Discover the Truth About Liver Shrinking Diet and Diarrhea: Causes, Effective Management Tips, and Essential Considerations

For individuals undergoing bariatric surgery or managing specific health conditions, a liver shrinking diet may be recommended. This dietary approach aims to reduce liver volume, making surgical procedures safer and more effective. However, such diets, along with bariatric surgeries themselves, can sometimes lead to gastrointestinal issues, including diarrhea. This article explores the relationship between liver shrinking diets, diarrhea, and related health considerations.

What is a Liver Shrinking Diet?

A liver reduction diet is typically low in calories and carbohydrates. People undergoing some laparoscopic procedures may need to be on this special diet if they have a fatty liver. The purpose of a liver shrinkage diet is to force the body to use up stored carbohydrate (glycogen) from the liver. During laparoscopic (keyhole) surgery the liver has to be lifted out of the way to access the stomach lying beneath it. A large, fatty liver makes it harder for the surgeon to see and gain access to the stomach underneath. This can increase the duration of your surgery and therefore your time under general anaesthetic. It can also be dangerous as your liver could bleed heavily during surgery or there could be injury to other organs. If you do not follow the liver shrinkage diet and your liver has not shrunk, surgery may be deemed unsafe and the surgeon may cancel the surgery on the day. It is essential you follow this diet as a fatty liver can obscure the view for the surgeon whilst operating and if he/she is not able to see properly, your procedure might be stopped or you could end up with an open procedure which will take longer to recover from.

An energy-restricted diet is often prescribed before bariatric surgery to reduce weight and liver volume. While very-low-calorie diets (VLCDs, 450-800 kcal per day) have shown to be effective, the effectiveness of low-calorie diets (LCDs, 800-1500 kcal per day) is less obvious. A systematic review aimed to elucidate the effectiveness of LCD on liver volume reduction in patients awaiting bariatric surgery. Eight studies (n = 251) were included describing nine different diets (800-1200 kcal, 2-8 weeks). The LCD was effective in liver volume reduction (12-27%) and weight loss (4-17%), particularly during the first weeks, with acceptable patient compliance.

Diet Options

Patients are typically required to pick one of the options and follow it as per instructions. Examples of liver shrinkage diets include:

SLIMFAST®: a nutritionally complete, low calorie diet (LCD) meal replacement product.
Liquid Diet: Consuming only liquids for two weeks before the operation.

What to Consume

Lemon juice and vinegar (including balsamic vinegar) is allowed.
3 pints of skimmed OR semi skimmed milk OR lacto-free OR soya milk per day. The milk can be hot/cold and flavoured with vanilla essence, SUGAR FREE syrups (e.g.
2 x 125g low-fat plain or natural yogurt or 0% fat yogurt per day. Aim to avoid fruit yogurts as they can be high in sugar and fat.
An additional minimum of 2litres of fluid per day (i.e.
Avoid adding any sugar into your tea/coffee. Sweeteners are allowed to be used as an alternative.
You will need to take supplements daily as this diet is not nutritionally complete.
You are allowed to have 1 or 2 salty drink a day to help maintaining electrolyte levels.
Creamy or ready-made pasta or meal sauces (choose tinned tomatoes to use in cooking i.e.
You will need to start taking a multivitamin and mineral supplementation once daily as this diet is not nutritionally complete.

Possible Side Effects

You might experience side effects for the first few days. These are related to your body getting used to fewer calories.

Fatigue: During the first week you may feel tired and weak. We recommend you try to eat smaller meals regularly throughout the day.
Ketosis: unpleasant side effects may occur as your body is burning fat instead of carbohydrates. This results in the body producing ketones which can cause bad breath, tiredness, headaches, mild dizziness and nausea. We advise you brush your teeth more frequently and use mouthwash. Try sugar free chewing gum or mints as this might help.
Constipation: This may occur as a result of reduced fibre intake. Ensure you drink enough fluid (two to three litres). You may need to take 1-2 sachets of Fybogel each day or any other laxatives in the tablet or powder form in order to prevent this.
Menstrual cycle change: female patients need to be aware that you may experience a change in your menstrual cycle during this period.

Considerations for Specific Conditions

Patients on insulin or gliclazide (tablets): If you have diabetes and take insulin injections or gliclazide (tablets) please contact the person who normally helps you control your diabetes. It is likely you will need to reduce your insulin or gliclazide because the diets are all low in carbohydrate (less than 100g) and will make your blood sugars go lower than normal. Check your blood glucose levels 4 times a day. If you do not have a blood meter, you can ask to have your blood sugar checked at your local pharmacy.
Inform your surgeon / dietitian /specialist nurse if you have any of the following conditions: diabetes, renal failure, gout, epilepsy, low blood pressure, migraines or if you have suffered a stroke in the last six months.
This diet is often not suitable if you have problems with your kidneys.

