Answers to Your Most Common Questions

I receive a lot (dozens) of emails each week from confused, frustrated GPers who just want answers to their most pressing questions. I do my best to answer each one individually, but I’m sure for every person who emails me there are several more people with that same question. So, I’ve decided to post the answers to the most frequently asked questions. For many, many more answers, check out my new book, Living (Well!) with Gastroparesis, as well as my FAQ Friday videos.

What is a bezoar and should I be worried about getting one?

Bezoars are hardened masses of undigested food. They can block the outlet of the stomach, causing a sudden and/or severe exacerbation of symptoms such as vomiting and fullness. Only about 20% of all GPers will ever get a bezoar. Once you’ve had one, however, you’re more prone to getting another. Bezoars are typically diagnosed via an upper endoscopy.

Foods specifically associated with bezoar formation are apples, berries, broccoli, Brussel sprouts, coconuts, corn, green beans, figs, oranges, persimmons, potato peels, sauerkraut, and fiber supplements, such as Metamucil, Perdiem, Benefiber, Fibercon and Citrucel. Some medications, like Carafate, can also cause them.

What causes the nausea associated with gastroparesis?

This is something I’ve talked about quite a bit with my own motility specialist (Dr. Brian Lacy at Dartmouth-Hitchcock Med Center). In his opinion, and is this is supported by studies, the nausea isn’t a direct result of the delayed gastric emptying. Some people have severely delayed emptying but no nausea. Some have severe nausea (with no other cause) but nearly normal emptying. Some have both. Based on what Dr. Lacy has said, they’re not sure exactly what causes the nausea but it is probably more of a sensory issue than a direct result of the dysmotility. The nerves may be more sensitive than they should be or they may be sending inappropriate messages to the brain for one reason or another. Either way, it’s pretty clear that it’s not just from the delay in emptying.

I’m taking a prokinetic medication, but I still feel lousy. How come?

Unfortunately, this is pretty common. For many people with gastroparesis, especially idiopathic GP, there is probably more going on than just slow motility (see previous Q/A). Therefore pro-kinetics, which do increase contractions in the stomach and therefore promote motility, don’t always improve symptoms. Most people need a combination of medical management, dietary modification and lifestyle practices to really manage the symptoms well.

Why do I sometimes I feel hungry even though my stomach is full?

Because your stomach empties slowly, it’s very possible for you to be both hungry and full at the same time. Your stomach is full, but the food hasn’t been digested/absorbed, so your body is hungry (your blood sugar is low and your body is in need of nutrients). Depending on what you’ve already eaten, eating more could make you feel worse in the long run. You might try drinking 100% fruit juice to raise your blood sugar. That sometimes does the trick.

How do you handle dinner party invitations?

I usually bring my own food. It’s honestly easier that way. People who don’t have any experience with GP just don’t know/understand the complexities of the dietary restrictions. A lot of times I’ll make a GP-friendly dish that I can share with everyone. If there are things served that are GP-friendly, then I might choose to eat those, too. But I never rely on someone else to make my food. I just explain the situation and emphasize that what I’m really looking forward to is their COMPANY. Most people understand.

I am iron deficient, but I can’t tolerate supplements. Any suggestions?

Blackstrap molasses (not regular molasses) is really high in iron and is usually well-tolerated. You might try 1 tablespoon per day mixed with hot water.

I have a lot of anxiety around food and eating. Is that normal?

A lot of GPers develop anxiety around food and eating. It’s completely understandable — I’ve even dealt with it myself. I strongly recommend seeking counseling if it’s an ongoing issue for you, since it can negatively impact your nutrition and overall quality of life. In addition, feelings of anxiety and stress trigger our “fight or flight” response and that can further disrupt digestion. There is absolutely a connection between our brains and our guts — if either one isn’t functioning properly, it effects the other.

Is there any hope that my gastroparesis will improve over time?

GP is a dynamic condition. It doesn’t often stay the same over time. I’m 10 times better now than I was two years ago (thanks to the gastric neurostimulator, really good nutrition, careful dietary choices, lots of physical activity and stress management). Though it doesn’t happen for everyone, I’ve worked with many people who have gotten better over time. Also, a well-balanced management plan, one that includes medical and complimentary therapy AND dietary modifications AND lifestyle practices, can make a big difference. Just one isn’t usually enough. The key is to educate yourself and be proactive and keep your attitude as positive as possible (that matters, too — it really does!).

Should I be concerned about nutrition when following a GP diet?

Yes! A typical gastroparesis friendly diet is quite poor nutritionally and the less nutrition your body has, the more difficult it is for it to repair itself and function normally.  I strongly believe that’s the reason so many GPers seem to get worse over time — it may be the diet more than the condition. But it doesn’t have to be that way. Aim to maximize the nutrition in every bite and sip you take and choose nutrient-dense foods and beverages instead of ones that fill you up without nourishing your body. I also suggest that everyone following a gastroparesis diet take a multivitamin, as well as these other supplements.

How do I make sure I’m getting enough fiber for good health?

In general, most gastroparesis patients do best with a maximum of about 15 grams of fiber per day. (That’s actually right around the average intake for all Americans.)  If you’re getting much less than 15 grams, you can experiment by slowly replacing some of the GP-friendly “empty foods” in your diet — such as white rice, white pasta, white crackers, sugary cereals, white bread — with well-cooked and/or pureed GP-friendly fruits and veggies, like sweet potatoes, carrots, turnips, parsnips, pumpkin, beets, bananas, applesauce, canned pears, and canned peaches. This will increase your total fiber intake in a GP-friendly way. Please note that fiber supplements aren’t recommended for GPers because they have the potential to cause blockages in the stomach (bezoars).

