Gastroparesis, characterized by delayed stomach emptying, disrupts the normal digestive process. The stomach, through regular contractions, typically empties its contents within 90-120 minutes after eating. In gastroparesis, these contractions are sluggish or less frequent, leading to a delay in stomach emptying. This condition can arise from various factors, including diabetes mellitus, nervous system disorders, and certain medications. In some cases, a viral infection is suspected, while in others, the cause remains unknown.
The primary goal of a gastroparesis diet is to alleviate symptoms and ensure the maintenance of fluids and adequate nutrition. Often, physicians prescribe medication to stimulate stomach contractions alongside dietary adjustments. The gastroparesis diet is typically structured in stages, progressing from liquids to more solid foods as tolerated.
Understanding Gastroparesis
Gastroparesis affects the stomach's ability to empty its contents properly. The stomach usually contracts about three times a minute to facilitate the movement of food and liquid into the small intestine. When these contractions are impaired, food remains in the stomach for an extended period, leading to symptoms like nausea, vomiting, bloating, and abdominal pain.
The Gastroparesis Diet Stages
The gastroparesis diet is designed to gradually reintroduce foods while minimizing symptoms. It is typically divided into three stages:
- Step 1 Diet: Primarily liquids
- Step 2 Diet: Introduction of low-fat foods
- Step 3 Diet: Long-term maintenance
Step 1 Diet: Liquid Foods
The Step 1 diet consists exclusively of liquids, which are generally well-tolerated and leave the stomach quickly due to gravity. This stage is crucial for providing hydration and some essential nutrients while minimizing the strain on the digestive system.
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Purpose of the Step 1 Diet
The main aim of the Step 1 diet is to:
- Provide hydration
- Minimize digestive effort
- Reduce gastroparesis symptoms
Suitable Liquids for Step 1 Diet
The following liquids are typically recommended for the Step 1 diet:
- Water: Essential for hydration.
- Clear broths: Such as chicken or vegetable broth (low-sodium options are preferable).
- Clear juices: Apple, white grape, or cranberry juice (unsweetened).
- Electrolyte solutions: Sports drinks or oral rehydration solutions to help maintain electrolyte balance.
- Herbal teas: Non-caffeinated teas like chamomile or ginger tea, which can soothe the stomach.
- Gelatin: Plain gelatin desserts.
Considerations for Step 1 Diet
- Duration: The Step 1 diet is nutritionally incomplete, lacking sufficient calories, fiber, and essential nutrients. It should not be followed for more than three days without medical supervision or additional nutritional support.
- Nutritional Deficiencies: The Step 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium.
- Diabetes: Patients with diabetes and gastroparesis may be allowed sugar-containing liquids on the Step 1 diet as a source of carbohydrates. However, it is essential to monitor blood sugar levels closely.
- Individual Needs: Diets must be tailored to the individual patient.
General Dietary Recommendations for Gastroparesis
Regardless of the specific stage, some general dietary recommendations apply to all gastroparesis diets:
- Small, Frequent Meals: Eating smaller portions more frequently (e.g., 6-8 small meals per day) can help prevent the stomach from becoming overly full and reduce symptoms.
- Thorough Chewing: Chewing food thoroughly before swallowing aids in digestion.
- Sitting Upright After Meals: Remaining in an upright position for at least 1-2 hours after eating can help facilitate gastric emptying.
- Avoid Lying Down: Avoid lying down immediately after meals.
- Hydration: Staying well-hydrated is essential, especially since gastroparesis can sometimes lead to dehydration due to vomiting.
- Low-Fat Foods: Limit or avoid high-fat foods, as fat delays gastric emptying.
- Limit Fiber Intake: While fiber is generally beneficial for digestive health, it can sometimes exacerbate gastroparesis symptoms. Therefore, a low-fiber diet may be recommended, especially during the initial stages.
- Avoid Alcohol and Carbonated Beverages: These can worsen gastroparesis symptoms.
- Limit Caffeine: Caffeine can stimulate gastric acid production and may increase discomfort.
