Hi all,

So this might be a stupid question. I have been wondering what the process involved in liver shrinking actually is?

I'm the kind of person who feel most comfortable with new things if I can see or understand how they work. I'm having a gastric bypass on July 15 and part of my prep has been to watch surgery videos to understand the mechanics of the operation. I might be a bit of a weirdo, I know.

Now I have started obsessing about the liver shrinking, scared to death that the surgeon will refuse to operate for some reason. I even taken to starting my pre-op diet early.

Anyway, can someone help put my mind to rest by explaining the liver shrinking? Does it happen due to the very low calorie intake? Or is it linked to the protein shakes? Is it because food intake is liquid - and why is it that pre-op diets are liquid?

I think it's the low calorie intake. Plus I know that it takes a lot of water to process carbs, and since you're not eating carbs, your body releases a lot of water - so it may be partially that, too. I do seem to remember that the liver responds quickly to changes in weight. There are a couple of nurses on here, so they're going to way more about this than I do- hopefully one of them will see your question.

I think it's the reduced carbs, but the reduced calorie intake may also have something to do with it. I was warned by my surgeon that typically my surgery is done in two parts because people don't tend to have their liver shrink enough, but I did a low carb pre-diet during my 6 month monitored weigh loss and the surgeon told my mom that my liver looked great and so they were able to do both parts of my surgery without issue.

Lower insulin levs are what allow the liver to start releasing all the stored glycogen (glucose). Higher insulin levs are also responsible for water retention (which is actually a result of kidneys reabsorbing/holding onto sodium). This is why a lower insulin lev as a result of caloric restriction will see a lot of water weight lost (its the sodium being excreted)

Does anyone know what the desired size of the liver is? Mine is 21 cm.

6 minutes ago, perfektlynrml said:

Does anyone know what the desired size of the liver is? Mine is 21 cm.

I dont know what the "desired" size is for surgery, but the "normal" size of an avg weight person along transverse diameter is 20-23 cm or less than 16 cm in the midclavicular line ... but 21 cm is a meaningless number if you dont know if this is the traverse length or midclavicular line

Calorie restrictions:

https://pubmed.ncbi.nlm.nih.gov/25411646/

I was told by my revision surgeon to think of an obese persons liver like a marbled steak (fat ribboned through out- fatty liver) and the goal is to remove that fat and make it more lean, soft and pliable so that it does not crack tear or break while manipulating it to reach the digestive system

You’re not shrinking the liver itself but reducing the fat on & in the liver. @GreenTealael is correct & it also helps give the surgeon a better field of vision whilst doing the surgery.

I was not given a size that my liver must reduce to just that I had to lose some weight in the fortnight prior to surgery. I lost a good 4kgs but a friend had to lose 8 kgs in the three weeks prior to her surgery.

Good luck.

Thank you all so much! You are all so helpful. ?

I find the three protein shakes a day + vegetables very difficult, not so much because the shakes are yucky, but more that they are making me so hungry. I find myself gravitating towards intermittent fasting in stead - I don't feel as hungry and can go about my day much easier. I do one shake in the morning and then some plain vegetables at night.

In terms of weight loss this is working quite well - I've lost close to 11 lbs this past week.

Intermittent fasting not very good for preop. I don't know any surgeon who would recommend it. There are some very good tasting protein shakes. Have you tried Fairlife Nutrition Chocolate. Tastes just like chocolate milk. I really hated Premiere Protein shakes and most powder-based shakes. You will need lots of protein (60-80g per day) after surgery so best you find one you like and start using now.

Alright, in case anyone is interested here's what the dietrist team told me:

They do not mind the intermittent fasting as long as I get in three shakes a day. So after discussing it with them, I'm going to do a food window from 1 pm - 7 pm, having one shake at 1 pm, one shake at 4 pm and one shake at 7 pm.

That way I can contrate on work before lunch and not be too hungry during work in the afternoon, yay! ?