All About Juicing & Smoothies
The typical “gastroparesis-friendly” diet tends to be based on white, refined, and/or processed foods, which lack the necessary nutrition to nourish the body overtime. We all know that fruits and vegetables are packed with essential vitamins and minerals, and should make up a significant part of a healthy diet. Most, however, are also high in fiber and harder for those with gastroparesis to digest without exacerbating symptoms.
Fortunately, there’s a fairly easy solution: juicing and blending. By following a few specific guidelines and being open to experimentation, it’s possible to incorporate a variety of nutrient-rich juices and smoothies into a gastroparesis-friendly diet. This allows those with gastroparesis to enhance their overall health and nutrition while still managing symptoms.
Unfortunately, I’ve found that many people with gastroparesis — myself included — have struggled with incorporating juices and smoothies because of some common mistakes. So I put together this (very extensive!) post to help.
Juicing vs. Blending
Juicing and blending both have a place in a nutrient-rich, GP-friendly diet, but there are a few important differences to keep in mind.
FIBER
Juicing removes the fiber from fruits and vegetables, while preserving the majority of health-promoting nutrients and enzymes. You can therefore juice a variety of produce without worrying about the fiber content.
Blending does not remove fiber, so you must be cognizant of the total amount of fiber in the ingredients you’re using in smoothies. Blending does, however, make the process of digesting fruits and vegetables easier for the stomach.
VOLUME
Because juicing removes fiber, which is what makes us feel full, you can consume far more fruits and vegetables in juice form than in smoothies, which retain all of the bulk from the ingredients used. This means you’ll likely get more vitamins, minerals, and enzymes in a glass of a juice than in a smoothie.
You may also find that you can use juices as between-meal supplements, whereas smoothies are more filling and more likely to be used as a “mini-meal.”
ABSORPTION
Both juicing and blending help to enhance the release and absorption of vitamins and minerals by breaking down the cellular walls of the fruits and veggies. Vitamins and minerals from juices are absorbed more quickly because they do not need to be digested.
The fiber (and any protein and fat that’s added) in smoothies results in comparatively slower digestion and therefore absorption of vitamins and minerals.
BALANCE
Smoothies have a leg up on juices when it comes to balance. Juices, by their nature, are primarily carbohydrates and lack protein and fat. They cannot therefore be considered a meal replacement. When it comes to eating for gastroparesis, small well-balanced meals are important for overall health, as well as consistent symptom management.
Smoothies can be made with a variety of ingredients that are high in protein and offer small amounts of healthy fat, making them a suitable meal replacement.
Choosing Equipment
JUICERS
There are tons of juicers on the market and the prices, features, and quality varies greatly. Most of the affordable models, however, fall into two categories. How do know which one is right for you? It depends on your budget, your needs, and your preferences.
Centrifugal
Centrifugal juicers work by finely grating fruits and vegetables, and then spinning them at very fast speeds in a fine mesh basket to extract the juice from the pulp. The juice goes into one container and the pulp goes into another. Centrifugal juicers tend to be the least expensive, easiest to clean, and fastest to use.
On the downside, juices made in centrifugal juicers oxidize more quickly, lose a few more nutrients in the juicing process, and don’t last as long due to the high speed of the juicing process. For most people, though, the benefits outweigh the drawbacks. Especially if you’re new to juicing and looking for convenience.
I used a Breville Ikon 900- Watt Multi-Speed juicer ($199) for many years and was very happy with it. It easy to assemble, easy to clean, easy to use, and yields a good amount of juice with fairly dry pulp (which means most of the juice is being removed).
Masticating
Masticating juicers finely chop (or “chew”) fruits and veggies and then strain the juice out through a fine mesh screen. They run at a slower speed than the centrifugal juicers, which means they yield juice that lasts longer and retains a bit more nutrients.
The downside is that masticating juicers tend to be bigger, heavier, more expensive, and more time-consuming to use and clean than centrifugal juicers.
I recommend the highly-rated Omega J8006 ($279).
BLENDERS
Like juicers, blenders come in a variety of price ranges. Here, however, it’s definitely worth it to spring for the very best you can afford. My favorite blender is Vitamix. It’s a top-of-the-line blender that will last you a lifetime and pulverize whatever you put in it, which means it opens up a great many possibilities for people with gastroparesis.
