Gastroparesis, also known as delayed gastric emptying, is a chronic condition where the stomach takes too long to empty its contents into the small intestine, despite there being no mechanical obstruction. In healthy individuals, stomach contractions crush ingested food and propel it into the small intestine for further digestion and nutrient absorption. When these contractions are slowed or don't function properly, gastroparesis occurs. This article will provide a comprehensive overview of gastroparesis diet guidelines to help manage symptoms and maintain adequate nutrition.
Understanding Gastroparesis
Gastroparesis disrupts the normal digestive process. Symptoms of gastroparesis can range from mild to severe and can significantly impact a person's quality of life. Common symptoms include:
- Feeling full shortly after starting a meal (early satiety)
- Nausea
- Vomiting
- Belching
- Bloating
- Abdominal pain
- Weight loss
- Regurgitation
Certain foods and beverages, such as fatty foods and carbonated drinks, can exacerbate these symptoms.
Causes of Gastroparesis
Several factors can contribute to the development of gastroparesis, with diabetes being one of the most prevalent causes. Other potential causes include:
- Post-surgical complications following stomach surgery
- Bacterial or viral infections
- Certain medications, including narcotics and antidepressants, which can delay stomach emptying
Diagnosing Gastroparesis
Several diagnostic tests are available to determine if a person has gastroparesis. These tests help measure the rate at which the stomach empties. Common diagnostic methods include:
Read also: Comprehensive Guide: Gastroparesis Diet
- Gastric Emptying Study: This test involves consuming a small amount of radioactive material mixed with food. Imaging equipment then tracks the rate at which the stomach empties. This is the most commonly used test.
- 13C Spirulina Gastric Emptying Breath Test: This non-radioactive test evaluates for gastroparesis by measuring the amount of carbon dioxide exhaled after consuming a spirulina-containing meal.
- Wireless Capsule System (SmartPill®): This involves swallowing a capsule containing a small electronic device that records information as it travels through the digestive system. The data is transmitted to a receiver worn on the waist, and the capsule is eventually passed in the stool.
Initial Treatment: Dietary Modifications
The initial approach to managing gastroparesis often involves dietary modifications aimed at alleviating symptoms. A physician may recommend the following:
- Eating frequent, small meals
- Avoiding fatty, spicy, acidic, and high-fiber foods
Gastroparesis Diet: A Three-Step Approach
The gastroparesis diet is structured in three steps to gradually reintroduce foods while minimizing symptoms. The primary goals are to reduce symptoms and maintain adequate fluids and nutrition.
Step 1: Liquids
This initial phase focuses on liquids that are easily digested and leave the stomach quickly. This step is crucial for preventing dehydration and maintaining electrolyte balance. It's important to note that this step is not nutritionally complete and should not be followed for more than three days.
Recommended:
- Plain saltine crackers
- Gatorade & soft drinks (sipped slowly throughout the day)
- Fat-free consommé and bouillon soups
Step 2: Introduction of Low-Fat, Easily Digestible Foods
This step introduces additional calories and some dietary fat while still prioritizing easy-to-digest foods. Fat intake is restricted because fatty foods delay stomach emptying. Most patients can tolerate less than 40 grams of fat per day at this stage. This step may be inadequate in Vitamins A & C and the mineral iron, so a multivitamin supplement is usually prescribed.
Recommended:
- Skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses
- Fat-free consommé & bouillon soups, fat-free broths containing pasta/noodles and “allowed” vegetables, soups made from skim milk
- Breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers
- Eggs, peanut butter (max of 2 Tbsp/day)
- Vegetable juice (tomato, V-8); well-cooked vegetables without skins (squash, beets, carrots, mushrooms, potatoes, spinach, strained tomato sauce, yams)
- Apple juice, cranberry juice, grape juice, prune juice, pineapple, canned fruit without skins (applesauce, peaches, pears)
- Any type of fat, but only in small amounts
- Hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, ice milk, gelatin, jelly, honey, syrups
- Gatorade, soft drinks (sipped slowly throughout the day)
Step 3: Long-Term Maintenance
This step is designed for long-term management of gastroparesis. Fat intake is limited to 50 grams per day, and fibrous foods are restricted due to the difficulty in digesting many plant fibers. This step may still be inadequate in Vitamins A & C and the mineral iron, so a multivitamin supplement is usually prescribed.
Read also: Managing Gastroparesis Symptoms
Recommended:
- Skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses
- Fat-free consommé & bouillon, fat-free broths containing pasta/noodles and “allowed” vegetables, soups made from skim milk
- Fruit juices, canned fruits without skins (applesauce, peaches, pears)
- Eggs, peanut butter (2 Tbsp/day), poultry, fish, lean ground beef
- Any type of fat, but only in small amounts
- Breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers
- Vegetable juices (tomato, V-8), well-cooked vegetables without skins (squash, beets, carrots, mushrooms, potatoes, spinach, strained tomato sauce, yams)
- Hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, ice milk, gelatin, jelly, honey, syrups
- Gatorade, soft drinks (sipped slowly throughout the day), coffee, tea, water [note: non-caloric beverages should be limited if patient cannot maintain adequate caloric intake]
General Dietary Recommendations for Gastroparesis
Beyond the three-step diet, several general dietary recommendations can help manage gastroparesis symptoms:
- Eat Smaller, More Frequent Meals: Instead of 2-3 large meals, aim for 4-6 small meals per day.
- Choose Low-Fiber and Low-Fat Foods: High-fiber and high-fat foods take longer to digest.
- Stay Hydrated: Drink plenty of liquids throughout the day.
- Sit Upright While Eating: Avoid lying down for at least 30 minutes after meals.
- Consider High-Fat Liquids: While solid fats should be limited, some high-fat liquids may be tolerated.
Medications for Gastroparesis
In addition to dietary changes, medications may be prescribed to help manage gastroparesis symptoms.
- Metoclopramide: Is an important medicine to treat gastroparesis. There are risks in using this medication that you need to discuss with your physician.
- Erythromycin: Erythromycin also causes stomach contractions. Your physician may consider this option if you fail to respond to metoclopramide or you wish to try something else. Erythromycin also has side effects. It does not work after 4 weeks.
- Other Medications: Your physician may also consider the use of medications like prochlorperazine (Compro), diphenhydramine (Several brand names including Benadryl), ondansetron (Zofran).
G-POEM (Gastric Peroral Endoscopic Myotomy)
G-POEM is a specialized endoscopic procedure for patients who haven't responded to other therapies. An endoscopy is performed after intravenous sedation.
Experimental Options
There are additional experimental options that your doctor may discuss with you including surgically placing an electric stimulation device on your stomach.
Read also: The Hoxsey Diet
tags: #gastroparesis #diet #guidelines