Jackson’s story: “One thing I’m determined to do now is attend the British Liver Trust’s NAFLD support group.”

After being diagnosed with NAFLD, Jackson was successfully following his dietician's eating plan, but work-related stress led to him eating 'naughty things'. When his consultant suggested bariatric surgery, Jackson wasn't sure it was right for him. Thank you for sharing your story with us, Jackson 

I used to be a bit of a comfort eater and didn’t portion my food correctly. My weakness was peanut butter and I also did not bring a lot of variety into my diet.

My therapist recommended a dietician who was an absolute revelation. There was no calorie counting or calculating Syns and the meal plan recipes, such as a spinach and chickpea salad, were fresh, delicious and easy to prepare. There was a lot of variety and a huge amount on my plate which seemed too much, but because it was all low calorie I could eat as much as I wanted. I looked forward to the meals and got rid of my sugar cravings – instead of chocolate, my comfort food became a little bowl of rice, some kimchi, a pickled egg and soy sauce. I lost between two and three stone.

However, there are weak points and triggers that stop you sticking to a good diet plan and I would advise people to identify theirs. One of mine was work-related stress – I would take on too much – and worrying about it crept into my non-work time. I began to fall out of the meal plans and bought naughty things to eat. It was hard to get back into it again and I didn’t attend the British Liver Trust’s support groups either for quite a while which was bad.

I had been diagnosed with NAFLD in 2021 and my consultant immediately said he would get me a referral for bariatric weight loss surgery. To assess if I was suitable, I had three interviews over one day in the autumn of that year. The first was an education session with a nurse who explained what the surgery entails. I was then interviewed by a psychologist who asked whether I had eating disorders or food addictions because after surgery you could become addicted to something else. I also saw a surgeon who looked at my general suitability for the procedure.

In February 2022 I had a final interview with another surgeon, who turned out to be Andrew Jenkinson. He wrote a fascinating book called Why We Eat Too Much, which really opened my eyes about how the body reacts to the amount of food you put in and I was a bit starstruck when I met him! He put me on the waiting list for bariatric surgery and said it would take a year.

I was worried about the eating pattern I'd have to follow after bariatric surgery

I still wasn’t sure if surgery was right for me. Once they’d chop my stomach and sew it back smaller, there would be no going back. I’d have to take vitamin tablets every day for the rest of my life and vitamin B injections every three months because you can’t absorb vitamins with an irregular-sized stomach. I was also worried about the eating pattern I’d have to follow afterwards and the tiny quantities. Gone would be the days of fruit and vegetables being important – I was the king of salads – for a bariatric diet half the plate must be protein because it’s the most important thing for the body and it should be eaten first. Then it’s a quarter carbs and a quarter vegetables. It all sounded a bit daunting and I think I was focusing on that too much.

My therapist gently reminded me there would be many positive things to come out of the surgery. My diabetes would go into remission, I’d have a different shaped body with less weight on it and more energy. I remember also my therapist putting the decision in a more black and white way: would I want to eat in a slightly weird way for the rest of my life or would I want to have NAFLD and lose years off my life.

When put it that way there was no question – I had a potentially life-threatening condition, so I needed to do this. During the final interview I had also asked the surgeon if it was medically necessary and he said yes. So a year later when I got the call with a date for the surgery and was asked if I still wanted to do it, I replied: “Of course. Give me any date you want and I’ll take it.”

Because the liver partially covers the stomach, I had to follow a liver shrinkage diet for two weeks before the operation so they could access my stomach a bit better. Every day I had two cans of soup, three yogurts and a pint of milk and that was it. I was quite amazed that I didn’t have hunger pangs at all and lost a lot of weight.

On the day of the operation I hadn’t been allowed to eat from 2am and arrived at the hospital at 7am. The anaesthetist came and explained how the surgery would work, a surgeon then got me to sign a consent form and went through the operation. It wasn’t until 2pm, but I can sleep anywhere, so I did that rather than sit and worry.

When I got the call I walked straight into the operating theatre in my gown. There was a huge bank of machines, wires and tubes everywhere, it was amazing to see. They set me down on the bed, hooked up my veins to the equipment and injected the pain killer first. This made me feel a bit drunk, then I got the general anaesthetic and, boom, I was out. I woke up at 5pm and my parents visited me half an hour later. I could hardly speak and was very tired and groggy for a couple of days afterwards.

I spent one night in the hospital and was discharged back to my parents’ house with a month’s worth of pills that I would have to crush. I also had to wear special thrombosis socks for six weeks and give myself blood thinner injections for two weeks.

I've lost three-and-a-half stone since I started the pre- bariatric surgery diet and my hunger cravings have completely gone

In the first two weeks after the operation I had a liquid diet, the second two weeks was puree, then the final two weeks was soft food and then normal food again. I’ve lost three and a half stone since I started the pre-op diet and my hunger cravings have now completely gone. I can smell food, but it’s like I’m a robot and someone’s turned off the hunger craving circuit. It will return in time, but it’s very strange.

I’m looking forward to eating normal food again. My diet was mainly pescatarian before, but there’s quite a significant amount of protein in meat so I have to go with it. My dietician said I should stay away from red meat which I had been looking forward to, and overly processed food, but chicken and fish is fine.

I’m really looking forward to my next appointment with my liver consultant and the fibroscan to see if this weight loss will have an effect. I’m currently between stage three and four of NAFLD and it will probably go down a bit more. One thing I’m determined to do now is attend the British Liver Trust’s NAFLD support group. It offers some really good information and it’s good to share experiences with other people and hear theirs too.

Being signed off for a month after the surgery allowed me to reflect on my life and I wrote a list of the things I wanted to achieve which I’ve categorized into exercise, learning, social, travel and diet. My therapist says I sound like a different person and wants me to keep up the momentum. I do too.

I used to keep myself to myself and do virtual things online at home. Now I realise I have to go out and socialise more, make new friends and get into more social groups, maybe do a yoga class and learn Spanish as I am intending to travel to Chile. I thought about learning via an app, but a good friend said: “Go to a class!”

Jackson's earlier story - Diet plans have made a difference

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