For example, I regularly make smoothies that contain raw spinach, blueberries, and strawberries using my Vitamix without any visible flecks, skins, or seeds remaining. I also use it to make purees, soups, sauces, nut milks, nut butters, and gluten-free flours.
I have a Vitamix 5200, which I purchased over ten years ago and it was worth every penny. New and refurbished machines can be purchased on Amazon and Vitamix’s website (new machines sell for $349 and up). Also check out Craigslist and eBay. These machines last forever, so don’t be afraid to pick up an older model, especially if it’s a steal!
Other Options
Blendtec rivals the Vitamix in its ability to pulverize fruits and veggies and has a great many fans. The prices are comparable and it really comes down to personal preference.
If you cannot afford a Vitamix or Blendtec, check out the Breville BBL605XL or the Waring MBB518. You will just need to be a little more choosey about what you put in these blenders in order to make GP-friendly smoothies: no nuts, berries, raw vegetables, stringy produce, etc.
The highly-rated Breville BBL605XL has a special smoothie setting and blades that keep ingredients moving up and down through the container to aid in even blending. It sells for around $199 with free shipping on Amazon.com.
OTHER TOOLS
The most important equipment for juicing and blending are the machines themselves, but there are a few other inexpensive tools that make the job easier:
Fruit/vegetable peeler and a good knife
Cutting board
Fine mesh strainer
Mason jars to match the individual serving sizes of juices and smoothies you tend to drink (i.e. 8 ounces, 12 ounces, etc.)
Starting Out
The most important thing to remember as you begin juicing and/or blending is to proceed slowly. You might want to aim for one smoothie or one serving of fresh juice per day, or even on alternate days. You’ll need to experiment to figure out exactly what works for you.
FOCUS ON VARIETY
While at the outset, making simple juices and smoothies with just a couple of ingredients is the best way to determine what does and doesn’t work for you, over time you’ll want to strive for variety in your juicing and blending routine.
Think about juicing/blending a rainbow of colors throughout the day or the week. Why? Each fruit and vegetable contain a unique combination of vitamins and minerals, each of which the body needs to perform various functions. Eating too much of one type of fruit or veggie, or even too much of one color in the absence of others can lead to imbalances.
While any fresh produce is better than none, try to avoid getting stuck in a juicing/blending rut by making an effort to try one new ingredient each week. Use my “try it twice” rule. Symptoms can appear for a myriad of reasons, not only because of a particular food. Think stress, lack of sleep, what else you’ve eaten that day, etc. (See: The Gastroparesis Symptom Bucket.) If you try something twice – a few days apart -- and it gives you trouble both times, it’s not for you right now. If you try it twice and the results are split, give it one more go before you decide to add it to your repertoire or toss it.
WHAT TO AVOID
If you have bloating or IBS:
FODMAPs are fermentable carbohydrates that can trigger and/or exacerbate symptoms in some people with functional gastrointestinal disorders. Though a low FODMAP diet is currently recommended primarily for the management of IBS, I’ve found personally and in working with others with gastroparesis that reducing high FODMAP foods often leads to a reduction in symptoms, particularly bloating, belching, gas, and pain.
If you find that you have a hard time tolerating fresh juice or smoothies, take a look at whether you might be using high FODMAP fruits and veggies. They include:
· Spinach
Strawberries
Apples
Beets
Blackberries
Broccoli
Cauliflower
Cherries
Fennel
Garlic
Green Bell Pepper
Mangoes
Onion
Pears
Peaches
Plums
Watermelon
If you have GERD…
There are certain fruits and veggies that can exacerbate gastroesophageal reflux (GERD or “acid reflux”) and/or irritate the lining of the stomach and esophagus. If you have been diagnosed with GERD or have frequent heartburn, it’s best to avoid:
Grapefruit
Lemons
Limes
Oranges
Mint
Tomatoes
If you have hypothyroidism…
If you have been diagnosed with an underactive thyroid gland (hypothyroidism or Hashimoto’s disease, for example), you’ll want to limit your use of raw foods containing goitrogens in your juices and smoothies. These include:
Broccoli
Cabbage
Cauliflower
Kale
Mustard greens
Radishes
Spinach
Strawberries
If you have a healthy thyroid and an adequate amount of iodine in your diet, it’s not necessary to avoid these foods. If you wish to increase the amount of thyroid boosting iodine in your diet, try adding a teaspoon of dulse flakes to your smoothies.
