not need to follow the liver shrinkage diet.

Who is not eligible for the liver shrinkage diet?

• pregnant women, adolescents, elderly cohort of patients will unlikely be asked to follow a liver shrinkage diet however This decision will always be made on an individual basis.
• those with underlying cardiac, kidney, liver problems, acute psychiatric disorders or a history of eating disorders may not be suitable to follow the liver shrinkage diet.

What are the different types of liver shrinkage diets?

Liver shrinkage diets can come in the form of several plans depending on suitability and fit for the individual.

1.         Food plan

This plan involves using normal foods with carefully measured portions of carbohydrates. It is designed to provide and limit carbohydrate ingestion to 100g per day. It will also be low in fat and moderate in protein. The energy ingestion on this option will be roughly 1000kcal per day. It is important to measure portions accurately or you may end up having too little or too much.

Examples

Breakfast: Having one of the following options roughly 15g carbohydrates each without exceeding 200ml of milk for the day. One of the following:

• 5 spoons of bran flakes or cornflakes
• 1 shredded wheat or 1 and a half Weetabix
• 6 spoons of all bran flakes
• 25g of oats or porridge
• 1 medium slice toast with low fat butter spread
• Lunch: 15-20g carbohydrates each
• 1 medium sliced toast/Half bagel/Half pitta combined one of the following:
• 2 eggs
• 60g of cheese
• 6-8 slices of ham, chicken, turkey
• 1 chicken breast
• 2 grilled (not fried) fish
• 100g of tinned fish
• 100g tofu, tempeh, Quorn, soy or pea protein meat alternatives
• Cereal bowl side of vegetables*

Dinner: 20g carbohydrates

One of the following:

• 125g of boiled or mashed potato
• 2 roast potatoes
• 3 spoons of rice/pasta

With one of the following:

• 2 eggs
• 60g of cheese
• 6-8 slices of ham, chicken, turkey
• 1 chicken breast
• 2 grilled (not fried) fish
• 100g of tinned fish
• 100g tofu tempeh, Quorn, soy or pea protein meat alternatives
• Cereal bowl side of vegetables*

Supplement this with 2 portions of fruit and 1 pot (125g) of low-fat unsweetened yoghurt or dairy free yoghurt

You can consume unlimited water, sugar-free squash and black tea or coffee. Aim for at least 2L per day of fluid

Alcohol must be avoided during the two weeks.

*Recommended vegetables to choose from

Avoid using high fat products to cook foods; baking/grilling/boiling uses less fat and will be more beneficial. Fat-free sugar free condiments can be used in moderation. 

Feeds can be made more interesting or enjoyable by adding spices, herbs, vinegars and lemon juice

Refrain from undereating the recommended amount as this can make you feel unwell and lead to malnutrition or constipation

This will not be nutritionally complete. Please start a multivitamin and mineral tablet e.g.  Sanatogen A-Z, Tesco’s A-Z, Centrum Advance/Performance

2. Meal replacement shake plan

Nutrition drinks that provide low energy, low carbohydrate liquid diet may be used as part of the liver shrinkage diet. They contain daily vitamins and minerals.

Slimfast bottled shakes and protein bars

• 5 Slimfast shakes (325ml)
• Exchange a bottle shake with Slimfast high protein meal bar or 2 x cereal bowl sized portion of vegetables from table above.

3.    Milk plan

This is a liquid diet plan of semi skimmed milk for 2 weeks prior to surgery.

• 2 litres of skimmed or semi skimmed milk, hot or cold

or

1.7L skimmed or semi skimmed milk, hot or cold and 2 x 125g pots plain or natural 0% yoghurts or dairy-free equivalent

• 1 multivitamin and mineral tablet e.g.  Sanatogen A-Z, Tesco’s A-Z, Centrum Advance/Performance

Splitting the milk into 4-5 ‘meals’ per day can be helpful. Unlimited water, black tea or coffee, low calories fizzy drinks. You may use dairy alternatives such as soya milk in same quantities but these should be unsweetened and fortified with calcium, vitamin D and iodine such as Tesco Unsweetened Soya Milk or Oatly Semi

Milk can be flavoured with vanilla or orange blossom essence or sugar-free syrups.

How will my body adjust?

The body will release ketones as you adjust to a lower carbohydrate diet. Ketones are released when the body breaks down fat for energy. After the first 2-3 days, you will adapt and appetite will be suppressed, meaning you feel less hungry than you would have expected. You may feel a little lightheaded in the first few days and ensure you drink plenty of fluids.

You may become constipated due to lower amounts of fibre being ingested, so you can take Fybogel form the chemists. Please avoid lactulose as a laxative option as it contains high amounts of sugar.

Should you have any concerns with this, support is available to you and it will not be a pre-requisite that will be forced upon you. The aim is not to cause further stress or anxiety and there will be a team to address your concerns.

The liver shrinkage diet has been proven to benefit patients undergoing surgery and so recommended in certain circumstances as outlined in this leaflet throughout the UK.

This diet is not designed to be used for longer than 2 weeks and could lead to nutritional deficiencies and be harmful in the long-term. Please do not continue this diet behind the period outlined by your medical professional.

Who should I contact if I have a problem or question?