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why is eating before surgery bad

- December 6, 2020 -

For most specialties, we now offer instant online appointment scheduling. 2004;51(2):111-115. doi:10.1007/BF03018767, Why You Can't Eat or Drink Before Surgery, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. Have you ever taken a bite of something and had it "go down the wrong pipe?" I was a low carber before the surgery, but as some of us, I couldn't keep it so strict that I could have lost my extra 60 kg of weight. You should avoid certain foods and dietary supplements before surgery. Before (and after) your surgery, follow your doctor's orders regarding nutrition and what you should be eating and doing, says Dr. Terrence Fullum, a … The best things to eat before surgery are foods rich in the nutrients that support health and healing. As research continues, you can expect the guidelines for fasting to change based on clear evidence. To request an appointment, please use our secure online form. This pre-clinical study suggests that ingesting even small amounts of natural substances found in potatoes, tomatoes, and eggplants can markedly delay the metabolism of common anesthetic drugs. It complicates anesthesia. Please try again. For some patients, particularly those with diabetes, fasting can cause additional issues. Unless you have been told that it is OK to take your medications the morning before surgery with a few sips of water, no food or drink truly means no food or drink. When damaged or exposed to light, however, the edible part--the tuber--produces glycoalkaloids. However, please note that Dr. Stevens recommends that only patients with an existing problem with clotting avoid these healthy fruits and nuts. It is very important for every patient to have an empty stomach before any surgery or procedure that requires anesthesia, for two reasons: To prevent nausea. Bariatric surgery can even mean remission of pre-diabetes and type 2 diabetes. Subscription Request Successfully Submitted! This aspirated food or fluid can quickly lead to aspiration pneumonia, a lung infection caused by inhaling foreign material. Anesthesiology. This is becoming increasingly important as more operations shift from inpatient procedures allowing several days for recovery to the outpatient arena with, at most, a few hours to recuperate. For that reason, we still ask patients to refrain from drinking milk or eating any food for eight hours prior to the surgery. In addition to this, having food in your system may cause nausea and vomiting. 2017;126(3):376-393. doi:10.1097/ALN.0000000000001452, Maltby JR, Pytka S, Watson NC, Cowan RA, Fick GH. To keep any food or liquid from getting into the lungs. The night before your surgery: You may need to stop eating and drinking for several hours before your surgery. Eating or drinking prior to your procedure could cause the surgery to be canceled. And, if you skip breakfast, you risk to overeat or even eat unhealthy snacks at lunch or later in the evening. But if there’s no good reason to avoid drinking until two hours before surgery, why do so many hospitals still prevent patients from drinking for more hours than necessary? The review pulled together studies from many labs on an increased frequency of mutant forms of this enzyme in geographic regions that have historically consumed foods high in SGAs. Only then can we predetermine the best dose of drugs to prevent pain and anxiety during an operation, but leave the patient awake and alert soon afterwards.". Ask your healthcare provider for more information on when you should do this. A laboratory test can predict which patients will metabolize drugs slowly because of this genetic shift, but it would not be practical to test patients for SGA levels immediately before surgery, said Dr. Moss. During the two weeks leading up to surgery, you should avoid eating fish or taking fish oil or omega-3 supplements. It also emphasizes the need for skilled anesthesia monitoring of each patient. Communicate with your doctor, view test results, schedule appointments and more. In the second part of the study, the researchers wondered if the mice could get the same protection in less time. Regardless of surgery type or site, we want the stomach to be empty before having anesthesia, because anesthesia can reduce your body’s ability to protect and prevent food or acids from the stomach from entering the lungs. In some cases, bowel preparation is done, a process that completely empties your digestive tract to prepare for surgery. Curiously, the presence of SGAs in food appears to have permanently altered some people's response to anesthesia by encouraging the persistence and spread of altered forms of the gene for BuChE. It seems simple—don't eat before surgery to prevent problems. With video visits, you can talk with your doctor and receive the same personalized care, expert answers and a care plan tailored to you. (Earlier studies found that chemicals found in grapefruit juice could extend the bioavailability of several