What can I do about constipation?

Constipation is a common “side effect” of a typical gastroparesis diet. One option is to try a magnesium supplement. Magnesium has natural laxative properties and it’s also important for muscle and nerve health — a win-win in terms of the gastroparesis.

Here’s more info about magnesium supplementation:
  • Deficiency symptoms include: anxiety, insomnia, irritability, muscle weakness or cramping, Restless Leg Syndrome, and irregular heartbeat.
  • Avoid magnesium oxide, which is not well absorbed.  Magnesium citrate is well absorbed and readily available.
  • Typical dosage: 400 mg per day; if your stools become loose, decrease dosage.   Those who take a calcium supplement should take half as much magnesium as they take calcium in order to prevent constipation.
  • Note:  if constipation is an issue, doses as high 1,000 mg are considered safe and may help to regulate bowel movements.
  • I use: Solgar Magnesium Citrate.

You might also try 4 ounces of warm prune juice or 1 tablespoon of blackstrap molasses mixed with hot water once a day.

Which kind of protein powder do you recommend for smoothies?

It really depends on your tolerances. When choosing a protein powder, make sure you to check the fiber content. In most cases, you want one with no more than 2-3 grams per serving. Many people do well with an egg white protein. (I like MRM brand. ) If you tolerate dairy products, then a whey protein powder may be a good choice (whey is made from cow’s milk; if you do not tolerate dairy product, avoid whey protein). Brown rice protein is typically well-tolerated but the texture is on the gritty side, which turns many people off. In general, I don’t recommend pea or hemp protein, which are often high in fiber. Soy protein, while well-tolerated by some, is hard to digest and can cause gas and bloating for many people.

Can I still exercise with gastroparesis?

Not only can you, you should! Mild physical activity, such as walking, is one of the most effective symptom management tools we have. The key is the word mild. If you try exercising at a higher intensity, you’re more likely to notice increased symptoms. That’s because when we’re working hard, the blood flows away from the digestive organs to the muscles in our arms, legs and heart. (That’s why even a healthy person gets nauseous if they work out really, really hard!) What usually works better for GPers is to exercise less intensely for a longer period of time. Exercises that squeeze the abdomen — such as crunches, sit-ups, Pilates, etc. — often exacerbate symptoms, especially regurgitation and reflux.

What do you eat?

I post a lot of recipes and dietary information, but I talk very little about I actually eat. There’s a reason for that. I don’t want anyone thinking that how I eat is how they should eat. Gastroparesis is a highly individualized condition. The severity of symptoms and specific dietary tolerances vary tremendously. All of that said, because so many people have asked, I will share with you my current diet.

Please keep in mind that I have had idiopathic gastroparesis for over seven years (probably closer to 9, if you count the time I was searching for a diagnosis). I was also on proton pump inhibitors for misdiagnosed GERD for nearly 10 years and I very much believe that compromised my digestion in ways not directly related to gastroparesis. I also have chronic slow transit constipation, which plays a role in my dietary cohices. In general, I do not do well with animal protein, too much dairy, too much sugar, or too much wheat (remember that even “white” bread, pasta, cookies, and crackers are made from wheat).

My diet largely consists of nutrient-dense foods and beverages, including Orgain, smoothies made in a Vitamix, fresh fruit/veggie juice, pureed veggie soups, bananas, potatoes, squash, and MacroBars. This is deliberate. It’s not necessarily because I can’t eat “real food,” but the other food that I could eat (bread, cereal, pancakes, rice, etc.), doesn’t come anywhere close to the nutritional value of these other sources. You always hear me talk about maximizing the nutrition in every bite and sip…that’s exactly what I do with my own diet.

I want to reiterate that I’m not suggesting anyone follow this exact routine. If I could tolerate lean proteins, like chicken, turkey and/or ground beef, I would eat them (organic and grass fed whenever possible, please). If I could eat non-pureed veggies and fruit not in smoothies, I would. I would could tolerate more dairy, I’d be eating Greek yogurt everyday! What I’ve done is build the most nutritionally dense diet possible within my own limitations.

Then why do you post all of these recipes?

Because, as I mentioned above, there are wide variety of experiences with gastroparesis. In fact, the majority of people can tolerate “real food,” so long as they find ways to lower the fat, cut back on fiber, remove anything that’s indigestible, and reduce portion sizes. That’s what my recipes are for. Plus, I post a lot of recipes for things I do eat, like smoothies and soups.

That’s also not to say that I never eat anything not on the plan I outlined for you above. I certainly do. If I’m out, I’ll eat baked potatoes or soup at restaurants. Sometimes I have a bagel with light cream cheese or peanut butter. Every Wednesday night, my husband and I walk down to our local Abbott’s Frozen Custard and I get a flurry made with fat-free vanilla ice cream and (get ready…) Oreos! (Once a week, I can both tolerate this and I don’t feel the slightest bit guilty because the rest of my diet is packed with nutrition.) The same goes for the recipes I post for cookies and other less-than-nutritious treats. They’re “sometimes foods” for me, as they really should be for anyone with GP. Regardless of your tolerances, your goal is the same: maximize your nutrition as much as possible…but don’t feel bad about treating yourself (in a smart, GP-friendly way!) now and then.

*Note: this is for informational purposes only and does NOT constitute medical advice. Not all recommendations are suitable for everyone. Ask your doctor about any specific medical concerns you have.

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