The liver shrinking diet is a specialized eating plan designed to reduce the size of the liver, often as a preparatory step for weight loss surgery (bariatric surgery). This article explores the purpose, process, and practical aspects of this diet.
Understanding the Liver Shrinking Diet
The liver shrinking diet is a low-calorie, low-carbohydrate, and high-protein eating plan typically followed for about 2 weeks before bariatric surgery, though the duration can vary based on a surgeon’s guidelines. The goal of this diet is to shrink a fatty liver, which can obstruct the surgeon's access to the stomach during the procedure. On average, it ranges between 800-1,200 calories per day.
Why is a Liver Shrinking Diet Necessary?
Many candidates for weight loss surgery have enlarged livers, often due to diets high in sugars and starches. An enlarged liver, frequently resulting from fatty liver disease, sits on top of the stomach, the area where surgeons need to operate. The primary reason patients must follow a liver reduction diet before surgery is to ensure the surgery is safe and successful. During surgery, the patient is lying down causing the liver’s location to be directly on top of the stomach. The surgeon is going to need access to the stomach, and an enlarged liver can get in the way and make it very hard for the surgeon to move the liver safely aside to prevent complications. This diet helps to decrease the amount of fat in the abdomen, both in and around the organs.
How the Liver Shrinking Diet Works
The liver shrinking diet works by prompting the body to use stored glycogen and lipids in the liver. As glycogen reserves deplete, water also leaves the liver, making the organ softer and smaller. This process is crucial because carbohydrates provide energy in the form of glycogen, which is stored in the liver and muscles. When carbohydrate consumption is high, the body stores more glycogen along with water (every gram of glycogen stores with 3 grams of water), leading to liver enlargement. The liver-shrinking diet, being high in protein and low in fat and carbs, forces the body to pull glycogen out of storage, thus reducing the liver's size.
Duration of the Diet
The duration of the liver-reduction diet is determined by the bariatric surgeon, often based on the patient’s starting BMI. For example:
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- BMI 35-39.9: 1 Week
- BMI 40-49.9: 2 Weeks
- BMI 50-59.9: 3 Weeks
What to Eat on a Liver Shrinking Diet
A liver shrinking diet is low in calories, carbohydrates, and fats. Foods included on a liver shrinking diet include eggs, chicken, Greek yogurt, and non-starchy vegetables like broccoli. This diet consists of proteins such as beef, pork, eggs, seafood or chicken, and non-starchy carbohydrates including foods like broccoli, cauliflower, leafy green vegetables. Fruit is limited, as it can be high in carbs and sugar. Alcohol, carbonated beverages, and sugar are also off-limits.
The diet is structured to provide the body with essential nutrients while minimizing unnecessary components. Johns Hopkins suggests a 2‑week plan with a protein shake for breakfast, a fruit snack, another shake at lunch, then a yogurt or shake later, and finally a lean dinner with veggies.
Here's a sample of what a liver-shrinking diet might look like:
- Breakfast: Protifar mixed with kefir and a banana.
- Lunch: Low-fat milk and protein powder, plus a couple of tablespoons of Protifar.
Liver-Shrinking Diet Protein Shake Criteria
Your bariatric clinic will often provide you with a list of "ready-made" protein shakes or powders that meet their criteria but the universal standards are as follows:
- No more than 200 calories.
- Contains between 20-25 grams of protein.
- 15 grams or less of carbohydrates.
- 5 grams or less of sugar.
- < 10% of the daily recommended amount of total fat.
You can mix powdered supplements with unsweetened almond milk, unsweetened soy milk, 1% milk, or water. Do not add in extras, fruit, or avocado.
Read also: Is a Liver Reduction Diet Right for You?
Sample Menu Ideas
- Option 1: Four 325 mL (approximately 11 ounces) premade Slimfast protein meal replacement shakes along with 2 servings of non-starchy vegetables a day.
- Option 2: A more solid food-based plan:
- Breakfast: 1 carbohydrate and 1 dairy portion
- Lunch: 2 protein and 2 vegetable portions
- Snack: 2 fruit portions
- Evening Meal: 1 protein, 1 vegetable, 1 dairy, and 2 carbohydrate portions
A sample daily menu on this diet might include:
- Breakfast: Overnight oats (½ cup quick oats, 1 tbsp chia seeds, low-fat milk).
- Lunch: Chicken salad (Greek yogurt, light mayo, celery, salt, pepper, garlic powder).
- Other options: Oatmeal (made with water or milk) with mixed nuts. Baked salmon, asparagus, and sweet potato (sheet pan or air fryer). Season with Mrs.
