Pre-Surgical Diets: Overkill?

Rouxful
on 2/9/12 4:38 am, edited 2/9/12 4:40 am
Okay, people. For those of us who have been through the ringer and have endured the two weeks of hell before surgery where we're chugging medical-grade, sci-fi movie slop in order to shrink our livers I'm sure you asked yourselves througout, "Is this really necessary?"

Every day I come on this forum, I see people struggling with the liquid diets their surgeons put them on. And I see the inevitable wistful reply from someone that says "Oh, well everyone's doctor is different." In my opinion, it shouldn't matter. A sleeve is a sleeve, and one would hope that your doctor is doing the procedure within some kind of medically-accepted parameter.

That being said, the goal of a pre-op diet, as I understand it, is to enter ketosis and drastically lower your glucose levels until your liver sheds various fatty deposits in order to make it easier to access your stomach with the laparoscope. As any of us dieters know, this can be accomplished through low-carbing, like Atkins. But the main difference is there's plenty of solid sources of good protein: chicken, fish, tofu, eggs, etc. Also plenty of snacks one can enjoy, like cheese, sugar free candy, and pork skins. My doctor said there are no calorie limitations on the diet, and indeed anyone who isn't used to low-carbing is going to go ketogenic, no matter how many calories they put away, so long as they cut carbs cold-turkey.

So here's the question: Why only liquids? What does it matter whether someone is getting their protein from shakes or from a grilled chicken breast? No one has ever been able to answer this question for me. And when I asked my surgeon's nutritionist, she admitted that there was no reason to keep the diet exclusively liquid, she just insisted I keep my net carbs under 30g per day and have no less than 70-80 grams of protein per day. 

On my surgery day, my liver was fine and my surgery went great. So I ask, are those who are spending two weeks without a scrap of solid food needlessly torturing themselves? 

    
HW 403 / SW 372 / CW 204 / GW 199    

LeahBea
on 2/9/12 4:55 am
VSG on 05/31/11 with
No medical basis of this... Just a thought...

I don't know about you, but I know that I ate WAY more than I ever actually needed before surgery. I stretched the hell out of my stomach. I would assume that liquids for more than a few days would give the stomach a chance to go somewhere closer to normal size again. Again, just a thought.

I did 3 weeks of liquids pre-op, and I'm thankful my surgeon made me do it. Wanna know why? Because it prepared me for the 3-4 weeks after surgery that I would be on only liquids. As most people know if they've done a liquid diet like that, the first 4 days are the worst, but once you get past that you get into a rhythm and it's not so bad. I actually kinda enjoyed liquids, there was no guess work. I knew what was allowed and what was not, no thinking required. Maybe I'm a freak, who knows?!

Just my 2 cents...

Leah
    
                                            

Ms. Poker Face
on 2/9/12 7:24 am
Totally agree with the part about preparing for after surgery.  

 

5'5"    Goal reached, but fighting regain.  Back to Basics.
Start Weight 246    Goal Weight 160    Current Weight 183

Starting size: 22, 2x
Current size: 12, L

 

vocalcoach
on 2/9/12 7:25 am - MD
I totally agree w/ LeahBea.  I found in very empowering to (for the first time in my life) have control over the food and not rely on it to "feed" my emotions for those 2 weeks!  I lost 14lbs during that 2 weeks and felt so strong physically and mentally...just my experience.  I know everyone has their own journey
    
(deactivated member)
on 2/9/12 5:03 am, edited 2/9/12 5:03 am
I did not do a two week liquid diet, but I did have to lose 10% of my body weight on a high protein, low carb, low fat diet BEFORE my doc would allow me to be scheduled. Then I had to maintain a loss until surgery day. It was not easy at all and I believe this method really prepared me for the discipline needed to be successful after surgery. I also had to go through physchological counseling to prepare for surgery.

I gained a pound before surgery and considering I had to navigate Thanksgiving and maintain, I think I did pretty well. The report was that my liver was just fine - Not fatty and small in size and easy to work around. 

I did do a one day liquid and cleansing day the day before surgery, but that was it.

I for one, was glad to have to do my pre op the way I did it. I think it prepared me well for the journey with my sleeve.
frisco
on 2/9/12 5:19 am
 
A couple things....

