Before having weight loss surgery, your surgeon has recommended that you follow a low sugar, reduced calorie diet for the next 14 days, it is essential you follow a special pre-operative diet for two weeks prior to having weight loss surgery. Patients will need to have a liquid diet during this time; the diet is to help shrink the liver prior to surgery. A shrunken liver during surgery gives the surgeon greater access to the exposed stomach laparoscopically, when preforming surgery and makes the surgery go easier, allowing the doctor to have more room to work around the liver.

The diet is low in fats and in carbohydrates, therefore, reducing the glycogen stores. This in returns reduces the size of the liver causing it to shrink and soften. When performing bariatric surgery the surgeon will need to lift your liver to access your stomach. Having a liver which is immobile, fatty, and heavy, will make it difficult for the surgeon to see and have access to the stomach. Following this diet you will lose weight prior to surgery, and more importantly you will reduce the size of your liver, resulting in a safer surgery.

Special Instructions
**Special Note for Patients with Diabetes
If you have diabetes and are treated with insulin or a sulphonylurea tablet (gliclazide, glibenclamide, tolbutamide, glimepiride, glipizide), you will need to adjust your insulin or medication. They will need to understand your calories will be around 800/day from the time you start this diet and medication management goal is to have less medication and not more food. For this reason please contact your Diabetes Specialist Nurse/Practice Nurse/GP/PCP before starting the preoperative diet to discuss your medication and any possible adjustments needed. It is also recommended you monitor your blood sugar closely. This diet will likely be a reduction for normal intake of carbohydrates and calories. Consult with your medical provider as needed.

**Special Note for Lactose Intolerant Patients.
If dairy products including milk give you gas, cramping, bloating or diarrhea you may be lactose intolerant. It is recommended you choose Boost Diabetic for your meal replacement choice because it is lactose free. If you choose to use a protein shake made with milk products take a Lactaid or similar lactase enzyme pill at the start of each meal containing one of these products. As you will see in the Pre-Operative diet snack choices include cottage cheese, and yogurt many lactose intolerant individuals are able to consume yogurt without experiencing gas or bloating. If you choose to eat cottage cheese it is recommended you take the lactase enzyme with your cottage cheese.

**NO CAFFINE, PEPPER, ALCOHOL, PEPPERMINT & NO OATMEAL.

** No Chewing gum with sugar or carb sweetener, breath mints, cough syrup, hard candy or cough drops they contain high amounts of sugar.

** Stop usage of tobacco products during this pre-operative diet and during the post-operative care informational you will receive.

Bariatric Pre-Operative Diet
Food Consumption
There are no caloric limitations on the liver shrinking diet. You are able to eat as much and drink as much as you like from the list of allowable things. We do suggest reasonable limits to aid in your weight loss of a maximum of 40-50 carbohydrates daily. Typical protein intake between 70-120 grams a day, through protein shakes. It is suggested you take a multi-vitamin during your pre-op diet and during post-op. Many patients have stated that Premier Protein & Unjury as being some of the better tasting shake choices.

Here is the list of Pre-Op Diet food to follow before having your weight loss surgery. You will be following something very similar to a liquid diet.

All the water you can drink
All the natural fruit juice you can drink (make sure it has No Sugar Added on the label)
Coffee or Tea (decaf only)
Low fat creamer, Skim or 1% milk, Soy milk
Sugar-free drinks only (Crystal Light, G-2 Gatorade, Diet PowerAde, Propel, etc.)
All the broth you can eat chicken or vegetable is OK
Please drink 3 Vitamin supplements per day Any Flavor is fine (with low sugar & carbs)
Diet V-8 fusion, etc.
Sugar-free Gelatin (no fruit added)
Sugar free popsicles
Sugar-free pudding
All the plain yogurt you can eat (Greek yogurt has almost double the amount of protein per serving)
We are aware this can be a challenge for many of our patients to do for the entire period of time. If you get hungry it is okay the first week to eat 4 ounces of fish, lean turkey, chicken breast, ham, roast beef, but it must be baked, broiled, or grilled (NO FRIED FOODS). The day prior to surgery attempt to drink all clear liquids such as water, broth, clear juice, Kool-Aid (sugar free), pulp free drinks, lemonade, grape juice, apple juice, broth, etc.

The Night Before your Surgery, DO NOT EAT OR DRINK anything after Midnight 12 am and we need you on a 100% Fast that day when you arrive for surgery.