Undergoing surgery can be a stressful experience, and ensuring your body is well-prepared is crucial for a successful outcome and recovery. A key aspect of pre-operative preparation is following specific dietary guidelines, particularly regarding fasting and consuming a light diet before the procedure. These guidelines are designed to minimize risks and ensure your safety under anesthesia.
Why Fasting is Essential Before Surgery
You've likely been given strict instructions about abstaining from eating and drinking for a particular period before your surgery. While fasting can be uncomfortable, this requirement keeps you safe and helps your procedure go smoothly. The primary concern is to prevent aspiration, a dangerous condition where stomach contents enter the lungs.
“The main risk we are trying to mitigate is something called aspiration, which is when stomach contents travel up the esophagus and then down into the lung causing injury,” says Cam Norris, MD, an anesthesiologist at University of Utah Health.
When you are under anesthesia, your body's natural reflexes, like coughing, are suppressed, making it difficult to protect your airway. If there's food or liquid in your stomach, it can easily enter the lungs, leading to severe complications. The risk is significantly lower when the stomach is empty.
Potential Risks of Aspiration
Aspiration can lead to several life-threatening complications:
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- Aspiration pneumonia: When contents of the stomach enter the lungs, it can lead to an infection.
- Hypoxia: This life-threatening condition occurs when there are low levels of oxygen in the body.
- Acute respiratory distress syndrome (ARDS): Inhaling food or drink into your airway and lungs can damage your respiratory system and make it difficult for the body to get enough oxygen.
To minimize these risks, adhering to your doctor's fasting guidelines is paramount.
Clear Liquids: Staying Hydrated Before Surgery
“We actually encourage patients to keep drinking clear liquid until two hours before surgery because it helps with hydration,” Norris says.
Clear liquids are permissible up to two hours before surgery because they are easily digested and leave no residue in the stomach. Examples of clear liquids include:
- Water
- Clear fruit juices (apple juice, white cranberry juice)
- Plain tea or black coffee (without milk or creamer)
- Clear electrolyte-replenishing drinks (Pedialyte, Gatorade, Powerade)
- Ensure Clear or Boost Breeze (not milkshake varieties)
It's crucial to avoid milk and dairy products, as they take longer to digest.
Light Meals: What to Eat and When
A light meal is considered something like plain toast with a clear liquid. Heavier meals, especially ones that are fried or high in fat, take longer to digest and therefore require more fasting time.
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Be mindful of what you eat the 24 hours before your surgery. Eat a light, well-balanced meal about 12 hours before your surgery. Consider having a protein-rich beverage such as chocolate milk, as well. Six hours before, eat about 50 grams or half a cup of carbohydrates.
What to Eat the Night Before Surgery
Eating the right meal the night before knee surgery can help ensure that your body is well-nourished and prepared for the procedure. Here are some guidelines to follow:
- Light and Balanced Meal Avoid Heavy or Rich Foods: A light, balanced meal is recommended to avoid any digestive discomfort. Avoid foods that are heavy, fried, or rich in fats and spices, as these can cause indigestion or bloating.
- Lean Protein: Include a source of lean protein, such as grilled chicken, turkey, fish, tofu, or legumes. Protein is important for muscle repair and recovery.
- Complex Carbohydrates: Include a small portion of complex carbohydrates, such as brown rice, quinoa, or whole-grain pasta. These will provide a steady release of energy and help maintain blood sugar levels.
- Vegetables: Include steamed or roasted vegetables like broccoli, carrots, or spinach for vitamins, minerals, and fiber. Avoid very fibrous or gas-producing vegetables like beans or cabbage.
- Hydration Water: Ensure you are well-hydrated, but avoid overhydrating right before bed. Drinking plenty of water throughout the day can help maintain hydration levels, but cut back on fluids a couple of hours before bed to avoid frequent bathroom trips during the night.
- Avoid Alcohol: Do not consume alcohol the night before surgery as it can interfere with anesthesia and may dehydrate you.
- Timing Eat Early: Aim to have your meal at least 2-3 hours before bedtime to give your body enough time to digest the food. This will help you sleep better and avoid discomfort during the night. Follow Fasting Instructions: Your surgeon or anesthesiologist will likely give you specific instructions about fasting before surgery. Typically, you may be required to stop eating solid food at least 8 hours before your surgery. Follow these instructions carefully to avoid complications during the procedure.
