Unlocking the Truth About Gastroparesis: How It Affects Your Weight and What You Can Do

Gastroparesis is a chronic digestive disorder characterized by delayed gastric emptying, which means the stomach takes too long to empty its contents into the small intestine. This delay can lead to a variety of uncomfortable symptoms and significantly impact a person's ability to maintain a healthy weight. While it's often associated with weight loss, some individuals with gastroparesis paradoxically experience weight gain.

What is Gastroparesis?

Gastroparesis occurs when the stomach muscles don't function properly, slowing down or stopping the movement of food through the digestive tract. Normally, the vagus nerve controls these muscle contractions. Damage to this nerve disrupts the signals, leading to delayed emptying.

Dr. Gluckman prefers the term "delayed gastric emptying" because the stomach is not paralyzed.

Causes of Gastroparesis

The exact cause of gastroparesis isn't always clear, but several factors can contribute to its development:

Diabetes: High blood sugar levels from poorly controlled diabetes can damage the vagus nerve.
Surgery: Surgeries on the stomach or vagus nerve can sometimes lead to gastroparesis.
Medications: Certain medications, such as opioid pain relievers, anticholinergic drugs, some antidepressants, and medicines for high blood pressure, weight loss, and allergies, can slow down stomach emptying. Newer weight loss medicines like semaglutide have also been linked to gastroparesis as a side effect.
Viral Infections: Viral infections, such as herpes simplex or Epstein-Barr virus, can sometimes trigger the condition. Some instances have even been linked to the recent pandemic
Nervous System Disorders: Conditions like Parkinson's disease and multiple sclerosis can affect the vagus nerve.
Eating Disorders: Anorexia or bulimia.
Metabolic Disorders: Hypothyroidism.
Idiopathic: In many cases, the cause remains unknown, termed idiopathic gastroparesis.

Symptoms of Gastroparesis

Gastroparesis symptoms can vary in severity and may include:

Nausea
Vomiting
Feeling full quickly when eating (early satiety)
Abdominal bloating
Abdominal pain
Weight loss
Heartburn
Undigested food that hardens and stays in the stomach. This food can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting.
Changes in blood sugar.

The Link Between Gastroparesis and Weight Loss

Gastroparesis can lead to unintentional weight loss due to several factors:

Reduced Appetite: The discomfort and bloating associated with gastroparesis can decrease appetite, leading to reduced food intake.
Early Satiety: Feeling full after eating only a small amount of food makes it difficult to consume enough calories to maintain a healthy weight.
Malabsorption: Delayed gastric emptying can disrupt the normal digestive process, potentially affecting nutrient absorption.
Vomiting: Frequent vomiting can lead to a loss of calories and nutrients.

In those who have restricted calories resulting in weight loss, whether in the setting of a clinically evident eating disorder or even with relative energy deficiency in sport (RED-S), movement of food and waste through the gastrointestinal (GI) tract can be slowed. The exact reason why this occurs is not entirely known though it is believed to be in part due to an attempt for the body to conserve energy during periods of low energy input. Delayed emptying of food from the stomach, also called gastroparesis, can lead to early fullness, bloating, abdominal distension, and nausea.

The Paradox of Weight Gain in Gastroparesis

Ironically, some individuals with gastroparesis experience weight gain despite their difficulties with eating. This can be attributed to:

Dietary Changes: Patients often turn to foods that are easier to digest, often those high in carbohydrates. When carbohydrates are consumed in excess, especially in a sedentary lifestyle often resulting from the fatigue and discomfort of gastroparesis, the pancreas produces insulin which then stores them as fat.
Hormonal Imbalances: The disrupted communication between the stomach and brain due to delayed gastric emptying can affect appetite-regulating hormones, which can lead to increased cravings for high-calorie comfort foods.
Reduced Physical Activity: Fatigue and discomfort can limit physical activity, contributing to weight gain.

