For individuals considering bariatric surgery, the journey to a healthier life often begins weeks before the actual procedure. A crucial step in this preparation is the liver shrinking diet, also known as the pre-operative diet or liver reduction diet. This specialized eating plan aims to reduce the size of the liver, making the surgery safer and more effective. This article delves into the details of the liver shrinking diet, answering common questions and providing practical tips for success.
What is a Liver Shrinking Diet and Why is it Necessary?
The liver shrinking diet is a low-calorie, low-carbohydrate, and often low-fat diet prescribed to patients before bariatric surgery. Many individuals with obesity have enlarged livers, often due to diets high in sugars, starches, and unhealthy fats. This condition, known as nonalcoholic fatty liver disease (NAFLD), is present in up to 90% of bariatric surgery candidates.
An enlarged liver can pose significant challenges during surgery. The liver sits atop the stomach, the very area surgeons need access to during procedures like gastric bypass or sleeve gastrectomy. If the liver is too large, it can obstruct the surgeon's view and make maneuvering around the organ difficult. This can lead to complications such as:
- Increased risk of bleeding
- Prolonged surgery time
- Difficulty accessing the stomach
- Slower healing after surgery
By reducing the liver's size, the liver shrinking diet allows surgeons to safely and effectively perform the bariatric procedure, minimizing risks and promoting faster recovery. Moreover, this diet can also decrease the amount of fat in your abdomen, both in and around your organs.
Meredith C. Sweeney, M.D., a bariatric and laparoscopic surgeon with Norton Surgical Specialists, emphasizes the importance of working with a dietician before and after weight loss surgery. This collaboration ensures that patients are well-prepared and supported throughout their weight loss journey.
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How the Liver Shrinking Diet Works
The liver shrinking diet works by depleting the liver's glycogen stores. Glycogen, the storage form of glucose, is produced from the carbohydrates we eat. When carbohydrate intake is reduced, the body is forced to use stored glycogen for energy. As glycogen is broken down, it releases water, leading to a reduction in liver size.
Each gram of glycogen stored in the liver is accompanied by approximately 3 grams of water. Therefore, when glycogen reserves are depleted, a significant amount of water is also eliminated, contributing to the shrinking effect.
What Can You Eat on a Liver Shrinking Diet?
The liver shrinking diet typically emphasizes lean proteins and non-starchy vegetables while restricting carbohydrates, sugars, and unhealthy fats. Specific food recommendations may vary depending on your surgeon's preferences and individual needs, but common components include:
- Lean Proteins: Beef, pork, eggs, seafood, chicken, low-fat Greek yogurt, tuna, protein shakes (meeting specific criteria).
- Non-Starchy Vegetables: Broccoli, cauliflower, leafy green vegetables, and other non-starchy options.
- Limited Fruits: Due to their carbohydrate content, fruit intake is typically limited.
- Healthy Fats: Avocado.
Foods and beverages to avoid include:
- Alcohol
- Carbonated beverages
- Sugary drinks and foods
- Full-fat dairy products
Sample Liver Shrinking Diet Menu Ideas
While your surgeon and dietician will provide a personalized meal plan, here are a couple of sample menu ideas to illustrate the principles of a liver shrinking diet:
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Option 1: Primarily Protein Shakes
- Four 325 mL (approximately 11 ounces) premade protein meal replacement shakes (meeting specific criteria).
- Two servings of non-starchy vegetables.
Option 2: More Solid Foods
- Breakfast: 1 carbohydrate portion, 1 dairy portion (e.g. Greek yogurt with a small serving of rolled oats).
- Lunch: 2 protein portions, 2 vegetable portions (e.g., tuna salad with lettuce and cucumber).
- Snack: 2 fruit portions (e.g., a small apple and a handful of berries).
- Dinner: 1 protein portion, 1 vegetable portion, 1 dairy portion, 2 carbohydrate portions (e.g., chicken breast with broccoli, a small serving of brown rice, and a glass of milk).
