Pre-operative liver reducing diet

PATIENT INFORMATION

Pre-operative Liver Reducing Diet

As part of your preparation for surgery your surgeon feels it would be beneficial for

you to follow a diet very low in calories, carbohydrate (starches and sugars) and fat

for 2 weeks before your surgery.

Why do I need to follow this diet? This is to shrink your liver down to ensure that the

operation can be done by the keyhole (laparoscopic) method. If your liver is too big,

the surgeon may abandon the operation, or you will have to have an open operation,

the risks of surgery will increase, and your recovery will be delayed.

By following a strict diet, your body reduces its glycogen stores (glycogen is a form of

sugar stored in the liver and muscles for energy). With each ounce of glycogen, the

body stores 3-4 ounces of water, so when you follow a very strict diet, especially one

that is low in starch and sugar, your body loses its glycogen stores and some water.

The liver shrinks as it has less glycogen and water in it.

IMPORTANT For some people who might have had difficult experiences with food /

eating or dieting in the past, this diet can be challenging and sometimes distressing.

For this reason, you are invited to have support from a specialist dietitian experienced

in dietary counselling. (See below for contact details)

If you are taking medication for diabetes (e.g. Insulin, gliclazide, glibenclamide,

metformin), you will need to contact your GP or diabetes doctor/nurse/dietitian to have

your dosage adjusted while you are on this diet in order to make sure that your blood

sugar does not fall too low.

This diet is only recommended for two weeks before surgery and is not to be

followed afterwards.

Working with you, for you

NOTE: If you have received this information leaflet please inform the team at your pre-

assessment appointment. You will not take the pre-op drinks usually offered before

surgery

WHAT HAPPENS NEXT?

• If Your Body Mass Index (BMI) is 40+ or you have a BMI of 35 upwards and

diabetes you will receive an invitation to an appointment with a dietitian. If you do not

hear from them or you have any worries or concerns you can call the secretary on

01803 654380. If you are given a date for surgery before you have seen the

dietician please contact either the dietician team or your consultants secretary.

At the appointment, your dietitian will support you to choose your diet option. You will

also have the opportunity to discuss any questions of concerns that you may have.

• If your BMI is less than 40 you will not routinely receive an appointment to see a

dietician and should choose from the diets below, however, if you feel you need

support with the diet please contact our dietitian team.

Pre-operative Liver Reduction Diet (LRD) is not advised for:

Adolescents, pregnant/lactating women, the elderly, people with unstable cardiac or

cerebrovascular disease, acute or chronic renal failure, severe or end stage liver failure,

or acute psychiatric disorders. If in doubt, please contact the dieticians for advice.

There are three different plans available for a liver reducing diet:

1. Food plan: Normal foods using carefully measured portions of carbohydrate.

2. Milk plan: Using only semi-skimmed, soya or almond milk and multivitamin tablets.

3. Meal replacement Shake plan: Using only shakes Slimfast®

1. Food plan

This diet is designed to give you approximately 100g of carbohydrate per day. It is low

in fat (although how low will depend on the foods you chose) and moderate in protein.

The energy value of the diet is between 800-1000kcal per day. It is very important to

measure your portions accurately or you may end up eating too much and the diet will

not work.

Per day you should take three meals and choose from the options listed below.

Breakfast (15g carbohydrate each)

Choose one of the following options (use milk from your additional daily allowance

listed on the next page):

• 5 dessert spoons of bran flakes or fruit & fibre or cornflakes

• 1 shredded wheat or 11⁄2 Weetabix

• 6 dessert spoons of All Bran

• 5 dessert spoons of Rice Krispies

• 25g of rolled oats or cornmeal porridge

• 1 medium slice toast with scraping of low fat spread.

Lunch

Choose one of the following options:

(15-20g carbohydrate each)

• 1 slice medium sliced bread/toast

• 2 crisp breads

• 1⁄2 bagel

• 1⁄2 pitta bread

With one of the following protein options:

• 2 eggs (cooked without fat)

• 60g /2oz cheese (2 x matchbox size)

• 8 thin packet slices of ham, chicken or turkey

• 1 small chicken breast without skin

• 4 rashers of grilled back bacon

• 100g/4oz (small portion) meat

• 2 grilled low fat or

• 100g/4oz tinned fish

Plus plenty of vegetables/salad (low fat dressing).

Evening meal (20g carbohydrate each) Choose one of the following options:

• 1 average size old potato (approx 125g boiled/mashed)

• 4 egg-sized new potatoes with skin

• 2 small roast potatoes

• 125g yam – boiled

• 1 small green banana – boiled

• 3 dessert spoons cooked rice (any variety)

• 3 dessert spoons cooked pasta (any variety)

• 40 strands of spaghetti (count when raw!)

With one of the following protein options:

• 2eggs

• 60g/2oz cheese (2 x matchbox size)

• 8 thin packet slices of ham, chicken or turkey

• 1 small chicken breast without skin

• 4 rashers grilled back bacon

• 100g/4oz (small portion) meat

• 100g/4oz tinned fish

• 100g/4oz tofu

• Plus you can have plenty of vegetables/salad (low fat dressing).

Additional allowances throughout the day

• 1/3 pint/200ml milk for drinks/cereal (10g carbohydrate)

• 2 portions of fruit or 1 x 150ml fruit juice and 1 x portion fruit (see fruit portions list

below for details)

• One small pot (125g) low fat, low sugar yoghurt per day (diet or ‘lite’ varieties) or

1 small pot low fat natural yoghurt (about 10g carbohydrate)

Plus unlimited water, tea, coffee, low calorie squash, low calorie fizzy drinks. Please

note that alcohol is NOT allowed while you are following any of the 2-week pre-op diet

options.

