Gastroparesis- slow stomach motility
The amount of patientsmisdiagnosed with IBS when they really have a dysmotility issue like gastroparesis is astounding! It is not a subtle difference- IBS is abdominal pain and a change in bowel habits. Gastroparesis is nausea, vomiting, early satiety, and severe upper abdominal bloating and pain. Root cause. root cause. root cause. Let’s take a deep dive.
The amount of patientsmisdiagnosed with IBS when they really have a dysmotility issue like gastroparesis is astounding! It is not a subtle difference- IBS is abdominal pain and a change in bowel habits. Gastroparesis is nausea, vomiting, early satiety, and severe upper abdominal bloating and pain. Root cause. root cause. root cause. Let’s take a deep dive.
Gastroparesis is slow stomach motility. Normal gut motor function is a complex series of events that requires coordination of the sympathetic and parasympathetic nervous systems, neurons and pacemaker cells (interstitial cells of Cajal), and the smooth muscle cells of the gut. Abnormalities in any part of this process can lead to a delay in gastric emptying AKA gastroparesis symptoms-BLOATING! Also nausea (93%), vomiting (up to 84%), abdominal pain (up to 90%), early satiety (up to 86 %), fullness after eating, and, in severe cases, weight loss. The vomitus may contain food ingested several hours previously.
WHY does your stomach slow down?
- The majority of cases are “idiopathic“: In most cases “idiopathic” just means no one asked the right questions- many cases may be post-infectious with sudden onset of symptoms after an infection, from COVID to H. pylori to Norwalk virus and rotavirus. Postinfectious gastroparesis often improves over one year BUT some people may develop severe dysautonomia or even selective cholinergic dysautonomia leading to persistent symptoms due to extrinsic autonomic denervation
- Diabetes and high blood glucose
- Medication-induced- like Ozempic
- Neurologic (multiple sclerosis, parkinsons)
- Autoimmune (gut dysautonomia that is idiopathic or could be associated with cancer like small cell lung cancer, or scleroderma)
- Postsurgical with injury to the vagus nerve
Get tested:
- ENDOSCOPY: first an endoscopy to make sure there is no blockage. Consider imaging such as MRI enterography as well.
- MOTILITY TESTING:
- Nuclear medicine scintigraphy (gastric emptying test) with solids (usually eggs) that lasts about 4 hours. Normally, you should have 37- 90% of the meal remaining in your stomach at 1 hour, 30-60% at 2 hours, and 0-10% at 4 hours.
- Wireless motility capsule (WMC) AKA smartpill- no radioative food! just a big pill to swallow. Insurance is not crazy about covering this test though– AND it is being taken off the market so limited availability.
- Spirulina breath test– Love this option and can get it with Dr. Ivanina at CIGH. You can do it at home, no radioactive food… BUT there is dairy and gluten in the food. Pick your poison.
- ROOT CAUSE EVALUATION:
- Blood tests: Hemoglobin, fasting plasma glucose, serum total protein, albumin, thyrotropin (TSH), and an antinuclear antibody (ANA) titer, HbA1c and ANNA-1 or anti-Hu antibody in smokers. consider IBS-smart
- Pylorospasm: Have a gastroenterologist look for pylorospasm on endoscopy with ENDOFLIP- the treatment can then completely change including a G-POEM (Gastric peroral endoscopic myotomy) as a minimally invasive procedure to relieve symptoms of gastroparesis.
- DYSAUTONOMIA TESTING: sweat test, postural blood pressure, vagus reflux bradycardia, and others
The gutlove approach to gastroparesis= the gutlove gastroparesis diet
- Concepts:
- Decrease foods that are fatty, acidic, spicy, and roughage-based: Fat slows gastric emptying and non-digestible fiber (eg, raw fruits and vegetables) require really good stomach motility
- Increase soluble fiber! soluble fiber or fiber that is cooked and reduced to small particle size by homogenization can be more easily digested and emptied from the stomach
- Eat small, frequent meals: frequent small meals (ex. 5-6 per day) produce fewer symptoms than large meals
- Stay hydrated
- Chew foods well! chew all food to a puree consistency. Solid foods may be tolerated better if ground or pureed. Many foods can be liquefied in a blender or food processor or else cut solid foods in pieces and thin with liquid.
- Sit up while eating and for at least 1 hour after finishing your meal (don’t lay down!) — and ideally, take a post-meal walk!
- Diet tips:
- Lots of smoothies, soups, purees – you still get the fiber!!! but easier for digestion.
- Well-cooked veggies without skin
- Avoid dairy
- Drink 2-2.5L of water a day
- Avoid carbonation
- Supplemental nutrition with products like kates farms as needed after nutritional testing performed
- Lifestyle
- Limit alcohol or smoking
- Exercise – if you don’t move, your gut doesn’t move!
- Acupuncture helps: Previous studies have found that acupuncture modulates important components involved in the pathogenesis of delayed gastric emptying, such as relaxation of the lower esophageal sphincter and gastric myoelectrical activity
- Natural prokinetics – only take after discussing with your integrative gastroenterologist! book an appointment with Dr. Ivanina today for your own personalized protocol.
- Ginger, ginger, ginger – tea, cook with it, put it in your smoothie, motility activator, and check out the ginger people products!
- Iberogast
- Triphala
- Probiotics! yes some probiotics increase motility – many people even get significant benefits from eating daily fermented & cultured food… or making their OWN yogurt!
Sample menu
breakfast: daily harvest smoothie (discount code: GUTLOVE), oatmeal, or if eating animal products- egg salad
snack: justin’s peanut butter packet
lunch: gazpacho with sweet potato puree, miso soup with soba noodles and well-steamed broccolli
snack: banana with sunflower butter
dinner: cauliflower rice with tofu scramble, or if eating animal products- butternut squash puree with ground chicken burger (hold the bun!)
dessert: 2 squares hu chocolate (discount code: gutlove)
breakfast: daily harvest smoothie (discount code: GUTLOVE), oatmeal, or if eating animal products- egg salad
snack: justin’s peanut butter packet
lunch: gazpacho with sweet potato puree, miso soup with soba noodles and well-steamed broccolli
snack: banana with sunflower butter
dinner: cauliflower rice with tofu scramble, or if eating animal products- butternut squash puree with ground chicken burger (hold the bun!)
dessert: 2 squares hu chocolate (discount code: gutlove)