Chris Arroliga RN, CDE, SMC, CBN

Balsama Bariatrics Class 2

Stages 1 and 2 Post-op diet

Advocare Surgical Specialists

Washington Township - Dr.

Balsama

The Golden Rules

◼ Never eat/drink together – separate food and drink by 30 minutes

◼ Solid lean protein for life

◼ Self-monitoring

◼ Exercise

The first six weeks takes you up to about the soft food stage

Stage Protein Needs

Stage 1 Clear: 20 – 30 grams protein

Stage 2 Full: 40 – 50 grams protein

Stage 3 Soft: 60 to 80 grams protein

Stage 4 Regular: Will be calculated by the bariatric nurse

In the Hospital

◼ 4 oz cup broth

◼ 4 oz cup sugar-free Jello

◼ 4 oz juice (cranberry or apple)

◼ 4 oz decaffeinated coffee/tea

◼ Protein Jello

◼ Water

◼ Gatorade 2

◼ NO soda

Protein drinks

◼ See Protein sheet hand-out

◼ Can be ready-made or powder

◼ Mix powder in 8 oz skim milk or 12 oz almond milk or any amount of water.

◼ Guidelines for choosing a shake:

▪ Greater than 20 g protein per serving

▪ Less then 3 g of fat

▪ Less than 5 to 8 g carbs

Clear Liquids – Stage 14 to 5 days

◼ Vegetable, chicken or beef broth (should be low fat or fat free). Diluted fruit juices

◼ Sugar-free Jello®, Crystal Light® or sugar-free popsicles are OK

◼ Decaffeinated coffee or decaffeinated tea. A little skim milk is ok.

◼ Can mix powered protein with water or add water to ready-made shakes

◼ Sugar substitutes such as Splenda® or Equal® are OK to use.

◼ Beverages less then 15 calories per serving

PriorityHYDRATION

Sip on 1 oz of fluid every 10 minutes

Goal is 64 oz of fluid a day

Typical Stage 1 day

◼ 8am: 1oz water

◼ 8:10: 1oz decaf tea

◼ 8:20: 1oz crystal lite

◼ 8:30: 1oz diet Jello

◼ 8:40: 1oz protein shake

◼ 8:30: 1oz broth

◼ 8:40: 1oz Gateraid 2

◼ 8:50: 1oz water

◼ 9:00: 1oz water

Repeat every hour

any variation of the fluids allowed in

stage 1.

Vitamins

◼ Multivitamin Complete

◼ Calcium Citrate with D 1200 mg

◼ Vit B12 SL

Start supplements in stage 2 of your diet.

Full Liquids – Stage 27 to 10 days

◼ Cream of wheat or plain oatmeal (not flavored oatmeal), grits, Screamed soups like cream of chicken.. Use skim milk,

◼ unsweetened applesauce and fat-free or low-fat whipped cottage cheese.

◼ Can add EggBeaters® to boiling broth for a higher protein soup.

◼ Yogurt like Dannon Lite and Fit Greek fat-free.

◼ Condiments allowed like cinnamon or artificial sweeteners.

¼ cup (2 oz) food per meal. Have 4 meals a day and continue protein shake and fluids to stay hydrated.

Sample Full Liquid Menu

Breakfast: 8am ¼ cup oatmeal

Lunch: 12pm ¼ cup cream of chicken soup

Dinner: 4pm ¼ cup yogurt

4th meal: 8pm ¼ cup qpplesauce

In between, nurse on a protein drink and hydrate. If you can drink more then 1 oz at a time, that is

recommended.

Honor the 30/30 rule now as these are considered meals/food.

Other Sources of Hydration

◼ Anything less than 15 calories a serving

◼ Crystal light

◼ Vitamin water Zero

◼ Diet kool-aid

◼ Flavored non-caloric water

◼ Decaf beverages

◼ Gateraid 2 or Zero

Constipation

◼ Fluids

◼ Physical activity

◼ Unprocessed bran

◼ Calcium magnesium citrate

◼ Ferrous fumerate or gluconate for iron

◼ Stool softener

◼ Smooth Move Tea

FLATUS – GAS!

Causes

◼ Swallowing air◼ Lactose intolerance◼ Overgrowth of intestional bacteria◼ Intolerance to one type vs another type of

food◼ Lack of physical activity◼ Continued narcotic use

Treatment◼ Try any of the OTC products◼ May need RX like Reglan◼ May need probiotic◼ No drinking out of straw◼ No chewing gum◼ Activated charcoal◼ Beano◼ Lactaid◼ Ginger tea

Medications

◼ Diabetes

◼ High blood pressure

◼ Acid reflux

◼ Arthritis

◼ Cholesterol

◼ Heart

Must consult with PCP for adjustments

Medications to avoid

◼ Celebrex

◼ Ibuprofen/Motrin

◼ Aspirin containing products

◼ Sugar/alcohol containing medications

◼ Aleve

Tylenol is safest. Consult with the bariatric nurse if you must use.

Questions

◼ What if something gets stuck?

◼ Can I try a new food while I’m out?

◼ What if I get a stomach virus?

◼ What if I need some other surgery in the future?

◼ What if I get pregnant?

◼ What if I’m not losing enough weight?

◼ What if I start gaining weight back?

The bariatric nurse is available to answer questions like these. 856-701-8668.

Remember if there is an emergency, call the office directly, or go to the ER.

After Surgery Care

◼ Continue support groups

◼ Repeat nutrition power points

◼ Continue weigh-ins

We follow our patient for 5 years.

At 2 weeks post-op, 6 weeks, 3 months, 6 months, 12 months, 18 months and every year for the next 4.

Thank you

For any questions, call Chris at 856-701-8668 or email

Chris at Christine @drbalsama.com or Sandy at Sandy @drbalsama.com