Bariatric surgery is a transformative choice for individuals grappling with obesity, significantly enhancing their health and overall quality of life. To ensure the best possible outcome from weight loss surgery, doctors often recommend a pre-operative liquid diet. This article delves into the guidelines, rationale, and crucial aspects of adhering to a liquid diet before gastric surgery.
Why a Liquid Diet Before Surgery?
A liquid diet before bariatric surgery is crucial for successfully preparing the body for the procedure.
- Shrinking the Liver: One of the primary reasons for following a liquid diet is to promote weight loss, specifically to reduce the size of the liver. Weight loss before surgery will shrink the size of the liver. This allows for the surgeon to see the stomach better. A large liver prevents your surgeon from visualizing certain anatomy during the operation, making it unsafe to perform your gastric surgery.
- Reducing Complications: Weight loss before surgery reduces your risks of developing complications by lowering your BMI.
- Shorter Operating Room Time: Some studies of shown before surgery weight loss shortens OR times time as well.
- Preparing the Digestive System: A liquid diet prepares your digestive system for all the changes post-surgery. The liquid diet usually starts 2 to 3 weeks before your bariatric surgery. It seeks to train your body for the transformations it will experience later by giving your digestive system a break.
The Phases of a Pre-Surgery Liquid Diet
The liquid diet typically spans two to three weeks before bariatric surgery and involves a phased approach:
- Phase 2A Meal Plan: Two weeks before surgery, all surgical weight loss patients follow a Phase 2A meal plan. This high protein full liquid diet will allow you to lose body fat while preserving your muscle mass, which is the powerhouse of the body.
- Clear Liquids: In the first phase, you will only drink clear liquids, such as water, broth, unsweetened tea, and clear fruit juices. A clear liquid diet limits you to options such as water, broth and plain gelatin. These are easy to digest, and they don't leave food bits in your digestive tract.
- Full Liquids: As you move forward, you will move to full liquids, which include soups, smoothies, milk, and protein shakes.
- Protein Shakes: Protein shakes are an important part of this liquid diet. During this time, it is essential to include a protein shake multiple times daily to help ensure good nutritional status before surgery. Aim for a goal of ~ 60-80 grams of protein per day obtained from your protein shake.
Guidelines for Following the Liquid Diet
Adhering to the liquid diet requires discipline and attention to specific guidelines:
- Protein Intake: You should try to consume 60-80 grams of protein per day.
- Hydration: Don’t dehydrate. Drink plenty of water in the weeks before your procedure.
- Sipping: Drink slowly or SIP, SIP, SIP. It should take you 30 minutes to drink up to 8 ounces of fluid; it is common to feel “full” after drinking only 4-6 ounces immediately after surgery.
- Avoid Carbonation: Avoid all carbonated fluids.
- No Grazing: Do not graze between meals.
- Medication: Also, take any medication as directed by Dr.
- Fasting: Do not eat or drink anything, including mints or gum. Do not swallow any water while brushing your teeth and rinsing. It’s normal to feel hungry in the morning when you check into the hospital.
- Two Days Prior to Surgery: Starting two days prior to your operation, you will begin a clear liquid diet and continue throughout the day to prepare your digestive tract for surgery. This diet ensures your stomach and intestines are mostly empty while keeping you hydrated. You may also have protein drinks such as Nectar and Isopure if Dr. Taylor instructs you to, but make sure to consume only the recommended amount.
- Bowel Prep: Around noon the day prior to your weight loss operation you will be instructed to begin bowel prep. Dr.
Managing Hunger and Expanding Variety
- Hunger Management: You can expect to feel a certain amount of hunger and will have to manage with this. Since you will not have a tool working for you, you may feel hunger. This is expected and normal. You will likely feel real physical hunger and also “head hunger.” Head hunger is the wanting to crunch or snack on certain types of foods.
- Limited Variety: The reality is that your variety will be limited while following the high protein liquid plan. Your surgical weight loss dietitian has provided you with a list of acceptable liquid drinks. The variety is limited, but remember this is only for a short period of time.
What Happens If You Don't Follow the Plan?
The goal is to have weight loss. Following the liquid plan will guarantee a significant weight loss in a short period of time. Not sticking to the liquid diet before bariatric surgery probably leads to difficulties during surgery, such as a larger liver, which can affect the surgeon’s capability to perform the procedure effectively.
Read also: Is a liquid diet right for you?
The Importance of Avoiding a "Last Meal"
It is NOT recommended to over indulge before surgery. High blood sugars the morning of surgery may result in a canceled surgery.
Pre-operative Nutritional Status
Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. It would also be beneficial to add a general multivitamin and calcium supplement as a safety net in meeting basic nutrient needs.
Evidence-Based Insights on Pre-operative Weight Loss
Although BS has a low mortality rate, surgical complications (e.g., anastomotic leakage, bleeding, and infections) remain common (5-20%) and partly dependent on patient factors like age, sex, and comorbidity [23]. Laparoscopic surgery in patients with severe obesity is challenging because of the thickness of the abdominal wall, intra-abdominal obesity, possible mesenteric thickening, and hepatomegaly [24]. The presence of visceral fat can increase the complexity and risk in patients undergoing any type of abdominal surgery [25]. Thickened abdominal walls may limit precise surgical movements during laparoscopy, and intra-abdominal obesity can limit visibility during surgical procedures.
- Modest Weight Loss Benefits: In this contest, a modest weight loss of 5-10% in the immediate preoperative period has been suggested as a mean to facilitate surgery and reduce the risk of complications.
- VLCD and VLCKD: Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today.
Lifestyle Adjustments and Long-Term Success
To succeed in the weight loss process and maintain your perfect weight, you will have to permanently change your nutritional lifestyle. The sooner you start healthier eating habits, the easier your transition will be after your surgery. In the months prior to your surgery, it is recommended to get into the habit of eating healthy foods.
- Avoid Alcohol: After surgery, changes to the digestive tract can cause patients to become intoxicated more quickly.
- Limit Caffeine and Carbonation: Caffeinated and carbonated drinks are strictly forbidden, and patients should wait at least 30 minutes between meals and the consumption of liquids.
Post-Operative Diet
Your post-op diet - what you eat in the weeks and months after your gastric sleeve surgery - is just as important as your pre-op diet. Following your post-op diet is essential if you want to realize the benefits of a bariatric procedure. It will also help you avoid potential health complications, including diarrhea, nausea, vomiting, constipation, and gastric leaks.
Read also: Explore the pros and cons of liquid diets
- Clear Liquids (Week 1): During your first week after surgery, you will be restricted to clear liquids. In addition to water, you can drink clear broth, decaffeinated beverages, and the sugar-free versions of drink mixes like Kool-Aid and Crystal Light.
- Thicker Liquids (Week 2): The second week will see the addition of thicker liquids to your post-op diet.
- Soft and Pureed Foods: Soft and pureed foods come next. Examples include eggs, ground meats, fish, beans, cooked vegetables, and soft fruits.
- Solid Foods (Week 4): Solid foods are finally back in the fourth week after surgery. At this point, the post-op diet is similar to your presurgical diet. Certain items remain off limits: fried foods, candy, nuts, seeds, whole dairy products, breads, pastas, and fibrous vegetables such as broccoli. Over time, you can add some of the excluded items above but always as small portions. Your focus should remain on lean protein, complex carbohydrates, and healthy fats. Avoid processed foods and sugar-added products.
Read also: Risks of Liquid Diets