Dietary advice for diabetes-related gastroparesis

About gastroparesis

Gastroparesis is the medical term for delayed stomach emptying.

The stomach helps to break down the foods we eat before it passes into the bowel, where it is further digested and absorbed. The vagus nerve is the main nerve that controls the movement of food into the stomach and through the bowel.

Gastroparesis occurs when the nerve to the stomach is damaged, which can delay or prevent movement of food through the stomach.

What causes gastroparesis?

A main cause of gastroparesis is diabetes, as the vagus nerve can be damaged by sustained high blood sugar levels. Gastroparesis is also common in chronic liver or kidney failure, pancreatitis, cancer, neurological disorders and after surgery. It can be caused by certain medications. Many cases however, may be due to an unknown cause.

What are the symptoms of gastroparesis?

You may experience a range of symptoms such as:

• abdominal bloating and pain
• heartburn
• early feelings of fullness when eating
• nausea and vomiting
• hard to control and unpredictable blood glucose levels
• reduced appetite
• unintentional weight loss

What are the effects of gastroparesis?

• Reduced oral intake as a result of missing meals and early feelings of fullness.
• Food may linger in the stomach causing problems such as bacterial overgrowth from the fermentation of foods which may lead to abdominal pain and bloating.
• Medications may not be digested properly.

Patients with diabetes who take insulin may be more prone to low blood glucose levels after mealtimes. This is because food may remain undigested. Food needs to be digested before absorption and a subsequent rise in blood glucose level.

How is gastroparesis treated?

Gastroparesis is usually a long-term condition. Treatment does not aim to cure, but instead helps to manage the condition so that you can be as healthy and comfortable as possible.

The treatment for diabetes-related gastroparesis is to optimise blood glucose levels and to relieve symptoms. Your doctor, diabetes specialist nurse or dietitian will discuss your blood glucose control with you.

Medications

Your doctor may recommend medications that help the stomach to empty more quickly. For example Metoclopramide, Erythromycin and Domperidone. If you suffer nausea or vomiting, your doctor may recommend anti-sickness medications such as Cyclizine or Ondansertron.

Diet and lifestyle advice

These suggestions may help to relieve your symptoms. However, they will be individual to all.

Have smaller meals and drinks more regularly throughout the day

This will help the stomach to empty more quickly.

• Try smaller drinks and drink separately from meals.
• Try eating six small meals or snacks a day instead of three large meals.

Try more fluid or pureed food

Fluids and puree foods are often better tolerated than solid foods as they pass through the stomach much faster. Try to identify what time of day your symptoms are at their best and worst. If your symptoms are worse at night, try solids in the morning and puree foods/ fluids in the evening. Keeping a food and symptom diary may help. An alternative to pureed food is to have a soft and moist diet, taking care to chew your food very well before swallowing.

Avoid alcohol and fizzy drinks

These can make symptoms such as abdominal bloating and pain worse and are best avoided.

Choose foods low in fat and fibre

Foods high in fat and fibre delay stomach emptying and therefore may need to be limited or avoided dependent on your symptoms. The information below lists foods to limit or avoid and provides suitable alternatives.

The following may also help to reduce symptoms:

• Reducing stress around mealtimes.
• Sitting at the table, taking time to eat and chew foods well.
• Sitting upright during and after meals for one to two hours.
• Light exercise after meals, such as a gentle walk.

Do I need to take a vitamin or mineral supplement?

Your dietitian may recommend a vitamin or mineral supplement if you are unable to get enough vitamins and minerals from your diet. If you are struggling to eat five portions of fruit and vegetables, consider taking an A-Z multivitamin.

What if I am losing weight?

Please contact your dietitian if you have lost, or are losing, weight. Your dietitian may recommend nutritional supplements to help maintain your weight.

It is important to remember that treatment for gastroparesis is not a cure, but instead helps to relieve your symptoms.

Who do I contact for further information?

If you have any concerns or questions about any of the above please either call your dietitian on 01223 348769 or send us a message via the Diabetes Educator on MyChart (opens in a new tab).