Pre-Op Liver Shrinking Diet

The Liver Shrinking Diet: Essential Pre-Surgery Guidelines for Bariatric Patients

(FOR WEIGHT LOSS SURGERY 800 – 1000 CALORIES A DAY)

Patients need to follow this liver shrinking diet for the 14 days immediately before the surgery. It will reduce the fat and glycogen stored in your liver, make the liver smaller and allow the surgeon to perform the operation safely.

This diet is ONLY recommended before surgery and should NOT be followed at any other time as it is too restrictive.

Have three meals a day and use the ‘extra’ fruit or yoghurts as desserts or as snacks.
Try to vary the foods as much as possible during the fortnight to help make sure you are getting a good range of nutrients. It may be a good idea to start having the multivitamin and iron supplement (that you are recommended to take after surgery) while you are on this restricted diet.
Do not guess weights – use scales to measure portions accurately.
No sugar, cooking oils, margarine, butter, low-fat spread, mayonnaise or sauces are allowed.
The following drinks and flavourings are allowed freely: Water, tea and coffee (using milk from allowance), low calorie squash.
A small amount of the following can be added to food if needed: salt, lemon juice, vinegar, balsamic vinegar, garlic, herbs and spices, pepper, artificial sweeteners
Include at least 2 litres (4-5 pints) of fluid a day.

Breakfast

30g non-sugar-coated and nut-free cereal e.g. porridge oats, ready brek, bran flakes, rice crispies, special K, cornflakes, shreddies, sultana bran. OR 1½ weetabix or shredded wheat OR 1 portion of fruit OR 1 diet yoghurt OR 1 small slice of bread or roll.

Lunch and Dinner

1 small slice of bread or small roll or 2 crispbreads or 100g potato (uncooked weight) – jacket, boiled or mashed with milk from allowance, or 30g (uncooked weight) of rice, couscous, pasta or noodles.

With

100g of vegetables OR cereal bowl of salad with 1 teaspoon of low-calorie dressing (no salad cream or mayonnaise)

With

Choose ONE of the following – all are cooked weights:

150g steamed or poached fish (No batter or breadcrumb coatings) OR 50g lean meat (Trim off all fat before cooking) OR 1 large egg eg poached, boiled or scrambled with milk OR 110g Quorn or Tofu OR 25g cheese eg. cheddar, brie, stilton etc. OR 50g low-fat soft cheese eg. Philadelphia light, Laughing Cow light etc. OR 75g chicken or turkey OR 100g tinned tuna/pilchards (not in oil) OR 50g tinned salmon/sardines (not in oil)

Each day also includes:

260ml (½ pint) of skimmed or semi-skimmed milk

2 portions of fruit (one of which could be swapped for a small (150ml) glass of fruit juice)

1 diet/light/virtually fat-free yoghurt or from age frais

A portion of fruit is:

1 large fruit eg. banana, apple, pear, orange, grapefruit OR 2 small fruits eg. kiwi, plum, satsuma

OR 200g strawberries, raspberries, blueberries, blackberries, rhubarb or gooseberries OR

10 grapes or cherries, OR 100g tinned fruit in juice

Preparing for bariatric surgery? Get your liver shrinking diet plan prepared by us at Smart Cliniqs by the top nutrition counselor in Delhi.

Bariatric and Metabolic Surgery Centre: Essential Components

Key Components of a Leading Bariatric and Metabolic Surgery Centre

Rising Incidence of Morbid Obesity

As the incidence of Morbid Obesity is rising day by day, more and more hospitals have started bariatric surgery programs. However, managing a morbidly obese patient is challenging in the way that obesity brings a lot more other diseases with it. Obstructive sleep apnea, Diabetes Mellitus type 2, Hypertension, and Hypothyroidism are a few of them.

Therefore it’s mandatory to set up a comprehensive management program for treating these patients in the best bariatric and metabolic surgery centre.

The decision to recommend bariatric surgery requires a multidisciplinary approach to evaluate the indications for surgery and to define co-morbidities properly.

Key Components of a Bariatric and Metabolic Surgery Centre

The surgeons at the best bariatric hospital must demonstrate the necessary training skills, experience, and leadership. The essential components of a bariatric surgical center include a Director, critical support, appropriate equipment and instruments, 24-hour qualified call coverage, continuous care, long-term follow-up care, and most importantly regular support groups. There must be facilities for data collection and maintaining a database. By collecting and sorting data, a well-maintained database would demonstrate past performance and help in directing future trends. Periodic evaluation and comparison will allow centers to develop improvement plans.

Role of the Bariatric and Metabolic Committee

There must be a bariatric and metabolic committee which is headed by the program director and includes the coordinator, clinical reviewer, and hospital administration staff. All the surgeons included in the committee must focus on quality improvement which includes a reduction in variation, standardization of practice, establishing selection guidelines, and quality improvements. This can result in decreasing rates of complications, re-admissions, length of stays, surgical site infections, etc. The committee also establishes pathways of care for pre-operative and post-operative management. All relevant staff must be educated in patient safety and complication recognition. The goal of the pathways is to prevent failure to rescue situations which means early recognition and treatment of the post-surgical complications.

Responsibilities of the Bariatric Surgical Care Coordinator

The Bariatric Surgical Care coordinator assists and reports to the director of the committee. The coordinator assists in center development, managing the accreditation process, maintaining relevant policies and procedures, patient education, outcomes and data collection, quality improvement efforts, and education of relevant institution staff. The coordinator supports the development of written protocols and education of nurses to recognize the critical vital signs required to minimize delays in the diagnosis of serious adverse events.

