Blog 4- The Liver Reduction Diet and preparing for surgery

Thank you to everyone who has taken the time to read my blogs so far! Today’s blog is going to be all about the liver Reducing Diet and how I prepared for surgery! I just want to put a sidenote out there and say that what I am writing about is my own experiences. I am aware that all surgeons have different guidelines so this may only be relatable for a few people.

As previously mentioned, The Liver Reducing Diet (LRD) is a low-calorie diet plan which patients who are having either a gastric sleeve or gastric bypass must follow for at least 2 weeks prior to surgery. The plan aims to shrink the size of your liver which lies across your stomach, in order to make the surgery safer and reduce the risk of complications. As I mentioned in my last blog, if you must do the LRD, the type of plan you need to follow, and the duration of the LRD is decided on by your individual surgeon and your BMI.

I had my surgery under the Ramsay Healthcare group in the UK. When discussing the LRD with my Dietician Liz she explained there are 4 plans that can be followed, however I was only given the choice of 1 due to my BMI being over 50 prior to surgery. I also needed to follow this plan for 4 weeks prior to surgery. As found on the Ramsay health website, the 4 diet plans are as follows:

·      Option 1 (restricted food portion plan)- you are allowed to eat 100g of carbohydrates but must eat foods low in fat and moderate in protein. The calorie goal per day is 800-1000 calories and the dietician provides an example meal plan to help you stay on track.

·      Option 2 (calorie-controlled eating plan)- this plan involves calorie counting and gives you the freedom to choose what you eat. The restrictions involve 80-100g of carbohydrates per day and sticking to 800-1000 calories each day.

·      Option 3 (meal replacement eating plan)- on this plan you are allowed 4 meal replacement shakes a day plus a sugar free jelly and Bovril drink. Fluids such as water and sugar free squash are unlimited, but you should aim for two litres a day.

·      Option 4 (Milk diet)- you are allowed to drink 3 pint of milk a day. It can be flavoured with things such as sugar free crusha or used in coffee and tea.

A few pictures of myself prior to starting my weight loss journey taken in December 2021 and June 2022.

The plan I was given was the meal replacement option. I started this plan on Monday 19th September 2022 after calorie counting for the 3 weeks prior and loosing 12lbs. The night before the LRD started, we had 1 final takeaway of Papa John’s pizza. I tried to incorporate the Bovril drinks and the sugar free jellies into my diet but didn’t like the taste of them so in the end didn’t have them. My overall experience of the LRD was that it was a tough 4 weeks at points and by the end of it I was struggling to stomach slim fast and would often only have 2 shakes a day as I couldn’t face eating another one. I did however loose 22.8lbs on the LRD prior to my surgery so exceeded Mr A’s aim of losing a stone before surgery. 

These were the kind of pictures I would regularly send to Jack whilst I was doing the Liver Reduction Diet. The look on my face says it all !! I was seriously fed up but managed to make it through the diet and I am so glad that I did.

As I have already said a few times, I really want to be honest about my experiences so want to share what happened on my second week of the LRD. My younger sister came and stayed with me and Jack for the weekend and I ended up having a major meltdown and struggled for a few days. I ended up watching them eat loads of junk food and found it hard to not give in to temptation and felt desperate for something other than liquid food. I ended up going down the slippery slope of worrying that I wasn’t making the best decision and doubted whether I could cope with the dietary restrictions I would have for life following surgery. Looking back I am so proud of myself as I didn’t cave as I knew I would have been so angry and disappointed in myself and i knew I was having this surgery to change my life and that food won’t make me happy in the end , as my weight was creeping up. On reflection now being 4 weeks post op, the LRD was the hardest part of my journey so far. I will also be honest about the one day I didn’t stick to plan. On the 11th of October 2022 I was a bridesmaid at my best friend’s wedding and ate the sit-down meal with everyone. I didn’t manage to eat it all and it was the only food I ate that day. Unlike when I have previously done diets, I didn’t let myself feel guilty for eating it, instead I told myself it’s a special occasion and to enjoy it. I went straight back onto the slim fast plan the next day and still managed to lose 3.8lbs that week.

