STEP 1 DIET consists of liquids, which usually leave the stomach quickly by gravity alone. Liquids prevent dehydration and keep the body supplied with vital salts and minerals.
The STEP 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium. It should not be continued for more than three days without additional nutritional support. STEP 2 and STEP 3 Gastroparesis Diets may be inadequate in Vitamins A and C, and the mineral iron. A multi-vitamin supplement is usually prescribed.
Allowed fruit juices:
apple juice, cranberry juice, grape juice, pineapple, prune juice,
Not recommended juices:
citrus juices, all fresh and dried fruits, canned fruits with skins
vegetable juice (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)
Not recommended vegetables:
all raw vegetables; cooked vegetables with skins; beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Sweets & desserts*
hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups
Bread & grains
breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers
Not recommended: oatmeal; whole grain rice, cereal, bread
Milk & milk products
skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses
Avoid: whole milk products, creams (sour, light, heavy, whipping), half & half
NUTRITION - MALNUTRITION Dietitians recommend 6 small meals daily
Foods more easily digested Foods increasing symptoms
fruit juices protein foods - meat, eggs canned fruits & vegetables raw fruits & vegetables soft starches (white bread dairy products & rice, mashed potatoes, cereals) caffeine, chocolate soups nuts & seeds baby foods non-carbonated beverages jello
Liquid Nutritional Supplement Drinks Diabetic: Choice dm (Mead-Johnson), Glucerna (Ross Labs) Ensure Glucerna OS (Ross Labs) Non-diabetic: Ensure/Ensure plus, Sustacal (Ross Products Div) Nutrition via: IVs (fluids or TPN) Tube feedings (eq. Osmolite or Supplena) PHYSICAL - Remaining upright at least a half hour after eating, stomach massage, enemas, glycerine suppositories, stool softeners (for example, psyllium husk powder: Metamucil and other brands)============
Once gastroparesis has been confirmed as the major cause of high overnight blood sugars and wide random variations in blood sugar profiles, we can begin to attempt to control or minimize its effects. If your blood sugar profiles reflect significant gastroparesis, there is no way to get them under control by only juggling doses of insulin. There’s just too much danger of either very high or very low blood sugars for such approaches to work. The only chance for effective treatment is to concentrate on improving stomach-emptying.
How do we do this?
We have four basic approaches. First is the use of medications. Second is special exercises or massage during and after meals. Third is meal plan modification utilizing ordinary foods, and fourth is meal plan modification utilizing semiliquid or liquid meals. It’s unusual for a single approach to normalize blood sugar profiles fully, so most often we try a combination of these four approaches, adapted to the preferences and needs of the individual. As these attempts
start to smooth out blood sugars, we must modify our doses of insulin or ISAs accordingly.
The guidelines that we use to judge the efficacy of a given approach or combination of approaches are these:
• Reduction or elimination of physical complaints such as early satiety, nausea, regurgitation, bloating, heartburn, belching, and constipation
• Elimination of random postprandial hypoglycemia
• Elimination of random, unexpected high fasting blood sugars—probably the most common sign of gastroparesis that we encounter
• Flattening out of blood sugar profiles
GASTROPARESIS: CAUSES AND EFFECTS
Most of these symptoms, as well as effects upon blood sugar, relate to delayed stomach-emptying. This condition is called gastroparesis diabeticorum, which translates from the Latin as “weak stomach of diabetics.” It is believed that the major cause of this condition is neuropathy (nerve impairment) of the vagus nerve. This nerve mediates many of the autonomic or regulatory functions of the body, including heart rate and digestion. In men, neuropathy of the vagus nerve can also lead to difficulty in achieving penile erections. To understand the effects of gastroparesis, refer to Figure 22-1.
On the left is a representation of a normal stomach after a meal. The contents are emptying into the intestines, through the pylorus. The pyloric valve is wide open (relaxed). The lower esophageal sphincter (LES) is tightly closed, to prevent regurgitation of stomach contents. Not shown is the grinding and churning activity of the muscular walls of the normal stomach.
On the right is pictured a stomach with gastroparesis. The normal rhythmic motions of the stomach walls are absent. The pyloric valve is tightly closed, preventing the unloading of stomach contents. A tiny opening about the size of a pencil point may permit a small amount of fluid to dribble out. When the pyloric valve is in tight spasm, some of us can sometimes feel a sharp cramp above the belly button. Since the lower esophageal sphincter (LES in Figure 22-1) is relaxed or open, acidic stomach contents can back up into the esophagus (the tube that connects the throat to the stomach). This can cause a burning sensation along the midline of the chest, especially while the person is lying down. I have seen patients whose teeth were actually eroded over time by regurgitated stomach acid.
Because the stomach does not empty readily, one may feel full even after a small meal. In extreme cases, several meals accumulate and cause severe bloating. More commonly, however, you may have gastroparesis and not be aware of it. In mild cases, emptying may be slowed somewhat, but not enough to make you feel any different. Nevertheless, this can cause problems with blood sugar control. Consuming certain substances, such as tricyclic antidepressants, caffeine, fat, and alcohol, can further slow stomach-emptying and other digestive processes.
Low Residue Diet for GastroparesisBecause the stomach is emptying more slowly, the Gastroparesis and Dysmotilities Association recommends a low residue diet of foods that are easy to digest. This includes foods that are processed and refined such as white breads, white rice and cereals which are often not considered part of a healthy diet.
Because fiber is hard to digest, patients with gastroparesis should avoid foods with high fiber content like:
Dietary Changes for Patients with GastroparesisPeople with gastroparesis often must alter their dietary habits to help decrease the symptoms of their condition. This involves a lifestyle modification that includes:
- eating small meals more frequently
- keeping a food diary for particular foods that cause problems
- reducing stress
- not lying down after eating
- exercising to improve digestion