Data Management and Accreditation

The clinical reviewer enters data into relevant platforms. The reviewer should not be contributing to patient care to avoid bias.

The hospital must be accredited by relevant authorities to ensure that the care for metabolic and bariatric surgery patients is provided in a safe environment. In this respect, Apollo Hospitals New Delhi has been accredited by the JCI.

Certifications and Training

The director or the chief surgeon must have obtained a verification certificate to operate on morbidly obese patients by relevant governing bodies. These certificates are purely based on the volume of surgeries and quality of care and dedication to the practice. Similarly, there must be 24-hour call coverage for the patients attended by qualified persons.

The bariatric surgical nurse must obtain specialized training such as the Certified Bariatric Nurse certification.

Essential Support Services

There must be dedicated physicians, dieticians, psychologists and psychiatrists, social workers, and physical therapists.

Registered dieticians are absolutely essential for the success of any bariatric surgical center.

They do all the nutritional counseling and follow-up.

Psychologist and psychological evaluation is a must before any bariatric and metabolic procedure. These patients are often suffering from depression, anxiety, and other stress-related disorders. Psychological education, evaluation, and preparation are useful in achieving overall patient stability and emotional well-being.

Facilities and Equipment

Morbidly obese patients must feel welcome upon entering an institution. There must be appropriate furniture to accommodate them in the waiting room as well as the examination room. The plus size hospital clothes, beds wheelchairs, and floor-mounted toilets are a must. There must be dedicated beds or floors for bariatric surgical patients. Similarly, operating room tables and equipment are accordingly sized to the needs of such patients.

Critical Care and Anesthesia

The critical care support providers must be trained in identifying early signs of potential complications. The anesthesia team must be trained to give anesthesia to such patients taking care of DVT prevention and obstructive sleep apnea to name a few.

Various specialty consultants are also asked to give preoperative clearances to the patient in view of the existing co-morbid conditions.

Support Groups and Electronic Media

A pediatric and adolescent medical advisor is also a part of the team at the center. He/she operates on adolescent patients.

Support groups are designed for the patients who are in the recovery phase. These are primarily organized to take care of the medical, nutritional, psychological, and social issues experienced by the patients.

The development of electronic information media such as dedicated websites is an essential part of addressing various issues and reaching people in remote places.

Future Trends and Institutional Commitment

As more and more people are undergoing bariatric surgical procedures these days, the demand for safe treatment facilities will grow. According to Dr. Atul NC Peters, Senior Consultant and Head of Apollo Institute of Metabolic and Bariatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India, the most important element in the best bariatric surgery center is leadership from the surgeon and integrated medical staff. They require dedication, strong fundamental infrastructure, and total institutional commitment.

Importance of Protein Post-Bariatric Surgery

The Power of Protein: Essential Post-Bariatric Surgery Nutrition for Optimal Weight Loss

Protein is practically a component in each cell of our body. It is known for their ability to build and repair our tissues. Along with carbohydrates and fats, protein is also called a MACRONUTRIENT, which means the body needs a large amount of it for daily wear-and-tear activities. In your first consult with Team Bariatric, you are made familiar with the diet post-weight loss surgery, and the importance of protein is explained as a top priority.
A meal rich in protein and low in carbohydrates will help you lose weight faster, as protein makes the digestive system work harder to metabolise and digest the food. In simple words, you will burn more calories when you consume proteins.

What is your protein requirement?

Generally as per the RDA, an adult needs 50-60 grams of protein per day, but these recommendations change post your surgery. ASMBS recommends 60- 90g of protein daily, depending on their medical conditions, type of surgery, and activity level.

5 Best Sources of Protein Post-Bariatric Surgery

Meat and Poultry

This group is one of the most generous sources of proteins for you. 1 serving of 30 grams would give you approximately 7 grams of high biological value protein, which is easy to absorb by the body, and good news it is nearly free from carbohydrates. Choose only lean meats and don’t forget to remove the skin and fat.

Fish

Fish has been known to be the best source of not just protein, but also omega-3 fatty acids. 30 grams of fish would give you roughly 7 grams of protein and a good dose of healthy fats. Try flaky fish, including tuna, tilapia, or salmon.

Egg

Egg is my favorite and most versatile ingredient. One serving equals one egg or two egg whites, which gives you roughly 7 grams of proteins. Prepare eggs without added fat by using a nonstick pan. Make an omelet or scrambled eggs of whole eggs or egg whites with spinach, onions, cheese, or chicken for added nutrition.

Legumes

Dried pulses and peas, provide about 7 grams of protein in one cup. Add kidney beans (Rajmah) or chickpeas (white channa) or Black Channa to your salad or mix brown rice with peas. A mixture of rice and pulses becomes a source of complete protein. Soy and its products are another great source of protein for you.

Milk and Its Product

Dairy provides you with both calcium and protein, but choose the nonfat or low-fat options to avoid consuming too many calories. One cup of skim milk gives 8 grams of protein. Low-fat plain yogurt or curd is very good for maintaining the healthy bacteria’s in the gut and drinks made using it can be great to meet your protein and water requirements of the day. Buttermilk is your best bet. Paneer or low-fat cottage cheese can be used very flexibly.

Along with the above food items it is always recommended to include a high-quality low-calorie protein powder in your daily diet to help you meet your protein requirement.

Conclusion

It is best to discuss your protein requirements and options with your bariatric dietitian. They will help you plan your meals so that you can get the best result from your weight loss surgery. It is a very vital step towards a “new you”.

Good Luck