The Gastroparesis Symptom Bucket

During a recent Facebook Live video, I mentioned my "Bucket Theory" of gastroparesis management. This is something I developed for participants in a group coaching program that I used to run (mostly as an explanation for why they shouldn't just jump ahead to the dietary sections of the course!).  It seemed to resonate with many of you, so I thought I'd share it more fully here.

Why is a comprehensive management plan so important?  

Imagine that you have a Gastroparesis Symptom Bucket. As long as your bucket doesn't overflow, you're at your baseline in terms of symptoms. You may very well be able to improve your baseline over time -- by addressing underlying conditions, for example, or spending more time in "rest and digest" mode --  but whatever it is in the moment, that's how you feel until your bucket overflows. Once it overflows, your symptoms "flare."

There are many things that can fill your bucket:

- dietary factors, including:  fat, fiber, food sensitivities, meal size, meal timing, etc.

- non-dietary factors, including: stress (physical, mental, environmental), anxiety, flare ups in other health conditions, infections, poor sleep, etc.

There are also things that can empty your bucket to varying degrees.  These tend to be non-dietary factors, including:  physical activity, relaxation exercises, medication, complementary treatments, etc. For the most part, there's nothing you can eat that will empty your bucket.

Despite appearances, it's rarely just ONE thing that leads to increased gastroparesis symptoms. All of your bucket fillers -- and in a different way, your bucket emptiers -- play a role.  (Read:  Are flare-ups random?)

Having worked with hundreds of people with gastroparesis and heard from thousands more via email and Facebook, I can tell you that the most common question I receive is some variation of... "What should I eat to make my symptoms go away?"

Nearly everyone's first instinct is to go straight to the diet.  And it certainly makes sense!

Often it is a dietary factor that causes the bucket to spill over (symptoms to flare)... but if we're not looking at everything else that filled up our bucket, we're not likely to make much headway with improving the quality of the diet (to better nourish your body) or consistently managing symptoms (to improve your quality of life).

Some people find their bucket overflows seemingly all day, everyday.  With these clients, I tend to hear,  "I can't eat anything without feeling horrible." Some people find their bucket overflows at a predictable time each day, commonly in the afternoon or evening.  Some people find they can usually keep their bucket from overflowing by keeping a very tight grip on the foods they consume, filling their bucket with the same dietary factors each day... but if anything changes, even slightly, their symptoms flare.

Consider this example:  say I'm starting my day with a bucket that's half full as soon as I wake up because I haven't slept well in a week, I'm really constipated, and I have an underlying condition that always stays in my bucket.

I grab a cup of coffee with artificial sweetener and, if I'm sensitive to FODMAPs, my bucket fills a bit more. I get in an argument with my spouse on the way out the door and I'm late to work because there's a traffic jam...this fills my bucket, too.  (If you don't understand why, read this article.)

All of these things have been filling my bucket and it's now, say, 3/4 full and I haven't even eaten anything yet.  (Note that of the "bucket fillers" above, only one of them is something I ingested.)

Now, let's say that this same scenario happens on two different days.

On Day One, I choose a "safe" food for breakfast. Perhaps I choose a small low-fat, low-fiber breakfast bar and I eat it and feel okay.  I continue to consider this bar, a "safe" food, thinking it prevents me from becoming symptomatic. My bucket may be filled right to top but it doesn't overflow.

Maybe it overflows at lunch or maybe I "empty out" some of my bucket by taking medicine, taking a walk, or practicing self-hypnosis.  If I  feel okay after lunch, too, I'm likely attributing that to another "safe" food choice but notice that the real reason I'm not symptomatic is because I emptied my bucket with non-dietary choices.

On Day Two, everything may be the same right up until breakfast. My bucket is 3/4 full. This time I choose a slightly higher fiber and/or higher fat, though still "GP-friendly" breakfast.  Perhaps some hot cereal with pureed fruit and nut butter.  This time, my bucket overflows.  I'm symptomatic and what I am going to blame?  Probably my breakfast choice. I might say, "well, I guess I can't tolerate hot cereal!"

In a way, this is true... the breakfast choice is what triggered the overflow.  But it's not -- at least not solely -- what caused the overflow.

Note also that on a third day, I may have the same small low-fat, low-fiber breakfast bar and I may feel symptomatic afterward.  Now I'm really confused. I thought this bar was "safe!?"  In that situation, I have to consider whether I may have had additional bucket fillers that morning, or even the previous day (an abnormally large dinner, for example), as the bucket may not fully empty overnight.  Or, if I'm a female, maybe I'm now at a point in my menstrual cycle that causes my digestion to slow a bit more.  See how many factors go into this?

This certainly isn't a perfect analogy but I think it's an easy way to conceptualize the reasons that a multi-faceted approach is the most effective way to reduce gastroparesis symptoms. 

At this point you may be wondering if diet matters at all. The answer is yes, absolutely.  If you're not following a GP-friendly diet, then it is likely that everything you eat will cause your bucket to overflow.  Unless you have some very powerful bucket emptiers and you have no other bucket fillers, a GP-friendly diet is usually a necessary part of the equation - especially in the beginning. 

But that's not the only diet-related consideration.  I also think that the nutrition we get from our dietary choices is an incredibly important part of feeling and living well.

In order to have enough leeway to build a nutrient-rich GP-friendly diet that allows us to improve our health and our quality of life, we must employ bucket emptiers and address all other bucket fillers rather than relying on primarily dietary restriction to keep the bucket from overflowing.  A diet restrictive enough to manage gastroparesis on it's own is not likely to be nutritious enough to provide your body with it what it needs to stay or become healthy.

Now for some, this approach seems overwhelming as there's suddenly so much more to think about than "just" diet. But I've actually found it lessens the pressure when you consider there are a lot of areas in which to make small improvements. It can also help to realize that there are ways to empty your bucket and they don't include further restricting your diet.

Here's the thing:  if you're trying to keep your bucket from overflowing by focusing on just one area, you have to be nearly perfect in that one area  -- whether that's diet, medical treatment, stress management, etc. Since perfection is usually not sustainable (and, to be honest, there is no perfect medication for this condition yet), this often leads to inconsistent symptom management, as well as an increasingly restricted diet/constant search for the "right" doctor or drug or procedure/giving up more responsibilities than otherwise necessary, etc.

The point of this theory, and more importantly of the comprehensive plan I teach, is to bring the focus to a larger number of areas of your life so that no area has to be perfect and each area can be less severely altered.  The result of all of these small, varied improvements is that your bucket is consistently LESS FULL overall, meaning you experience better symptom management and, mostly likely, improved quality of life.

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An easy place to start is with my free Quick Start Guide to Gastroparesis Management. This eBook will take you step by step through each area of the comprehensive management plan without adding to your overwhelm.

** If stress, anxiety, or overwhelm is filling your bucket (and, honestly, for most of us it's a huge but sneaky bucket-filler!), the absolute best resource I can recommend is The Little School of Big Change.  The live version of this program is offered a couple of times each year. A self-study version is also available.