So, the materials I got from my surgery center said that I could choose between two pre op diet options. I could either do a two week diet of two protein shakes and one low calorie meal (like lean cuisine) or I could do nine days of only liquid protein and all the green vegetables I want. My husband seems to be concerned with me getting in less than 1200 calories as that slows my metabolism down especially coupled with three weeks of no real solid food. Does anyone know why we need to do this pre op diet anyway? I can understand fasting before the pre operative testing but why for nine days!? Has anyone not lost weight on the pre op diet and had their surgery delayed?

That's a good question seeing that I have to do the Optifast diet for basicly 7 weeks. Does anyone have the answer?

A pre-op diet is required to shrink the liver. All surgeons have different pre-op diet requirements. Mine is the same diet I have been doing for 7 months. High Protein, low carb. I don't have to do a liquid only, or one meal only ect. I get 3 balanced meals each day w/ low carbs.

So, the materials I got from my surgery center said that I could choose between two pre op diet options. I could either do a two week diet of two Protein shakes and one low calorie meal (like lean cuisine) or I could do nine days of only liquid protein and all the green vegetables I want. My husband seems to be concerned with me getting in less than 1200 calories as that slows my metabolism down especially coupled with three weeks of no real solid food. Does anyone know why we need to do this pre op diet anyway? I can understand fasting before the pre operative testing but why for nine days!? Has anyone not lost weight on the pre op diet and had their surgery delayed?

The main purpose of the pre-op diet is to reduce the size of the liver making the operation easier and quicker. The liver loves to store extra calories. Steatosis is the medical term or "fatty liver". Fortunately, the first weight you lose comes out of the liver reducing the liver size very significantly. There are other benefits to pre-op weight loss such as making it easier for the anesthesiologists to place the breathing tube and it improves your cardiovascular function, but the main reason is the reduction in liver size. This becomes critically important in men, patients with diabetes and BMI>45. Females with BMI<45 and no diabetes have the easiest livers to deal with and for these patients I only ask them to do one week of liquid protein fast as that is all that is required to reduce the liver size.

Brad Watkins MD

The main purpose of the pre-op diet is to reduce the size of the liver making the operation easier and quicker. The liver loves to store extra calories. Steatosis is the medical term or "fatty liver". Fortunately, the first weight you lose comes out of the liver reducing the liver size very significantly. There are other benefits to pre-op weight loss such as making it easier for the anesthesiologists to place the breathing tube and it improves your cardiovascular function, but the main reason is the reduction in liver size. This becomes critically important in men, patients with diabetes and BMI>45. Females with BMI<45 and no diabetes have the easiest livers to deal with and for these patients I only ask them to do one week of liquid Protein fast as that is all that is required to reduce the liver size.

Brad Watkins MD

Thanks Dr Watkins! My BMI is 31 so I should have been good to go with a 7 day liquid protein diet right? Oh well, I added a few extra days.

The main purpose of the pre-op diet is to reduce the size of the liver making the operation easier and quicker. The liver loves to store extra calories. Steatosis is the medical term or "fatty liver". Fortunately, the first weight you lose comes out of the liver reducing the liver size very significantly. There are other benefits to pre-op weight loss such as making it easier for the anesthesiologists to place the breathing tube and it improves your cardiovascular function, but the main reason is the reduction in liver size. This becomes critically important in men, patients with diabetes and BMI>45. Females with BMI<45 and no diabetes have the easiest livers to deal with and for these patients I only ask them to do one week of liquid Protein fast as that is all that is required to reduce the liver size.

Brad Watkins MD

Why does it have to be liquid protein only though?

Thanks Dr Watkins! My BMI is 31 so I should have been good to go with a 7 day liquid Protein diet right? Oh well, I added a few extra days.

Yep. What I have found is that one week of liquid protein fast is all that is required for female, no diabetes, BMI<45 but the best advice is to always follow your surgeon's instructions. Over the years we've tried a bunch of different things pre-op to reduce the size of the liver and by far the thing that works best in my experience is liquid protein fast - i.e. you drink 3-4 Protein shakes per day which total about 800 calories. It never hurts to do it longer and lose a bit more but those are the minimums.

In the pre-op room, when I ask how the liquid protein diet went, if patients say they hated it, I typically find a small liver during surgery. If they tell me it wasn't that bad, watch out for a big liver (usually means they didn't stick to it very well). In extreme cases you simply can't do the surgery or you really struggle with the liver. The most dramatic liver size you see is in men, BMI>45 and diabetes. In some cases I'll have diabetic males with BMI>60 do three weeks of liquid protein fast. We always want the surgery to be as perfect as humanly possible. There are some things we can't control but liver size is one we can.

The surgeon & RN suggested I go ahead and replace two meals with shakes, keep one high protein/low carb meal, and 1-2 snacks high protein when I went for my consult in June. Due to insurance problems, I didn't have surgery until 11/22. I didn't always stick to it (I kept the high protein, but often ate too much) but worked hard at the beginning and once insurance finally approved me. At my consult, my liver was large and mushy, but it looked great in the pics of my surgery. Small and firm.

Thank you Dr. That explanation cleared up a lot for me but I just wish I wouldnt have to do for 7 weeks. I'm weak and very very hungry.

Why does it have to be liquid Protein only though?

My opinion is that the only magic to it is simplicity. We have tried plans in the past where you do one or two protein shakes per day and eat small healthy meals but all of those plans we tried, the livers were huge during surgery. I think that in many cases, patients would just eat whatever they wanted or they would eat their regular meals and add the shakes on top of that so we were probably increasing calories before surgery and not decreasing. In my experience, if a patient does liquid protein fast only, the liver is drastically reduced making the surgery easier which makes your recovery easier.

For a time, I started waiving this requirement in lower BMI women, but those cases ended up being the most difficult cases we were doing because of the liver so now we basically have everyone do it and the results are excellent.

Dr. Watkins,

My wife is losing weight during the pre-op diet, but she cannot stand the Protein shakes. She has been substituting chicken broth with a little Grilled Chicken in it.

She has 10 days to go on a 14 day regimate. Is it crucial that she drink the shakes, if so why?

Or is losing the weight with a low carb diet the most important part.

She is doing Water, tea, Crystal Lite Lemonade (once a day) 2-3 all green salads with some mushrooms, 2 Chicken Broth with Grilled Chicken and a Healthy Choice meal for dinner.

Thanks,

SD