- Examples of Meals: Grilled Chicken with Quinoa and Steamed Vegetables: A well-balanced option that includes lean protein, complex carbohydrates, and fiber. Baked Salmon with Brown Rice and Asparagus: A light meal rich in omega-3 fatty acids, which have anti-inflammatory properties. Tofu Stir-Fry with Brown Rice: A vegetarian option that provides protein, fiber, and essential nutrients.
- Avoid Certain Foods High-Fiber Foods: While fiber is generally good for digestion, avoid high-fiber foods like beans, lentils, and bran, as they can cause gas and bloating. Spicy or Acidic Foods: Avoid spicy dishes or acidic foods like citrus fruits that can cause heartburn or indigestion. Sugary Foods and Desserts: Avoid sweets and desserts, which can cause fluctuations in blood sugar levels.
The Importance of Following Guidelines
Aspiration can happen with both solids and liquids, which is why it’s important to carefully follow your doctor’s guidelines for fasting from food and beverages. Not adhering to these fasting guidelines could mean delaying or rescheduling your procedure to keep you safe under anesthesia.
Emergency Situations
Unfortunately, sometimes emergencies happen, and someone may find themselves needing a surgery they weren’t planning on having that day.
“When there’s an emergency, the need for the surgery outweighs the risk of possible aspiration, so we adjust our technique to reduce the risk of aspiration,” Norris says. “We use higher doses of medications to help us place the breathing tube in 30 to 60 seconds after the patient falls asleep, instead of the standard procedure, which is to wait a couple of minutes while we help the body breathe without a breathing tube as the standard doses of medications take full effect. It may not seem like that big of a difference, but it can be the difference between aspirating and not aspirating.”
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Special Considerations: GLP-1 Medications
Norris says another important factor to consider is if the patient is taking GLP-1 medications, such as Ozempic. Since those medications prolong the amount of time food is in the stomach, patients have a different set of guidelines they must follow:
- Do not take the medication for a week before surgery
- Only consume clear liquids for 24 hours before surgery
Addressing Uncertainty: Ultrasound Checks
If you do arrive for your procedure and you haven’t quite hit the minimum fasting period, an ultrasound can check to see if anything is still in your stomach. This can help doctors make the safest decision if you’re in a gray area of being close to your recommended fasting period.
Pre-Surgery Diet: Foods to Focus On
Maintaining a healthy diet in the days and weeks leading up to your procedure can significantly aid in a successful recovery. Here’s a closer look at the best foods to eat before surgery:
Lean Protein: Protein is a key part of any pre-surgery diet, according to the American College of Surgeons. Protein is often referred to as the building block of life, because it's found in every cell, tissue, and organ in your body, according to The Nutrition Source. It also supports immune health, and the amino acids from protein-rich foods help make new blood and tissue.
According to the 2020-2025 Dietary Guidelines for Americans, adults should aim to eat 46 to 56 grams of protein per day - including the days leading up to your procedure. Some of the best protein-rich foods to eat before surgery include lean meats like chicken and turkey, fish, eggs, and beans.
Fruits and Vegetables: Fruits and vegetables are great light and nutritious foods to eat before surgery, according to Cleveland Clinic. They're full of vitamins and minerals that support your immune system, including vitamins A, B, C, and E.
You should aim to eat at least five servings of fruits and veggies every day, especially in the weeks leading up to your procedure. If your goal is to follow an anti-inflammatory diet before surgery, fruits and vegetables can help. According to Harvard Health Publishing, some notably anti-inflammatory foods are:
- Dark leafy greens like spinach, kale, and collards
- Tomatoes
- Berries
Whole Grains: Whole grains also make the list of what to eat before a surgery, according to the American College of Surgeons. They're rich in B vitamins, which can support your immune system during your recovery.
Eat at least four servings of grains per day in the weeks prior to your procedure. One serving is:
- 1 slice of whole-grain bread
- 1/2 cup cooked grains (whole-grain pasta, brown rice, quinoa)
- 1/2 cup cooked cereal like oatmeal
- 1 cup whole-grain cold cereal
Specific Guidelines by Age Group
Recommendations about when to stop eating and drinking are different for each age group.
Adults and Teenagers Over 12
For your safety, it is very important to follow instructions about eating or drinking before surgery. Adults and teenagers over the age of 12 may have solid foods and dairy products until 8 hours before their scheduled arrival time at the hospital or surgery center. Please don’t drink any alcoholic beverages within 8 hours of your scheduled arrival time. You are encouraged to drink clear liquids before surgery or anesthesia - NOT milk or dairy products - until 2 hours before the time you are scheduled to arrive at the hospital or surgery center.
