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You might be asked to follow a liver reduction diet for two to four weeks prior to bariatric surgery. It might feel restrictive, but it’s actually for your own safety.
Adipose (fat) tissue doesn’t just build up under the skin. It also builds up deep within the abdomen around the internal organs (visceral fat). Accumulating visceral fat leads to inflammation and metabolic dysfunction that can affect multiple organs, but one of the organs most impacted is the liver.
It’s incredibly common for people living with obesity to develop excess fat within the liver, causing it to become enlarged. In fact, up to 90% of bariatric surgery candidates have nonalcoholic fatty liver disease (NAFLD), a condition characterized by fat accumulation in the liver.1 The resulting enlargement can make bariatric surgery more technically challenging.
The Dangers of Visceral Fat
Visceral fat is metabolically active. It releases hormones and inflammatory substances that can disrupt normal metabolic processes, increasing the strain on organs responsible for regulating blood sugar, cholesterol, and other essential functions. The pancreas, for example, may become less effective at regulating blood sugar.
As fat accumulates within the liver, the organ becomes enlarged and less able to efficiently carry out its responsibilities, including processing nutrients, storing energy, and filtering waste products from the blood.
When it comes to bariatric surgery, the left lobe of the liver sits over the upper portion of the stomach, where much of bariatric surgery is performed. When the liver is enlarged from excess fat, it reduces the available working space inside the abdomen, making it more difficult for the surgeon to clearly visualize and safely access the stomach. Because a fatty liver is also more fragile, it is more susceptible to injury and bleeding during surgical manipulation.
To reduce surgical risk, you may be put on a special diet several weeks before your surgery. Studies have found that low-calorie diets prescribed before bariatric surgery can reduce liver volume by an average of 16%, with most of that reduction occurring during the first two weeks.1 Although the diet can feel restrictive, its purpose is very specific: to reduce fat stored within the liver so the organ becomes smaller, giving your surgeon better visibility and more room to operate safely.
You Want Your Liver to Shrink as You Do
It can seem a little ironic. You’re preparing for surgery that’s designed to help you lose weight, yet your surgeon is asking you to follow another diet first. If you’ve struggled with obesity for years, it can feel discouraging. The difference is that this isn’t a traditional weight-loss diet. It isn’t intended to replace surgery or prove that you can lose weight on your own. It’s a temporary eating plan to shrink your liver and keep you safe.
During the first phase of the diet, anywhere from two to four weeks before surgery, we’ll recommend a combination of high-protein shakes, approved protein-rich snacks, and one “lean and green” meal each day consisting of lean protein and non-starchy vegetables. The goal is to include 80-120 grams of protein daily, as well as at least 64 ounces of water. At one week prior to surgery, the protocol will change and become a little more stringent. You’ll continue to aim for the same amount of protein and hydration, but you’ll eliminate solid foods, replacing them with protein shakes and approved hydration fluids like water, decaffeinated coffee or hot tea, unsweetened beverages, and low-sodium broths.
There is also a timing component – when you eat is just as important as what you eat on the liver-shrinking pre-op diet. Intentionally spacing meals and snacks two hours apart throughout the day provides a steady source of protein while helping patients stay satisfied and avoid long periods without nutrition. Following the recommended schedule as closely as possible and resisting the temptation to add unapproved foods or beverages maximizes the diet’s effectiveness.
Preparing for bariatric surgery is a team effort. Even if you follow a vegan diet or have food allergies or other dietary restrictions, we’ll work with you to develop an appropriate liver reduction plan that supports a safe and successful surgery. Our registered dietitians work with patients to create realistic, individualized meal plans that fit their lifestyle and nutritional needs.
The fellowship-trained bariatric surgeons at Bariatric Specialists of the Carolinas have more than 50 years of combined experience specializing in advanced laparoscopic and robotic bariatric surgery. The practice has been responsible for numerous surgical firsts in North Carolina and has performed thousands of bariatric procedures, giving patients access to a team of bariatric surgeons, registered dietitians, and nurse navigators with extensive experience in both routine and complex cases. Bariatric Specialists of the Carolinas is part of Lantern’s Network of Excellence, in which bariatric procedures for qualifying State Health Plan members are covered with no out-of-pocket cost for eligible patients.
- Romeijn, M. M., Kolen, A. M., Holthuijsen, D. D. B., Janssen, L., Schep, G., Leclercq, W. K. G., & van Dielen, F. M. H. (2021). Effectiveness of a Low-Calorie Diet for Liver Volume Reduction Prior to Bariatric Surgery: a Systematic Review. Obesity surgery, 31(1), 350–356. https://doi.org/10.1007/s11695-020-05070-6.