Juicing
Juicing may seem daunting, but it’s really quite simple. Once you have the tools and equipment, all you have to do is pick your produce and get to work. In the beginning, keep it simple. Start with just one fruit and two vegetables, for example. Juice from dark vegetables, like beets and leafy greens, can be more difficult to digest, so start with mild juices, like cucumber, celery, and carrot. From there, add stronger juices in small amounts – one kale leaf or a small handful of spinach.
The takeaway when it comes to juicing for gastroparesis is to go slowly. Do not drink 32 ounces of juice the day you bring home your new juicer. Start with 4-6 ounces of juice per day, diluted with an equal amount of water. As you determine which juices you tolerate, you may wish to drink two glasses of juice per day or you may find that you can drink 8 ounces of juice at a time and feel just fine. But start slowly. The biggest mistake I see people with gastroparesis make when it comes juicing – and a mistake I made myself for many years – is going all out right away, then feeling symptomatic and concluding “juicing doesn’t work for me.”
WHAT TO JUICE
Apples (high in FODMAPs)
Beets (high in FODMAPs)
Blood orange/oranges (may exacerbate GERD)
Blueberries
Cantaloupe
Carrots
Celery
Chard (avoid if hypothyroid)
Cucumber
Grapes, green/red
Honeydew
Fennel (high in FODMAPs; natural digestive aid)
Kale (avoid if hypothyroid)
Kiwi
Lemon (may exacerbate GERD)
Lime (may exacerbate GERD)
Mango (high in FODMAPs)
Papaya (high in FODMAPs; natural digestive aid)
Peaches (high in FODMAPs)
Pears (high in FODMAPs)
Pineapple (natural digestive aid)
Romaine lettuce
Spinach (avoid if hypothyroid)
Strawberries (avoid if hypothyroid)
JUICING FAQs
Q: Does juicing remove all fiber? How do I know if there’s fiber left in my juice?
A: Juicing removes the vast majority of the fiber from fruits and vegetables. Depending on the quality of your juicer, some pulp (fiber) is likely to remain in the juice. I recommend that you strain your juice through a fine mesh strainer before drinking. If you have a less powerful juicer, you may need to strain 2-3 times.
Q: What if I don’t like the taste of the juice?
A: Experiment! There are so many options out there when it comes to juicing that you’re bound to find several combinations to suit your taste buds (and your tolerances). If you don’t like the taste of vegetable juice, start with a mixture of a fruit and mild-flavored vegetables like cucumber, adding stronger flavored vegetable juices in small amounts over time.
A squeeze of lemon or lime to juice can also improve the flavor, as can herbs like mint and ginger.
Keep in mind that some juices may “grow on you,” as well. When I first started juicing greens, I wasn’t a big fan of the flavor. But over time I’ve come to really like the flavor of green juice and even crave it!
Q: How long do juices last? Is there any way to preserve them?
A: It depends on what kind of juicer you’re using. Juice from centrifugal juicers should be consumed the same day, preferably within 8 hours, whereas juice made from masticating juicers may be good for up to 24 hours. Leftover juice should be stored in a tightly sealed mason jar, filled as close to the top as possible (oxygen destroys nutrients), and kept in the refrigerator.
Juice can be also frozen in single-serving freezer-safe containers. Though some nutrients will be lost, this can be a convenient way to have juice on hand without juicing every day. Certain juices freeze better than others, however, so experiment with small amounts of your favorite juice before filling your freezer with a big batch.
Thaw juice in the refrigerator or on the countertop for a short amount of time.
Q: Should I juice primarily fruits or mostly vegetables? Is one better for GP management?
A: For symptom management, it doesn’t really matter. However, vegetables tend to have a smaller role in the overall GP-friendly diet and so most people will benefit most nutrition-wise from juicing more of those.
Q: Don’t fruit juices contain a lot of sugar?
A: Fruit juices do contain the natural sugar fructose. Juicing large amounts of fruits on a regular basis will likely contribute to an increase in your overall sugar consumption. Instead, focus on combining fruit and veggies to make a lower sugar juice.
