Authors: Pache K M et al.
A & A Practice, 20(3):e02171, March 2026
This nonrandomized controlled trial evaluated whether adding a small amount of creamer to black coffee meaningfully delays gastric emptying compared to black coffee alone—an issue with direct implications for preoperative fasting guidelines.
Current guidelines classify coffee with creamer as a nonclear liquid requiring a 6-hour fasting period, despite limited supporting evidence. This study sought to determine whether that classification is physiologically justified.
Healthy volunteers were assigned to drink either 16 ounces of black coffee or the same amount with two standard half-and-half creamer pods. Gastric emptying was assessed hourly using ultrasound until participants reached a grade 0 antrum, indicating an empty stomach.
The results showed no clinically meaningful difference between the groups. In the black coffee group, 47% had emptied their stomachs at 1 hour, 94% at 2 hours, and 100% by 3 hours. In the coffee-with-creamer group, 42% had emptied at 1 hour, 97% at 2 hours, and 100% by 3 hours. The near-identical emptying profiles suggest that the addition of a small amount of creamer does not significantly delay gastric clearance in healthy individuals.
These findings challenge the long-standing assumption that coffee with creamer behaves like a “full” or nonclear liquid. Instead, the data suggest that small amounts of creamer may not meaningfully alter gastric physiology compared to black coffee.
However, the study has limitations. It was nonrandomized, involved a relatively small sample size, and included only young, healthy volunteers. Results may not apply to patients with delayed gastric emptying, obesity, diabetes, or other comorbidities. Additionally, only a small, standardized amount of creamer was studied, so larger volumes or different compositions could produce different results.
Despite these limitations, the study provides practical, real-world evidence that may help reduce unnecessary case delays or cancellations caused by strict interpretation of fasting guidelines.
Key Points
- No difference in gastric emptying between black coffee and coffee with small amounts of creamer
- Nearly all participants in both groups had empty stomachs by 2–3 hours
- Findings challenge current 6-hour fasting recommendations for coffee with creamer
- Study limited to healthy volunteers and small creamer volumes
- Suggests need for reevaluation of preoperative fasting guidelines
What You Should Know
This is one of those studies that directly impacts your day-to-day practice. If a healthy patient had coffee with a small amount of creamer a few hours before surgery, the physiology may not support automatic cancellation or long delays. While guidelines have not yet changed, this evidence supports a more nuanced, patient-specific approach—especially when ultrasound is available. Expect this topic to evolve as more data emerge, and be ready to rethink how rigidly we apply “clear liquid” definitions.
We want to thank A & A Practice for allowing us to summarize and share this important work with the anesthesia community.