Nutrition Q&A

Posted in: Diet ♦ Saturday, September 11th, 2010, 1:30 pm ♦ 10 Comments

Earlier this summer, I did a nutrition Q&A for G-PACT’s quarterly newsletter.  I’ve pasted the interview below, but be sure to check out the full newsletter for some other great info and an inspiring Letter from the Editor (all-around fantastic woman, Erika Mott).

P.S.  Still have questions about diet, nutrition and eating for gastroparesis?  I’ll be releasing an electronic book later this month with tons of information, recipes and answers to even more of your questions. Stay tuned!

Nutrition Q and A with Crystal Saltrelli, CHC

1.) What is the single most important factor regarding nutrition maintenance in DTP patients?

The most important thing to remember is that while there are general dietary guidelines for Gastroparesis, every patient responds differently to specific foods and supplements. In addition, a patient’s tolerance and symptoms may vary from day-to-day. For these reasons, there is no such thing as a one-size-fits-all dietary plan for DTP that can be followed day in and day out. Some careful trial-and-error – within the boundary of the general guidelines — is necessary to figure out what works best for each person.

Some other important considerations:

- Volume is the primary factor affecting gastric emptying. The larger the meal, the slower it will empty. So eat small meals frequently throughout the day, but try to pack as much nutrition into each bite/sip, as possible!

- Liquids tend to empty more quickly/easily than solids. If your symptoms worsen as the day goes on, try eating solid food earlier in the day and switch to liquids (smoothies, soups, meal replacement drinks) in the evening.

- While high-fat solid foods should be avoided, many people can tolerate fat in the liquid form (e.g. full-fat dairy products), which can be a good way to increase calories and maintain weight.

- No studies have been done to determine what foods are best tolerated by those with Gastroparesis; dietary advice is mostly based on the collective experience of Gastroparesis patients and the basic principles of digestion (i.e. high-fiber foods digest more slowly than low-fiber foods).

2.) Is coffee recommended for patients with Gastroparesis?

In general, coffee (both regular and decaf) is irritating to the digestive tract. However, whether or not to completely eliminate it from your diet is a personal decision based on what makes you feel your best. Some people actually find that a moderate amount of coffee improves their symptoms.

3.) Which foods are more likely to cause bezoar formation?

Food that is poorly digested can collect in the stomach and form a mass called a bezoar. [Note: only about 20% of gastroparesis patients will ever get a bezoar.) In general, those with Gastroparesis should avoid foods with indigestible parts. Specific foods associated with bezoar formation include: apples, berries, broccoli, Brussels sprouts, coconuts, corn, green beans, figs, oranges, persimmons, potato peels, and sauerkraut.

Fiber supplements such as Metamucil, Peridem, Benefiber, Fibercon and Citrucel should also be avoided if bezoar formation is a concern.

4.) At what point do artificial means of nutrition (ie a feeding tube or TPN) need to be considered?

This is really at the discretion of each patient and their doctor(s). Artificial nutrition may be considered when there is significant/uncontrollable weight loss, frequent hospitalizations, or an inability to tolerate even a liquid diet despite other medical interventions.

5.) What should each meal consist of?

For most people with Gastroparesis, carbohydrates usually make up the basis of a meal but some protein and fat (as tolerated) should also be included to stabilize blood sugar and provide required nutrients. This might mean having a small portion of fish or chicken alongside ½ of a skinless baked potato, for example. Be sure to watch portions sizes, however. A general guideline is no more than 1 to 1.5 cups of total food at a time.

(Tip: adding 1 tablespoon of smooth nut butter to toast/crackers/etc. is an easy way to add some fat and protein to a snack without increasing volume.)

6.) How do I avoid constipation when fiber is so limited?

If you are not having regular bowel movements, it’s important to inform your doctor. Chronic constipation can worsen symptoms of nausea and bloating, as well as further delay the emptying of the stomach. Regular use of over-the-counter products such as Miralax or Milk of Magnesia is often necessary to prevent/alleviate constipation. Some patients also find probiotic supplements, such as Align, or yogurt, such as Activia, helpful. In addition, safe forms of fiber – well-cooked vegetables and pureed fruits – should be included in the diet, as tolerated.

7.) Should I continue forcing myself to eat if I am repeatedly vomiting?

At the very least, you must remain hydrated. Dehydration can actually worsen vomiting. During periods of frequent vomiting, drink small sips of electrolyte-enhanced beverages (Gatorade, Pedialyte, etc.) and/or broth through the day to prevent dehydration. If you are unable to keep anything down, contact your doctor.

8.) Do you recommend organic/whole foods over processed products?