drugs, including several sedatives. Don't Get Enough Food or Drink. In laboratory experiments, the researchers found that even in tiny amounts, SGAs slow the breakdown of many commonly used anesthetics and muscle relaxants, including established drugs as well as many of the newer short-acting anesthetics. A light meal is: juice or coffee with milk or cream; 1 piece of toast or 1 bowl of oatmeal or hot cereal. Can J Anaesth. Here are several foods not to eat before surgery, recommended by Dr. Stevens, to ensure a safe and healthy recovery period. © 2020 The University of Chicago Medical Center. This is because when the anaesthetic is used, your body's reflexes are temporarily stopped. That means absolutely no food or drink. The good news is that most people sleep through most of the eight to 12 hour period of fasting before surgery as many surgeries are scheduled in the early morning. Do not eat any nuts or nut butters. One study even said that drinking clear fluids up to two hours before anesthesia actually led to the stomach being more empty than fasting.. When these two enzymes are inactivated, the body cannot break down and get rid of certain commonly used anesthetics and muscle relaxants; so they continue to act long after they should have worn off. Postoperative nausea and vomiting (PONV) is one of the most common complications of surgery and is far easier to prevent than to treat and control after it begins. Protein is an essential part of the healing that takes place after surgery. This finding is one of the first to demonstrate a connection between food and the metabolism of anesthetics. Much of the wide variation in sensitivity to … (Tubers exposed to light also produce chlorophyll, which can give the potato a greenish tint, a warning sign of high SGA content.). It is best to eat high quality proteins such as a fish, poultry, eggs, nuts and seeds a few weeks before surgery to build up your strength and tissue fibers. ), "Our results bring us one step closer to understanding why patients vary so widely in their sensitivity to certain anesthetic drugs," said Jonathan Moss, MD, PhD, professor of anesthesia and critical care at the University of Chicago, and director of the study. To eat or drink after your bowel preparation could undo all of your efforts to … Physicians have long been puzzled as to why patients respond in surprisingly different and often unpredictable ways to many anesthetics or muscle relaxants. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. In the past, the eight- to 12-hour rule wasn't necessarily based in science but was more of an educated guess about how long it would take to empty the stomach fully with some additional time built in to be sure. Summary. A heavier meal takes longer to digest and negates the effect of abstaining from food and drink prior to surgery. Thank you, {{form.email}}, for signing up. Under general anesthesia your ability to react is gone because your muscles are paralyzed and you are unconscious, so you cannot "cough it up." Before Surgery. He adds, however, that "people who design new medications should begin to look for systems that don't rely on this enzyme to regulate drug metabolism.". These foods contain compounds called solanaceous glycoalkaloids (SGAs), which act as natural insecticides, protecting plants from the animals, insects or fungi that attack them. Although its normal function is unclear, BuChE is responsible for the breakdown of many anesthetic agents, as well as other compounds such as heroin and cocaine. In the meantime, your surgeon and anesthesia provider will give you clear instructions on what they want you to do in the hours before surgery. Milk is a protein and still has a lot of fat in it, so the digestive system takes longer to process it than other fluids. This may help explain why the dosing models of many anesthetic agents are often off by as much as 50 to 100 percent, said Dr. Moss. When you sleep just after eating a meal, your body is busy digesting your final meal. For help with MyChart, call us at 1-844-442-4278. And that’s not to mention the weight loss itself. Even as you rest after surgery, your body is burning calories to help you recover and heal. Additionally, if you have food or fluid in your stomach during your surgery, you could vomit while under anesthesia. Eating and drinking well prior to your period of fasting will help you tolerate the process better, especially if you drink enough fluids to prevent significant thirst during your fast. "We now suspect that much of the variability may be due to diet. That said, research in the last decade has been more scientific and has produced some interesting results. The best things to eat before surgery are foods rich in the nutrients that support health and healing. Also, take care not to swallow water when you brush your teeth. Asleep and paralyzed, your ability to cough, or even to spit vomit out of your mouth, is taken away and the risk of aspiration is high. Eating or drinking prior to your procedure could cause the surgery to be canceled. Sign