Gastroparesis, or delayed stomach emptying, is a challenging digestive condition that can have a major impact on quality of life. Gastroparesis slows, or even stops, the movement of food from your stomach to your small intestine (where nutrition is absorbed) – even though there is no actual blockage. Because gastroparesis prevents your stomach from emptying properly it can interfere with normal digestion and cause unpleasant symptoms like nausea, vomiting and abdominal pain. The good news? Changes to your diet can have a big impact on symptom management. Keep reading to learn all about a gastroparesis diet plan, written by Gabrielle Ebbers, a dietetic student who lives with gastroparesis herself. Gabrielle wrote this article to help spread knowledge and awareness about a disorder that has had a significant impact on her life, as well as to share a bit of her personal journey with this disorder. She even includes a gastroparesis meal plan pdf for you to download at the end!
What is Gastroparesis?
Gastroparesis is a condition that causes partial paralysis of the stomach. The condition affects the normal, spontaneous movement of the stomach that propels food through the digestive tract. In individuals suffering from gastroparesis, stomach motility is slowed down or sometimes does not work at all. This partial paralysis of the stomach prevents the stomach from emptying properly, causing food to sit in the stomach for extended periods of time.(8)
What are the symptoms of gastroparesis?
The delayed stomach emptying associated with gastroparesis can cause a wide range of uncomfortable and potentially life-threatening symptoms including (8):
- Vomiting undigested food hours after consumption
- Acid reflux
- Abdominal pain
- Bloating of the abdomen
- Premature feeling of fullness despite having eaten very little
- Lack of appetite
- Weight loss
The symptoms of gastroparesis can lead to:
- Severe dehydration: caused by regular vomiting. (4)
- Malnutrition: gastroparesis can cause malnutrition in a couple of ways. The frequent vomiting associated with the disorder can prevent the absorption of nutrients and calories. Poor appetite, another common symptom of the disorder, can make it challenging to consume enough calories to maintain a healthy weight. (4)
- Bezoar: a bezoar is undigested food that becomes hard and accumulates in the stomach. The clump of hard, undigested food can lead to nausea, vomiting and in some cases a life-threatening condition where food is unable to pass into the small intestine. (4)
- Erratic changes in blood sugar: the decreased motility in the stomach leads to frequent changes in the rate and amount of food passing into the small intestine, where it can be digested. These unpredictable changes in the amount and frequency of food being released into the small intestine for digestion can lead to sudden changes in blood sugar. These dramatic changes in blood sugar are of particular concern for those with diabetes. (6)
- Decreased quality of life: the symptoms associated with gastroparesis can make normal daily functions particularly challenging (4)
My personal experience with gastroparesis:
In the fall of 2020, during my first year of university, I began to experience some very uncomfortable GI symptoms. I was experiencing extreme stomach pain, nausea, vomiting, loss of appetite and drastic weight loss. I tried numerous home remedies with no success. When I returned home for Christmas break my parents became extremely worried about me, stating that I was just skin and bones. When I went to see my family doctor she was puzzled as to what could be causing such drastic weight loss and severe stomach pain in an otherwise healthy 19-year-old girl. Being extremely concerned, my general practitioner referred me to a gastroenterologist for further testing.
How is gastroparesis diagnosed?
There are a multitude of ways that gastroparesis may be diagnosed, such as:
- An endoscopy of the upper GI tract
An endoscopy is a procedure which uses a small camera at the end of a long flexible tube to view the upper GI tract. Before the procedure individuals are asked to fast for a certain length of time. By the time the procedure is performed, the stomach should be empty. If the stomach still has food in it when the procedure is taking place, this is indicative of gastroparesis. (1)
High frequency sound waves can be used to produce images of structures. Often an ultrasound is used to make sure symptoms are not coming from another issue. (1)
- Gastric emptying test
This procedure shows how fast food moves through the stomach. And can be done in a couple different ways. (3)
- Scintigraphy – during the test patients are asked to consume a small meal such as eggs and toast containing a small amount of radioactive dye. A scanning device is placed above the abdomen after the meal is eaten to observe the movement of the meal through the stomach. The scanning device uses the radioactive dye to view the food move through the digestive tract. (3)
- Breath test – during the test individuals are asked to consume a food or drink which contains a protein that the body will absorb. The doctor will then test the breath of the patient 4 hours after ingesting the meal, in order to test if the protein has been absorbed. (3)
My personal experience with diagnosis:
In March of 2021 I returned to my doctor’s office because I had lost even more weight and was experiencing stomach pain so bad that I was finding it nearly impossible to attend my university lectures. I had tried cutting out nearly every food, with no success in alleviating my symptoms. After closer inspection of my family history, we discovered that my late grandmother had celiac disease, an autoimmune condition in which a person experiences an immune response as a result of ingesting gluten. Keeping this new finding in mind I was placed on a waiting list to receive an endoscopy which I received in June of 2021.
