This was the first article in the series I wrote for Gastroparesis Awareness Month at the Unchargeables. I have reprinted it here with their permission. The orginal can be accessed here.
August is Gastroparesis Awareness Month. Gastroparesis is a gastrointestinal disorder that affects the stomach’s ability to digest and pass food.
I want to discuss some of the many ways one can improve gut motility naturally. While there is plenty out there about medical interventions for gastroparesis, there’s not a great deal available about how to treat the symptoms of gastroparesis using naturopathic or holistic modalities. Despite the lack of copious information, there are a variety of simple things a person can do to improve motility and get relief from mild to moderate symptoms, many of which I employ myself.
In this two part series, we’ll first discuss how changes in diet and medications can help. The second article will cover supplements that promote motility and mediate other symptoms, along with ways to stimulate the vagus nerve for improved gastric flow.
There are many medications that can be prescribed for gastroparesis. A lot come with unpleasant side effects and are only meant to be used short term, while others are only effective for a short period of time. There are a number of easy, natural remedies that can help, some of which you probably already have on hand. Diet and exercise also play an important role in managing the condition. Most people with gastroparesis lose the ability to digest certain kinds of foods which should be avoided. Additionally, avoiding things like smoking and alcohol can improve slow gastric emptying and gut motility.
What is Gastroparesis?
Gastroparesis (GP) is a condition that affects the normal movement of muscles in your stomach, causing delayed gastric emptying. GP is believed to be caused by damage to the nerve that controls the stomach’s muscles, the vagus nerve. In some patients, damage to the vagus nerve has been documented.
In its early stages, GP can also be referred to as dyspepsia. Some people with gastroparesis experience few symptoms, while others are plagued by severe symptoms. Some researchers have proposed a classification system for GP, ranging from mild, or grade 1, to severe, or grade 3.
This dysfunction can be caused by a variety of factors, such as neuropathy, post-surgical complications, medications that cause delayed gastric emptying such as opioids, viral gastroenteritis, nervous system disorders (e.g., Parkinson’s), collagen disorders (e.g., EDS/HSD), connective tissue diseases (e.g., RA, lupus), metabolic disorders (e.g., diabetes and hypothyroidism), anorexia nervosa and bulimia, chronic liver or renal failure, and chronic pancreatitis. Gastroparesis may also be induced by medications, associated with total parenteral nutrition, or related to bone marrow and other organ transplants. Additional causes include paraneoplastic syndrome, mitochondrial disorders, visceral neuropathies (e.g., Guillain-Barre syndrome), and visceral myopathies (e.g., systemic scleroderma).
“Reports from one tertiary referral center found that out of their 146 patients with gastroparesis: 36% were idiopathic (unknown causes), 29% were diabetic, 13% were post-surgical, 7.5% had Parkinson’s disease and 4.8% had collagen diseases (NORD).”
While there is no cure for gastroparesis, some recovery of function and improvement of symptoms is sometimes possible after successful treatment. While I have to watch what I eat carefully and treat my symptoms regularly, I have improved my motility significantly using the strategies outlined below.
Gastroparesis and Medications
One of the simplest ways to improve gut motility is to eliminate or replace any medications you are taking which slow motility or have an anticholinergic effect, if at all possible. The best way to accomplish this is to consult with your pharmacist about the medications you are currently taking and see if they can recommend alternatives for any that are suspect. If you choose, you can often find natural supplements that are just as effective, but don’t have an anticholinergic effect. Popular medications that slow digestion include most gastrointestinal agents including proton pump inhibitors and antacids, antiemetics (e.g., promethazine), and anti-diarrheals; tricyclic antidepressants and other psych meds, opioids, some heart medications, and more (see a full list here).
Gastroparesis and Diet
The best place to start when attempting to improve motility is a modified diet. Modifying the diet to eliminate anything the digestive system no longer processes is essential to helping your stomach run smoothly again.
The Problem with Carbohydrates
Often people with GP lose the ability to process certain carbohydrates. The FODMAP diet, designed by researchers at Monash University, was created specifically for this reason. It is used for people with a variety of gastric disorders. The FODMAP diet is an elimination diet that helps you test various carbohydrates to see how your body reacts to them after a period of going without them. If you still react poorly to them after going without for the specified time period, then you need to eliminate them from your diet.