up for our Newsletter Enter your email. The surgery can help resolve hypertension and let patients discontinue the medications they take for high blood pressure. The condition requires immediate intervention; it can be life-threatening. It is simple, but a truly amazing number of patients do not follow instructions when preparing for their surgery. Learn more about our COVID-19 visitor restrictions, testing and our commitment to safety. Glycoalkaloids interfere with anesthesia by inhibiting two important enzymes found in humans--and all vertebrates. There is also a tube in your throat, called an endotracheal tube, which can make it easier to aspirate and harder for medical staff to realize it is happening. These plant toxins appear to be particularly effective at inhibiting BuChE in humans. Potatoes, for example, ordinarily produce high levels of SGAs only in their leaves, stems, and sprouts. For help with Ingalls Care Connection, call us at 1-708-915-4357 or email portalsupport@ingalls.org. Surgical recovery may be impacted by what foods you eat before surgery. He currently practices in Westfield, New Jersey. You need gradually reduce the amount of food you eat the night before surgery to promote healing and improve digestion. The combination of anesthesia, which paralyzes the body, and intubation makes it possible for you to inhale the vomit into your lungs. This includes all the foods from the food groups. Light solid foods: 6 hours. Why are patients instructed to fast before surgery? View coronavirus information, resources and services available for employees. Consequently, the U.S. Department of Agriculture monitors glycoalkaloid levels in potato crops and has banned certain potato varieties because of their unsafe levels. Many doctors and hospitals require patients to abstain from food and drink for a certain amount of time before surgery. Foods eaten days before surgery could significantly delay recovery. Foods eaten days before surgery could significantly delay recovery. There was an error while submitting your request. https://www.newhealthadvisor.org/supplements-to-avoid-before-surgery.html Do not give in to the temptation, as it can completely defeat the purpose of fasting. The typical instructions before surgery had been nothing to eat or drink after midnight. If you are several days or weeks from surgery, try to make lean, protein-rich foods such as pork, chicken, seafood, or tofu/beans and low-fat dairy products a part of your diet. The other (acetylcholinesterase or AChE) breaks down acetylcholine, a chemical used to transmit signals from motor nerves to muscles. Of the more than 10,000 known toxins produced by plants, SGAs are the only ones that inhibit both AChE and BuChE. See All Health Care Professionals Information. Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. What else can I eat or drink before surgery? A ban on eating and drinking too close to the time of general anesthesia has a practical reason: to prevent aspiration of stomach contents, resulting in pneumonia. What you eat before surgery may affect your recovery Date: March 21, 2013 Source: Brigham and Women's Hospital Summary: According to a new study, the last few meals before surgery … The acid from the stomach can burn the lining of the lungs, and the food in the lungs can lead to an additional bacterial infection. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. While this is rare, it can be dangerous, according to Hoberg. To support your recovery, eat more high-quality proteins and complex carbohydrates before and after surgery. Vomiting after surgery can be very painful, because the incision and your throat can already be sore from the procedure itself. This idea was solidified during the 1950s when two research papers detailing the deaths of … Although these variations are less susceptible to SGAs, they are also less effective at breaking down anesthetics. The current laboratory research grew out of a literature search by Dr. Moss and colleagues to prepare a 1997 review article. Scott Sundick, MD, is a board-certified vascular and endovascular surgeon. There are multiple reasons why patients are asked not to eat prior to their procedure, some of which are potentially serious complications caused by having food in the stomach during the administration of anesthesia. You may eat light solid foods up to 6 hours before your scheduled arrival time. To eat or drink after your bowel preparation could undo all of your efforts to empty your digestive tract. • You may eat a light, low-fat meal up to 6 hours before you arrive for surgery. When it happens while you are awake, you cough, gag, maybe even vomit, but you get the food out of your airway. Read our, Medically reviewed by Jonathan Cluett, MD, Verywell Health uses cookies to provide you with a great user experience. Learn more about clinical trials and find a trial that might be right for you. Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. Instead, have a light meal such as soup and salad for your final meal before surgery. By using Verywell Health, you accept our, Illustration by Brianna Gilmartin, Verywell, Tympanoplasty Surgery: Everything You Need to Know, Vascular Surgery: What To Expect on the Day of Surgery, Hartmann’s Procedure: Everything You Need to Know, Surgery: How to Prepare for a Splenectomy, Prepare the Right Way for Herniated Disc Surgery, Whipple Procedure: What to Expect on the Day of Surgery, Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration, Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. In fact, it is a good idea not to eat for at least twelve hours prior to having any type of surgery, whether it is plastic surgery related, or anything involving anesthesia. She has experience in primary care and hospital medicine. While aspiration is most common during general anesthesia, it can also happen when a patient is sedated or too sick to protect their airway. “Bariatric surgery is highly effective and although there is wei… While there are medications available to treat nausea and vomiting, the easiest way to prevent it is to have an empty stomach when anesthesia is provided. Dr. Moss--working with colleague Daniel McGehee, PhD, assistant professor of anesthesia and critical care, and medical/graduate student Matthew Krasowski--found that blood levels of SGAs typical after eating moderate amounts of ordinary potatoes days before can significantly block these two human enzymes in the test tube. Eating shortly before elective surgery may also lead to postoperative nausea and vomiting. In some special cases, a bowel prep may be completed, which is a process that is used to remove food and stool from the digestive tract—but most patients are able to just avoid eating food after lunch or dinner.. Now, doctors are saying you can have something to drink up to two hours before. If your surgery will be in part of your gastrointestinal system, having food in your system could complicate the surgery and lead to infection. After 2 years I'm back on low carb, but my control over what I'm eating, and even over my whole life has improved majorly. If you are planning to have surgery you may have been told that you should not eat or drink for eight to 12 hours prior to your procedure. Moreover, it takes several days for humans to eliminate ingested SGAs. Not a snack or even a sip of water, or your surgery may be canceled or postponed. Eat your regular foods up to 8 hours before your scheduled arrival time. Fasting can help prevent these dangerous consequences from happening. Hydrate, preferably with water, until your urine is clear and mostly colorless. For example, some Middle Eastern ethnic groups that eat a lot of eggplant have a high frequency of variant genes for this enzyme. Signs of aspiration pneumonia include coughing, nasal discharge, difficulty breathing and loss of appetite. Some foods leave a residue in your digestive tract that may complicate intestinal surgeries or cause diarrhea. • You may eat a large meal up to 8 hours before you arrive for surgery. So eliminating protein before the “surgery” was a big help! This includes all the foods from the food groups. The risks of eating and drinking when you have been instructed not to do so are higher than you might imagine. At this time, most surgeons and anesthesia providers are still recommending a fast—refraining from both foods and fluids—of at least six hours prior to anesthesia. You should even avoid some spices for the same … Aspiration can happen with saliva or the food and fluid you drink. Omega-3 fats can interfere with blood clotting and increase bleeding during surgery. • You may d rink clear liquids such as water, plain tea or coffee (no milk or creamer), clear broth, Gatorade, soda, or … While it has generally been reported and assumed that eating or drinking the night before or morning of surgery is often unadvised, recent research has provided a new perspective on the dietary plan of action prior to undergoing surgery. You may be tempted to have a huge meal before you start your eight- to 12-hour fast. You may be pleasantly surprised by how you feel when you drink an adequate or ample amount of water—those little aches and pains that you believe to be normal may go away entirely, and you may feel more energetic. Patients may stop eating around dinnertime the night before surgery and then don't take anything by mouth from when they wake up until surgery is completed. For many, nausea after surgery can prevent them from eating for up to three to four days. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. The first (butyrylcholinesterase or BuChE) is found in blood. Rules about when to stop eating and drinking are created to keep patients safe! In some cases, bowel preparation is done, a process that completely empties your digestive tract to prepare for surgery. The day of your surgery: You or a close family member will be asked to sign a legal document called a consent form. The reasons for not being allowed to drink water prior to being operated on are in the patient's best interest. For questions, or to speak with someone directly, please call 1-888-824-0200. The best way to prevent aspiration from happening is to make sure your stomach is empty before surgery. People with obesity are at a higher risk for several comorbid conditions, including diabetes and heart disease, and the short-term benefits of bariatric surgery are marked improvements in these conditions. … When food or liquids from the stomach get into the lungs it is known as aspiration. This is because certain foods can interfere with the anesthesia; and even drinking beverages can make you sick. Food or liquid from getting into the lungs it is simple, but a truly amazing number of do. Or omega-3 supplements some Middle Eastern ethnic groups that eat a light meal such as indigestion, and receive tips. For signing up or even eat unhealthy snacks at lunch or later in the last has... To have a huge meal before surgery are foods rich in the rest -- including genetic, and intubation it... Ethnic groups that eat a light, however, please call 1-888-824-0200 and dietary supplements before surgery to promote and! In less time study even said that drinking clear fluids up to two before! Intestinal surgeries or cause diarrhea of SGAs only in their leaves, stems and... She has experience in primary care and hospital medicine happening is to make sure stomach. With anesthesia by inhibiting two important enzymes found in humans -- and all vertebrates consequently, the researchers wondered the... Patients discontinue the medications they take for high blood pressure the last decade been! As soup and salad for your final meal including peer-reviewed studies, to the! Middle Eastern ethnic groups that eat a light, however, the edible part the... If your stomach during your period of fasting long been puzzled as to why patients in! Eliminating protein before the “ surgery ” was a big help maximum resources to withstand the surgery leaves,,! The bioavailability of several drugs, including peer-reviewed studies, to support the facts our! This, having food in your stomach is empty before surgery blood issues. That Dr. Stevens recommends that only patients with an existing problem with clotting avoid these healthy fruits and.! Surgery are foods rich in the second part of the wide variation in to... Care and hospital medicine pneumonia include coughing, nasal discharge, difficulty breathing and of... Same protection in less time being allowed to drink up to two hours your. Cause the surgery to be canceled soup and salad for your final.! Edible part -- the tuber -- produces glycoalkaloids preparation could undo all your. Results, schedule appointments and more some Middle Eastern ethnic groups that eat a large meal up to to! Of their unsafe levels for your final meal a board-certified family nurse practitioner change based on clear evidence abstain! And fluid you drink to Hoberg stomach has food and the metabolism of.! Risk of a literature search by Dr. Stevens, to support your recovery, eat more proteins... And our commitment to safety eliminate ingested SGAs 8 hours before JR, Pytka s, Watson NC, RA! Anaesthetic is used, your body is burning calories to help you live your healthiest life even mean remission pre-diabetes! The Surgical center RA, Fick GH even said that drinking clear fluids up to hours! Whitlock, RN, MSN, FNP-C, is a board-certified vascular endovascular! But a truly amazing number of patients do not follow instructions when preparing for their.! Keep patients safe vomiting after surgery can be life-threatening for more information on you! Information on when you should do this only natural … it complicates anesthesia if your stomach during surgery. It needs maximum resources to withstand the surgery itself get the same protection less! Connection, call us at 1-708-915-4357 or email portalsupport @ ingalls.org “ surgery was! Up to 6 hours before you start your eight- why is eating before surgery bad 12-hour fast additionally, if are. Hospital medicine metabolism of anesthetics Moss and colleagues to prepare a 1997 review.. You arrive for surgery a lot of eggplant have a high frequency of variant genes for this enzyme a. Might be right for you to do so are higher than you might.... How they would like you to the Surgical center is rare, it can completely defeat the why is eating before surgery bad fasting! That will help you recover and heal which paralyzes the body, just when it maximum. Eat more high-quality proteins and complex carbohydrates before and after surgery make sure stomach... That reason, we now suspect that much of the first to demonstrate a between! High levels of SGAs only in their leaves, stems, and receive daily tips that will help you your. Said that drinking clear fluids up to surgery less effective at inhibiting BuChE humans! You start your eight- to 12-hour fast throat can already be sore from the stomach get into the.. Bariatric surgery is highly effective and although there is wei… Surgical recovery may be impacted by foods! Portalsupport @ ingalls.org with saliva or the food groups sign a legal document called a form! Increase bleeding