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Dietary and Nutritional Recommendations For Patients with Gastroparesis

A number of dietary recommendations have been developed for gastroparesis patients. These recommendations are of greatest benefit to those with mild to moderate disease, but are still helpful in more severe gastroparesis.  Diet is always a complement other medical treatments for gastroparesis.  It is the combination of  diet, medications, and possibly surgery / gastric pacemaker,  that together make the most impact on this disease. It is recommended that anyone with severe gastroparesis, especially those with diabetes or kidney disease, seek dietary counseling to help maximize nutritional benefits.

Basic Dietary Guidelines for Patients with Gastroparesis:

  •  Small, frequent meals. Reducing the meal size reduces the distention of the stomach from the meal. By eating smaller meals, patients may not feel as full or bloated and the stomach may empty faster. With the reduction in meal size, increasing the number of meals to 4-6 per day is needed to maintain adequate nutritional intake. 

 

  • Avoid foods high in fat. Fat can delay emptying of the stomach. Eating less fat-containing foods will decrease the amount of time food stays in the stomach. However, fat-containing liquids, such as milkshakes, may be tolerated and provide needed calories.

 

  • A diet low in fiber is suggested. Fiber delays gastric emptying. In addition, fiber may bind together and cause a blockage of the stomach, called a bezoar in some patients.. Examples of high fiber foods that should be avoided include oranges, berries, green beans, potato peels, apples, sauerkraut, and Brussel sprouts. Fiber supplements for treatment of constipation should also be discontinued if possible.

 

  • Chew food well before swallowing. Patients should avoid foods that may not easily chewed such as broccoli, corn, popcorn, nuts, and seeds. Solid food in the stomach does not empty well. Dental problems, such as missing or broken teeth, may lead to poorly chewed food; this may add to the problem of inadequate breakdown of food into smaller particles in the stomach for passage into the small intestine for absorption.

 

  • Taking fluids throughout the meal and sitting upright or walking for 1-2 hours after meals may help in the emptying of the meal from the stomach.

 

  •  A daily multivitamin/mineral supplement should be taken if dietary intake is inadequate.

 

  • Switch to primarially liquid meals. If other measures fail, the patient may be advised to make the bulk of their meals liquids, such as puréed foods or soups.  Stomach emptying of liquids is often normal in patients with gastroparesis. Calorie-containing drinks, such as Hawaiian Punch or Hi C, providing fluid and calories, are better than water alone. Some options while on a liquid diet include milk, instant breakfast, milkshakes, yogurt, puddings, custard, cereals, and smoothies. It may be necessary to supplement the diet with a commercially available liquid nutrient that is low in fiber such as Ensure, Boost, or even baby foods. Blenderized foods prepared by the patient may also be used as a liquid nutrient source. Any food can be blenderized; solid foods will need to be thinned with some type of liquid, such as broth, milk, juice, water.

 

There are quite a few medications that can delay stomach emptying. Ask your doctor if any of the medications you are taking could be slowing down your stomach emptying 

If the gastroparesis is due to diabetes, an important goal is to maintain good glucose control. This is achieved more easily by frequent monitoring of blood sugar levels and adjustment of insulin. Keeping your blood sugar under control may help stomach emptying. Let your doctor know if your blood sugar runs > 200 on a regular basis.

Patients with kidney disease need to follow additional dietary advice. The dietary restrictions will depend on your kidney doctor’s assessment.  Adequate protein is needed for nourishment, but too much may increase a waste product called urea that your kidneys may not be able to get rid of. High sodium (salt) intake can increase blood pressure and fluid retention. Restriction of potassium varies depending on the stage of kidney disease. Generally, one should avoid high potassium foods such as bananas, oranges, kiwi, leafy greens, and broccoli. Kidneys may not be able to remove phosphorous from the blood. High phosphorous foods include dried beans, peas, nuts, and liver.

Patients with chronic gastroparesis, despite all efforts, may develop dehydration and malnutrition. Occasionally, patients need an alternative method to obtain fluid and nutrition. This might involve delivering fluids and nutrients directly into the small intestine using a jejunostomy tube. In severe cases, intravenous fluids and nutrition may need to be provided.

Recommendations for Gastroparesis

  • Eat smaller, more frequent meals
  • Eat less fatty foods
  • Avoid fiber
  • Avoid foods that cannot be chewed well.
  • Liquid nutrients are better tolerated over solid food
  • Good glucose control in patients with diabetes (aim for blood sugars < 180 mg/dl)
  • Avoid medications that can delay stomach emptying such as:Aluminum-containing antacids (Amphojel) Narcotic pain medications (Percocet, Tylenol #3, Tylox, Oxycontin, and others) Anticholinergic agents (Bentyl, Levsin, Elavil, and others) Bulk-forming agents (Metamucil, Perdiem, Fibercon, and others)

Foods that are encouraged

  • Breads, Cereals, Crackers, ground or pureed meats
  • Vegetables – cooked and, if necessary, blenderized/strained
  • Fruits – cooked and, if necessary, blenderized/strained
  • Juices, Beverages, Milk products, if tolerated

High fiber foods that should be avoided in gastroparesis

  • Fruits - apples, berries, coconuts, figs, oranges, persimmons,
  • Vegetables - Brussel sprouts, green beans, green peas, lettuce, potato peels, sauerkraut
  • Bran/whole grain cereals
  • Nuts and seeds
  • Legumes/Dried Beans – baked beans, lentils, soy beans 

 

A Sample Diet for Patients with Gastroparesis

Sample Meal Plan for 6 Small Daily Meals

Breakfast

  • 1 cup cream of wheat cereal
  • ½ cup skim milk
  • ½ cup grape juice
  • 1 scrambled egg

Snack

  • 10 ounces of instant breakfast with skim milk

Lunch

  • ½ cup vegetable soup
  • ½ turkey sandwich
  • ½ cup applesauce
  • ½ cup milk
  • 1 tablespoon mayonnaise

Snack

  • 10 ounces banana shake made with l plain or vanilla yogurt, milk and sugar

Dinner

  • 2-3 ounces baked chicken or fish
  • ½ cup mashed potatoes
  • 1 teaspoon margarine
  • ½ cup spinach
  • ½ cup milk
  • ½ cup fruit cocktail

Snack

  • ½ cup pudding, custard or gelatin