Gastroparesis: Symptoms, Causes and Natural Support Strategies
Gastroparesis is a disorder that slows or stops the movement of food from your stomach to your small intestines. It can cause many undesired and uncomfortable symptoms including nausea and vomiting, heartburn, bloating, and a feeling of fullness.
There are many causes of gastroparesis. While most often associated with diabetes or a damaged vagus nerve, gastroparesis is linked to a number of conditions and risk factors. It is important to identify and address the underlying cause of your symptoms. Testing can be very helpful for identifying possible causes.
Gastroparesis may lead to serious complications including a life-threatening blockage. Fortunately, there are natural strategies you can take to help support your condition. Changing your diet can provide huge relief from your symptoms. Targeted supplementation and other lifestyle strategies may also help to support your health.
What is Gastroparesis?
Gastroparesis, also called delayed gastric emptying, is a delay in the movement of food from the stomach to the small intestine, even with no blockage (1). During the process of digestion, the stomach must contract to empty itself of food and liquid. It normally contracts about 3 times per minute and empties within 90-120 minutes after eating. When these contractions are sluggish or less frequent, stomach emptying is delayed.
There are many symptoms of gastroparesis, including:
- Feeling full shortly after starting a meal
- Feeling full long after eating a meal
- Vomiting undigested food
- Heartburn or GERD
- Abdominal bloating
- Poor appetite and weight loss
- Poor blood sugar control
Gastroparesis is a relatively common and very costly disorder. It affects up to 4% of the U.S. population, and inpatient care costs $7,000 monthly for people with severe gastroparesis (2). Additionally, around 25% of adults in the United States have symptoms that are similar to gastroparesis. Gastroparesis affects more women than men, often by a 3:1 margin (3).
Major Causes of Gastroparesis
Gastroparesis is often associated with diabetes and damage to the vagus nerve from surgery. In most cases, doctors are unable to determine the underlying cause. Idiopathic gastroparesis is the most common category for gastroparesis comprising over a third of gastroparesis cases (3).
A common cause of gastroparesis is diabetes. Diabetes is a number of diseases that affect how your body uses glucose. It can occur when the pancreas produces very little or no insulin, or when the body does not respond appropriately to insulin.
Diabetes can damage nerves, such as the vagus nerve and nerves in the stomach. It can also damaged pacemaker cells, special cells in the wall of the stomach. When these nerves or cells do not work normally, the stomach does not empty.
2. Damage to the Vagus Nerve
Gastroparesis can be caused by damage to the vagus nerve which regulates the digestive system. A damaged vagus nerve prevents the muscles in the stomach and intestines from functioning. This prevents food from moving through the digestive system properly. Along with diabetes, surgery on the esophagus, stomach, or small intestine may injure the vagus nerve.
Infections may increase your risk of gastroparesis. Postviral gastroparesis occurs when there is a viral injury to the nerves or muscles of the stomach (3). Viruses that may cause gastroparesis include cytomegalovirus, Epstein-Barr virus, and herpes varicella-zoster. Symptoms of postviral gastroparesis are usually less severe than from other causes and have resolution of their symptoms.
4. Certain Medications or Treatments
Cancer treatments such as radiation on a person’s chest or stomach area can cause gastroparesis. Certain medications may delay gastric emptying or affect motility, resulting in symptoms similar to gastroparesis. These medications may make symptoms worse for people who have gastroparesis.
Medications that delay emptying or make symptoms worse include narcotic pain medications, antidepressants, anticholinergics, medications used to treat overactive bladder, and pramlintide (1).
Hypothyroidism, or low thyroid function, is associated with altered gastrointestinal motility. People with hypothyroidism may experience a reduction in the motor activity of the stomach, small intestine, and colon. They often have symptoms of gas, constipation, nausea, and vomiting (2). Hypothyroidism also reduces esophageal motor activity and can cause gastrointestinal dysfunction (4).
6. Nervous System Disorders
People with a nervous system disorders may have gastroparesis. Parkinson’s disease and multiple sclerosis are associated with gastroparesis. Parkinson’s disease is a common neurodegenerative disease that affects the nerve cells of the brain. Multiple sclerosis is a chronic inflammatory disease in which the myelin sheath on the nerve endings gets inflamed and damaged.
