Gastroparesis, also known as delayed gastric emptying, is a condition where the stomach empties slower than normal. This can lead to various uncomfortable symptoms and make it difficult to maintain proper nutrition. Managing gastroparesis often involves dietary modifications and, in some cases, medical treatments. This article will explore dietary strategies, treatment options, and important considerations for individuals with gastroparesis, drawing upon insights from medical professionals and registered dietitians.
Understanding Gastroparesis
In gastroparesis, the stomach doesn't empty as fast as it should, leading to symptoms like nausea, vomiting, abdominal pain, and feeling full after eating only a small amount of food. This delayed gastric emptying can make it challenging to get enough calories, vitamins, and minerals, potentially leading to weight loss and nutritional deficiencies.
Common Symptoms of Gastroparesis
- Indigestion
- Bloated stomach
- Feeling full quickly and/or for a long time
- Upper abdominal pain
- Nausea and vomiting
- Regurgitating (spitting up) whole pieces of undigested food
- Loss of appetite
- Acid reflux and heartburn
- Blood sugar fluctuations
- Constipation
What Does Gastroparesis Feel Like?
When the stomach muscles aren’t working properly, food lingers in the stomach for an extended period after eating. This can cause a persistent feeling of fullness, even after consuming a small amount of food. Other symptoms may include a stomachache, nausea, vomiting, bloating, and acid reflux, which can manifest as heartburn.
Is Gastroparesis Painful?
The severity of gastroparesis symptoms varies among individuals. Some people experience persistent stomach pain that interferes with their daily lives. However, the intensity of pain doesn't always correlate with the severity of gastroparesis or the rate of stomach emptying. Some individuals may be more sensitive to pain due to nerve sensitization, which can be related to the underlying cause of their gastroparesis.
How Does Gastroparesis Affect Bowel Movements?
Gastroparesis slows down the entire digestive process, which can delay bowel movements. It can also result in large, undigested food particles entering the intestines, making them harder to pass. While gastroparesis doesn’t directly affect intestinal muscle movements, some underlying conditions that cause gastroparesis can also affect bowel function, leading to constipation.
Read also: Comprehensive Guide: Gastroparesis Diet
What is the Main Cause of Gastroparesis?
The primary cause of gastroparesis is damage to the nerves that control stomach muscle activity. Less frequently, the muscles themselves are damaged. This results in impaired muscle contractions that are essential for churning food and moving it through the digestive system, leading to indigestion and delayed gastric emptying.
Specific Causes of Gastroparesis
- Diabetes: About one-third of people with diabetes (Type 1 or Type 2) develop gastroparesis due to nerve damage caused by high blood sugar levels.
- Surgery: Surgery on or near the stomach can injure the vagus nerve, which coordinates stomach movements.
- Infections: Gastrointestinal infections, especially viral infections, can trigger gastroparesis.
- Autoimmune disease: Autoimmune diseases can cause the immune system to attack stomach nerves.
- Drugs: Certain medications and recreational drugs can interfere with nerve signals that activate stomach muscles. These include opioids, nicotine, marijuana, tricyclic antidepressants, progesterone, anticholinergics, calcium channel blockers, amylin analogs/GLP-1 antagonists, cyclosporine, clonidine, lithium, and antipsychotic medications.
- Other causes: Less common causes include neurological diseases, collagen-vascular diseases, endocrine disorders, and cystic fibrosis.
Complications of Gastroparesis
- Weight loss, malnutrition, and dehydration: Chronic nausea, vomiting, and loss of appetite can lead to weight loss, malnutrition, and dehydration. Hospitalization with nutritional therapy and fluid replacement may be necessary.
- Acid reflux complications: Gastroparesis can cause abdominal distension, increasing the risk of stomach acid escaping into the esophagus, leading to heartburn and inflammation (esophagitis).
- Blood sugar complications: Gastroparesis can disrupt the regular flow of food and glucose into the bloodstream, causing blood sugar levels to fluctuate. This is especially problematic for people with diabetes.
- Bezoar and gastric outlet obstruction: A bezoar is a hardened mass of undigested food that can block the stomach outlet, making it difficult for food to pass through.