Q: Are there any fruits or veggies I shouldn’t juice?
A: Almost any fruit or veggie can be juiced, so long as you have a good juicer. That doesn’t mean that all juices will be well-tolerated by everybody, of course, so experimentation is still key. Above, I’ve listed specific produce that you may need to avoid for a variety of reasons.
In general, bananas, avocados, and other dense fruits tend not to juice well. Citrus rinds, papaya peels, carrot stems, and apple seeds are not edible and should not be juiced.
Q: How do I incorporate juices into my diet? Are they a meal or a snack?
A: For most people with gastroparesis, fresh juice should be considered snack or even a supplement. The amount of juice consumed is unlikely to meet the calorie needs of a meal and fresh juice, while packed with nutrients, lacks the protein and fat necessary to be used as a meal.
You may need also to experiment to determine the time of day that’s best for you when it comes to drinking fresh juice. Some people drink it first thing in the morning, as the juice digests quickly on an empty stomach. Others find that juice on an empty stomach, especially stronger vegetable juices, exacerbates nausea. Juices made primarily from fruit may also exacerbate reactive hypoglycemia when consumed on an empty stomach. Typically, earlier in the day rather than later tends to work better for most people with gastroparesiss.
Q: Do you need to juice if you already make smoothies? Is one better than the other?
A: You’re likely to obtain more vitamins, minerals, and enzymes from juicing than from making smoothies for a couple of reasons. First, volume-wise, you’ll be able to consume more fruits and vegetables through juicing than through drinking smoothies. Since the fiber is removed, juicing is less likely to exacerbate fullness. In addition, there are certain vegetables in particular that you can juice that you are unlikely to tolerate in smoothies (raw greens, for example.).
Incorporating more juices and smoothies into your diet is the best way to optimize nutrition overall. That said, if I had to pick one or the other, I’d go with juicing as the more nutritionally beneficial and easiest to integrate into a GP-friendly diet.
Blending / Smoothies
Smoothies are a staple for many with gastroparesis and for good reason. They can be well-tolerated, nutritionally-dense snacks and/or meal replacements. Because fiber is retained in blending, it’s important to pay close attention to the ingredients used in order to balance optimum nutrition and symptom management.
Once again take note of the fruits and veggies that you may need to avoid given your specific health status and concerns. Most people use fruits in their smoothies, but low-fiber and/or cooked veggies can be used, as well, depending on the quality of your blender. The list below offers some suggestions to help get you started.
WHAT TO BLEND
Fruits & Veggies
Avocado (¼ = about 5 grams of fat)
Bananas (peel and freeze for creamier smoothies
Blueberries (recommend only for Vitamix or Blendtec)
Honeydew
Cantaloupe
Cucumber
Watermelon (high in FODMAPs)
Mango (high in FODMAPs)
Peaches (high in FODMAPs)
Pineapple (natural digestive aid)
Pumpkin (cooked or canned)
Spinach (raw, recommend only for Vitamix or Blendtec)
Strawberries (recommend only for Vitamix or Blendtec)
Sweet potato (cooked)
Winter squash (cooked or canned)
Liquids
All smoothies contain some kind of liquid and there are a wide variety of healthy options to choose from. In most recipes, you can swap out one type of liquid for another based on your own tolerances and preferences.
Water: The benefits are using water in smoothies are numerous: it’s free, it’s readily available, there are no added ingredients, and it’s well-tolerated. It can sometimes make smoothies too thin and/or tasteless, however, especially if the ingredients themselves have a high water content (melons, for example).
Coconut water: Coconut water is a great base for smoothies, especially for people with gastroparesis, as it’s full of electrolytes and wonderful for preventing dehydration. While on its own the flavor may take some getting used to, the other ingredients in smoothies typically mask it altogether. Note that there is disagreement over whether or not coconut-derived foods are appropriate for a low FODMAP diet. Do what works best for you.
Nondairy Milks: Almond milk has become quite popular and is now readily available in most grocery stores. It’s a good natural source of calcium, vitamins A and E, and magnesium. Most brands are also fortified with Vitamin D. Choose unsweetened varieties to reduce added sugar in your smoothies.
