DATE: __________________________
4 Days Prior to the Procedure:
Stop Eating: Nuts, seeds, popcorn, peanut butter, fresh fruits (except bananas), salads, corn, beans.
You May Eat the Following:
- Low Fiber hot cereals (grits, farina). No Oatmeal.
- Low fiber cold cereals with 1-gram fiber/serving or less (look on the box) such as Rice Krispies, Rice Chex, Puffed Wheat.
- Dairy products, including milk, yogurt, and cheese.
- Regular pasta, not whole grain.
- White rice, not brown.
- White bread and other grain products like bagels, pancakes, waffles, French toast, but not whole grain, whole wheat, or multigrain.
- Meat, fish, chicken (skinless), eggs.
- Well-cooked or canned skinless and seedless vegetables except corn and beans.
- Bananas, avocado, canned fruit except pineapple and prunes.
When in doubt, leave it out-it’s only a few days of your life and it may prevent you from needing another procedure!
1 Day Prior to the Procedure
Light breakfast by 9 AM of egg, white bread/toast with small amount of butter/margarine but no other dairy product, clear juice if not red or purple plus any liquid listed below.
Clear liquids rest of day—no RED or PURPLE anything—drink plenty to stay well hydrated:
- Soft drinks (cola, ginger ale, Sprite, orange, etc.), Kool-Aid.
- Sports drinks with electrolytes (Gatorade/Powerade).
- Clear fruit juices (apple, white grape, white cranberry, iced tea, lemonade [no pulp]). No orange juice!
- Water, clear tea, black coffee, sugar OK, but no cream/milk/creamer.
- Low sodium broth/bouillon chicken/beef/vegetable.
- Jell-O—lemon, lime, orange—no fruit toppings.
- Popsicles, Italian Ice, no sherbet, sorbets, fruit bars.
- Clear hard candies (no fruit filling).
**NOTHING BY MOUTH 4 HOURS PRIOR TO SCHEDULED PROCEDURE**