Highly Skeptical of Surgeon's Pre-Op Diet

[devotion 41]

I am in the process of preparing for gastric bypass surgery. I have my first appointment with the dietician today. In advance of the appointment, he sent me the pre-op liver shrinking diet instructions. Upon reading it, I'm very skeptical in terms of how it can possibly shrink my liver. There is nothing about Protein Shakes, broths or other liquids (other than drinking 8 cups of sugar free liquids per day). Rather, the instructions have me eating 3 small meals a day. There are meals with meat and eggs and veggies. Some of the ingredients seem totally contradictory to shrinking the liver but I'm no doctor. Here are some that raised my eyebrows:

• Shredded cheese
• PB2 Peanut Butter
• Eggs
• Sour cream
• Ricotta cheese
• Cottage cheese
• Whole wheat Pasta

Granted, the diet does not call for a large amount of the above ingredients. But I am wondering if I should follow another pre-op diet - one that calls for at least 2 Protein shakes a day and broth, etc. Any opinions on this? Thanks in advance!

[cellbell 113]

My program said that eating low carb is what shrinks the liver, since glycogen is stored there, so from that perspective it looks fine outside of the Pasta. My plan did still involve two Protein Shakes a day along with one small meal, which they said they wanted to make sure my Protein intake was adequate prior to surgery while being inside the calorie limit they set.

It is very frustrating that there is no standardization or regulation in terms of nutrition guidance both before and after surgery, and I feel like it is a huge disservice to patients who are trying to compare their experiences only to find themselves with apples and oranges. My Vitamin recommendations are so different from others that I'm having the same doubts, so you're not alone here

Ultimately, you can ask them to clarify the reasons for their specific diet, and if you don't trust their answers, it may not be the right doctor/office for you. Better you learn that before surgery than after! You can also ask about their post op plans to see if it's closer to your expectations.

[Sleeve_Me_Alone 656]

From what I've read, each surgeon/program has their own preferences for pre-op diets and the results vary pretty widely. The primary goals are 1) to prove ability to adhere to a diet (this is mostly an insurance thing, I think) and 2) to shrink the liver, but even if the liver remains relatively fatty, the surgery can still be conducted. It generally requires an additional incision to allow for direct liver retraction and can make the surgery time longer, but its not impossible. That being said, I would say if you have researched your surgeon and are confident in their skills/success rate, then you have no reason to doubt their pre-op diet recommendations. Its very likely that they are moving you towards a low carb, reduced calorie diet, even with the inclusion of some fatty/carby foods. And as you progress closer to surgery, the diet may become more restrictive/specific. If your trust your surgeon, trust their process!

[Tomo 1,191]

I think yours makes more sense to me than mine did lol. I had a clear liquid diet, all clear fruit juices unlimited. Therefore, lots of carbs. I followed it, lost weight but the jury is still out to why my surgeon preferred that diet. Everything turned out fine in the end. Surgery was fast and successful. But as cellbell said low carb is what shrinks the liver is what I have always read.

[RickM 1,747]

I would be eternally grateful that the surgeon has you on a diet of real food rather than one of these liquid things (which I still haven't figured out what they really do.) As noted, low carb is the main functional requirement for "shrinking the liver" (to the extent that such can be done in a couple weeks' time - there is still debate on that amongst the docs,) and as you see, even on the liquid diets aren't necessarily all that low carb. Go figure. Many of us never had any diet at all.

It all comes down to the surgeon and what they are comfortable with. I would be more concerned if the surgeon was one of those who threatens to "close you up and send you home..." if you haven't shrunk the liver enough (and occasionally one actually follows through with that) as that is a good indication of some deficient skills on his part.

For some docs, liver condition is not a major imperative for them - they can handle whatever you throw at them - and they devise diets for other purposes, or as noted, none at all.

Go with the flow and enjoy the ride. It seems to me to be an thoroughly sane diet that will likely lead to a more rapid recovery and better outcome than the liquid diets that others impose. Good luck

[Arabesque 7,271]

There’s a lot of variations in the pre surgery diets. Mine was real food too - specifically Keto. So I ate meat, eggs, full fat dairy, low carbs, non starchy vegetables & berries. Yours sounds like it may be keto or similar to keto too.

My surgeon requires different patients to follow different pre surgery diets based on various factors - weight, blood work, results from various medical tests, etc. Sometimes the diet is not only to reduce the fat around your liver, but to lose some weight before surgery, break some addictions/cravings (caffeine, sugar, carbs, etc.) & /or get you thinking about what you eat.

Best advice is to follow the plan you’ve been given.