Dietary Strategies for Managing Gastroparesis
While there isn't a one-size-fits-all "gastroparesis diet," making changes to how and what you eat can help ease symptoms and ensure adequate nutrition. Consulting a registered dietitian is highly recommended to create a personalized meal plan.
General Dietary Tips
- Eat Small, Frequent Meals: Eating 4-6 small meals a day, about 1 to 1½ cups of food each, can help prevent the stomach from becoming too full, which can reduce swelling and promote faster emptying.
- Eat Healthy Food First: Prioritize nutritious foods over empty calories like desserts or snacks.
- Blend Your Meals: Liquids empty from the stomach faster than solids. Blending food with water, juice, milk, or broth can make it easier to digest. This includes blending meats like fish and chicken.
- Reduce Fiber and Fat Intake: High-fiber and high-fat foods can slow stomach emptying. Aim for under 2-3 grams of fiber per meal and consider limiting fat intake to between 30 and 50 grams per day.
- Add High-Fat Drinks: Liquid fats may be better tolerated than solid fats and can help increase calorie intake if needed.
- Chew Food Thoroughly: Solid food is harder to digest, so chew food well until it has a mashed potato-like consistency before swallowing.
- Stay Hydrated: Drink plenty of water and other fluids throughout the day to prevent dehydration, which can worsen nausea. Sports drinks or electrolyte-rich beverages may be helpful if vomiting is frequent.
- Eat Solid Foods First: Try eating solid foods in the morning and switching to more liquid meals later in the day. In severe cases, a doctor may recommend an all-liquid diet temporarily.
- Sit Upright: Avoid slouching or lying down while eating. Stay upright for at least 1-3 hours after meals to reduce pressure on the stomach.
- Take a Walk: Light exercise, such as a walk after meals, may improve symptoms.
- Keep a Food Journal: Track what you eat and how you feel afterward to identify foods that worsen your symptoms.
Foods to Limit or Avoid
- Raw Vegetables: Raw vegetables can be difficult to digest.
- Full-Fat Dairy: Lactose, a sugar found in milk products, may be poorly digested. Opt for lactose-free or non-dairy alternatives.
- Fried, Fatty Foods: These can significantly slow down stomach emptying.
- Alcohol and Smoking: These can further delay stomach emptying.
- Carbonated Drinks: The extra air can fill up the stomach and cause discomfort.
- Large Amounts of Fluid: Drinking too much liquid at once can make you feel overly full.
- High-Fiber Foods: High-fiber foods can be hard to chew and may cause bezoar formations (fiber clumps that can block the stomach). Examples include:
- Raw and dried fruits (apples, berries, coconuts, figs, oranges, persimmons)
- Raw vegetables (Brussels sprouts, corn, green beans, lettuce, potato skins, sauerkraut)
- Whole-grain cereals
- Nuts and seeds (including chunky nut butters and popcorn)
- Legumes (lentils, soybeans, baked beans)
- Tough Foods: Meats like steak and roast, or anything with skin, can be difficult to digest.
- Too much fat: Limit solid foods high in fat, such as non-lean meats (sausage, hot dogs) and fried or greasy foods. Try fat-free, low-fat, or reduced-fat options.
Foods to Consider
- Starches:
- White pasta
- White bread
- Crackers
- English muffins (white)
- Quick oats
- White rice
- Low-fiber cereals (less than 2 grams per serving)
- Protein:
- Chicken, turkey, or fish (lean sources)
- Tofu
- Lean meats (beef or pork)
- Smooth nut or seed butters (1-2 tablespoons)
- Fruits (peeled, canned, or cooked):
- Applesauce
- Bananas
- Grapefruit
- Peaches or pears
- Honeydew or cantaloupe
- Vegetables (well-cooked and peeled):
- Carrots
- Zucchini
- Squash
- Peppers
- Sweet or white potatoes, peeled
- Dairy or Plant-Based Options:
- Skim milk
- Soy, rice, almond milk
- Low-fat cheese
- Pudding or yogurt
- High-Calorie Drinks:
- Fruit juices
- Sports drinks
- Milkshakes
- Protein smoothies
- Higher-fat milk (2% and whole milk, or full-fat oat milk)
- Nutritional drinks
- Water: Staying hydrated is essential.