Diagnosing Gastroparesis

Diagnosing gastroparesis involves a combination of medical history, physical examination, and diagnostic tests:

Medical History and Physical Examination: The doctor will ask about symptoms, medical history, and any underlying conditions.
Upper Endoscopy: A thin, flexible tube with a camera is inserted through the mouth into the esophagus and stomach to examine the stomach lining and rule out other conditions.
Barium Swallowing Study: This imaging test helps visualize the structure of the esophagus, stomach, and the first part of the small intestine.
Gastric Emptying Study: This test measures the rate at which the stomach empties food into the small intestine. During a gastric emptying study, a radioactive material is placed within a food (generally scrambled eggs or an egg substitute). Images of the digestive tract are taken at varying time intervals, usually with the last being 4 hours after the initial food ingestion. A radiologist will then read the images and determine what percentage of food remains in the stomach at each time interval. In those with gastroparesis, the amount of food retained at these intervals will be higher than those without delayed stomach emptying. Generally speaking, less than 10% of the food should be left in the stomach at the four-hour mark. While a formal gastric emptying study can be helpful in certain clinical settings especially where the diagnosis is not clear, they are often not necessary in those with a clinical history of restriction, weight loss, and symptoms consistent with gastroparesis given delayed gastric emptying is felt to be very common in this setting. Instead, empiric treatments can be undertaken without imaging. If symptoms linger despite traditional treatments, a gastric emptying study may then be indicated.
Blood tests: These tests check your blood counts and measure your chemical and electrolyte (mineral) levels.
Gastric manometry (antroduodenal manometry): This test checks the muscle movement in your stomach and small intestine.
Wireless capsule study: For this test, you swallow a wireless capsule (or pill). The capsule collects information as it moves through your digestive system.
Gastric emptying breath test (GEBT): This test checks stomach emptying. It measures how much carbon dioxide you breathe out over several hours after eating food.
Scintigraphic gastric accommodation: This test measures your stomach contents before and after a meal. It also checks how well your stomach relaxes after you eat food.

Managing Gastroparesis and Weight

Managing gastroparesis involves a multifaceted approach aimed at controlling symptoms and maintaining adequate nutrition:

Dietary Modifications:

Small, Frequent Meals: Eating 5-6 smaller meals throughout the day can be easier to tolerate than 3 larger meals.
Low-Fat and Low-Fiber Diet: These foods pass through the stomach more quickly.
Liquid Nutrition: Incorporating liquid nutrition can be helpful, as liquids empty from the stomach more readily than solids.
Avoidance of Carbonated Drinks: This may help reduce bloating.
Chewing Food Well: This promotes stomach emptying.

Medications:

Antiemetics: These medications help reduce nausea and vomiting.
Prokinetics: These medications help improve stomach emptying. Three different medications are commonly used and include metoclopramide, erythromycin, and azithromycin. For severe symptoms metoclopramide can be used in combination with erythromycin or azithromycin.

Surgery and Other Procedures:

Botox Injections: In some cases, injecting Botox into the pylorus (the end of the stomach) can help improve emptying.
Gastric Electrical Stimulation (GES): This involves implanting a device that delivers mild electrical pulses to the stomach muscles to help control nausea and vomiting.
Jejunostomy: A feeding tube is inserted into the small intestine to provide nutrients directly, bypassing the stomach.
Enteral Nutrition: Some patients may also require a feeding tube to get adequate nutrition. In cases of gastroparesis, the tube would be inserted into the jejunum (the small bowel), as opposed to the stomach.

Lifestyle Modifications:

Managing Blood Sugar: For individuals with diabetic gastroparesis, maintaining stable blood sugar levels is crucial.
Regular Exercise: Regular physical activity can help improve overall health and manage weight.
Stress Management: Stress can worsen gastroparesis symptoms, so finding healthy ways to manage stress is important.

To determine which treatment or treatments might work best, Dr. Gluckman believes a multi-disciplinary approach is key: âAn internist, a gastroenterologist, and a dietician should work together to address risk factors and optimize patient care,â he insists. âAnd ideally, the patient would see a GI motility specialist so they can be assessed for other conditions which often accompany gastroparesis.

Gastroparesis Life Expectancy

âIt should never affect a person's life expectancy, and it should never be fatal,â Dr.

Living with Gastroparesis

Living with gastroparesis can be challenging, but with proper management and support, individuals can improve their quality of life.

Seek Medical Care: It's very important to follow your doctorâs diet instructions. In most cases, you will be given a special diet. This will have foods that are easier to digest and pass through your stomach. You may also be given medicines to take. Follow all instructions carefully.
Find a Support System: Connecting with other people with gastroparesis can provide emotional support and practical advice.
Be Patient: Managing gastroparesis is an ongoing process, and it may take time to find the right combination of treatments.
Monitor symptoms: Contact your doctor or get medical care right away if your symptoms get worse or if you have new symptoms. Problems such as a stomach blockage or high blood sugar need to be taken care of right away.

Read also: Weight Loss Meds & BCBS

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