7. Eating Disorders
Eating disorders are serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating disorders can cause multiple health problems including gastroparesis. Additionally, the symptoms of gastroparesis may contribute to the disordered behavior in a person already struggling with an eating disorder.
8. Anxiety and Depression
Anxiety and depression are highly associated with gastroparesis. In fact, around 18% of people with gastroparesis have severe depression, and 31% suffer with severe anxiety (2).
Approximately 25% of people with gastroesophageal reflux disease (GERD) have gastroparesis. GERD, or acid reflux, is a condition in which stomach contents rise up into the esophagus. People with GERD may have a slower rate of gastric emptying (2).
10. Rare Conditions
Rare conditions such as amyloidosis and scleroderma may cause gastroparesis. Amyloidosis is a condition in which there are deposits of protein fibers in tissues and organs. Scleroderma is a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs.
How is Gastroparesis Diagnosed?
To diagnose gastroparesis, doctors use lab tests and other tests to measure how fast your stomach is emptying its contents.
Blood tests can show signs of dehydration, malnutrition, inflammation, infection, blood sugar, and thyroid function. Urine tests can indicate diabetes, dehydration, infection, and kidney problems.
Other tests doctors may use to diagnose gastroparesis include:
- Upper GI endoscopy
- Upper GI series (barium x-ray)
- Gastric scintigraphy (radioisotope gastric-emptying scan)
- Gastric emptying breath test
- Gastric manometry
- The SmartPill (wireless motility capsule)
- Ultrasound to eliminate other diseases
Complications of Gastroparesis
Gastroparesis can result in a number of complications. This include:
1. Bacterial Overgrowth
When food stays in the stomach for too long, it can ferment. This may lead to the overgrowth of bacteria and imbalances in gut flora.
When bacteria overgrow in the small intestine, this causes small intestinal bacterial overgrowth (SIBO). SIBO is very common in people with gastroparesis.
It is important to address SIBO because it can damage the intestinal lining and create leaky gut syndrome. This results in food sensitivities and chronic inflammatory processes in the gut. The bacteria in the small intestine interfere with normal enzymatic and metabolic activity. This leads to digestive issues and malabsorption of nutrients. To learn more about SIBO and strategies to beat this condition, read this article.
A bezoar is a hard, solid collection of food in the stomach (5). It is a mass of indigestible material that accumulates in the digestive tract, sometimes causing a blockage. When bezoars cause obstructions in the stomach, it can keep food from passing into the small intestine.
Bezoars can cause lack of appetite, nausea, vomiting, weight loss, and a feeling of fullness after eating only a little food. They can also lead to other complications such as intestinal bleeding and gastric ulcers.
3. Diabetic Complications
For people who have diabetes and gastroparesis, they may have difficulty controlling their blood sugar levels. Frequent changes in the rate and amount of food passing into the small intestine can cause erratic changes in blood sugar levels. Blood sugar rises when food finally leaves the stomach and enters the small intestine.
When blood sugar is harder to control, this can worsen diabetes symptoms. In turn, poor control of blood sugar levels makes gastroparesis worse.
4. Dehydration and Malnutrition
People with gastroparesis may become dehydrated from repeated vomiting. They may also be malnourished due to poor absorption of nutrients. Unwanted weight loss due to low calorie intake is a complication of gastroparesis.
5. Decreased Quality of Life
When people experience symptoms of gastroparesis, particularly acute flare-ups and severe symptoms, it can make life difficult. Gastroparesis can negatively affect a person’s ability to work and take care of responsibilities. It may decrease their overall quality of life.
Natural Support Strategies For Gastroparesis
To improve your digestive health, it is important to follow an easy to digest, anti-inflammatory diet, identify and address underlying issues, use targeted supplements, and implement other healing strategies. While these strategies are not FDA approved to prevent, mitigate, treat or cure gastroparesis they can help support the body and many have seen good results with them.