- Low-fat foods: Easier to digest.
- Food with high protein, low fiber: Can help provide necessary nutrients without exacerbating symptoms.
Sample Menu
Here's a sample menu that incorporates gastroparesis-friendly foods:
- Breakfast:
- 1 cup cooked farina
- 1/2 cup nonfat milk
- 1/2 cup orange juice
- 1 scrambled egg
- Morning Snack:
- 1 packet instant breakfast mix
- 1 cup skim milk
- Lunch:
- 1 cup chicken noodle soup
- 6 soda crackers
- 1/2 cup applesauce
- 1/2 cup nonfat milk
- Afternoon Snack:
- 6 ounces nonfat smooth yogurt
- 1 small banana
- Dinner:
- 3 ounces baked fish
- 1/2 cup mashed potatoes with 1 teaspoon margarine
- 1/2 cup cooked carrots
- 1/2 cup nonfat milk
- 1/2 cup canned fruit, in juice
- Evening Snack:
- 1/2 cup low-fat pudding
Recipes
- Blended Meats, Fish, and Poultry: Blend with broth, water, nonfat milk, vegetables or vegetable juice, tomato sauce, or low-fat gravies.
- Blended Starches: Blend pasta or potatoes with water, tomato juice, broths, or strained baby vegetables.
- Blended Fruits: Blend with their own juices, other fruit juices, or strained baby fruits.
- Blended Mixed Dishes: Puree lasagna, macaroni and cheese, spaghetti, chili, and chop suey by adding an adequate liquid of your choice. Blend well, and strain if necessary.
- Hot Cereals: Make hot cereal with a caloric beverage instead of water (nonfat milk, soy milk, rice milk, fruit or vegetable juice, liquid supplement). Add honey, molasses, syrup, or small amounts of fat like butter or margarine for added calories.
- Fortified Milk: Add 2 tablespoons powdered milk to 8 ounces of nonfat milk. Blend until well dissolved.
- Yogurt Smoothie: Combine 1 ripe medium banana OR 1 cup canned peaches, 1 cup fortified milk, 1 cup vanilla yogurt, 1 to 2 tablespoons powdered sugar, and 1/2 cup ice cubes in a blender until smooth.
- Tropical Smoothie: Mix 1/2 cup Greek fruit yogurt, 1/2 banana, and 4 ounces orange juice in a blender until smooth.
- Peach Plus Smoothie: Mix 1/2 cup canned peaches, 1/4 cup vanilla Greek yogurt, 1/4 cup nonfat milk, a dash of vanilla, and a dash of nutmeg in a blender until smooth.
- Lactose-Free Banana Strawberry Shake: Mix 1 banana, 1/2 cup soy OR almond milk, 1/2 cup liquid nutrition supplement (such as Ensure or Boost), 1/4 cup pasteurized liquid egg substitute or egg whites or 2 tablespoons soy protein powder, and 2 or more tablespoons strawberry syrup in a blender until smooth.
- Creamy Peanut Butter Banana Shake: Mix 2 tablespoons creamy peanut butter, 1 cup chilled fortified milk, 1/2 soft banana, and 1/2 cup ice cream in a blender until smooth.
- Mexican Chocolate Shake: Mix 8 ounces chocolate liquid nutrition supplement, 1 scoop whey protein powder, a dash of cinnamon, 1/2 teaspoon vanilla, and 3 ice cubes in a blender until smooth.
Medical Treatments for Gastroparesis
In addition to dietary modifications, medical treatments may be necessary to manage gastroparesis symptoms.
GIMOTI® (metoclopramide) Nasal Spray
GIMOTI is a prescription medicine used to relieve symptoms of slow stomach emptying in adults with diabetes. It is taken 30 minutes before meals and at bedtime for 2 to 8 weeks. It is not recommended for use in children under age 18.
Read also: Managing Gastroparesis Symptoms
Important Facts about GIMOTI:
- Tardive Dyskinesia: GIMOTI can cause tardive dyskinesia, a serious side effect involving abnormal, uncontrollable muscle movements, mostly of the face or tongue. The risk of tardive dyskinesia increases with longer use and higher doses of metoclopramide. Treatment with metoclopramide should not exceed 12 weeks at a time.
