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Date issued: August 2023 

Review date: August 2025 

Ref: A-382/RG/Dietetics/Your liver reduction cholecystectomy diet v4

PDF:  Liver reducing diet for cholecystectomy final August 2023 v4.pdf [pdf] 196KB

Why do I need to follow a pre-operative diet?

Before surgery, it is essential you follow a strict calorie controlled diet.  It is vitally important that for two weeks before your surgery (or three, you will be told how long by your surgeon) you follow a very restricted diet that is low in fat, sugar and carbohydrates.  This will reduce the size of your liver and minimise the risk of complications associated with surgery.  It will also ensure the operation can be done by keyhole/laparoscopic surgery.  If your liver is too big your operation will be abandoned.

By following a strict diet, your body reduces its glycogen stores (glycogen is a form of sugar stored in the liver and muscles).  When you follow a very strict diet especially one that is low in carbohydrates, your body loses its glycogen stores and some water, which in turn shrinks the liver. Surprisingly the liver can replace its stores very quickly, so it is important that you follow the diet strictly.  A single carbohydrate-rich meal shortly before your operation can undo all your good efforts and lead to difficulties during surgery.

This diet is not optional and only recommended prior to your operation.  Much of the weight lost on this diet is water. As a result you may become dehydrated so you need to drink more often than usual.

In addition to the diet remember to, avoid alcohol, stop smoking, and keep active e.g. walking 1-3 miles a day or swimming.  Even gardening is an excellent exercise.

What if I am a diabetic?

If you have diabetes and are treated with insulin or tablets (e.g. gliclazide, glibenclamide, tolbutamide) you may need to adjust your medication. Check your blood sugar levels more regularly to make sure that you do not experience ‘hypos’ (low blood glucose levels).

If your diabetes is controlled by diet alone, you will not need to worry about your blood sugars becoming too low.

Please contact the hospital Diabetes Centre on 01752 792963, who will be able to advise you about your medication.

What does the pre-operative diet involve?

You must choose ONE and ONLY ONE of the following options.

Option 1: Soup and Yogurt Diet

• 400 calories of soup per day.

     For example, 4 x cans of Weight Watchers® soup (under 100 calories per can) 

    Or 2 x 200 calorie portions soup per day (you must read the label)   

And

• 400 calories of yogurt per day.

   For example, 4 x low calorie yoghurts e.g., Muller Light® or Supermarket own brand low fat, low sugar varieties (under 100 calories per pot)     

and

• 200mls skimmed or semi-skimmed milk for additional drinks

• Take a complete A-Z multivitamin and mineral tablet every day

Option 2: A Meal Replacement Diet

• 4 meal replacement shakes such as Slimfast® per day (2 x level scoops of powder made up with 250mls skimmed milk as per instructions on tin) not readymade shakes, snacks or meal bars    

And

• 200mls skimmed or semi-skimmed milk for additional drinks

How much fluid can I have in total for all options?           

• The remainder of the milk allowance. Plus calorie free drinks e.g. tea, herbal tea, coffee, water, zero sugar flavoured water / no added sugar squash to make up at least 2 litres of fluid

• Spread drinks and food evenly throughout the day. Do not save everything for later in the day

• Drink at least 2 litres of fluid every day and drink more in hot weather

If you have an intolerance to milk or dairy please refer to the options below.

Dairy Free Options

Option 1: Soup and Yogurt

• 400 calories of dairy free yogurt per day (for example 4 x 125g Alpro® yogurt pots

• 400 calories soup per day (for example 2 x 400g tins of Heinz Big Soup® in the following flavours; beef and veg, steak and potato, chunky veg, lam and veg, sausage and veg, beef broth.

And

• 200 mls dairy free milk alternative for additional drinks

• Take a complete A-Z multivitamin and mineral supplement once a day

Option 2: Meal Replacement

• 4 x Exante® Meal Replacement Vegan Shakes (made as per instructions with water) to provide a maximum of 800 calories a day

And

• 200mls dairy free milk alternative for additional drinks

Exante shakes can be purchased online.

Please check labels before consuming as ingredients/recipes are subject to change over time.

Frequently asked questions

Are sweeteners ok to have on this diet?

Yes. Choose tablet sweeteners such as Silverspoon®, Sweetex®, Hermestas® or Truvia® as these do not contain any calories. 

Can I have anything else on this diet such as fruit or salad?

No.  This is a calorie controlled diet which must not exceed 800 - 1000 calories per day.

Preventing Constipation

The liver reduction diet is relatively low in fibre which can cause constipation. To prevent constipation, you may wish to take a fibre supplement while on the liver reduction diet.

See table below  

Fibre supplement

Fibre supplement	Calories	Fibre (g)	Gluten Free	Instructions	Available on Prescription or Over the Counter
OptiFibre (powder)	10 kcals / 5g (1 scoop)	4.3g fibre per scoop	Gluten Free. Plant based. Vegetarian. Halal. *May contain milk	Add to 200 mls liquid or 150g food. Start with 1 scoop per day for 2 days then increase by a scoop every 2 days. Suggest 2-3 scoops per day Provides 8.6 – 12.9g fibre per day	Over the counter and on prescription
Benefiber (powder)	15 kcals / 2 tspns	3g fibre per 2 tspns	Gluten Free Plant based	Recommended 3 x day. Provides 45 kcals & 9g fibre per day	Over the counter
HyFiber (liquid) (Nutrinovo)	36 kcals / 30mls sachet	12g fibre per 30mls	Gluten Free. Lactose Free.	Start 30 mls once a day Provides 12g fibre per day	Prescription only

I am getting constipated. What shall I do?

If you are feeling constipated you should see your local Pharmacist for a gentle laxative to help soften your stool such as Fybogel®. Take one sachet mixed with water twice per day as instructed. 

Alternatively, you can try docusate sodium to help keep your bowel movements regular.  It is known by the brand names Dulcoease® or Dioctyl®.  Take one capsule three times a day. Do not take more than 5 capsules in a day.

I am feeling very hungry and tired on this diet. Is this normal?

Yes.  You are having fewer calories than your body is used to and will be burning fat stores to help shrink the liver. The diet usually becomes easier after 3-5 days and hunger should subside.

Ensure that you follow your eating plan and spread your food allowance out over the day so that you are eating on a regular basis. Make sure to drink plenty of fluids (at least 2 litres per day in total).

I have lost weight on this diet and would like to continue to lose weight after I recover from my operation. Can I continue to follow it?

No, this very low calorie diet is only intended to be followed for 2 - 3 weeks prior to your operation date for medical reasons.

If you are interested in losing weight speak to your G.P. about referring you to a local Weight Management® Programme where you can get help and support to achieve long term healthy weight loss.