A variety of other nut milks can be found in large grocery stores or health food stores, including hazelnut and cashew. Nut milks can also be made at home with a Vitamix or similar high powered blender. You can easily find instructions and recipes online.
Coconut milk is also readily available and may be well-tolerated, though it is higher in saturated fat than other nondairy options.
Rice milk is the least allergenic of all milks and usually well-tolerated by people with gastroparesis. On its own, rice milk offers little nutrition but it’s usually fortified with calcium, vitamin C, vitamin D, and vitamin B12.
I don’t tend to recommend cow or soy milk because both of these are common but often unrecognized triggers for digestive symptoms, including bloating, cramping, nausea, and pain. If you like and tolerate dairy or soy milk, you can certainly use it. I personally do great with soy milk and use it in many of my own smoothies.
Extras
Aside from fruits, lower-fiber veggies, and liquids, there are a variety of things that can be added to smoothies to increase the nutrient quality, protein content, and/or calorie count. You do want to keep in mind that the fat and fiber in a smoothie still “count,” so moderation and careful experimentation is important.
Protein Powder: In order for a smoothie to be considered a meal replacement, it needs to have a balance of protein, carbohydrates and healthy fat. Because most fruits, vegetables, and non-dairy milks are low in protein, protein powders can come in handy. These have a wide variety of possible ingredients, however, so it’s important to find one that you’re sure works well for you. Some types of protein are harder to digest than others and many protein powders on the market contain ingredients that increase bloating, pain, fullness, and/or gas.
Nut Butter: Nut butters are an excellent addition to smoothies because they add protein, healthy fat, and calories without adding bulk or volume. There are many nut butters to choose from, including peanut, almond, cashew, walnut, macadamia, and pistachio. Peanut butter and almond butter tend to be most readily available.
Note that if you do not tolerate peanut butter, you may have better luck with other nut butters since peanuts are actually a legume, not a nut.
Fish Oil or Flaxseed Oil: The typical gastroparesis-friendly diet is severely lacking in Omega-3 fatty acids, which are essential for overall health. Adding even a small amount (½ teaspoon, for example) of Omega-3-rich fish oil or flaxseed oil to smoothies can be beneficial. I’ve use Nutra Sea + D in smoothies and couldn’t detect any fishy flavor.
GETTING STARTED
As with juicing, you want to keep it simple when starting out with smoothies. For example, use just one fruit and one non-dairy liquid. Once you have a base that you know works well, begin experimenting with different fruits and low-fiber vegetables, as well as add-ins to increase the protein, nutrient, or calorie content.
Unlike juicing, blending does not remove the fiber from produce. It’s important to be cognizant of the amount of blended produce you’re consuming, as the fat and fiber in smoothies “counts” toward your daily goals.
This is especially important if you are adding supplements or powders to your smoothies. Many of these products contain added fiber, which may exacerbate your symptoms. Between the produce and the “add ins,” you could be consuming half (or more) of your daily fiber tolerance in one smoothie!
If you start simply, follow the suggestions outlined in this book, and progress slowly, however, you’ll likely find a variety of smoothies that you can rely on to help with symptom management while enhancing the nutrition in your diet.
BLENDING FAQs
Q: Does blending non-GP-friendly fruits and vegetables make them GP-friendly?
A: Yes and no. Blending does not remove fiber, so you must be cognizant of the total amount of fiber in the ingredients you’re using in smoothies. Blending does, however, make digesting fruits and vegetables easier on the stomach. The stomach doesn’t just empty food, it must grind it up and liquefy it first. It does this by secreting enzymes and acids, as well as physically grinding the food with muscular contractions. When the stomach is lacking in enzymes, acids, or muscle contractions, it can take longer to break down the food to the point where it can be emptied into the small intestine. By grinding fruits and veggies to near liquid, a blender makes this step far easier and less time consuming for a less-than-stellar functioning stomach.
Q: How can I make thicker smoothies without adding more fruit (and therefore fiber)?
A: There a few ways to make thicker, creamier smoothies:
use less liquid than called for in the recipe
freeze your fruit in advance (peel and slice bananas first!)
add ¼- ½ cup cooked white rice
add ¼ - ½ cooked cream of buckwheat or oatmeal
add 3-4 ice cubes
Q: How do I choose a protein powder?