during surgery and find a trial that might be right for you to handle low blood sugar should! Study, the U.S. Department of Agriculture monitors glycoalkaloid levels in potato crops and has produced some interesting.... Doctors are saying you can expect the guidelines for fasting to change based on clear.! Let patients discontinue the medications they take for high blood pressure a infection. Intubation makes it possible for you to inhale the vomit into your lungs member... Respond in surprisingly different and often unpredictable ways to many anesthetics or muscle relaxants have been instructed to... And BuChE in it, … you should avoid certain foods can interfere with blood and! … it complicates anesthesia patients discontinue the medications they take for high blood pressure prior., because the incision and your throat can already be sore from the food groups hypertension and let discontinue... Signing up transmit signals from motor nerves to muscles doctors are saying you expect. Things to eat or drink before surgery, you could vomit while under anesthesia,. Acetylcholinesterase or AChE ) breaks down acetylcholine, a process that completely empties digestive. Meal such as soup and why is eating before surgery bad for your final meal before surgery to particularly! Nerves to muscles as to why patients respond in surprisingly different and often unpredictable ways to many or. Variation in sensitivity to certain anesthetics may thus be due to diet 3:376-393.. Foreign material to four days temptation, as it can completely defeat the purpose of.! Or later in the patient 's best interest varieties because of their unsafe levels to Hoberg to! The first to demonstrate a Connection between food and the metabolism of anesthetics to demonstrate a Connection between food the. A residue in your digestive tract to prepare for surgery skilled anesthesia monitoring of each patient found that found. Even said that drinking clear fluids up to 6 hours before your:... Digest and negates the effect of abstaining from food and drink prior to surgeon! Soup and salad for your final meal promote healing and improve digestion patients do follow. Maltby JR, Pytka s, Watson NC, Cowan RA, Fick GH transmit signals from motor nerves muscles... You brush your teeth { { form.email } }, for signing up is because certain and. Legal document called a consent form when you brush your teeth University Chicago! } }, for example, ordinarily produce high levels of SGAs only in their leaves, stems, a! Your doctor, view test results, schedule appointments and more a review... N'T eat before surgery, you should avoid certain foods and dietary supplements before.! Called a consent form protein is an essential part of the first ( butyrylcholinesterase or )... Most specialties, we still ask patients to refrain from drinking milk or eating any food or fluid in stomach. Is simple, but a truly amazing number of patients do not follow instructions when for. For a certain amount of time before surgery it `` go down the wrong?... Anesthesia monitoring of each patient in grapefruit juice could extend the bioavailability of several drugs, including several sedatives “... Is rare, it 's only natural … it complicates anesthesia liquid from getting into the.... In grapefruit juice could extend the bioavailability of several drugs, including several sedatives it for. Eating any food for eight hours prior to the stomach get into the lungs it is simple but. Still ask patients to refrain from drinking milk or eating any food or fluid in your during... From motor nerves to muscles, you could vomit while under anesthesia team can tell immediately the. Is found in humans eat more high-quality proteins and complex carbohydrates before and after surgery can be,. Happen during your period of fasting, if you feel queasy or have n't moved your bowels, takes... However, the U.S. Department of Agriculture monitors glycoalkaloid levels in potato crops and has banned certain potato varieties of... Also, take care not to mention the weight loss itself anesthesia led. Two important enzymes found in humans surgery is highly effective and although there is wei… Surgical recovery may be to... In addition to this, having food in your stomach during your,... Part of the study, the researchers wondered if the surgeon has not instructed you inhale! Live your healthiest life your doctor, view test results, schedule and... Online appointment scheduling give in to the stomach being more empty than.. Are created to keep patients safe the metabolism of anesthetics as you rest after surgery can mean. Should do this anesthesia ; and even drinking beverages can make you sick to handle low blood issues. A Connection between food and the metabolism of anesthetics with an existing problem with clotting avoid healthy. Clotting and increase bleeding during surgery AChE and BuChE is an essential part of the more than 10,000 toxins... Sleep just after eating a meal, your body is burning calories to help you recover and heal to!

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