Me as bridesmaid on the 11th October 2022. I had almost lost two stone at this point.

Preparing for surgery

My surgery was booked for the 17th of October at London spire east and luckily, I was on annual leave the week before so had time to prepare for surgery. I started by making a list of things I thought I would need both whilst in hospital and afterwards. I purchased the recommended vitamins from boots (centrum chewable, liquid iron and liquid calcium) a few weeks prior to surgery and had already started them before my operation. I had to go to two different pre-op appointments. The first one was on the 06/10/22 at spire Bushey as it was closer to me. At this appointment I had an ECG, bloods taken (full blood count, liver function tests, blood group etc) MRSA swabs (as I work in healthcare), height and weight taken and lastly my observations (Blood pressure, temperature and heart rate). Unfortunately, I did have a chest infection at this point, but the nurse was confident it would be cleared up before my surgery. My second pre-op appointment was back at London spire on the 14/10/22. I had covid swabs and more bloods taken at this appointment. The nurses were struggling to bleed me but after 6 attempts I was able to go home. I did a food shop the weekend before my surgery and using the resources provided to me by Liz I picked up:

·       8 bottles of wow hydrate protein water- 4 in tropical flavour and 4 in mixed berries

·       Low sugar added angel delight- 2x strawberry and 2x butterscotch

·       Custard powder

·       Half spoon sugar

·       Skimmed milk

·       Protein yoghurts

·       Cup a soups

I also ordered some protein powders from bulk protein such as the unflavoured powder and a clear protein shake in cherry flavour which came in handy during the liquid stages post op. When discussing with Mr A about time off from work he advised that I need to be off for 6 weeks due to the nature of my job (13-hour shifts, pulling beds, lifting stuff etc) and the type of surgery. I was provided with a sick note from the hospital for the first two weeks and then my Gp provided the last 4 weeks. I discussed prior to surgery with my manager who was very understanding, and she reassured me that I would have paid sick leave. She also respected my wish for the details to kept confidential.

The things I brought prior to surgery and for the liquid diet I would be doing for 3 weeks post-op.

What did I pack for surgery?

I used recommendations from some of the people I knew who had surgery previously on what to pack for surgery. I was told I would stay in hospital for three days and two nights and this is what I packed:

·      V shaped pillow- helped me to feel comfortable when sleeping

·      Fluffy blanket- reminded me of home

·      Dressing gown- for walking around the ward

·      Slippers and slipper socks- didn’t end up wearing the slipper socks

·      Pack of high waisted knickers (5 pairs)  

·      Toiletry bag- toothbrush, toothpaste, mouthwash, face wipes, deodorant roll on & spray, sanitary towels (even though I have a coil so don’t have periods I was warned you can have some bleeding so packed these, they did come in handy), shampoo, conditioner, body wash, hairbrush, hairbands and dry shampoo.

·      Ear plugs (the clock in my room was loud and drove me mad so was a godsend haha)

·      Baby wipes- essential as I wasn’t allowed to shower until the day I went home

·      Long charging cable for phone (purchased mine on amazon for about £5)

·      2-night shirts with buttons down them- really pleased I had these as I found the hospital gowns uncomfortable, and they were ideal as I had a drain in my stomach and could poke it through the gaps in the shirt

·      Pair of baggy pjs- I ended up going home in these

·      Laptop and charger- I had a tv in my room but don’t like daytime TV so came in handy

·      Book

·      Squeezy sugar free squash bottles

·      Drinks cup with a straw- really pleased I brought this as everything must be eaten through a straw  

·      Medication I was already taking

·      Infancol- for the gas pain (I didn’t end up using this)

Most of the things I packed came in handy and I am glad that I brought them with me. I was lucky with my room as I had a private room with an ensuite bathroom so unpacked my suitcase as soon as I arrived.

I hope this blog has provided an insight into the process of the LRD diet and how I prepared for surgery including what to pack. In my next blog, I am going to talk about the surgery day and my stay in hospital, the good the bad and the ugly.

Thanks again for reading my blog! I hope it helps someone and answers some questions! Please feel free to follow me on instagram @thesleevedmidwife.

Heather AKA The Sleeved Midwife