Overall....yes I wonder the same thing.....I feel for the folks that have to several weeks of pre-op liquids. The only main advantage I would see is that it would detox you from most any issues and give you a clear slate of sort going into post-op life..... fine OK..... Clears a few days from surgery makes sense just to clear your digestive system..... 

The other thing......a sleeve is not just a sleeve....It's not standardized....Yes..... the concept is the same......using a stapler to perform a partial gastrectomy....that's the same. I've listened to my surgeon explain many techniques he does to do "his" sleeve..... there is a lot to it. The common misconception is that they put a bougie down your throat and cut/staple around it and done.

It gets pretty involved to make the proper size, shape and get the proper contour for food flow and such. The staple cartridges are straight.....and the skill is in making a curved shape with a straight staple and when done the sleeve lies flat and not kinked or corkscrewed and uniform without any tight areas.....the most common mistake less experienced sleeve surgeons make is they get it to tight at the curve. It's a natural place for the bougie to butt up against the spine of the stomach.

So it does help to get that liver smaller cause there needs to be a lot of moving around in there to get proper angles and such. My surgeon said about a year ago he couldn't do the SIL single incision VSG with the current technologies.

All that said..... I was just told to lose 10lbs. before surgery and clears a couple days before.

frisco

SW 338lbs. GW 175lbs. Goal in 11 months. CW 148lbs. WL 190lbs.

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Rouxful
on 2/9/12 5:29 am
 This is really enlightening, and it's interesting to see the diverse responses from everyone. But I would venture to say a nice grilled chicken and broccoli dinner with a chocolate low-carb shake for dessert is a fine meal for those leading up to surgery. If these diets cut the emphasis on liquids and just focused on eating good protein and kicking out the carbs, I think a lot of people could breathe easier leading up to surgery. I wouldn't tell anyone here that "I'm right, your doctor's wrong." But I would urge anyone who is struggling with two weeks of strict liquids to ask your doctor why liquids are necessary versus simply low-carbing. Like in my case, the answer might surprise you.

    
HW 403 / SW 372 / CW 204 / GW 199    

BROOKE H.
on 2/9/12 5:49 am - WI
I had this same question and even posted about it too. I searched all over online and couldn't find a real answer. It just didnt make sense to me and my NUT agreed - it really doesnt matter as long as its low carb and high protein.

Honestly, I couldnt make it through the torture, and even had McDonalds the day before (twice!) I felt so ashamed and scared that the DR was going to open me up and close me back up because of my liver (many horror stories I have read) but nope, he didnt say a thing about it, said I did great!

I know, bad bad, but Im doing great now so I feel fine about it! :)

Surgery Date: January 16, 2012
Highest weight: 367 Surgery weight: 360  Current weight:248
Total lost = 119

 

lnbrack
on 2/9/12 6:11 am - ALPHARETTA, GA
VSG on 02/23/12
 I have heard of some people being able to do a low calorie Diet and also being able to do high protein no/low carb diet pre-op and I always wondered myself why it varies so much and their surgery is still a success ither way.I am on a full liquid diet for the next 2 weeks and I have to be honest when I say I wish i was one of the ones that would be able to do the High Protein/no carb only because I feel I could work that without a problem even if i was allowed 1 high protein meal of the day and the rest of the day Meal replacement and Liquid diet(wishful thinking).But since that's not what My Surgeon's office approved I will stick to there list and follow the rules. 
TheBiscuit
on 2/9/12 6:19 am - TX
 I asked my surgeon this and his response was:

We just want the patient to lose weight so that they shrink their liver. It is a guarantee that the patient will lose weight adhereing to a liquid only diet. If we give concessions and say you can have this and that, people are more apt to cheat and reason with themselves. "Oh, I had that steak, I can have a bite of potatoes too", and so on. It's much easier to strap a one-size-fits-all rule to everyone, so statistically, they will all achieve the goal the surgeon wants.

In my case, I had already lost 30 pounds in the month before surgery just working my butt off and eating 700 calories a day. It was HARD. My surgeon saw my work and basically told me that for people like me, the liquid diet isn't that important. We have the discipline to do the weight loss on our own. Most people, he said, do not have that kind of mindset however, and just telling them to do 2 weeks of liquids is a sure fire way to see them lose what they need to.
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