Important Considerations:
- Drink at least 64 ounces (about 8 cups) of sugar-free, calorie-free, non-carbonated liquid per day.
- Consider taking a multivitamin or other supplements as recommended by your doctor.
- Choose protein shakes that contain no more than 200 calories, 20-25 grams of protein, 15 grams or less of carbohydrates, 5 grams or less of sugar, and less than 10% of the daily recommended amount of total fat.
How Long Do You Need to Follow the Diet?
The duration of the liver shrinking diet varies depending on individual factors, such as your initial BMI and the surgeon's preferences. Some general guidelines include:
- BMI 35-39.9: 1 Week
- BMI 40-49.9: 2 Weeks
- BMI 50-59.9: 3 Weeks
However, some surgeons may recommend a longer or shorter duration based on their assessment of your liver size and overall health.
Tips for Sticking to the Liver Shrinking Diet
The liver shrinking diet can be challenging, but with proper planning and support, you can successfully navigate this crucial phase of your bariatric surgery preparation. Here are some helpful tips:
- Plan Ahead: Prepare your meals and snacks in advance to avoid impulsive decisions and stay on track.
- Choose the Right Protein Shake: Select shakes that meet the specified criteria and that you find palatable.
- Stay Hydrated: Drink plenty of water and other approved beverages throughout the day.
- Eat All Your Portions: The diet is restrictive, so it's essential to consume all the portions allocated to you each day.
- Find Support: Connect with other bariatric surgery patients or join a support group for encouragement and guidance.
- Focus on the Goal: Remember that the liver shrinking diet is a temporary measure with long-term benefits. Visualize your future health and the success of your surgery.
- Communicate with Your Team: Don't hesitate to reach out to your surgeon, dietician, or other healthcare professionals with any questions or concerns.
- Consider coffee: You can have black coffee, usually decaffeinated.
What Happens if You Cheat on the Diet?
Adhering to the liver shrinking diet is crucial for your safety and the success of your surgery. If you deviate from the diet, your liver may not shrink adequately, potentially leading to complications during the procedure. In some cases, the surgeon may even reschedule the surgery if they feel the liver is too large to proceed safely.
The Role of Low-Calorie Diets (LCDs) in Liver Volume Reduction
Research has shown that low-calorie diets (LCDs), typically ranging from 800 to 1500 kcal per day, are effective in reducing liver volume and promoting weight loss in patients awaiting bariatric surgery. A systematic review of eight studies involving 251 patients found that LCDs resulted in a 12-27% reduction in liver volume and a 4-17% reduction in weight. The largest decrease in liver volume was observed during the first two to four weeks of the diet.
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While very-low-calorie diets (VLCDs, 450-800 kcal per day) have also been shown to be effective, LCDs may be a more sustainable and tolerable option for some patients. LCDs have been shown to result in less lean body mass loss compared to VLCDs.
Post-Surgery Nutritional Guidelines
The liver shrinking diet is just the beginning of your nutritional journey. After bariatric surgery, you will need to follow a specific eating plan to ensure proper healing and long-term weight management. This typically involves:
- First Weeks Following Surgery: A modified full-liquid diet for the first two to three weeks.
- Advancing to Soft-Solid Foods: Gradually introducing soft-solid foods after your first post-surgical visit.
- Regular Textures: Eating harder-to-digest foods (such as nuts, dried fruit, and asparagus) starting at three months post-surgery.
- Foods to Avoid: Sugary, starchy foods (to prevent dumping syndrome), high-fat foods, and hard-to-digest foods (like dry chicken breast, broccoli stalks, cauliflower, and mushrooms).
- Nutritional Supplements: Taking lifelong nutritional supplements to prevent malnutrition.
- Follow-Up Nutritional Visits and Support Groups: Attending regular follow-up appointments with a dietician and participating in support groups.