Diarrhea After Gastric Sleeve

Some patients may grapple with a pesky issue known as watery stool or diarrhea after gastric sleeve. This predicament can be quite a nuisance, particularly if it becomes a persistent issue. If the problem persists, your physician may prescribe some types of medications to alleviate your distress. Both constipation and diarrhea are common issues after weight loss surgery. The causes of diarrhea can be attributed to various factors, such as alterations in gut bacteria and the accelerated exposure of the small intestine to poorly digested food particles. There is a possibility that you may experience diarrhea after any bariatric surgery, but with time, your digestive system will get accustomed to its new shape, and the issue should eventually resolve on its own. In any case, if you do find yourself struggling with this issue after your gastric sleeve in Turkey, you must stay hydrated and modify your diet by avoiding food types that seem to trigger your diarrhea.

Diarrhea after gastric sleeve is quite common and might be an early indication of that sneaky problem known as "early dumping syndrome". This happens when food moves from your stomach to the small intestine faster than it normally should. Interestingly, many surgeons look positively to dumping syndrome and consider it an essential component of postoperative weight loss according to a study.

In General, diarrhea occurs when you e pooping more frequently than usual or when the poop is loose or watery. There are different types of diarrhea and the reasons behind them can vary significantly.

For example, theres osmotic diarrhea which happens when theres too much stuff in your gut that your body can absorb, like when you eat something your body can digest properly or when you e missing an enzyme that helps with digestion. If thats the case, avoiding that food or fasting should help put a stop to the loose stools. To combat this, take your time while eating and give yourself a good 20 to 30 minutes to savor each meal, even if its just a little bite.

Causes of Diarrhea After Gastric Sleeve

Diarrhea after gastric sleeve surgery in Turkey can be a result of different factors. we can categorize these factors as follows:

Fatty Acids Absorption: One of the most rampant culprits behind diarrhea following gastric sleeve surgery is the way your body deals with fatty acids. Ordinarily, these acids are absorbed in the small intestine; however, after gastric sleeve surgery, they may become prone to causing distress as they travel through the small intestine and irritate the colon.
Dumping Syndrome: Diarrhea is also a symptom of dumping syndrome. This issue is a common annoyance for bariatric patients and is caused by the rapid entry of high-sugar or high-fat foods into the intestines. This can be triggered by overeating or overdrinking too many liquids too soon after a meal. Along with diarrhea, you may also experience nausea and vomiting, which are also signs of this pesky syndrome.
Infections: Diarrhea could be a case of infectious agents. That occurs when a virus, bacteria, or other unwanted guests have taken over your gut. Don worry, your body will fight them off and make you better! In any case, the risk of intra-abdominal infection and UTI is quite high after bariatric surgery in general according to a study.
Medications: Some medications or drugs can cause “secretory diarrhea”. This is when your intestines are working overtime and secreting too much liquid, faster than it can be absorbed. Drugs, toxins, or laxatives could be to blame.
Food Intolerance: Food intolerance is often related to gluten, salicylates, and histamine, and is generally common after most types of obesity surgery in Turkey.
- Gluten: Wheat and barley with high levels of gluten can cause digestive problems for those who are intolerant to it. Its important not just to cut out bread and cereal products, but also to be mindful of ready-to-eat meals that contain gluten.
- Salicylates: These compounds are found in many healthy foods like fruits and veggies, nuts, and spices. They can cause issues for hypersensitive people. Keep an eye on foods high in salicylates like raisins, oranges, and spices. Stop eating these foods if you suspect they may be the source of your diarrhea.
- Histamine: This is a chemical in the body that helps protect against infections, but it can cause digestive problems for those with histamine intolerance. Foods like fermented products, hard cheese, and dried fruits should be limited if histamine is causing digestive trouble.
- Others: Some liquids and substances such as alcohol can cause diarrhea too.

Treatment of Diarrhea After Gastric Sleeve

Dealing with diarrhea after gastric sleeve isn’t as challenging as one may think, but it could increase the total gastric sleeve cost in Turkey. Simple measures such as the following can be enough:

Keep yourself hydrated by drinking plenty of water and steering clear of foods that are known to agitate your gut, like fatty foods or anything with caffeine.
Take control by experimenting with alternative foods that might be easier on your system.
Consider portion size and give your body some time to adjust to the changes and take it slow when introducing new foods back into your diet. Don’t go too fast or revert back to unhealthy eating habits that can cause diarrhea.
Reach out to a specialist if the diarrhea continues to get the medications you need to stop diarrhea.

Keto Diet and Diarrhea

Some people who follow a keto diet may experience diarrhea and other gastrointestinal (GI) problems as side effects. Various tips can help a person relieve keto diarrhea and other symptoms. In some cases, diarrhea or GI issues may be short term while the person’s body adjusts to the new diet. However, these problems can sometimes be more long term and even last the duration of the keto diet.

Typically, the body uses carbohydrates as an energy source. When there are insufficient carbohydrates in the body, it enters a state called ketosis. During ketosis, the body breaks down stored fat to create molecules called ketones, which it uses as fuel instead of carbohydrates.