Clear, see-through liquids include:
- Water
- Clear fruit juices such as apple juice and white cranberry juice
- Plain tea or black coffee (NO milk or creamer)
- Clear, electrolyte-replenishing drinks such as Pedialyte, Gatorade, or Powerade (NOT yogurt or pulp-containing "smoothies")
- Ensure Clear or Boost Breeze (NOT the milkshake varieties)
Children Between the Ages of 3 and 12
For your child's safety, it is very important to follow instructions about eating or drinking before surgery. Children between the ages of 3 and 12 may eat solid foods and drink milk or other dairy products until 8 hours before the scheduled time of their surgery or procedure. Encourage your child to drink clear liquids before surgery - NOT milk or dairy products - until 2 hours before the time of the procedure.
Babies and Toddlers Between the Ages of 6 Months and 3 Years
For your child's safety, it is very important to follow instructions about eating or drinking before surgery. Babies and toddlers between the ages of 6 months and 3 years may eat solid foods until 8 hours before the scheduled time of their surgery or procedure. Your child may drink milk, formula, or breast milk until 6 hours before the scheduled time of the surgery or procedure. Encourage your child to drink clear liquids - NOT milk or dairy products - until 2 hours before the time of the surgery or procedure.
Babies
For your baby's safety, it is very important to follow instructions about feeding before surgery. You may offer your baby formula or breast milk until 4 hours before the scheduled time of the surgery or procedure. Encourage your baby to drink clear liquids - NOT milk or dairy products - until 2 hours before the time of the surgery or procedure. Staying hydrated is good for your baby, and it's especially important in hot weather!
Clear, see-through liquids that you can offer to your baby include:
- Water
- Apple juice
- Pedialyte
Additional Tips for Preparing for Surgery
Surgery can be a traumatic event for your body, both during and after surgery. Like most serious illnesses or injuries, the right foods and nutrients can help aid in your recovery.
- "Including high protein and high carbohydrate foods prior to surgery can help prepare the body and potentially lead to a swifter recovery," she said.
- "After surgery, we also want to make sure you are getting an adequate amount of protein. A week to 10 days prior to your surgery, begin adding more high-quality proteins and complex carbohydrates to your diet. Protein aids in wound healing and can help fight infection, Crouch said.
- In addition to protein and carbohydrates, Crouch said it's important to incorporate healing foods that support the immune system. "Stress from surgery can weaken the immune system," she said.
- Arginine is an amino acid that helps the body produce protein and can be found in high-quality proteins.
- Omega-3s are fatty acids that support overall health.
- Iron and Vitamin C. In addition to boosting your immune system, Vitamin C can also help you absorb iron.
- Magnesium is known to reduce swelling, and zinc can help the skin heal from surgical wounds.
- Fiber-rich foods. Since the pain medications taken after surgery commonly cause constipation, Crouch said to start adding fiber back into your diet. Good sources of fiber include fruits, vegetables and whole grains.
- Many people experience a loss of appetite after a major surgery and don't get the proper nutrients and healing foods they need to recover. "There are always supplement options like the Boost and Ensure drinks," she said.
Important Reminders
When you are scheduled for surgery, you will hear the words “NPO” a lot. Eastern Maine Medical Center follows the guidance of the American Society of Anesthesiologists for fasting information before surgery. When you are having surgery, it is important that your stomach is empty to decrease the risk of aspirating (inhaling stomach contents into your lungs) while you are under anesthesia. You must not eat ANY solid food for at least eight hours before your surgery. In general, this means we ask you not to have anything to eat after midnight. Yes! We encourage you to drink CLEAR liquids after midnight until 2 hours before surgery. Clear liquids are easily digested, contain no bits of food particles, leave no residue, and may have color as long as you are able to see through them.
IMPORTANT! To prevent risk of aspiration and the harm it may cause, if you have eaten or had anything to drink outside of these guidelines, your surgery may need to be rescheduled. Certain procedures may require special eating and drinking instructions before surgery. For example, patients having colonoscopy, weight-loss, or bowel surgery, may be instructed to adhere to a clear liquid diet for a longer period of time. If you received special instructions from your surgeon, be sure to follow these carefully. These directions are based on your scheduled arrival time.
- Follow your doctor’s directions for taking medicine.
- Follow any specific instructions given by your doctor.
- Bring a list of your medicines with you to the hospital. Include prescription and over-the-counter medicines, vitamins and herbals.
- Remove all jewelry (including rings) and body piercings.
- Bring any forms given to you by your doctor.
- Please arrive at the hospital as directed before your surgery. It is common to be told to arrive two hours before your scheduled surgery time.
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