As much as possible, yes. In general, processed products are stripped of nutrition and loaded with artificial ingredients. Because gastroparesis patients should aim for maximum nutrition in each bite, whole foods are usually a better choice. Some options are: potatoes; white fish; chicken breast; ground turkey; well-cooked veggies (carrots, spinach, yam, squash); pureed fruits; eggs. Smoothies and blended soups, which are often well tolerated, are a good way to include more whole foods into a Gastroparesis diet.
All of that said, in most cases any food is better than no food.

9.) Do you recommend any naturopathic remedies such as bromelain and enzymes to help treat Gastroparesis?

Like diet, individual patients respond differently to supplements. The following may be helpful:

- Digestive enzymes (either pancreatic enzymes, papaya enzymes, or bromelain)

- Probiotics (for bloating and constipation; Align, in particular, is recommended by many GI docs)

- DGL (for reflux/heartburn)

- Aloe vera juice (to heal the lining of the digestive tract)

- Iberogast (for bloating and reflux; may increase gastric emptying)

- Ginger (capsules or tea; alleviates nausea and may increase gastric emptying)

10.) What over the counter supplements and medicines are recommended for this condition?

A daily multi-vitamin is recommended (there are chewable and liquid ones available). In addition, many people with Gastroparesis would benefit from supplemental vitamin D, vitamin B12, iron and magnesium due to restricted diet and impaired absorption.

11.) Will a liquid diet cause my GI tract to further weaken?

For those who cannot tolerate solid foods, a full-liquid diet can be safely followed for an extended period of time and may be the only way to ensure proper nutrition. Solid foods should be re-introduced when possible.

Other Comments:

In addition to dietary modifications, I also highly recommend regular exercise and stress management as part of an effective treatment plan. Both can significantly improve symptoms when practiced regularly.

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10 Responses to “Nutrition Q&A”

  1. Posted by: T. Johnson
    September 15th, 2010 at 10:23 pm

    Hi!

    I need help in understanding 6 small portions a day food intake.

    It’s it every 2 hours – like 8a to 10a to 12p to 2pm to 4pm to 6pm —-
    Is that workable?

  2. Posted by: Crystal
    September 20th, 2010 at 7:01 pm

    Hey, there! Sorry for the delayed response. Yes, a total of six small meals spaced about two to three hours apart is a good starting point. It’s just a guideline though, so you may find that 4-5 meals spaced a little further apart works better. Also, if fullness becomes an issue when eating every two hours, it may be helpful to alternate solid and liquid meals or to start with solid food in the morning and progress to softer/liquid foods as the day moves on. Does that help?

    Warmly,
    Crystal

  3. Posted by: Tjohnson
    September 21st, 2010 at 12:47 am

    Yes! that helps a great deal….by the way my boyfriend is scheduled for this Friday for his gastric-pacer! I am praying and hoping for wonderful results!

    thanks for the response!!!
    have a good one

  4. Posted by: MCHolst
    October 3rd, 2010 at 3:06 am

    Crystal,
    Please I need some help in working out what I should do.
    I was reading Dr Bernstein’s Diabetes book when I first realized I have gastroparesis and that I have had it for years. I was even taken to hospital a few years ago when a colleague (a physician) was alarmed by my heartburn. He wouldn’t believe that I wasn’t having a heart attack, and didn’t mention an alternative diagnosis even though I was pushing for one.
    Anyway, I’m reading Bernstein’s book because I’m borderline/prediabetic. My blood glucose levels are frequently above 100 and according to Dr.Bernstein, a normal level is about 81. Prolonged increased glucose levels and subsequent vagal nerve damage are known cause for gastric paresis.
    Dr Bernstein’s advice and that of a number of other people (eg, see publications by Dr Eric Westman) is to have a very low carbohydrate diet for diabetes and diabetic symptoms. [Yes, I understand that conventional wisdom believes otherwise but I don't trust this since it is resulting in a diabetic epidemic.]
    I appreciate that fat may exacerbate the gastric paresis symptoms but I am concerned that a diet high in carbohydrates (if this should be “the basis of my meal”) would worsen my borderline diabetic symptoms. So what should I eat?

  5. Posted by: Crystal
    October 4th, 2010 at 1:26 pm

    Hi there. Do you have a GI specialist for your motility issues? I think it’s best to start there, since there are some treatments and medications that can help minimize symptoms — and that’s important regardless of which diet you decide to try. What constitutes an optimal diet truly varies from person to person, especially for GPers. If the delayed gastric emptying is related to erratic blood sugar levels, then stabilizing blood sugar over time may help manage or reverse symptoms and following a low-carbohydrate diet can be an effective way to do that. Unfortunately, I can’t really give personal diet advice via blog comments since I don’t know enough about you, your symptoms, your needs or your history. That said, there’s no harm in experimenting to see if a low-carbohydrate diet works for you. Hope that helps!