Hydration
Drink at least 64 ounces (about 8 cups) a day of sugar-free, calorie-free, noncarbonated liquid per day.
Foods to Focus On:
- Fruits and vegetables
- Healthy fats
- Whole grains
- Lean or plant-based proteins
- Salmon and tuna
Foods to Avoid:
- Fried foods
- Excess sugar
- High fructose corn syrup
- Processed foods
- Alcohol
How Much Weight Can You Lose?
Patient results will vary, but most patients lose between 5 to 15 pounds on the pre-bariatric surgery liver shrinking diet. According to Mayo Clinic, patients can shrink their liver by up to 20% in just two weeks.
Can You Drink Coffee?
Yes, you can have black coffee, usually decaffeinated.
What Happens if You Cheat?
Cheating on the liver-shrinking diet can risk your safety, and the surgeon may reschedule the surgery. The surgeon will know at the start of surgery if you have followed your diet. If they feel the liver is going to hinder the procedure or the patient’s safety, they will not perform the surgery.
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How to Tell if Your Liver is Shrinking
Short of a CT scan, you would not be able to tell if your liver has decreased in size. If you are following the liver-shrinking diet that your surgeon provided to you and you are losing weight, this is an indication that the liver-reduction diet is working.
The Liver's Role in Weight Management
The liver has many important jobs in the body, several of which are important to digestion and weight loss. These include the production of bile, which helps break down fats in the small intestine during digestion. The liver also makes cholesterol and special proteins to help carry fats through the body. All of the body’s blood is continuously filtered through the liver throughout the day at around 1.5 liters per minute! While there are several detoxification organs, the liver is by far the most valuable. Any chemicals that are produced either by your body - hormones, inflammatory molecules, neurotransmitters, etc. - or that come from your environment - pharmaceutical drugs, plastic compounds, pollutants, etc. When it comes to weight gain, the demand on the liver increases, which can cause fatty tissue to accumulate in and around the liver tissue.
Lifestyle Considerations
Beyond the diet itself, it’s important to stay hydrated and rely on your healthcare team, including a dietician who can help with your diet plan and answer questions. Preparing for bariatric surgery has a lot to do with becoming mentally prepared, but what about the physical preparation?
The Bigger Picture: Liver Health and Diet
Diet has a major impact on the management of liver damage. Depending on the state of liver damage, diet and lifestyle changes can even help reverse fatty liver disease in many people. Fatty liver disease occurs when fat builds up in the liver. Nonalcoholic fatty liver disease occurs without the heavy use of alcohol. Simple fatty liver occurs when there is excess fat in the liver tissue, but there is no inflammation, and the liver cells are not damaged. Nonalcoholic steatohepatitis (NASH) occurs when there is fat in the liver and inflammation, and the liver cells are damaged. Alcoholic fatty liver disease occurs due to heavy use of alcohol. About 25% of the world has NAFLD, and it is the most chronic liver disease in the United States. Both types of fatty liver disease have few or no symptoms. Since there is currently no medical treatment for NAFLD, which will be the focus of this article, the best treatment options are healthy eating habits and lifestyle. The primary diet used to support liver health includes one high in fruits and vegetables, healthy fats, whole grains, and lean or plant-based proteins. Fat should comprise a maximum of 30% of daily calories. Certain key foods should be included when developing a fatty liver meal plan. It is recommended that half of the grain-based products consumed daily should be made from whole grains. Whole grains include the three parts of the grain kernel: the bran, germ, and endosperm. Fiber may benefit liver function and help keep it working optimally. Salmon and tuna - wild-caught being the best source - are rich in omega-3 fatty acids, which have been shown to provide protection for the liver and should be included in a fatty liver diet plan. Other nutrient-rich foods to include in a fatty liver diet plan are listed below. Just as there are foods to focus on including in a fatty liver diet plan, there are also foods that should be avoided. The foods listed below are linked with increased inflammation. Fried foods are high in fat and calories, and many are high in saturated fats. Excess sugar, especially added sugars, is thought to significantly contribute to the development and progression of fatty liver disease. It is also associated with increased inflammatory markers in the body. High fructose corn syrup is another major contributor to fatty liver disease. Processed foods typically contain added sugars, salt, and other inflammatory-promoting compounds. Consumption of ultra-processed foods is associated with rises in inflammatory markers. Alcohol causes fatty liver and other liver diseases. As the liver detoxifies the alcohol, harmful substances are generated that cause inflammation and damage the cells of the liver.