Nutrition for Gastroparesis and Diabetes
What is Gastroparesis?
Gastroparesis is a condition in which there is delayed stomach emptying. This means that food sits in the stomach longer than it should, which can cause things like lack of appetite, nausea, vomiting, acid reflux and unintentional weight loss.
Gastroparesis happens when there is damage to the nerves that control the stomach, so it can’t empty and move food along to the small intestine as it should.
Relationship Between Gastroparesis and Diabetes
When diabetes is uncontrolled and blood sugars are high, this can cause nerve damage, leading to gastroparesis. Diabetes is often the cause of gastroparesis, but other things such as viral infections, Parkinson’s disease, multiple sclerosis or injury to the nerves during surgery can lead to it as well. Sometimes the cause of gastroparesis is unknown, which is called idiopathic gastroparesis.
Diabetes and gastroparesis unfortunately work together to make both conditions more difficult to manage. Diabetes and high blood sugars can lead to further nerve damage, worsening gastroparesis, while gastroparesis can make blood sugars unpredictable and harder to control.
Even in the absence of gastroparesis, high blood sugars cause slow stomach emptying. So, if you do have gastroparesis, keeping blood sugars under control is very important for both short-term and long-term management.
When it comes to gastroparesis and diabetes, managing one condition can help manage the other, so you can’t really focus all your efforts on one condition at a time.
Dietary Strategies for Gastroparesis
Nutrition recommendations, when it comes to people with gastroparesis and diabetes, should not be a one-size-fits-all approach. Therefore, there is not a standard gastroparesis diet. Some people may be able to make just a couple modifications to their diet, while others may need to make several.
Ideally, these approaches are supervised by a dietitian that has experience working with people who have gastroparesis and diabetes. These professionals will be able to prioritize the nutrition recommendations based on the severity and symptoms of the gastroparesis, current blood sugar management, dietary preferences, other medical conditions and goals related to weight.
While there is not a robust amount of research related to the dietary management of gastroparesis, there are several approaches that can help:
Small Frequent Meals
Eating smaller meals is ideal for several different reasons. The more food that is consumed at one time, the longer it takes to empty from the stomach. Also, people with gastroparesis often struggle with feeling full quickly, so larger meals may simply not be possible. Finally, smaller, more frequent meals are generally better for blood sugar control, so this is a win-win strategy for both gastroparesis and diabetes.
Eating 4-6 times per day is often necessary to meet nutritional requirements when having smaller meals. Some people choose to eat four mini meals per day. Others may choose to eat a smaller sized breakfast, lunch and dinner, incorporating snacks in between.
While a high fiber diet is normally recommended for people with diabetes, a low fiber diet may be beneficial for gastroparesis. Fiber slows down digestion, which is normally favorable for diabetes management, but should be avoided with gastroparesis.
Fiber has many health benefits, so a low fiber diet, rather than a no fiber diet, should be followed. Spread fiber throughout the day rather than eating it all at one meal. Choosing foods with less than 2 grams of fiber per serving is a common recommendation.
To decrease fiber intake, have more refined grains like white bread while limiting fruits and vegetables. Peel the skins off apples, potatoes and other produce to decrease the fiber content. Limit or completely avoid nuts, seeds, beans, bran muffins and cereals, popcorn, blackberries and raspberries.
Be sure to avoid fiber supplements as well. Talk to your healthcare provider about other options for constipation management, if that is an issue you have.
Some dietitians and other healthcare providers may try different strategies before recommending decreasing fiber intake as fiber has so many health benefits.
Fat is another nutrient that takes a longer time to empty from the stomach, so it should be limited. Avoid fried foods, high fat meats and high fat dairy like ice cream and butter. Even healthy fats, like olive oil and peanut butter, should be limited.
Having more liquid meals and snacks can be very beneficial for gastroparesis. While gastroparesis causes delayed stomach emptying, this is typically only the case for solids not liquids.
Protein drinks, meal replacement drinks, low-fiber smoothies and soups can all be great options. A glass of milk can be a great snack as well.
Juice is a perfect option for people with gastroparesis that don’t have diabetes, but this often makes blood sugars spike in people who do. You could try having a small amount of juice to see what this does to blood sugars or take additional insulin to cover the blood sugar spike.
Choose Cooked, Soft and Pureed Foods
On the same lines of having liquid nutrition, foods that are cooked, soft and/or pureed can digest faster than more solid ones.
Applesauce instead of an apple
Ground beef instead of steak
Cooked vegetables instead of raw
Mashed bananas instead of whole
Canned fruits instead of fresh
Cottage cheese, yogurt, mashed potatoes, cream of wheat and even store-bought baby food can be great options.
Chew Food Well
It may sound silly, but chewing your food adequately can make a big difference. The mechanical digestion from chewing helps break down food so it can be digested faster. Saliva also has enzymes that break down certain carbohydrates.