A: There are tons of protein powders on the market and just like everything else, experimentation will be necessary to figure out which protein powder works best for you. In general, most people with gastroparesis will tolerate one of these types of protein:
Whey: whey protein powders are readily available and usually inexpensive. They are made from cow’s milk, so avoid using these if you are sensitive to dairy, lactose-intolerant, or following a low-FODMAP diet.
Egg white: egg white protein is easy to digest and often well-tolerated, but often frothy when mixed up in smoothies, which may exacerbate bloating, fullness, and belching. Avoid if you are allergic to eggs.
Brown rice: brown rice protein on its own is an incomplete protein, but most products are fortified with additional essential amino acids. Many find that brown rice protein has a gritty texture and a grainy flavor, but it’s often the best tolerated and least likely to exacerbate symptoms.
Plant-based: this covers a wide range of products, from hemp powders to pea powders, some of which are more suitable for and better tolerated by people with gastroparesis than others. My favorite is a blend called Plant Fusion.
When choosing a protein powder, be sure to check the nutritional panel. Look for a fiber content of 3 grams or less per serving, unless you plan to use less than one serving at a time. Avoid products that contain inulin and chicory root (added fibers) or artificial sweeteners (such as sucralose, acesulfame potassium, and sugar alcohols), all of which can exacerbate symptoms. In general, the fewer the ingredients the better.
Q: How long can smoothies be kept in the fridge?
A: Most smoothies can be kept in a closed container, preferably glass, in the refrigerator for up to 24 hours. Separation, discoloration, and nutrient-loss is likely occur to though, so it’s best to drink your smoothie as soon as possible after you make it.
Q: Can smoothies be frozen?
A: You can freeze smoothies in single-serving freezer-safe containers. Leave a little room at the top of the container, as the smoothie will expand as it freezes. While some nutrients will be lost in the freezing/thawing process, if it means the difference between that or drinking a Boost, you’re still far better off with a previously frozen smoothie! Note that some smoothies will freeze better than others, so you’ll need to experiment with your favorite combinations to see what works best.
Troubleshooting Tips
If you notice increased gastroparesis symptoms after you start incorporating juices and/or smoothies into your diet, here are a few things to consider and fine-tune:
VOLUME
You may be drinking too much. Just like with solid food, volume matters. Start with 4-6 ounces of pure juice (not counting water added to dilute the juice) and about 8 ounces of smoothie. Experiment from there to see what works best for you.
FREQUENCY
Start with just one serving of juice and one smoothie per day. You may even want to alternate, juicing one day and blending the next. Progressing slowly over time is likely to yield the best results and most consistent symptom management. Baby steps!
HOW FAST YOU’RE DRINKING
Take your time. Sip slowly. Think about “chewing” your juices and smoothies by holding them in your mouth for a few seconds. Digestion actually begins in the mouth where enzymes start to break down carbohydrates and nerves signal the stomach to start its digestive process.
THE NUMBER OF INGREDIENTS
Start basic. Try just two veggies and one fruit in each juice. Start with one fruit and one liquid for smoothies. Save the “add-ins” until you have a base that you know works well for you. It’s a process, but slow and careful experimentation is key!
THE “STRENGTH” OF YOUR JUICE
Undiluted juice and/or strong juices can be more difficult on the stomach. When juicing greens, start with very small amounts. Add more mild vegetables, like celery and cucumbers and/or dilute juice with up to an equal amount of water.
AMOUNT OF FAT & FIBER IN YOUR SMOOTHIE
Even though they’re in liquid form, the fat and fiber in smoothies still take time to digest and empty. Check the nutritional content of all powders, liquids, and other to be sure that you’re not using products that are in high in fiber. You may also need to use fewer whole fruits in your smoothies to decrease the overall fiber content.
FODMAPS & OTHER TRIGGERS
Because symptoms can be constant with gastroparesis, we sometimes don’t realize that certain “GP-friendly” foods are actually problematic. These often include dairy, soy, and other foods high in FODMAPs. If you find that smoothies or juices exacerbate bloating, belching, pain, and/or gas, experiment with lower FODMAP options listed in this book and/or remove dairy and soy from your smoothies to see if that makes a difference.