The lactose carbohydrate found in dairy is usually particularly hard on people with GP. But often they have difficulty processing a variety of carbohydrates, such as fructans (i.e., onion and garlic), polyols (i.e., stone fruits, berries, and artificial sweeteners such as xylitol and sorbitol) and other high fiber fruits, vegetables, grains, and legumes.
It’s difficult to glean just what is causing your stomach upset when there may be multiple culprits. The FODMAP diet may seem complicated, but in the end, it really simplifies things by putting into place a system of checks and balances where you test one kind of carbohydrate at a time. The diet can be very limited during the elimination and testing phases and can end up being quite limiting long term for people with gastroparesis. But the pay-offs in how you feel without the delayed gastric emptying, nausea, pain, bloating, gas, and pseudo-blockages are more than worth it.
Avoiding High-Fat Foods
People with gastroparesis often need to avoid high fat foods for the same reason. The doctor recommendations I’ve found is a total fat intake under 40 grams per day for gastroparesis patients (Arnold Wald, MD), but I find the kind of fat matters. For instance, I can eat high fat nuts with little problem, like peanuts and almonds, and seem to enjoy as much nut oil as I’d like. But I don’t process animal fats well and have had to cut out things like ribs, chuck roasts, and even burgers sometimes give me a bit of trouble.
Those Vexing Vegetables!
You may find that you can also no longer process a lot of raw vegetables or undercooked meats, like steak. Sadly, while these usually offer more nutritional value, they are harder for the stomach to process and may slow digestion. Instead, I tend to cook most of my meat in a slow cooker or roast until it’s fall apart tender. This helps me to digest it more easily. Using leaner cut roasts, such as bottom or top round instead of the traditional fatty chuck roast, keeps it lean enough that I avoid upset from fats.
With fresh vegetables, you will generally find the higher the insoluble fiber content, the harder it is to process them, raw or cooked. There are handy cheat sheets to help if you utilize the FODMAP diet.
No matter what you eat, you should always be paying attention to how it makes you feel. Your body will tell you when something is wrong. You just need to learn how to listen to these queues and trust them. I found utilizing the FODMAP diet to be very helpful in this arena. When I first went on it, my stomach was a raging dumpster fire. Eating anything made me feel bad 100% of the time. It wasn’t until I gave my stomach a rest from all the things it could no longer process that these signals became crystal clear and I could tell how my body reacted to things individually.
The Timing of Eating
How often you eat also matters. Doctors generally recommend several small meals a day, but some people with GP find it’s actually better to eat only once or twice a day, giving their digestive systems plenty of time to process food and rest in between. Personally, I eat a meal in the morning and the rest of my calories in the evening, letting my stomach signal when it’s time. I believe it works because these short periods of fasting give my body plenty of time to digest and reset and I have fewer problems with fluctuations in blood sugar and other symptoms.
I don’t just eat and lay down at night, though. I eat and then do the dishes and pick up around the house, making sure I get some activity in, as it’s recommended for people with GP. Often after my morning meal is when I exercise. However, I prefer to allow my food to digest for 30-45 minutes first to avoid stomach upset if I feel particularly full or nauseous.
Some people swear by smoothies for gastroparesis, as solid foods can become more difficult to process. However: I often question how they are being made. If you process carbohydrates poorly and need to consume less insoluble fiber, I would take great care in choosing ingredients and also question whether or not the raw fruits and vegetables are more likely to cause stomach upset. At this stage, I find cooked, soft solid foods work great for me, but it depends on what grade of gastroparesis you have and what you’re still able to process.
Listen to Your Body!
I can’t caution enough how important it is to listen to your body first. There is no “one size fits all” model for the GP patient. If you are giving your body food it’s unable to process, no other interventions will be as effective or helpful.
Cleaning up medications and modifying your diet to suit what your gastroparesis tummy can still process is paramount to gaining control of the condition. However, there is still work to be done to achieve the best outcomes possible for people with gastroparesis. People with GP often suffer from malnutrition as a result of poor absorption, for example, and need to learn the best ways to supplement their nutrition. Additionally, there are a number of naturally occurring agents that can increase motility, curb nausea, diarrhea, constipation, heart burn and other undesirable symptoms. Learn about them all in Natural Treatments for Gastroparesis: Part Two.