Gastroparesis Diet Q&A
Earlier this summer, I did a diet Q&A for a gastroparesis support group. I've decided to share it here, as well.
P.S. Still have questions about diet, nutrition and eating for gastroparesis? Check out my book, Eating for Gastroparesis.
Diet Q and A with Crystal Saltrelli, CHC
1) What is the single most important factor regarding nutrition maintenance for those with GP?
The most important thing to remember is that while there are general dietary guidelines for gastroparesis, everyone responds differently to specific foods and supplements. In addition, an individual’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 or even an individualized plan that should be followed day in and day out. Trial-and-error – within the boundaries 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 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 or higher-fat meal replacement drinks), 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 practitioners, patients, and the basic principles of digestion (i.e. high-fiber foods digest more slowly than low-fiber foods).
2) Is coffee recommended for people with gastroparesis? In general, coffee (both regular and decaf) is irritating to the digestive tract. However, whether or not to 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, particularly if they struggle with constipation. If you currently drink coffee, it’s worth experimenting to see if you better (or not) without it.
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. (It’s estimated that less than 20% of gastroparesis patients will get a bezoar.) In general, those with gastroparesis should avoid foods with indigestible parts just to be safe. 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 (feeding tube or TPN) need to be considered? This is really at the discretion of the individual 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. The majority of people with gastroparesis do not and will not require artificial nutrition.
5.) What should each meal consist of? In general, a gastroparesis-friendly meal should look like a “regular” meal, just smaller. That means consuming a variety of foods and a balance of carbohydrates, protein, and fat. For example, a small portion of grilled chicken or fish with 1/2 skinless baked potato and 1/2 cup roasted carrots. Or a scrambled egg with a slice of white toast with jam and 1/2 cup melon.
6) How do I avoid constipation when fiber is so limited? This is an important topic because chronic constipation can worsen symptoms of nausea and bloating, as well as further delay the emptying of the stomach. It’s important to be sure that you are eating some fiber. It’s not necessary to eat as little fiber as possible and may actually be counterproductive for the reason described above. Most people with gastroparesis do well with 12-15 grams of fiber per day. You’ll also want to be sure you’re well-hydrated and drinking plenty of water. Dehydration will exacerbate constipation. Engaging in mild to moderate physical activity is a great way to alleviate gastroparesis symptoms and is also helpful for constipation. If, after making these dietary and lifestyle adjustments, you are still not having regular bowel movements, it’s important to inform your doctor as there are both over-the-counter and prescription medications that can help.
7) Do you recommend whole foods over processed products? As much as possible, yes. In general, processed products offer less nutrition than whole foods. That's fine in moderation as part of an otherwise nutrient-rich diet but because those with gastroparesis tend to eat smaller amounts and need as many nutrients as possible, it's best to aim for as much nutrition as possible in each bite. Of course it’s not feasible for most people to eat only whole foods all the time. Processed/packaged foods can absolutely have a place in a GP-friendly diet; they just shouldn’t be the foundation of it.