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Liver Reduction Diet

Date issued: May 2022

Review date: May 2024 

Ref: A-382 v3

PDF: Liver reducing diet final May 2022 v3.pdf [pdf] 118KB

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

It is vitally important that for three weeks before your surgery date you follow a very strict calorie controlled diet. This diet 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 / laparoscopically.  If your liver is too big your operation will be abandoned as it will not be safe to proceed.

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 low calorie diet, 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 only recommended prior to your operation and is compulsory for everyone.  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.

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 you are taking a SGLT2 such as empagliflozin, dapagliflozin or canagliflozin these will need to be stopped 48 hours prior to starting the Liver Reduction Diet.

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 Plymouth 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 Yoghurt

  • 400 calories of soup per day (can be fresh or tinned, for example Weight Watchers® or supermarket own brand. Checks labels for calorie content).


  • 400 calories yoghurt per day (for example Muller Light® or Supermarket own brand low fat, low sugar varieties).


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

  • Take a multivitamin and mineral tablet every day.

Option 2: A Meal Replacement Diet

  • 3 – 4 meal replacement shakes to provide a maximum of 800 calories per day. For example, Slimfast® or supermarket own brand equivalent, made up as per instructions on the label.  


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

If you have an intolerance to milk or dairy there are suitable alternatives available. Please contact your Dietitian for advice.

How much additional fluid can I have in total for each option?

  • Remainder of milk allowance (200mls semi skimmed or skimmed milk per day).

  • Unlimited calorie free drinks e.g. Water, herbal tea, sugar free squash, tea and coffee, Oxo or Bovril stock cube.

  • 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.

  • Ensuring a good fluid intake will help with constipation which can be common on the liver reduction diet.

Please refer to the Constipation Advice Sheet if you experience difficulties opening your bowels. If you have concerns and would like to speak to someone, please email the Bariatric Team at:


Who do I contact if I have any questions?

If you have any questions or concerns, or need any further information please contact Claire Woods Bariatric Specialist Nurse or Bariatric Specialist Dietitians Ciara Caleshu or Rachel Griffin via email or telephone.

Email: plh-tr.DerrifordBariatrics@nhs.net

Telephone: 01752 431724.

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