Avoid Foods Associated with Bezoar Formation
Gastroparesis increases the risk of developing a bezoar, which is a mass of undigested material that gets stuck in the gastrointestinal tract. Bezoars are relatively rare, but gastroparesis does increase the risk of getting one.
Food high in fiber, especially cellulose fiber, can increase the risk of bezoar formation. Foods associated with bezoar formation include:
*persimmons particularly increase the risk
Balancing Nutrition for Gastroparesis and Diabetes
Learning how to eat for diabetic gastroparesis can be challenging as some of the advice goes against what is normally recommended for diabetes. Prioritizing nutrition goals with a dietitian can be very helpful in deciding what approaches are best for you.
If following nutrition recommendations to help with gastroparesis is raising blood sugars, either increasing the dose of current diabetes medications and/or adding additional ones can be potential options.
Nutrition Recommendations for Other Side Effects
Nutrition for Nausea
If you are experiencing nausea from gastroparesis, try eating foods like crackers and pretzels. Having ginger can also help.
Nutrition for Acid Reflux
Since foods sit longer in the stomach with gastroparesis, there is a higher likelihood of food going the wrong direction and causing reflux.
There are many different dietary strategies to help, including avoiding acidic, spicy and high fat foods as well as alcohol and caffeine. See this post about nutrition for acid reflux for more information.
Nutrition for Unintentional Weight Loss
Some people with severe gastroparesis may experience unintended weight loss that can lead to malnutrition and muscle loss. To avoid weight loss, focus on getting enough calories and protein especially from liquids, while being sure to not skip meals and snacks.
Medical management of the gastroparesis may be necessary to feel good enough to consume an adequate amount of food. Your healthcare provider can prescribe a variety of medications that can help with nausea and vomiting as well as stimulating the stomach to contract and empty.
Carbohydrates, specifically simple carbohydrates like juice and white crackers, are sometimes tolerated best. Taking additional diabetes medications, including insulin, may be necessary to cover the rise in blood sugars from eating these foods.
In severe situations, a jejunostomy feeding tube can be placed. This is a small tube that is inserted into the abdomen that provides nutrients into the first part of the small intestine, completely bypassing the stomach altogether.
Increase Physical Activity
Physical activity can be very effective for improving gastroparesis because it promotes motility and movement of your digestive tract. This lets foods move along faster.
Walking can be a great exercise for gastroparesis, but other types of exercise can be beneficial too. You’ll get the most benefit from exercising after meals.
Other Lifestyle Strategies
In addition to nutrition and exercise, there are other lifestyle recommendations that can be helpful.
Stay upright after meals. Avoid laying down for at least an hour after eating; ideally 3-4 hours would be the most beneficial. These strategies will promote the movement of food and decrease the chances of reflux happening thanks to gravity.
Stress management may possibly help with gastroparesis as well. The brain and gastrointestinal system are highly connected and have a direct relationship with each other.
Adjust Timing of Mealtime Insulin
Gastroparesis can make managing blood sugars more challenging for people that take insulin with meals. Since food is emptying from the stomach later than normal, blood sugars rise later than normal as well.
While it is generally recommended to take this type of insulin before meals, with gastroparesis, best practice is to take it after meals. Work with your doctor and/or diabetes care and education specialist to figure out the best timing for you. The use of a continuous glucose monitor and possibly an insulin pump can be advantageous in this situation.
If you are taking a sulfonylurea, such as glyburide, glipizide or glimepiride, this strategy of taking it after rather than before the meal may also be beneficial. Talk to your healthcare provider about changing the timing of this medication.
Other Things to Consider
GLP-1 RAs and Dual GIP/GLP-1 RAs
Certain drug classes that help manage diabetes also slow down digestion; these include GLP-1s like Ozempic and Trulicity as well as the Dual GIP/GLP-1 Mounjaro. While these medications can be prescribed to people with gastroparesis, they may not be the best choice, since they’re going to slow down gastric emptying even more.
There seems to be a relationship with vitamin B12 deficiency and gastroparesis, both of which can make each other worse. Be aware that metformin and certain acid reflux medications can increase the risk of a B12 deficiency.
Talk to your healthcare provider to see if testing for vitamin B12 deficiency is appropriate in your case. Increasing the intake of this nutrient through food and supplements as well as getting B12 injections are all potential treatment options.
Individualizing is Key
Everyone is going to have different gastroparesis symptoms of different severity.
In addition to dietary and lifestyle interventions, various medications and potential surgical options can also be used to manage gastroparesis.
Having a great healthcare team to individualize the treatment specifically to you is going to be the key to success in managing your conditions. The healthcare team may include a primary care physician, gastroenterologist, endocrinologist, dietitian and diabetes care and education specialist.