  6. Posted by: Mae
    March 22nd, 2011 at 5:28 pm

    This is so helpful. I’ve been drinking lots of Boost/Ensure and I hated the ingredient list and all the sugar. This seems a great alternative. Thank you.

  7. Posted by: Marilyn T Lanza
    January 3rd, 2013 at 4:50 pm

    I am so happy to have found your site and look forward to receiving your newsletter and book.
    You present all your information so well.
    I just learned that I have gastroparesis about a week ago when my thorough gastroenterologist
    (DO) insisted I has an upper endoscopy prior to gallbladder removal surgery. His reason primarily was because of hiatal hernia surgery in Nov. 2011 to remove Cameron ulcers which caused GI bleeding and severe anemia. He wanted to be sure I healed properly and “nothing ” else was
    lurking. Surgery has been cancelled for now even thoughis I do have some stones.
    Right now I am in a holding pattern waiting to find out what is causing the GP but am very symptomatic. I have begun to alter my eating pattern and diet and am grateful for your knowledge.
    We certainly must be our own health advocates, stay informed and trust our “gut” feelings.
    I look forward to communicating with you and may God bless you in all that you do.

  8. Posted by: lisa abrams
    May 5th, 2013 at 4:06 pm

    Really nervous about sending my daughter, Maddie, off to college in the fall with her recent diagnosis of gastroparesis. My sole purpose of bringing her in to the GI was bc of her unwanted and unintentional weight loss….constantly feeling full even after not have eaten for 4-6 hours. Three to four bites and she’s full. Im frustrated as is she. Shes down to 98 lbs at 5’3. The prescribed low-residue diet explains and somewhat helps with her emptying ability but has managed to lose 2 lbs in 3 weeks. This site is very helpful, thank you! Im looking for any specific foods she can have to help her gain the weight AND increase her energy level.
    Because shes going off to college, Im also trying to be a realist. Alcohol Im sure will likely present itself. Aside from the obvious, are there particular things she MUST avoid….consumption amount? Again, just trying to be realistic in a college situation. That said, she will HAVE to be her own advocate for sure when it comes to the cafeterias/food court etc. I have up until now, insisting she eats properly by making a lot of her meals. Although this hasn’t worked particularly well since shes lost weight and her GERD has not been cooperating at all, im wondering what easy things she can grab at school that doesnt require much if any preparation…preferably high in protein.
    On another note, any feedback on domperidone which is what she’s being recommended. Currently taking erythromyacin to aid in emptying bc she’s allergic to Reglan. ANY feedback would be appreciated!
    lisa Abrams

  9. Posted by: Crystal
    May 5th, 2013 at 8:21 pm

    Hi, Lisa. I’ve worked with a number of high school and college aged women, so I definitely understand your concerns. I’m not doing a lot of coaching right now, but I am working with two other high school seniors and their moms and would happy to work with you and Maddie, too. GP is a really individualized condition, and I find that the one-on-one work yields better results during the high school to college transition. If you’d like to discuss an appointment, you can email me at lwwgp@crystalsaltrelli.com.

    Otherwise, I really recommend that she start putting together a really good comprehensive management plan right now. That means not just diet and meds, but supportive lifestyle practices like sleep, exercise (even with weight loss; gentle exercise like walking and yoga can help with symptoms, which then increase intake), and possibly complementary therapies like acupuncture or hypnotherapy, if you’re comfortable with that (both are quite effective for many people with GP). Stress management is also a huge piece for the vast majority of GPers. Stress does not cause GP, but it almost always exacerbates it and it can keep the body stuck in “fight or flight” mode, which actually impairs digestion. This is obviously counterproductive to the management plan if stress is ongoing. (And GP is certainly a stressful condition for adults and young adults, alike!) You can find a video on this site about the comprehensive management plan, as well as the Quick Start Guide to GP Management, if you want to work through it with her step by step. All of those things will hopefully help her get to a more stable point before she goes to college in the fall.

    I’ll also add this question to the list for an upcoming FAQ Friday video, as well. There are lots of young ladies in Maddie’s position (and lots of mom’s in yours!), so I think it would be helpful.

    If you search the blog for “reglan,” you’ll find a video that I posted about the alternatives. I talk about domperidone in that video.

    Warmly,
    Crystal

  10. Posted by: Dianna Andrews
    June 23rd, 2014 at 12:58 pm

    What do recommend for a good powder protein with no soy and little fiber?

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