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Nutrition Timeline

Two Weeks Before Surgery

Pre-surgery liquid diet starts 2 weeks before surgery.

Three rules:

  1. Stop all solid, soft or pureed foods. 
  2. Only choose liquids that are listed. No other fluids are allowed.
  3. Surgery can be delayed if pre-surgery liquid diet is not followed.

Why a liquid diet?

This diet is also known as the liver shrinking diet. Your liver needs to shrink to make your surgery safer, so to do this, you must limit calories and carbohydrate to allow the liver to shrink. Your dietitian will give you your specific goals during your consult.

Meals and fluids must only consist of the following:

Water-based fluids
Water Crystal Light
MIO Dasani Water Enhancer
Sugar-free Koolaid Generic equaivalents

Fluids with carbonation, caffeine or calories are NOT allowed. Only have four to six 8-ounce servings of water-based fluids per day, between high-protein shakes.

To promote hydration, one 8-ounce decaf tea or decaf coffee per day is allowed.

Liquid meals
High-protein shakes Protein supplements

Protein supplements must include:

  • 20 to 30 grams of protein
  • Less than 5 to 7 grams carbohydrates
  • Less than 3 to 5 grams fat

Your supplement needs will be individualized with your dietitian on your visits. You can use ready-to-drink protein shakes or powdered protein, but will receive specifics on how many shakes you can mix with water, skim or 1% milk, light soy milk and unsweetened or light almond milk.

Optional snacks
8 oz. sugar-free gelatin Sugar-free popsicles Sugar-free Propel or Powerade Zero

No broth of soups allowed during this phase. No substitutions allowed.

Notes:

  • 8 oz. serving = one cup
  • Contact your dietitian if you experience vomiting or diarrhea
  • Continue taking supplements (multi-supplement, calcium and iron, if prescribed)
Next: One day before

One Day Before Surgery

Four rules:

  1. Stop drinking high protein liquid drink (no creamy shakes allowed)
  2. No red dye
  3. No caffeine, carbonation or calories
  4. Stop drinking decaf coffee and tea

Permitted fluids and foods:
Clear, low-sodium broth*
Sugar-free popsicles**
Sugar-free gelatin (no red or orange)

Choose one serving (8 oz) of these foods/fluids at least three times per day.

*Broth must be strained of any solids. You may use any type of broth (beef, chicken, vegetable), cooking stock or bouillon cubes.

**No fruit juice bars, sugar-free fudgesicles or sugar-free pudding popsicles. Popsicles must be 20 calories or less per popsicle, and no red color.

Water-based fluids

  • Water, plain or flavored
  • Sugar-free water enhancers, up to five calories per serving
  • Electrolyte drinks or water with vitamins (limit one per day)

It is very important to maintain hydration during the pre-surgery liquid diet. 

Drink at least 8 ounces between the sugar-free gelatin and/or broth meals.

No decaf coffee or tea

Clear protein drinks are optional

  • These protein drinks must contain protein from whey protein isolate. No other proteins allowed.
  • You can have these for breakfast or lunch only
Next: Midnight before

Day of Surgery

Day of surgery through three days after

Do not ingest anything by mouth after midnight on the day of surgery.

Begin sipping water and diluted electrolyte drinks as soon as possible after surgery. The nursing staff will provide further instructions. 

Clear liquids
3 oz. sugar-free gelatin Regular, clear broth*
Water, ice chips Diluted electrolyte drink**

*Three times per day, only at meal times

**Between meals only

Next: Four days after

Four Days After

Full liquids (two weeks)

NOTE: Fluids must pour easily out of a cup.

Sugar-free and non-fat milk products

Two to three ounces:

Thinned, plain or low sugar yogurt Low sugar Greek-style yogurt
Skim or 1% milk Low-fat buttermilk
Strained, low fat cream soup High protein bariatric soup mixes

Ensure there are no lumps or chunks.

RESTART high protein, low carbohydrate protein shake

  • Sip slowly over a one-hour period
  • Thin out with water or milk if needed
  • Woman: three shakes per day
  • Men: four shakes per day
  • Eight to 11 ounces, depending on goal

Refer to pages 15 & 16 for approved options.

 

Allowed between meals

Water Decaffinated coffee or tea
Bouillon or broth Sugar-free water enhancers
Non-carbonated, sugar-free drinks Sugar-free gelatin
Sugar-free popsicles under 20 calories* Sugar-free sports drinks**

* Limit two to three popsicles per day.

** Powerade ZERO, Gatorade Zero or Propel

Reminders:

  • Hydration is priority! Aim for 64 ounces daily. The first 36 ounces should be water, or other sugar-free, caffeine-free fluids.
  • After you meet the first 36 ounces, you can count other fluids such as protein shake or soups.
  • You can count about 75% of an 11 ounce shake; about 8 ounces.
  • Stop sipping when you get full.
  • Increase your protein intake by adding unflavored protein powder, plain Greek yogurt or nonfat dry milk to any food or beverage.

Frozen yogurt, ice cream and ice milk are not recommended as they are not low in protein and high in calories.

 

Next: 3 to 4 weeks after

Three to Four Weeks After

Soft proteins for 2 weeks

Try underlined foods first:

Dairy Eggs Beans Fish
Low-fat cheese Scrambled Canned low-fat refried Any white, flakey
Low-sugar Greek yogurt Hard-boiled Plain cooked  
Low-fat cottage cheese Poached    
Sugar-free pudding Fried with spray oil    

 

Deli-style meat Nut butters Tofu or soy Fruits/veggies
Chicken, ham, turkey Creamy peanut butter Tofu crumbles Canned vegetables
Roast beef Other creamy nut butter Tofu sausage Canned fruits
Egg or tuna salad   Tofu or soy grillers Pureed

Avoid hard large seeds, tough skins, corn, celery, stalks of broccoli, etc.

Use low-fat mayo, pickle juice, avocado, herbs, and spices as tolerated.

Next: 5 to 6 weeks after

Five to Six Weeks After

Regular, high protein, low carbohydrate

  • Pinkie nail-sized bites
  • Chew to applesauce consistency
  • Keep meats tender and moist
  • Utilize the "plate method"
  • Consume at least 64 ounces of fluids daily

Include a variety of fruits and veggies in your diet for fiber. Use caution with stringy veggies like celery. Consider peeling skin off produce.

Protein is priority, and starches like pasta and rice expand in your stomach. Cook rice and pasta thoroughly and then allow to sit in water until very soggy.

Use caution with "slider" foods such as crackers, popcorn, pretzels, etc.

Protein Options
Chicken*
Turkey
Dairy
Seafood/shellfish
Ground meat
Pork
Beef**
Protein shakes/supplements***

*Keep moist. Try dark meat or cook white meat in broth.

**Use caution with stringy meatsl like roast beef.

***See pre-op packet for a complete list.