- Contraindications: Do not use GIMOTI if you have a history of tardive dyskinesia, stomach or intestinal problems that could worsen with GIMOTI, a tumor that can cause high blood pressure (pheochromocytoma), epilepsy (seizures), or are allergic to metoclopramide.
- Precautions: Tell your healthcare professional about all your medical conditions, especially if you have problems controlling muscle movements, Parkinson’s disease, pheochromocytoma, kidney or liver disease, depression or mental illness, or high blood pressure. Also, inform your healthcare professional if you are pregnant or breastfeeding.
- Drug Interactions: Tell your healthcare professional about all the medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.
- Avoid Alcohol: Do not drink alcohol while taking GIMOTI.
- Side Effects: Common side effects of GIMOTI include unpleasant taste after dosing, headache, and tiredness. Serious side effects include uncontrolled spasms, parkinsonism, akathisia, Neuroleptic Malignant Syndrome (NMS), depression, thoughts about suicide, high blood pressure, and too much body water.
Other Medications
Certain medications may be prescribed to help manage gastroparesis or decrease symptoms.
The Gastroparesis Clinic
The Gastroparesis Clinic utilizes a multidisciplinary approach to improve treatment success and patient experience. The team includes gastroenterology, surgery, behavioral medicine, nutrition, and nursing.
Benefits of the Clinic
- Exposure to all available modalities to treat gastroparesis.
- Thorough evaluation of the entire gastrointestinal tract to confirm the diagnosis.
- Access to surgeons specializing in Gastroparesis related surgeries, including per oral endoscopic pyloromyotomy (POP).
- Access to registered dietitians and nutrition team.
Initial Evaluation
The initial evaluation is typically performed by a gastroenterologist and includes blood tests to look for etiologies of gastroparesis. After test results are available, a plan of care will be established based on the results. The patient will be instructed on diet, medications, and further care by the nurse coordinator.
Living with Gastroparesis: A Holistic Approach
Managing gastroparesis effectively requires a holistic approach that combines dietary modifications, medical treatments, and lifestyle adjustments. It's essential to work closely with healthcare professionals, including gastroenterologists and registered dietitians, to develop a personalized plan that addresses your specific needs and symptoms.
Diet Modifications for Gastroparesis
Gastroparesis symptoms can fluctuate, with some days being better than others. Amanda Igel, RD, LD, recommends listening to your body’s cues to guide your diet day to day. "On the worst days, you may only be able to tolerate a liquid diet. But as your symptoms improve, you can slowly start incorporating more foods," she says.
Read also: Dietary Guidelines for Gastroparesis
- Stage 1 gastroparesis diet: Severe symptoms: Stick to beverages that help you keep hydrated and maintain your electrolytes, like sports drinks and rehydration solutions (like Gatorade®, PowerAde® and Pedialyte®), bouillon, caffeine-free clear liquids, and broth. Saltine crackers can also help keep your energy up.
- Stage 2 gastroparesis diet: Moderate symptoms: Continue with stage 1 foods, and add skim-milk products, like yogurt, cheese, pudding, and custard; fat-free broth with noodles; Cream of Wheat®; vegetable juice; fruit juice; skin-free canned fruits; creamy peanut butter; and poultry, like ground turkey and chicken.
- Stage 3 gastroparesis diet: Mild and minimal symptoms: Limit your intake of fat and plant fibers. Fat and fiber are tough for your stomach to digest and result in slower emptying from your stomach to your small intestine.
Tips for Eating Out
- Review the menu beforehand.
- Plan your day's meals in advance.
- Eat half and save the rest for later.
Other Important Considerations
- Manage Blood Sugar: Uncontrolled diabetes can slow stomach emptying. If you have diabetes, keeping your blood sugar in goal ranges may decrease gastroparesis symptoms.
- Stay Active: Walking or other light exercise after meals can help increase stomach emptying and may make you feel better.
- Avoid Triggers: Identify and avoid foods and beverages that worsen your symptoms.
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