How much is a portion of fruit?

• 1 piece of a medium fruit (e.g. apple, orange)

• 1 slice of very large fruit (e.g. pineapple, melon)

• 2 pieces of small fruit (e.g. satsuma, plum, kiwi)

• 3 dates

• 1/3 large can fruit in juice (drained)

• 3 heaped dessert spoons fresh fruit salad

• 3 dessert spoons stewed fruit without sugar

• 1 dessert spoon dried fruit

• 3 dried apricots

• 1 glass (150ml) fruit juice (maximum one per day!)

Additional information for the food plan

You should aim to eat mostly green salad and vegetables as these are lowest in

carbohydrates. Vegetables such as peas, sweet corn and parsnips are higher in

carbohydrate and should be avoided if possible.

Try to use cooking methods that do not add fat to your foods such as baking, grilling or

boiling. You can try using the 1kcal spray oils instead of pouring oil. It is also okay to use

artificial sweeteners in place of sugar.

Any of the following spices/condiments can be used to add flavour: salt, pepper, fresh or

dried herbs, spices, mustard, curry powder, lemon/lime juice, vinegar, fish sauce, soy

sauce, Worcestershire sauce, stock cubes, vanilla and other essences.

It is important not to eat less than the specified portions of carbohydrate as this can make

you feel unwell. Other foods on the menu will provide you with protein and small amounts

of fat. The inclusion of these foods means that it should not be necessary for you to take

any vitamin or mineral supplement.

2. Milk plan

Many patients find it simpler to just follow a liquid diet plan of semi-skimmed milk for

the two weeks before surgery. If you choose to follow this plan you should aim to

have the following per day:

• 2 litres (3 1⁄2 pints) semi-skimmed milk

• 1 multivitamin and mineral tablet daily (e.g. Forceval, Sanatogen, Centrum)

• Fibre supplement (e.g. Fybogel or Benefibre) available from chemist

Try to split the milk into 4 – 5 ‘meals’ per day. You may add non-sugar containing

flavourings to the milk (e.g. sugar-free milkshake syrups, vanilla essence, coffee etc.)

but be careful not to add any sugar.

As an alternative to dairy you may use sweetened non-organic soya milk in the same

quantities as above.

Plus unlimited water, tea, coffee, low calorie squash, low calorie fizzy drinks. Please

note that alcohol is NOT allowed while you are following any of the 2-week pre-op diet

options.

3. Meal replacement Shake plan

These are a nutritionally complete low energy liquid diet suitable for use before

bariatric surgery. They contain the recommended daily intake of vitamins and minerals

and provide the reduced amounts of calories and carbohydrate per day required to

shrink the size of the liver.

Not all meal replacement shakes are suitable as many contain too much sugar

(carbohydrate). We therefore recommend you choose from the two shake plans below:

Slimfast Meal Replacement Plan You can choose to use ready-prepared bottled shakes

or prepare your own from powder (which is cheaper). The nutritional content of both forms

is different so if you choose powder you will need to also purchase a whey protein shake.

Slimfast Powder Shakes (make with skimmed milk) Per day:

• 3 Slimfast shakes per day

• 2 ‘Precision Engineered’ Whey Protein shakes (from Holland & Barrett)

• Plus unlimited water, black tea or coffee, low calorie squash, low calorie fizzy

drinks.

Slimfast Bottled Shakes and High Protein Meal Bars Per day:

• 5 bottled Slimfast shakes (325ml)

• You may exchange bottled shakes for Slimfast High Protein Meal bars (NOT

the snack bars) if you prefer, or use a mixture of both (e.g. 3 bottles and 2 bars).

Do not have more than 5 products total per day.

• Plus unlimited water, black tea or coffee, low calorie squash, low calorie fizzy

drinks

Please Note: Alcohol is NOT allowed while you are following any of the 2-week pre-op

diet options.

How will I feel while I am on this diet?

As your body responds to the diet it releases ketones, which are made when the body

breaks down fat for energy. These are released in the breath, urine and sweat –

sometimes causing odour. You may also experience other symptoms such as thirst,

and a slightly metallic taste in the mouth. In addition, you may also find that your

appetite is suppressed after the first 3 - 4 days, meaning that you feel much less hungry

than you would have expected. Some people report feeling a little light-headed in the

first few days. Just make sure you are sticking to the plan and drinking plenty – this

will pass.

For ongoing Weight Management support:

You can self-register for the following service:-

The Specialist Weight Management Service

A free programme designed to help people over 18 years to lose weight, develop a

healthier lifestyle, and reduce emotional eating. To be eligible for the programme you

must have taken part in a previous weight loss programme for at least 6 months, for

example: Weight Watchers, Slimming World or one to one support with a Dietitian or

Practice Nurse.

• Have a body mass index (BMI) 35-40 and have type 2 diabetes (including previous

diabetes during pregnancy) or sleep apnoea or Have a BMI 40 – 49kg/m

• If your BMI is 50kg/m

or over you are automatically eligible to join the service

https://www.torbayandsouthdevon.nhs.uk/services/nutrition-dietetics/specialist-

weight-management/

If you would prefer to use a self-help approach at the moment you might find some of

the following links:

https://www.nhs.uk/change4life

www.nhs.uk/Oneyou

www.nhs.uk/Livewell/weight-loss-guide

If you feel that your low mood or anxiety is impacting on your weight/eating please

consider speaking to the depression and anxiety service: 0800 0730741

http://www.devonpartnership.nhs.uk/DAS.das.0.html

Alternative self-help guides: www.ntw.nhs.uk/pic/selfhelp

For further assistance or to receive this information in a different format, please

contact the department which created this leaflet.

25434/V1/Directorate/TSDFT/01.20/Review Date 01.22