The "science" behind the liver shrinking diet.

The Cleveland Clinic had me do a liquid diet to eliminate carbs and because I was super morbidly obese -- those who were just obese do a low carb diet and those who are only morbidly obese do low carb with liquid diet the second week.

I stuck to my liquid diet completely -- I did not cheat at all -- my liver was still enlarged but it was smaller than it had been during pre-op sonograms.  If the liver had been the same size, my surgeon might have opted to do the surgery open rather than laparoscopically. 

I believe the idea is to use up your glycogen stores in the liver, thereby decreasing its size.  It's been a long time --

I will tell you this: I lost 25 lbs in 2 weeks pre-surgery -- and I detoxed from my carb laden diet.  I learned a lot about myself, my eating and really got my mind in the game, so to speak.

I wish you nothing but success!

Thank you Kat!

I agree! I learned more about myself and my food issues during the liver shrinking diet than at any other stage of this journey.

Isn't part of it too to reduce the fat in the liver itself and make it less prone to injury along with reducing the size?  I understand livers that are full of fat become very delicate and a small poke to it can become quite an emergency if it's fatty and easily injured.  I thank my lucky stars that I only had to do a 48hr liquid fast before my surgery!

Jen

To actually reduce the size of the liver takes several months. I'm convinced that surgeons call it a "liver-shrinking diet" because they think that's easier for patients to understand, and that will make them more compliant. What a two-week pre-op diet really CAN do is use up the glycogen stored in the liver, making its surface less slippery. This makes it easier for the surgeon to manipulate it.

The catch here is that many surgeons just put their patients on a liquid diet because that's an 'easy' diet to explain. However, in order to burn the glycogen in the liver, you have to eat LOW CARB. Not all diet shakes/meal replacements/etc. are low-carb, just low calorie. Nor do they have adequate protein for someone preparing their body for major surgery.

The ideal pre-op, liver-prep diet would be a sensible number of calories consisting mostly of protein, a moderate amount of fat, and very low in carbs. No need for a liquid diet until the day before surgery---and some surgeons don't even require that.

That's interesting about burning off the glycogen stores to make the liver less slippery. Makes more sense than true liver fat reduction in such a brief time 

Man, I'm jealous of all of you -- I have to do a prE-op diet of 100% liquids only, high protein and extremely low carb (Max 6 carbs per protein drink for total of 18-24 carbs a day).  No tea, no solids, and only clear liquids except for the 3-4 protein drinks a day.

For TWO WEEKS.

Over CHRISTMAS.

It is interesting to read all the answers people had to do the "Liver shrinking" or liquid diet....I know I had to do it too before my surgery.

Now in Terminal liver failure they (The doctors) actually want me to eat more healthy carbs like oatmeal, cream of wheat, etc. The Liver is one of the main organs that processes Protein and for people with to much AST/ALT/Ammonia it just causes seizures and problems to eat the amount of protein the docs often want us to eat post surgery (RNY or D/S) it's a strange balancing game....Go figure.

Just wanted to edit to say that my liver wasn't at all slippery (or fatty) not during the RNY surgery in 2010 not during my gallbladder removal in 2011 and not now in 2015 after several liver biopsies.

Warmly,

Jackie

My surgeons office has two plans:

1) Five shakes a day for two weeks.

2) Protein powder mixed in clear liquids 

I went with the five shakes. After the first day it was fine, and really I wasn't hungry the rest of the time. I found it nice that I didn't have to deal with thinking about what to eat that day. It was also a great way to detox prior to surgery. I can't imagine trying to carb detox and all that after surgery. My guess is some don't want people doing a "balanced" low carb diet because they are dealing with people who have eating issues. Oh, I didn't like this so I used this instead. Which could totally negate what the surgeon is trying to accomplish. My office also said it helps to weed people out. Some can't stick to the diet for two weeks, so there are concerns if they would be able to stick to a long term lifestyle change. It's not that they would deny surgery, they just might require a longer supervised diet phase.

Glycogen stores get used up predominately before the body switches into a ketogenic state.  A very low calorie or low carb diet does this. The glycogen is stored in the liver and muscles attached to water molecules.  As it gets "burned" the water releases - the liver shrinks somewhat, and also you lose water weight.  This also why you lose is the infamous 5-10 lbs of water weight whenever you go on a low-carbohydrate diet.  There isn't necessarily fat reduction in the liver.