• Reference Number: HEY-728/2015
  • Departments: Nutrition Support

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

This diet sheet will explain:

  • The aim of the diet
  • How long you will have to follow this diet
  • How many carbohydrates are allowed
  • Provide 2 diet options

What is the aim of the diet?

  • The aim of this diet is to be low in carbohydrate and fat.
  • Following this diet achieves changes to the liver, it 'shrinks' in size and softens, making it easier to move during surgery.
  • During laparoscopic or 'keyhole' bariatric surgery, the liver has to be lifted out of the way to access the stomach lying beneath it.
  • If the liver is heavy, fatty and immobile, it is harder for the surgeon to see and gain access to the stomach underneath. This could be a reason for changing to open surgery.  Open surgery means a larger abdominal scar, which results in longer recovery and increased risks.
  • To reduce the size of the liver, it is necessary to follow a diet that is low in carbohydrate, low in fat and moderate in protein.
  • Foods high in carbohydrate include sugars and starch food. The starch carbohydrate foods include bread, rice, potato, pasta and cereals; therefore it is necessary to temporarily avoid these.
  • You will lose weight by following this diet, but more importantly, your liver will shrink and you increase your chances of having a safe operation.

How long will I have to follow this diet?

Before your weight loss surgery, it is essential that you follow this special pre-operative diet for a full two weeks for the diet to be successful.  This diet is to help shrink the liver so the surgeon can operate more easily and increases the chances of your surgery being performed laparoscopically (by keyhole).

There may be a temptation to have a special or larger meal prior to surgery; however, if you do this, this will reverse the liver-reducing effects of the diet.

Please note this diet is not optional and is only intended for you to follow before your surgery. It should not be followed after surgery or by anyone else.

How much carbohydrate am I allowed?

The diet is designed to give you approximately 60 – 90g of carbohydrate per day. It is low in fat (although the extent will depend on the foods chosen and the way in which they are cooked) and moderate in protein. The energy value of the diet is approximately 600 – 800 kcal.

Diet Options

The following diet option 1 is the recommended diet for liver shrinkage:

Diet Option 1

Each day you will need to have:

  • 3 pints (approximately 1800mls or 9 glasses) of skimmed milk (Red Top bottle of milk usually – please check label)
  • Sugar free jelly made with water or you could include some of the required 3 pints of skimmed milk a day.
  • Unlimited water, tea, coffee, no added sugar, squashes (milk for tea and coffee as part of the required 3 pints of skimmed milk a day).

Ensure you take one Forceval tablet a day (A – Z complete vitamin and mineral supplement) as this will make sure you get all the vitamins and minerals required before your operation because this is a very restrictive short term diet.  (Approximately provides 600kcal, 60grams of protein, and 90 grams of carbohydrate)

Diet Option 2 (is an alternative liver shrinkage diet, you may be advised to follow this diet)

Each day you will need to have:

  • 2 pints (approximately 1200mls or 6 glasses) of skimmed milk (Red Top bottle of milk usually – please check label)
  • Sugar free jelly made with water or you could include some of the required 2 pints of skimmed milk a day
  • Unlimited water, tea, coffee, no added sugar squashes (milk for tea and coffee as part of the required 2 pints of skimmed milk a day)
  • One Meal – options include
    • 75 grams of grilled or oven baked skinless chicken and green leafy vegetables or salad (this includes lettuce, onion, tomato, peppers, cucumber and should not include potato)
    • Or 120 grams of grilled or oven baked white fish and green leafy vegetables or salad (this includes lettuce, onion, tomato, peppers, cucumber and should not include potato)
    • If using a dressing ensure a low fat option (small drizzle)

Ensure you take one Forceval tablet a day (A-Z complete vitamin and mineral supplement) as this will make sure you get all vitamins and minerals required before your operation because this is a very restrictive short term diet.

(Approximately provides 600kcal, 60 grams of protein, and 60 grams of carbohydrate)

Special note for patients with diabetes

If you have diabetes and are treated with medication, you will need to adjust your insulin or medication whilst following this diet.  Please contact your Diabetes Specialist Nurse/Practice Nurse/GP before starting the diet.  If you have questions or concerns, please ask at clinic appointments.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of Nutrition and Dietetics on telephone number: (01482) 623168

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

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