By the time June arrived, I had lost another 15 pounds and was emaciated with a BMI of just 13.5. When I had the procedure, they found something arguably more puzzling. My stomach which should have been empty after having fasted for 14 hours was full of food. This discovery is what started my healing journey.
After receiving my gastroparesis diagnosis, I then went to work on trying to discover the root cause of my gastroparesis. I had several more blood tests done to rule out conditions such as hypothyroidism and type two diabetes. The results of my endoscope were inconclusive regarding a diagnosis of celiac disease but after ruling out other possible causes for my gastroparesis, I was recommended to follow a gluten free diet.
What is the cause of gastroparesis?
There are many potential causes for gastroparesis and often the exact cause is not clear. Some potential causes for the condition include (8):
- Damage to the vagus nerve which controls the stomach muscles
- A viral infection
- Scleroderma, a connective tissue disease
- Diseases of the nervous system such as Parkinson’s disease or multiple sclerosis
- Certain medications that can delay stomach emptying such as narcotic pain medication
- A rare side effect of celiac disease
Gastroparesis meal plan: Helping manage gastroparesis with diet
Gastroparesis is generally treated with dietary modifications before more invasive treatments are considered. Many people with gastroparesis work alongside a dietitian to make dietary changes that help support gastric emptying. Changes such as eating small frequent meals, consumption of more liquid calories, reducing fiber intake, reducing dietary fat consumption, and consuming foods that are easily digested can all help the stomach empty more quickly (1).
These dietary changes help encourage and increased rate of stomach emptying in those with gastroparesis through a variety of mechanisms. Small frequent meals are important for individuals who suffer with gastroparesis. A small meal is between 1 cup and 1 ½ cups of food. Small frequent meals help to train the Vagus nerve to empty the stomach more frequently. Additionally small portions put less strain on the stomach and are less work to digest. Smaller meals also help to reduce uncomfortable symptoms such as nausea, vomiting and heart burn because the stomach is not expanding as much. (1)
Although you may have heard that you should reduce your consumption of liquid calories for optimum health, the opposite may be true for those with gastroparesis. Liquids move easily and quickly through the digestive system. Liquids are less likely to sit in the stomachs of those with gastroparesis for extended periods of time and reduce discomfort. Liquid calories also help those with gastroparesis consume an adequate number of calories, which can be very challenging for those with gastroparesis. (5)
Nutrients such as fiber and fat slow down digestion, which is great when it comes to keeping the average person full for longer, but when you have delayed gastric emptying these foods can further slowdown the digestive process and make symptoms worse. Thus, those with gastroparesis should avoid high fiber and high fat/ greasy foods whenever possible. Foods that are partially broken down during the cooking or during the food manufacturing process can help support gastric emptying and reduce symptoms of gastroparesis. An example of a food that can be partially broken down during preparation or manufacturing are cooked fruits and vegetables; the cooking process helps break down the fiber, making them easier to digest. Another example of a partially broken-down food is pureed food. (5)
Food such as smoothies, apple sauce and pureed soups are easier to digest because pureeing the food mechanically breaks the food down, reducing the amount of work that the stomach needs to do to break the food down. A final example of how food can be partially broken-down during food manufacturing are refined grains. White flour for example has had the husks, bran, wheat kernel and germ removed, this means that the white flour now has less fiber and is more easily digested. Although we often think of whole grains as being healthier, for those with gastroparesis, refined grain products are recommended. (5)
