The Eating WELL Approach to Weight Maintenance
I recently mentioned (again) on my Facebook page how important it is to make sure that your GP-friendly diet includes a variety of nutrient-rich foods. One of the responses went something like this:
“That’s nice, but when you’re trying to eat 2,000 calories a day to gain weight, there’s no room for healthy food.”
First of all, I totally understand why it seems that way. After all, most of the hype around "healthy" eating is related to weight loss. But this thinking misses an important point: it's not just about calories when it comes to health and nutrition or weight maintenance.
Not to say that eating an adequate amount of calories isn't important, but think about it this way: it's not really a specific number on the scale that your body needs to function properly, it's the nourishment that is reflected by that number. In other words, for health and healing what you really need are nutrients not just calories. (It's possible to be malnourished -- or not -- in nearly any size body.)
What you eat really, truly does impact how your body functions. Here's the good news: eating well and gaining weight are not mutually exclusive, even for those with GP. Focusing on the quality of the food in your diet may actually help you reach and maintain a healthy weight, while improving your overall health and reducing GP symptoms. That's because the refined, processed foods that are often considered staples of a GP-friendly diet tend to be low-fat, low-nutrient, and fairly low-calorie in GP-friendly portions. By making smart choices, you can replace at least some of those nutritionally-poor foods with similar (or even smaller) portions of nutrient-rich foods while maintaining (or even increasing) your caloric intake.
I know that figuring out how to balance weight maintenance, symptom management, and good nutrition can be difficult, so here are some tips:
Get more "bang for your bite." If the food you're eating is providing you with calories and nothing else, it's really not doing you much good health-wise. Swap white, processed, and/or refined foods for more colorful, nutrient-rich foods. That way even if you're not eating as many calories as you'd like, the calories you are eating will actually be nourishing your body! Bonus: many of these less nourishing foods are high in FODMAPs, which may exacerbate symptoms like bloating, gas, pain, and bowel issues. Replacing them with lower-FODMAP foods may actually decrease symptoms and allow you to eat more overall.
Eat more fat. What!? Yes, I said more fat. While a gastroparesis-friendly diet should be low in dietary fat, it is possible to restrict fat too much, making weight management quite difficult. That's because fat has twice as many calories per gram (9) as carbohydrates (4). You'd have to eat quite a bit more food by volume to make up that caloric difference, something that's not possible for most people with GP. If you're eating less than 25-30 grams of fat a day, try increasing your overall intake by including small amounts of olive oil, coconut oil, avocado, nut butter or other sources of healthy fats in your diet. Even small changes add up. For example, using a tablespoon of peanut butter on your toast instead of a tablespoon of jelly will provide twice as many calories and 8 additional grams of necessary fat without increasing the volume of your meal. Bonus: dietary fat is essential for the absorption of the fat-soluble vitamins, A, D, E, and K.
Stop snacking. While you may think that frequent snacking, also called grazing, is the best way to pack in calories, it may actually be working against you. First, GP-friendly "snacks" aren't usually well-balanced. They tend to be mostly processed carbs with little nutritional value. Second, continuous snacking never allows your stomach to make any progress with digestion. Based on my work, more often than not continuous snacking seems to exacerbate symptoms, especially fullness, nausea, bloating, and pain in the afternoon and evening. This often results in skipping evening meals or even breakfast the next day. If you're a grazer, eating 4-6 mini meals spaced fairly evenly throughout the day may allow you to better optimize the calories and nutrition in your daily diet (see pages 60-61 in Living (Well) with Gastroparesis to figure out how many meals work best for you). Bonus: well-balanced mini meals tend to be more satisfying for both the mind and body, as well.
Drink responsibly. Many people with gastroparesis rely on liquid calories to help with weight maintenance. If you're drinking soda or sports drinks, however, consider swapping them for fresh juice. Juicing allows you to consume far more fruits and veggies than you could otherwise, and the calories are significantly more concentrated. Also consider smoothies. While they can be filling, drinking a small amount several times a day really adds up, both in terms of nutrition and calories. For example, this simple 600-calorie smoothie can be divided into two or three (4-6 ounce) portions and consumed throughout the day: 1 Orgain + 1 banana + 2 tablespoons nut butter.
Move it, move it. This may seem counterintuitive, but exercise may be more likely to help you maintain weight than lose weight. That's because mild to moderate activity doesn't burn many calories, but it does stimulate appetite. What's more, exercise enhances digestion and often alleviates fullness, bloating, and other gastroparesis symptoms allowing you to eat more overall. Bonus: regular exercise also helps to reduce stress, which is another vital part of GP management.
Be comprehensive. Dietary modifications are not and should not be the only means of managing symptoms. When we attempt to rely solely on dietary modifications, we usually end up over-restricting and still not finding adequate symptom management. Bolstering other areas of your comprehensive management plan will almost always allow you to broaden your diet while continuing to manage your symptoms. Please do not underestimate the importance of this step, especially if you're really struggling with an inability to gain weight.
Unfortunately, there's no silver bullet or one-size-fits-all solution when it comes to anything related to gastroparesis. While these tips are likely to help with weight maintenance, some people have a very difficult time maintaining their weight regardless of what they do. Any steps you can take to enhance the nutrition in the calories you are able to consume, however, will benefit your overall health and well-being.
Relevant Resources
Need more info? These books and classes might be helpful:
Living (Well!) with Gastroparesis (comprehensive management plan; recipes; nutrition information)
Eating for Gastroparesis (guidelines of a GP-friendly diet; tips; recipes)
Ten Updated Gastroparesis Diet Guidelines (updated 2021)