- Individual Tolerance: Pay attention to individual food tolerances and keep a food diary to identify trigger foods.
Transitioning to Step 2 and Step 3 Diets
As symptoms improve, you can gradually transition to the Step 2 and Step 3 diets, which involve reintroducing solid foods in a controlled manner.
Step 2 Diet
The Step 2 diet provides additional calories by adding a small amount of dietary fat - less than 40g each day. For patients with gastroparesis, fatty foods and oils should be restricted because they delay stomach emptying.
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Step 3 Diet
Step 3 Diet is designed for long-term maintenance. The Step 2 and Step 3 diets may be inadequate in Vitamins A and C, and the mineral Iron.
Foods to Include and Avoid on a Gastroparesis Diet
While individual tolerances vary, here are some general guidelines for foods to include and avoid:
Foods to Include (in small amounts as tolerated):
- Cooked Vegetables: Cooked vegetables only, such as carrots, string beans, peas, beets, spinach.
- Lean Proteins: Lean meat, chicken, or turkey (cooked, broiled, or baked, but no fried or fatty meats).
- Fish: Nothing fried. No canned fish, such as salmon, tuna, etc., except water packed.
- Fruits: All fruit juices; Cooked or canned fruit without skins, seeds, or tough fibers; Avocados and bananas; Grapefruit and orange sections without membrane.
- Breads and Grains: White, refined wheat, seedless rye breads. Plain white rolls, white melba toast, matzo, English muffin, bagel, pita bread, tortilla; Cooked, refined cereals such as cream or wheat, oatmeal, farina, cream of rice. Dry corn and rice cereals such as puffed rice or corn flakes; Enriched rice, barley, noodles, spaghetti, macaroni, and other pastas; Couscous.
- Milk & Dairy: All milk and milk products; Plain mild cheeses; Cottage cheese.
Foods to Avoid:
- High-Fat Foods: Fried foods, fatty meats, gravies, and oily sauces.
- High-Fiber Foods: Raw vegetables, dried peas and beans, corn; Gas forming vegetables such as broccoli, Brussels sprouts, cabbage, onions, cauliflower, cucumber, green pepper, corn, rutabagas, turnips and sauerkraut.
- Whole Grains: Seeds in or on breads, and crackers; Bread or bread products with nuts or dried fruit.
- Certain Fruits: All other fresh and dried fruit; Berries and figs.
- Other: Potato chips, fried potatoes, wild rice; Highly seasoned, cured, or smoked meats, poultry, or fish.
Diverticulosis and Gastroparesis
For individuals with both diverticulosis and gastroparesis, dietary management requires careful consideration. Diverticulosis benefits from a high-fiber diet to maintain pressure on the large intestine walls and prevent bacterial accumulation. However, the increased fiber intake can conflict with gastroparesis management. In cases where diverticulitis occurs, switching to a low-fiber diet during the acute infection period is recommended.
Soft/Bland Diet
A soft/bland diet consists of foods that are easily digestible, mildly seasoned and tender. Fried foods, highly seasoned foods and most raw gas-forming fruits and vegetables are eliminated.
Low Fiber or Low Residue Diet
A low fiber or low residue diet limits the consumption of dietary fiber, oftentimes by placing restrictions on foods found to have high amounts, including certain fruits, vegetables, dairy, and whole-grain products. Dietary fiber is the undigestible part of plants that maintains the structure of the plant. Dietary fiber includes cellulose, hemicellulose, polysaccharides, pectins, gums, mucilages, and lignins.
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In certain medical conditions, it is important to restrict fiber. These include acute or subacute diverticulitis and the acute phases of certain inflammatory conditions of the bowel-ulcerative colitis or Crohn’s disease. After some types of intestinal surgery, a low fiber, low residue diet may be used as a transition to a regular diet. Depending upon individual food selection, the Low Fiber, Low Residue Diet is adequate in all nutrients (National Research Council’s Recommended Dietary Allowance). If the diet must be strict and followed over a long period of time, the intake of fruits and vegetables may not be adequate, and/or on a low residue diet, there may not be enough calcium included.
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