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.
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.