Dr Office pushing their line of food for pre-op

Absolutely nuts (IMHO). The rules were so different when I had my surgery so I can't make any suggestions other than to tell them no and that you will eat equivalent foods. Are you "required" to lose a certain amount of weight before your surgery?

Go low carb/high protein before surgery. After your DS make sure they have you following a DS diet, not counting calories and eating low fat.

I'm not required to lose weight, but the diet is suppose to shrink the liver (but I'm assuming that means losing weight, too). I've been keeping it 800 calories or less and getting at least 100g of protein a day and not going over 35-40 carbs and keeping it low fat, too. Then the paperwork says liquid only 2 days prior to surgery. Honestly, it's gotta be a money grab since the other doctor in the office owns the line of food. I just can't wrap my head around a doctor pushing their food onto their patients like that.

I don't have any experience with any of the newer protein powders...that are Rx'd.

It sounds like they are doing the in office ones as a way to make sure some people who have more money than sense stay on a set number of calories.... and make good money for the owner of said products.

. I would keep my carbs to the low level you have posted..make sure any fats are truly healthy ones like olive oil or coconut oil,a little fat will help you stay feeling full longer..and keep you from becoming constipated...the closer you can consume to 100 grams, and up to 120, protein the better off you will be.... I would defitely seek another protein shake to use during the last few days in prep for surgery...and also to have something for the first days.weeks, after surgery when the surgical wounds are healing.

Many years ago,( after a WLS,) I used sugar free hot chocolate and protein supplement to get my proteins in...with a pouch size of 45 cc...for several weeks...I would try other meats/protein sources, but this was my back up to make sure i got the protein in, so healing could happen.warm liquids were easier to get in than cold proteins...I was using a baskin robbins tasting spoon and chewing each bite 10 x to slow down eating process/per Dr orders..by the time i had eaten 3 bites everything was cold.

If you don't like it or it is a financial hardship for you, do not buy, over priced products... from anyone. Be sure to keep a tight diet diary.. complete with times, amounts, carbs, protein,calories,..so you can prove your compliance.

There is also an Organic Pea Protein and a whey protein powder swansons supplement company sells. If you get one in vanilla and do not like the taste can use unsweet coolaid to change the flavor- I used tropical punch- with some stevia powder to keep carbs low. both the organic pea and whey based ones can be mixed with milk to add protein and i like both mixed with lactose free milk.. There is also an egg ased

Stats on....whey , choc..has 100 cal, 17 g protein, total carbs 6.5mg.sodium is 40mg is from grass fed, cert. rBGH free, 15 servings per 14.8 oz../20$ I can't find the jar i had for the pea protein.( I can't use legumes now, so chickens got it.will get benefit as i eat their eggs.) but info is on website...cost is comparable to the whey..

The liver shrinking diet shrinks it, not really because of fat loss, but because the stored glycogen is dumped primarily. Glycogen is stored in the liver and muscles attached to water molecules. This is the "water weight" everyone loses on ketogenic diets. A liquid diet does it because it's low carb. A low calorie diet does it because it pushes you into ketosis, which causes you to use up the glycogen.

My major was originally biochem. what they are telling you is stupid. It's also not how any DS patient should eat post-op, either.

Well I'm not really sure what to believe anymore. I've heard so many conflicting things. It's really frustrating to turn around have hear something different all over again. :-\

Well, here's an example. If we reverse fatty liver disease caused by alcoholism it takes a minimum of six weeks. It takes far longer for obesity, because we have fatty infiltration of many organs. Two weeks of diet changes will not reverse it. Anyone who says a two week liquid diet reverses fatty liver and that's how it shrinks is incorrect.

Now, if you've been on a low carbohydrate diet, that might have done it if it was significantly engaged in prior to surgery.

As for evidence, the burden of proof is on me as I made the claim, which is fine. This article talks in more detail, but here are some non-paywall links.

What is glycogen first of all? It's, simply put, stored glucose. Glucose's form is changed into glycogen and it's stored in your muscles and liver for emergencies and for quick energy. Now, what's notable, is that it can exist in the liver in a concentration of up to 10%, and only 2% of skeletal muscle composition is. 10% of the liver is... a huge amount, and it needs to bind to water molecules to be stored. So it's like your liver is holding all your bags of groceries... you overpacked them because you want to make one trip. If someone needs something in a bag, the groceries are easy to carry and get smaller, right? So the liver is holding just 1-2 bags then with some soap and maybe ramen noodles (because no one wants those heh), and the groceries are being circulated.

That's why the liver shrinks on a low carb diet, because the body switches from using glucose as the main fuel for our cells to using fat in a form known as ketones.

The human liver stores anywhere from 100-120 grams of glycogen. Each gram of glycogen binds to several grams of water to be stored. So, that's like nearly 400-500 grams of water in some cases. 400 grams of water is equivalent to weighing 14 ounces. Thus, after two weeks of liver shrinkage, your liver may weigh nearly a pound less and is easier for surgeons to move up to dissect the stomach which lies below it.

However, don't take my word for it - this is science and is available in many forms.

Here's one: "Glycogen in muscle, liver, and fat cells is stored in a hydrated form, composed of three or four parts of water per part of glycogen associated with 0.45 millimoles (18 mg) of potassium per gram of glycogen." Source. Referenced article.

And, everyone says different things because when I was in med school, unless stuff changed, we only had one biochem course. Most doctors know very little of biochemistry unless they do endocrinology, and since most of us are on low-carb diets for months before surgery, the actual fat reduction is via that method. However, if we have been eating higher carb, the "liver shrinking" comes from burning the glycogen, because when we use up this stored glucose, we don't need to store the pounds of water it's attached to.

So how does their food shrink the liver? It is high in carbs. 6 items a day from their stuff adds up to well over 80 carbs. Isn't that a bit much? Why wouldn't low carb liquids help shrink the liver?

Just because they are marketing/selling food at the clinic does not mean you have to buy it. Many docs do this (as well as vets). Do not purchase what you do not want, no explanation required. You can also ask directly if surgery is dependent on you buying any thing, which I highly doubt is the case.

Yeah I agree! I'm going into their office tomorrow to talk to them about it. It just doesn't seem right.

Update: I talked to the nutritionist and told her I couldn't afford the food and wasn't going to buy their stuff. She finally sent me an "alternative" plan which basically says protein supplements (bars, shakes, etc..) 2 weeks before surgery (90g+ protein and 800 calories or less a day), and then 2 days before surgery, liquid supplements only. It only reinforces my thought that they are indeed trying to rake money from people because they say that anyone with a BMI over 50 has to be on their plan for 4 weeks. I was suppose to be on it for 3 weeks.

Thank you for all of the input! I appreciate it so very much.