If changes in diet prove to be unsuccessful then there are other more invasive treatments such as tube feeding, various medication, and even surgery can be offered to help manage symptoms. A feeding tube can be placed in those with gastroparesis to bypass the stomach and relieve uncomfortable side effects of the disorder. Prokinetic medications can be used to encourage gastric emptying. These medications cause strong muscle contractions in the stomach, effectively forcing the stomach to empty. (2)
Anti-nausea medication for example, can be used to help deal with the chronic nausea and vomiting associated with gastroparesis. As a final resort for those who do not see improvement with dietary changes and medication, is gastric electrical stimulation surgery. During this procedure a small device that sends mild electric shocks to the stomach is placed inside the abdomen. This device acts like a pacemaker for the stomach which helps signal the stomach muscles to contract. The device ultimately helps food move through the stomach at a more effective pace, relieving the symptoms of gastroparesis. (1)
Gastroparesis Meal Plan PDF:
My experience with gastroparesis treatment:
Alongside my gluten free diet, I made some other pretty drastic dietary changes to try and manage my symptoms. My digestive system needed a break and I desperately needed to gain weight. I was put on a nearly complete pureed diet. For 8 weeks I lived off juice, smoothies, pureed soup, soft tofu, dairy free ice cream, soy yogurt and popsicles. I worked on eating small amounts of low fat and low fiber foods frequently even though I felt sick. I started taking a probiotic and I also took L-Glutamine which is an amino acid which has been used to help repair the lining of the small intestine in people with GI conditions.
Through the implementation of the above dietary changes and the use of these supplements, I saw great improvements in my symptoms. After three months of following a very strict diet I was able to start implementing more solid foods one at a time, evaluating how I felt in the coming days after reintroduction. It took me over a year to regain all the weight and return to feeling like myself again, but I now live a relatively normal life.
Of course, I still have flare ups, but I can now identify the cause of the flare up and treat it accordingly. Most of my flare ups are caused by gluten exposure or trying a new food. During a gastroparesis flare up, I try to stick to light foods that are fluid based, things like smoothies, soups, and popsicles.
Although the past two years have not been without challenges, I feel I now have a more profound understanding of the importance of dietetics in the medical field. I feel like my experiences with gastroparesis and potential celiac disease have made me better equipped to be a more competent and empathetic dietitian. After having experienced the misfortune that is having a disease of the gastrointestinal tract, I hope to go forward and use my personal experience and education to help individuals in similar situation.
- Copyright © 2023 The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. All rights reserved. (2021, September 1). Gastroparesis treatment. Gastroparesis Treatment | Johns Hopkins Medicine. Retrieved February 23, 2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/gastroparesis/gastroparesis-treatment
- Gastric Electrical Stimulation Procedure. Stanford Health Care (SHC) – Stanford Medical Center. (2017, September 12). Retrieved February 10, 2023, from https://stanfordhealthcare.org/medical-treatments/g/gastric-electrical-stimulation/procedure.html
- Home. Cincinnati Childrens. (n.d.). Retrieved February 23, 2023, from https://www.cincinnatichildrens.org/service/c/colorectal/treatments/gastric-stimulation
- Mayo Foundation for Medical Education and Research. (2022, June 11). Gastroparesis.
- Karthik Kumar, M. B. B. S. (2022, July 8). Gastroparesis diet: Foods to avoid, foods to eat & diet plan. MedicineNet. Retrieved March 13, 2023, from https://www.medicinenet.com/gastroparesis_diet_foods_to_avoid_foods_to_eat/article.htm
- Mayo Clinic. Retrieved January 23, 2023, from https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787#:~:text=Gastroparesis%20is%20a%20condition%20that,food%20through%20your%20digestive%20tract.
- Petro, H. (2021, June 9). Diabetes & gastroparesis: Symptoms, causes & treatment. US MED. Retrieved February 23, 2023, from https://www.usmed.com/blog/diabetes/diabetes-gastroparesis-symptoms-causes-treatment/
- © 2023 Cleveland Clinic. All Rights Reserved. (2018, July). Gastroparesis: Symptoms, causes, diagnosis & treatment. Cleveland Clinic. Retrieved January 30, 2023, from https://my.clevelandclinic.org/health/diseases/15522-gastroparesis