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Date issued: August 2023 

Review date: August 2025 

Ref: A-583/RG/Dietetics/Liver Reduction Diet

PDF:  Liver reducing diet final August 2023.pdf [pdf] 199KB

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 Yogurt

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

And

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

And

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

• Take a complete A-Z 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.  

And

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

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 Soups in the following flavours; beef and veg / steak and potato / chunky veg / lamb 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.

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.

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 overleaf.

Fibre supplements

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

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

plh-tr.DerrifordBariatrics@nhs.net

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

01752 4314509 or 01752 437279