1. Liquid Nutrition
Initially, a liquid diet may be necessary for people with severe gastroparesis. Consuming liquid nutrition for is great for stimulating the digestive process, increasing nutrient absorption, and improving gut health. Liquid nutrition does not require as much energy to digest, so your body can focus on healing and repair.
A great way to use liquid nutrition is with high-quality hypoallergenic protein powder that contains essential amino acids and powerful antioxidants to support gut function and improve detoxification. You can make protein shakes using this powder along with coconut milk.
Doing a bone broth fast can help to heal the gut and take stress off the digestive system. Additionally, intermittent fasting is a good starting point for anyone with gastroparesis. This means going for longer periods of time, such as 12-14 hours, without eating.
2. Low FODMAPs Diet for Gastroparesis
For some people, eating foods low in FODMAPs may improve their gastroparesis symptoms. FODMAPs are short-chain carbohydrates that are poorly absorbed in the small intestine. FODMAPs is an acronym for Fermentable Oligo, Di- and Monosaccharides and Polyols. These fermentable sugar-based carbohydrates include fructose, glucose, galactans, polyols, and lactose.
High FODMAPs foods can be difficult for some people to digest and pass along the gut to the large intestine where they are fermented by bacteria. This fermentation results in many digestive symptoms like gas, pain, and bloating.
A diet high in FODMAPS can contribute to functional gut disorders, while a diet low in FODMAPs is effective for relieving gut symptoms such as bloating, gas, abdominal pain, diarrhea, and constipation. Check out this article for more information on how to improve digestive issues with a low FODMAPS diet.
3. Change Eating Habits
If you are struggling with gastroparesis, it is important to follow an anti-inflammatory diet. You should avoid pro-inflammatory foods such as refined sugars, processed foods, vegetables oils, meat and dairy from conventionally raised animals, and farmed fish. These foods contain chemicals, trans-fats, and other toxic ingredients which are highly inflammatory, create extra acidity in the tissues, and damage the gut.
For gastroparesis, be sure to eat whole, unprocessed foods: clean protein, organic low-fiber vegetables, and small amounts of healthy fats. Clean protein sources are grass-fed meats, pasture-raised, organic chicken and eggs, and wild-caught salmon.
Great sources of healthy fats are coconuts, olives, avocados, and their oils, and in grass-fed butter and ghee. Healthy fats are anti-inflammatory and low in FODMAPs. However, fats can delay stomach emptying so only small amounts may be tolerated.
It is important to eat foods that are easy to digest. Raw foods and foods high in fiber should be limited or avoided. Fiber is an indigestible carbohydrate found in various foods. High fiber foods include artichokes, brussels sprouts, leafy greens, broccoli, and other vegetables. Cooking and removing the peel from foods makes them easier to digest.
How you eat is also important. Eat smaller meals which will not overwhelm your digestive system. It is important to chew your food well and eat in a relaxing environment. Avoid carbonated beverages and alcohol. It may also be helpful to do some gentle activity after a meal and avoid lying down for at least 2 hours after a meal.
4. Support Stomach Acid and Digestive Enzymes
Many people with gastroparesis have low stomach acid and insufficient digestive enzyme levels. Adequate levels of both are necessary for proper digestion and nutrient absorption. If levels are low, indigestion, bloating, nutrient deficiencies, and multiple food sensitivities may occur.
You can improve stomach acid levels by consuming liquid nutrition during the day with at least half of your meals in an easily digestible form. Be sure to hydrate outside of meals because drinking water with or right after a meal will dilute your digestive juices.
Eat your protein first, chew each bite many times, and eat in a relaxing environment. Squeezing fresh lemon juice or apple cider vinegar on meat and vegetables can help pre-metabolize the food.
Supplementation with hydrochloric acid may be necessary for individuals with low stomach acid. Finding a supplement that has betaine HCl, pepsin, l-glutamic acid, and possibly bitter herbs such as gentian root or ginger to support gastric acidity, digestion and normal gastrointestinal flora.
For people with insufficient digestive enzymes, taking enzymes with meals may be very beneficial. Digestive enzymes help to reduce stress on the digestive system, improve the digestion of food and absorption of nutrients, reduce inflammation in the gut, and improve digestive issues. They may be very beneficial for anyone struggling with gastroparesis.
