What to eat with gastroparesis?

Via the Q&A section of our site we got the following question: "I've been having a hard time with gastroparesis. I know my diet needs to be low fat and low fiber. Any chance you’d write a post on nutrition for gastroparesis patients?" Here at The GutDigest we are passionate about normalizing GI illness and this question highlights an important condition that we plan to write a ton about: gastroparesis. To catch everyone up to speed, let's start with some basics.


What is gastroparesis?

Patients with symptoms of nausea, vomiting, poor appetite, bloating, abdominal pain and/or the sensation of feeling very full with meals often undergo GI studies including an endoscopy and ultimately testing to assess how slow their stomach empties. The healthy stomach empties in 2-4 hours. If there is nothing physically blocking the stomach's exit such as a mass or ulcer AND the testing shows slow stomach emptying >4-5 hours (depending on the test) they are diagnosed with gastroparesis. We plan to write a ton on gastroparesis, so for now will hold off on getting into too many details regarding causes and treatment, but it is often difficult to treat and there is still a lot left to learn about the disease itself.


Finding a gastroparesis nutritionist

First thing I want to convey here is that I am not a nutritionist. If you have gastroparesis and are having issues with maintaining your weight or finding a diet that works for you, I'd recommend reaching out to a nutritionist that can help coordinate along with your doctor a sustainable plan that's tailored to your needs. Doing so is an important part of getting treated, but is often overlooked. As few as 32% of gastroparesis patients actually see a nutritionist, while the majority of patients' diets are deficient in calories, carbs, protein, and vitamins.

The stereotype of patients with gastroparesis is that they are underweight, however the two studies above showed that over half of the patients were both overweight and still deficient in essential nutrients. Getting a thorough assessment will help identify any dietary deficiencies that may be contributing to the problems your experiencing; in both studies the most symptomatic patients unsurprisingly had greater nutritional deficits.


What should you eat with gastroparesis?

I did my best to review the literature on the topic and my key take aways are below. Truthfully, my suspicion is that this isn't breaking news to those of you with gastroparesis, which is why our next section focuses on specifics.

1) Eat frequent, small meals

Pretty straightforward logic here; with slower emptying, minimizing the task ahead for the stomach is important. In a study surveying which foods gastroparesis patients tend to tolerate, small quantities of bland, salty, and starchy all tended to be better tolerated. Typically, 5 small meals rather than 3 normal meals is what's recommended. 

2) Liquids > solids

Fluids move faster than solids, and in many gastroparesis patients, liquids may not be affected by the slower emptying times that solids are. Finding soups or blending small particle foods (more details below) that adhere to all the other rules here may be helpful.

3) Low fat, low fiber

Fat and fiber take longer to digest. Avoiding the feedback loop of your gut slowing down the process of digestion will help keep your gut moving. Not all fiber is created equal, however. There are plenty of healthy foods with small particle fiber that have been shown to generally be well-tolerated. 

4) If you have diabetes, monitor and control your blood sugar

This is an important one, particularly because the most common individual cause of gastroparesis is diabetes. When your blood sugar is high, your gut's natural reaction is to slow things down. Less food moving through the gut means less absorption of glucose. Keeping your glucose under control prevents this mechanism, and is one of the most important things you can do to minimize your symptoms.


Foods to eat with gastroparesis

The best data on the topic shows that the smaller the particle size of the food, the better.  Easily digestible, small particle size foods include mashed turnips, asparagus tips (not stalks!), green pea puree, vegetable paté, mushroom paste, mashed sweet potatoes, white fish, salmon, and mashed avocado. If you're going to try fruits, consider peeling them - a lot of the fiber content is in the skin. Additionally, the manner in which you prepare the fruits is important. Puree and cooked fruits instead of fresh will help reduce particle sizes, and thus (in theory) symptoms.

Here are a few examples of processed foods that tend to be well-tolerated: saltine crackers, jello, graham crackers, ginger ale, tea, pretzels, white rice, popsicles, and applesauce.


Foods to avoid with gastroparesis

Avoiding large particle foods is key. These include carrots, turnips, cauliflower, broccoli, green pea, boiled corn, cooked beans, cooked brussel sprouts, raw or cooked cabbage, cooked leaks, rhubarb, salads, cucumber, tomatoes, pepper, banana, citrus fruits, almonds, fried or french potatoes, pasta, and breads with seeds are a few examples.

The worst offenders? In the aforementioned study, these were the worst tolerated foods: orange juice, fried chicken, cabbage, oranges, sausage, pizza, peppers, onions, tomato juice, lettuce, coffee, salsa, broccoli, bacon, and roast beef.


Bottom line?

Figuring out what to eat with gastroparesis is incredibly difficult, and ultimately working with a nutritionist to find what works for you is key. Small, frequent meals, small particle foods, controlling blood sugar if diabetic, and avoiding fatty foods are the most important things you can do.

-The Gut Doc


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