Ask Crystal: How Do I Manage Multiple Dietary Requirements?
Question
In addition to gastroparesis, I have {Celiac disease, food allergies, type 2 diabetes, SIBO, GERD, IBS, and/or another medical condition that requires dietary modifications} ... how can I manage multiple dietary requirements and still eat well?
Answer
This is a challenge I know well! Between gastroparesis, reflux, and IBS, and my daughter's multiple food allergies, I currently follow a gastroparesis-friendly, GERD-friendly, low-FODMAP, gluten-free, dairy-free, egg-free, tree nut-free diet. It's a lot, and I won't pretend it's easy. But it IS doable!
Before I offer up my advice for devising a "multi-friendly diet" (I just made that up for lack of a better term), there are a few things I'd like you to keep in mind.
1. Experimentation is required. There is no one-size-fits-all gastroparesis-friendly diet, therefore there is no one size fits all "gluten-free, gastroparesis-friendly diet," "low-FODMAP, gastroparesis-friendly diet," etc. Not everything that's gastroparesis friendly will work for you... not everything that's not gastroparesis-friendly will exacerbate your symptoms. (If this idea is new to you, be sure to check out this FAQ for a full explanation.)
Keep in mind that portion size is often the determining factor when it comes to tolerance. One cup of mashed sweet potato, for example, is around 8 grams of fiber. That's too high to be considered "GP-friendly" for one meal and it's likely to leave most people with gastroparesis feeling quite full for quite a while. If you sit down and eat a cup of mashed sweet potato, you might think, "well, I guess I can't tolerate sweet potatoes." But... a 1/2 cup of mashed sweet potatoes is 4 grams of fiber and may be well-tolerated, especially if paired with a lean protein that has 0 grams of fiber and is low in fat (chicken breast, turkey breast, white fish, one egg, etc.).
So, regardless of your other dietary requirements, with gastroparesis in the mix experimentation is key (with various foods and various portion sizes). This may be frustrating in the short-term, but it will leave you with a healthier, more satisfying diet in the long run.
2. Your diet today is not your diet forever. In this moment, your multi-friendly diet may look terribly limited and boring. You may find yourself thinking, "Wonderful. I can eat 10 foods for the rest of my life." But that's very unlikely to be the case.
Clearly some restrictions will not change. If you have Type 1 Diabetes or Celiac Disease or true food allergies, you must avoid certain foods or types of foods indefinitely. But restrictions due to gastroparesis, GERD, IBS, SIBO, and food sensitivities caused by poor gut health... those can and often do change over time with proper treatment - especially when you're focusing on a comprehensive management plan.
3. Focus on whole foods. Though a typical gastroparesis-friendly diet if often based on packaged, processed foods, focusing on whole foods usually makes figuring out a multi-friendly diet easier and more nourishing. The "nourishing" part is especially important for two reasons.
First, if you're dealing with multiple health concerns, your body needs that much more support. Good nutrition is an important part of that support.
Second, a multi-friendly diet is probably going to be limited in variety, especially in the beginning as you're getting handle on your tolerances and your management plan. A gluten-free, gastroparesis-friendly diet that consists mainly of chicken, applesauce, and carrots, for example, would not be ideal... but it'd still be better than a gluten-free, gastroparesis-friendly diet that consists mostly of Cocoa Pebbles, Swedish Fish and frozen yogurt. A little bit of nutrient-rich food is always better than a little bit of nutrient-poor food.
Another factor is that processed foods tend to contain more of the things that people need to limit for reasons aside from gastroparesis (gluten, FODMAPs, sugar, food allergens, etc.) than whole foods do. Focusing on gastroparesis-friendly foods with one ingredient (chicken, rice, sweet potatoes, spinach, etc.) will make adhering to other restrictions less confusing.
Creating Your Multi-Diet
To figure out what you can eat despite your multiple restrictions, I recommend starting with the list of gastroparesis-friendly food from the 2014 version of Eating for Gastroparesis. You can download a free copy of that list in PDF format here. (Note: the page numbers skip, but the full list is included in the download)
You can find other gastroparesis food lists on the internet, but many are based on those processed, packaged foods. As mentioned above, if you're also trying to limit or eliminate sugar, gluten, dairy, and/or FODMAPs, you're probably going to take a look at those lists and (falsely) think it's absolutely impossible to combine a GP-friendly diet with any of your other diets.
Once you've downloaded the GP-friendly food list, start cross-referencing it with whatever other restrictions you have. If you're well-educated in your other condition(s) you may be able to do this yourself. For some people, this may require the help of a professional, whether that's a Certified Health Coach or a Registered Dietitian knowledgeable in those other conditions.
