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Low FODMAP Diet for Gastroparesis

Gastroparesis is a long-term weakness of the stomach. One of the best ways to manage the condition is via dietary changes. If you’re wondering what gastroparesis exactly is and how you can manage it with your diet, you’ve come to the right place. We’ll also discuss whether a low-FODMAP diet can treat the condition.


What is gastroparesis?


Gastroparesis is a weakness of the stomach. The word literally means “weakened stomach”, and it’s usually due to damage to the vagus nerve. The vagus nerve is the largest nerve in your body and it supplies most of the intestinal tract, including the stomach.

Normally, the vagus causes muscles in the stomach to contract intermittently, which pushes food down into the small intestines. If the vagus doesn’t function properly, the muscles of the stomach don’t contract as often and food remains stagnant in the stomach for long periods.

If you have gastroparesis, you may experience:

● Heartburn, as food (and stomach acid) reflux back into your esophagus
● Feeling full after eating just a little
● Abdominal pain
● Bloating
● Weight loss
● Nausea
● Vomiting

One common cause of gastroparesis is diabetes. As blood glucose builds up, it can damage the vagus nerve, leading to impaired stomach contraction. Other causes include:

● Surgical damage to the vagus nerve
● Viruses
● Amyloidosis — this is when a misfolded protein deposits in various organs, causing widespread damage
● Scleroderma — this is similar to amyloidosis except that a different protein (collagen) deposits in various organs, causing damage

Gastroparesis is a long-term condition, and it’s important to seek treatment for it. If left untreated, it can cause complications like bezoar, dehydration, malnutrition, and bacterial overgrowth.

As food stays in your stomach for longer periods, it serves as a meal for bacteria, leading to bacterial overgrowth (and its symptoms). Other times, food can turn into a hard mass, called a bezoar. A bezoar can cause intestinal obstruction because it’s difficult to move along the gut compared to a soft bolus of food.
Can a low-FODMAP diet help in gastroparesis?
A low-FODMAP diet may help in gastroparesis if you have other gut conditions like irritable bowel syndrome (IBS) and bacterial overgrowth on top of it.

Currently, there are no studies that support the use of a low-FODMAP diet to treat gastroparesis alone, and no doctor will recommend the diet as first-line treatment.

However, there are reports of patients suffering from multiple gut conditions simultaneously (like IBS, bacterial overgrowth, and gastroparesis) benefitting from a low-FODMAP diet after all other treatment options failed.

It’s easy to see why a low-FODMAP diet could potentially help gastroparesis patients. FODMAPs stand for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. They are sugars and one example is fructose. FODMAPs are osmotic, which means they increase the water content of your gut. Additionally, they can be digested by bacteria in the gut, which release gas during the process. The surplus liquid and gas can give you abdominal pain, bloating, and cramping.

Since bloating is a major symptom of gastroparesis (some patients report feeling 9-months pregnant due to bloating), a low-FODMAP diet may help reduce it.

Plus, small intestinal bacterial overgrowth (SIBO) is very common in gastroparesis patients. That’s because these patients often have diabetes or vagal damage, both of which are also risk factors for SIBO. In SIBO, there’s an abnormal overgrowth of bacteria in the small intestine, leading to:

● Bloating
● Flatulence
● Greasy diarrhea

If you develop SIBO with gastroparesis, a low-FODMAP diet can be very useful as it restricts the availability of nutrients to abnormal bacteria in the small intestine.

Still, it’s important to consult your doctor before you make any changes to your diet, especially with gastroparesis, where the chances of getting malnourished are higher.
How is a low-FODMAP diet carried out?
A low-FODMAP diet is carried out under the supervision of a doctor (or dietitian). You begin by eliminating all FODMAP-containing foods from your diet for 2-6 weeks. This is called the elimination phase.

Examples of foods to avoid during the elimination include:

● Wheat
● Beans
● Barley
● Sweeteners
● Nuts
● Fruits and vegetables (ask your doctor about the fruits and veggies you can eat)
● Milk

Once your symptoms go away, you start adding back the foods one by one to your diet. It’s highly unlikely that all FODMAP-containing foods trigger your symptoms, so the goal here is to catch the ones that do, and eliminate only them from your diet.

As mentioned earlier, there’s no evidence that a low-FODMAP diet helps in gastroparesis (unless you have other gut conditions too), so talk to your doctor before implementing it.


What foods to avoid in gastroparesis?


Generally, fatty and high-fiber foods should be avoided in gastroparesis. While a low-FODMAP might not help you, avoiding the following food items will:

● Cheese
● Alcohol
● Beans
● Legumes
● Butter
● Oil
● Carbonated drinks
● Corn
● Red meat

All of these slow down gastric emptying, which can make your gastroparesis symptoms worse.


What to eat in gastroparesis?


Doctors recommend eating low-fat, high-protein foods that are easy to digest in gastroparesis.

Examples of foods you want to increase in your diet are:

● Bananas
● Bread
● Crackers
● Peanut butter
● Vegetable juice
● Eggs
● Nut butter
● Vegetables that are easy to digest
● Yoghurt smoothies
● Protein shakes

It’s also important to reduce your meal size in gastroparesis. But to make sure you don’t get malnourished, increase the number of your meals from 3 to 6-7 times a day.

Since gastroparesis may make you malnourished (especially when you’re recovering from an episode), talk to your doctor about multivitamin supplementation to fulfill your nutritional requirements.

Drinking lots of water, staying away from alcohol, and chewing food properly are all helpful lifestyle changes in gastroparesis.


Takeaway


Gastroparesis is when your stomach slows down. It occurs due to damage to the vagus nerve, which can happen from a wide range of causes. Common causes of gastroparesis include diabetes and surgical damage to the vagus nerve.

There is no scientific evidence to suggest a low-FODMAP diet helps with gastroparesis. However, patients with the condition have reported benefitting from a low-FODMAP diet. These patients often have other gut conditions like IBS along with gastroparesis.

If you have IBS or SIBO on top of gastroparesis, it may be a good idea to talk to your doctor about a low-FODMAP diet. You should not make any changes to your diet without a doctor’s advice.

Unlike a low-FODMAP diet, a low-fiber, low-fat, and high-protein diet will help you in gastroparesis as it’s easier for the gut to digest.



Medically Reviewed by Onikepe Adegbola, MD PhD


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