5. Vagal Nerve Stimulation For Gastroparesis
The vagus nerve is the longest cranial nerve in the body, running from your brain through your neck and chest to your abdomen (6). The function of the vagus nerve is to control your mood, heart rate, digestion, and immune response. It plays a central role in the parasympathetic (rest and digest) nervous system.
People with gastroparesis have impaired functioning of their vagus nerve. Stimulating the vagus nerve may help improve their symptoms.
There are natural ways to collaborate stimulate the vagus nerve. These include singing, laughing, deep and slow breathing, cold exposure, fasting, massage, exercise, prayer, yoga, positive thoughts, social connection, and mediation.
6. Test for and Reduce Gut Infections
The GI tract is a major entry point for pathogens. When these pathogens invade our gastrointestinal system, they can cause infections. (7). Infections are a possible cause of gastroparesis, so it is important to take steps to eliminate gut infections. Addressing gut infections will help to reestablish a healthy microbial balance and strengthen the gut mucosa.
To test for gut infections, the GI-MAP™ Stool Analysis Test is the most thorough stool test on the market. It is the only FDA-approved DNA test for gastrointestinal microbes and pathogens available.
The GI Map tests for imbalances in the gut microbiome, candida and other fungi, viruses, and parasites, including both protozoa and worms. This comprehensive test reveals the integrity of your gastrointestinal system. It will indicate whether you are producing enough digestive enzymes, your immune response to gliadin, inflammation in the gut, and the level of the immune system in the gut.
7. Balance Gut Flora
The large and complex community of microorganisms in the gastrointestinal tract is called the gut microbiome. Proper diversity and balance of your gut flora is essential to overall health. Gastroparesis may cause imbalances in your gut flora with overgrowths of opportunistic (“bad”) bacteria.
One way to help rebalance your gut microbiome is by supplementing with probiotics. Probiotics are beneficial microorganisms (bacteria and yeasts) that keep your gut and body healthy. They are similar to the microorganisms that naturally live in our bodies and support digestive health in many ways (8).
There are 4 main categories of probiotics: food based, spore-forming soil based, probiotic yeast, and combination probiotics. If you are struggling with digestive issues, a good strategy is to try one probiotic from each category for a short time to determine which is most beneficial. You should also rotate probiotics to keep the microbiome adapting. For information on the benefits and categories of probiotics along with suggested protocols, read this article.
8. Correct Nutritional and Electrolyte Deficiencies
Gastroparesis can lead to deficiencies in vitamins and minerals (3). Vitamins, minerals, antioxidants, and amino acids are all micronutrients. They play a central role in metabolism and the maintenance of tissue function.
It is important to address and correct these nutrient deficiencies. Using a multivitamin/multimineral formula can be very helpful. In certain cases, I recommend taking a b complex supplement. Look for one with pre-activated forms of B vitamins such as methyl-folate, methyl-cobalamin (B12), Pyridoxal-5-Phosphate form of B6, and Riboflavin-5-phosphate form of vitamin B2. The methyl groups are in the active form and will be better utilized by the body.
The best way to test micronutrient levels is with the Spectracell Micronutrient Test. This test measures functional deficiencies of micronutrients at the cellular level and gives the most comprehensive nutritional analysis available. This allows you to use targeted supplementation to address any deficiencies.
Conclusion on Gastroparesis
Gastroparesis is a chronic disorder of the stomach where there is delayed emptying. This prevents food from moving through the digestive system properly. Common causes include diabetes, damage to the vagus nerve, certain medications, neurological issues, and idiopathic causes.
One of the best ways to help control the symptoms of gastroparesis is to modify your daily eating habits. Consume smaller meals with easy to digest foods. Chew your food well and eat in a relaxed environment.
Testing can be extremely valuable in determining the health of your gut and the underlying cause of your gastroparesis symptoms. Once the underlying cause is identified, you can use diet, targeted supplementation, and lifestyle strategies to help support your health.
If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. At my clinic, we offer long-distance functional health coaching programs. For further support with your health goals, just reach out and our fantastic coaches are here to support your journey.