Reasons for GI Problems on Keto

As with any extreme dietary changes, starting on the keto diet can have an effect on a person’s stomach and intestines, causing GI problems. Some people may continue to have GI problems throughout the keto diet. A person on a keto diet must consume a lot of fat and little carbohydrate to reach and maintain ketosis. Some people may find that their body struggles to adjust to the high fat content of this diet. There are a few other reasons why people on a keto diet may experience GI problems. These include:

Microbiota: A 2019 study found that diets high in fat might cause inflammation of the digestive tract, a decrease in healthful fatty acids, and unfavorable changes in the gut microbiome.
High fat: To break down fat, the liver needs to produce bile. A diet high in fat requires the liver to release extra bile. As bile is a natural laxative, an excessive amount may push waste through the digestive tract quicker than usual, leading to diarrhea. The high fat and low carb content of the keto diet may also lead to other gastrointestinal symptoms, such as nausea and bloating.
Artificial sweeteners: During a keto diet, people may consume more artificial sweeteners and sugar alcohols than usual if they try to find low carb alternatives to items that they previously consumed. Research has found that excessive consumption of certain artificial sweeteners can cause a laxative effect, leading to diarrhea.
Eating more dairy: As whole dairy products are high in fat, people starting on a keto diet may consume more of these than they previously did. This dietary change may reveal an intolerance to dairy, common symptoms of which are diarrhea, bloating, and gas.

Other Symptoms

Diarrhea may not be the only symptom that manifests when a person begins a keto diet. People may also experience the following symptoms:

Read also: How Liver Massage Works

constipation
cramping
abdominal bloating
nausea
abdominal pain
vomiting

Relieving GI Problems on Keto

If someone on the keto diet is experiencing GI problems, they can try to relieve the symptoms by:

Eating more fiber: Fiber can help relieve constipation or diarrhea. Greens, cucumber, broccoli, and cabbage are some high fiber foods that are suitable as part of a keto diet.
Eating less dairy: This dietary change may reveal an intolerance to dairy, common symptoms of which are diarrhea, bloating, and gas.
Easing into the diet: A sudden change in the diet may disrupt the GI bacteria. Easing into a keto diet by slowly reducing carbs and increasing fats may help the body adapt better.
Staying hydrated: Drinking can help improve constipation. If a person is experiencing diarrhea, it is important to replace fluids. Drinking water and sugar-free electrolyte beverages can help replace these fluids and any lost electrolytes.
Adding probiotics and prebiotics: Taking a probiotic supplement or increasing the intake of probiotic- and prebiotic-rich foods may effectively support the gut bacteria during a keto diet. Doing this may reduce the GI effects of a keto diet.
Eating fermented foods: Eating fermented foods, such as sauerkraut and kimchi, can help improve digestion, possibly reducing constipation or diarrhea.
Decreasing the intake of sugar substitutes: Cutting back on the intake of foods and beverages that contain keto-friendly sugar substitutes may help relieve gastrointestinal symptoms.

Low-Calorie Diets and Liver Volume Reduction

An energy-restricted diet is often prescribed before bariatric surgery to reduce weight and liver volume. While very-low-calorie diets (VLCDs, 450-800 kcal per day) have shown to be effective, the effectiveness of low-calorie diets (LCDs, 800-1500 kcal per day) is less obvious. The objective of a systematic review was to elucidate the effectiveness of LCD on liver volume reduction in patients awaiting bariatric surgery. Eight studies (n = 251) were included describing nine different diets (800-1200 kcal, 2-8 weeks). An LCD was effective in liver volume reduction (12-27%) and weight loss (4-17%), particularly during the first weeks. The LCD showed acceptable patients’ compliance.

LCD Benefits and Considerations

Liver Volume Reduction: Left liver lobe volume showed a decrease of 11-29% and total liver volume showed a decrease of 12-27% with a mean of 16%.
Weight Loss: The weight loss ranged from 5.4 to 23.6 kg, corresponding with a percentage original body weight loss ranging from 4.2 to 16.7% with a median of 6.0%.
Body Composition: LBM accounted for 22.9-59.7% of the weight loss with a median of 50.9%.
Compliance and Tolerance: The studies reported a generally high compliance of 80-89%. Tolerance was measured in three different ways: (1) questionnaires, (2) unblinded patient interviews, and (3) unknown assessment technique.

Comparison with Very-Low-Calorie Diets (VLCD)

A VLCD is known to be effective in liver volume reduction (5-20%, mean 14%) according to a previously published systematic review including 140 patients. However, it also results in negative side effects due to this extreme energy restriction. The largest decrease in liver volume was observed when an LCD lasted for two to four weeks.

When to Seek Medical Advice

Before making any significant lifestyle or dietary changes, it is always worth consulting with a healthcare professional. Anyone who is experiencing diarrhea that is severe or lasts longer than a week should consult their doctor. Similarly, if constipation is long lasting or extremely painful, it is best to seek medical attention.

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