Gastroparesis and Diet

Gastroparesis leads to delayed transmission of food from the stomach to the intestines. This is a long term condition with often no cure.

Over time this delay in food transit may lead to several complications. Malnutrition and deficiency of essential nutrients is one of the complications.

In addition as food brings about symptoms of gastroparesis including nausea and vomiting, there may be special dietary modifications that may relieve symptoms to some extent.

Diet change thus is one of the mainstays of treatment for those who suffer from gastroparesis.

Difficult to digest foods

It has often been seen that some foods are more difficult than others for the stomach to digest.

Some of these include:-

• Fatty foods take a longer time to digest even in healthy persons. In patients with gastroparesis fatty foods may significantly delay gastric emptying
• High fibre foods like raw fruits and vegetables also take longer to cross the stomach to the intestines and may worsen symptoms of gastroparesis. Fibre when eaten should be chewed well and cooked until soft.
• Carbonated and fizzy drinks as well as high fat drinks may slow gastric transit even further and also lead to backwards movement of the stomach muscles aggravating reflux disease and symptoms of gastroparesis

Bezoar

Food that is poorly digested can collect in the stomach. This can undergo bacterial changes and fermentation or may become hard to form a bezoar.

A bezoar is a mass of undigested matter that may cause a blockage, preventing the stomach from emptying and cause nausea, vomiting and pain.

Diet advice for gastroparesis

Many people with gastroparesis can live a relatively normal life. This can be achieved by following a diet routine and avoiding certain foods.

Feeding tubes placed in the small intestine (jejunostomy) are needed in moderate to severe cases. In very severe cases nutrients may also be given as injections – parenteral nutrition.

Some of the diet advice includes:-

• Calorie intake – Calories are energy provided by the food. Calories are needed for the body to perform all activities every day. Protein, carbohydrate, and fats all provide calories.
• Proteins are needed for tissue repair and to build the body. Most people need about 60 grams of protein per day to meet their protein needs. These can be obtained from meats, fish, poultry, milk, eggs etc.
• Carbohydrates are the energy source and one of the most available nutrients for the body to use. These are obtained from wheat, bread, crackers, potatoes, rice, pasta etc.
• Fats are high energy source that are stored for future use. Fats are found in dairy, butter, mayonnaise, vegetable oil etc.
• Water or fluids prevent dehydration and can be obtained from juice, milk, water, tea, coffee etc.
• Vitamins and minerals are small amounts of essential nutrients found in foods. Vitamins and minerals do not supply energy but may cause severe changes and problems if they are deficient in diet.

For a patient with gastroparesis the diet therapy involves:-

• Appropriate volume of food
• Larger meals usually mean slower gastric emptying. In addition, gastroparesis also causes filling up quickly after eating only a little bit.
• Calorie and protein needs, as well as vitamins, minerals and fluid requirements may not be met since the whole meal cannot be taken. Thus volume of meals needs to be reduced but eating needs to be increased in frequency. Most doctors advice six or more small meals instead of three large meals.

Food taken as liquids

If the volume reduction fails to work, the foods can be taken as liquids. Patients with gastroparesis will often tolerate liquids even if solids are not passing well.

Liquids provide nutrients and are also absorbed and passed through the stomach quickly. Almost all liquids, even those that are high in calories, will empty from the stomach. Pureed foods are nearly liquid after mixing with saliva and stomach juices and are usually advised.

In patients with symptoms of gastroparesis liquid foods may be tried followed by thinned-down pureed foods. Some patients who experience increasing fullness as the day progresses are advised solid food for breakfast, switching to liquid meals over the rest of the day.

Fibers in diet need to be avoided

These are found in raw fruits, vegetables, legumes, dried beans, whole grains, bran, nuts, seeds, dried fruits, popcorn etc.

Foods associated with bezoar formation include apples, berries, legumes, oranges, brussels sprouts, coconuts, corn, green beans, sauerkraut, tomato skins, potato peels etc.

Chewing and dental care

Due to the inability of the stomach to transmit food chewing of food beforehand becomes even more important.

Frequent vomiting in addition may damage the teeth as well. Dental care is thus very important

Movement after meals

After meals the patients are advised to sit up or go for a walk to allow the food to transit from stomach to the intestines.

Medications to avoid

Medications that delay gastric emptying including Aluminum-containing antacids, narcotics, anticholinergic agents, bulk-forming agents etc. should be avoided.