It's usually easier to find a professional who is trained in Celiac disease, diabetes, IBS, etc. than one who is truly knowledgeable about gastroparesis. Starting with the food list I created for Eating for Gastroparesis helps bypass that challenge.
On your own or with help, cross off the foods on the GP-friendly list that do not fit within your other requirements. What you'll be left with is the foods that (on paper) suit all of your restrictions. This is then where you start experimenting to see what works for you.
If you're like many people with gastroparesis, you currently eat a small number of what you consider "safe" foods. It's likely that your multi-friendly diet will allow for gastroparesis-friendly foods that you haven't tried or that you've previously ruled out. I encourage you try or retry these foods within the context of your multi-friendly diet. Nearly all of the clients I've ever worked with have had more "safe" foods than they initially thought.
If you find yourself thinking, "but everything I eat makes me sick" please keep in mind that diet is only ONE part of a gastroparesis management plan and only of many things that can cause symptoms to flare. Check out my blog post on the Gastroparesis Symptom Bucket to learn more.
With experimentation, you may find that there are foods on your list that are both GP-friendly and suit your other needs that still don't work for you. On the flip side, there may be foods that are not GP-friendly but that fall within your other dietary guidelines that you find do not provoke your GP-related symptoms. By experimenting over time, you'll come up with a refined "you-friendly" diet.
What's left to eat?
As an example, here's what was left on my list after I cross-referenced all of my current restrictions (low-ish fat, low-ish fiber, low-FODMAP, GERD-friendly, gluten-free, dairy-free, egg-free, tree nut free) and excluded a few things I just don't like:
coconut milk, rice milk, soy milk (soy milk is not low-FODMAP but I do just fine with it)
Canadian bacon, chicken and turkey breast, ground turkey/bison/lean pork/lean beef, deli turkey
cod, haddock, halibut, salmon, tilapia
peanut butter, sunflower seed butter
grapes (green/red, juiced), cantaloupe, squash (summer, spaghetti), honeydew, carrots (orange, purple, yellow), sweet potatoes, leafy greens, parsnips, peas, turnips, potatoes (white, purple)
cream of rice, oatmeal (small portion), cream of buckwheat
gluten-free flours, rice pasta, quinoa pasta, buckwheat pasta
buckwheat, millet, quinoa, white rice
coconut oil, olive oil, red palm oil
assorted herbs and spices
So this is my starting point for where I am right now. This is clearly not every possible food that meets my requirements and/or that I'm able to eat, nor is everything on this list is in frequent rotation in my diet. Peanut butter doesn't always make me feel great, for example. Though I'm trying, I'm not a huge fan of fish. In addition to what's on this list, I also regularly eat blueberries, gluten-free waffles, and swing by Starbucks for a soy hot chocolate now and then.
In real life -- trying to juggle my 3-year-old, my business, and my health -- this list translates mostly into simple meals of ground turkey, baked chicken and salmon, roasted and steamed vegetables, baked sweet potatoes, hot cereal, rice, gluten-free pasta, and homemade soup.
Do I stick only to the foods on my list all the time? No. I don't waiver on gluten-free or dairy-free, but I'm fairly flexible with "low-fat" and "low-fiber" at this point. Do I feel best when I do stick mostly to these foods? Yes. Is it kind of boring? Sometimes, sure. But it's nourishing, it works, and I know that it's always evolving.
Update: see this later post about my normal gastric emptying study and resolution of more symptoms!
Additional Info
The majority of the 75 recipes in Eating for Gastroparesis: Guidelines Tips and Recipes are or can easily be modified to be gluten-free, dairy-free, GERD-friendly, and/or low-FODMAP in addition to being GP-friendly.
Also keep in mind that like gastroparesis, lifestyle modifications can have a significant impact on the management of GERD, IBS, and even SIBO (in conjunction with appropriate medical treatment). The comprehensive management plan that I teach for GP management may also alleviate symptoms due to these other conditions.
In fact, past participants in the The Living (Well!) with Gastroparesis Online Program, in which I work with clients with gastroparesis to help them build their personal management plans, have said that it positively impacts ALL areas of their health and well-being, not just GP. And it's often this progress that allows the diet to continue expanding as noted in Tip #2 above.
A great resource for information on the low-FODMAP diet is Kate Scarlata. You can find a FODMAP Q&A that I did with Kate here and lots of info on her website.
If you are diabetic, you may benefit from The Gastroparesis Cookbook by Karen Frazier, which lists the carbohydrate content for all of its recipes. It also designates which recipes are low-sugar and low-carbohydrate. You can watch the video below for my full review of the book.