Digestive Disorders

Managing Gastroparesis: A Case Study

When I first met my client for our initial consult, I was startled by how young she appeared. This 30-year-old woman looked just 15 years of age. At 5’2’’ and 87 lbs, she was frail and malnourished—even her voice sounded weak. This young lady was diagnosed with gastroparesis and suffered daily from severe acid reflux with stomach and chest pain, nausea with early satiety, and waking multiple times throughout the night due to a harsh burning feeling in her throat from the acid. In addition to these issues, she also was facing high A1c levels and recurring symptoms of small intestine bacterial overgrowth.

Her daily diet consisted of banana muffins, macaroni, bread, curries, and peanut butter energy balls, with water as her only beverage. Her top goals for treatment included the following:

  • improve energy enough to be able to dance and exercise;
  • manage gastroparesis complications;
  • gain weight; and
  • improve sleep.

Her doctor requested I discuss a low-FODMAP (fermentable oligo-, di-, and monosaccharides and polyols) diet with her to ease any gastrointestinal issues related to irritable bowel syndrome. She was currently taking Gaviscon to alleviate her acid reflux and supplementing with IV vitamin B12 and iron.

In our first session, I reviewed the low-FODMAP diet strongly focusing on foods that help and hurt acidity (no more peanut butter bites, white flours, or spicy tomato-based curries), educated her on diet for gastroparesis (low fat and low fiber with small meals often), how to healthfully gain weight, and control blood sugar. I then merged all of these varying diets into one concise plan to work for all of her health concerns. Her weekly meal plan was low-FODMAP and gastroparesis- and acid reflux-friendly, with a focus on decreasing sugars (for improved blood sugar control and decreased acid reflux) and increasing protein and overall calories.

One of the sample menus looked like this:

  • 6 AM Breakfast: rice porridge (rice cooked in dairy-free milk with 1/4 cup puréed berries mixed in) and a side of scrambled egg whites;
  • 9 AM Snack: Orgain plant-based protein shake;
  • 12 PM Lunch: chicken soup made with low-fat coconut milk, nonspicy seasonings, and soft-cooked vegetables (eg, zucchini and carrots) with rice noodles;
  • 3 PM Snack: a second serving of lunch or breakfast;
  • 4 PM Snack: one-half of an Orgain shake; and
  • 6 PM Dinner: Oven-baked fish sticks made with egg whites and wheat-free panko for breading, sprayed with coconut oil, and baked with a side of roasted sweet potato fries.

Suggested supplements included magnesium citrate before bed for constipation. In addition, I asked the client’s doctor to switch from liquid Gaviscon to a tablet form or another brand free from artificial sweeteners. Liquid Gaviscon contains sorbitol, an artificial sweetener often linked to gastrointestinal pain and upset.

At our one-month follow up appointment, there were positives and negatives. My client had gained only 1.5 lbs and still complained of low energy and acid reflux at night. Constipation continued, as she decided she couldn’t take magnesium; she claimed it made her feel “loopy and drugged.”

However, her bloating and stomach pains improved greatly from the dietary changes, and even more improvement came after switching from liquid Gaviscon to chewable Zantac, which is free of sorbitol. The Orgain shakes felt good on her stomach, and her blood sugar readings decreased slightly.

Over the next few months, we found that the following protocol worked to greatly improve remaining symptoms.

  • Constipation. To decrease constipation, we increased her water intake by planning small increments to shoot for throughout the day and including warm digestive tea. Daily fresh carrot juice with breakfast was just the natural “laxative” she needed to have daily, complete bowel movements.
  • Acid reflux and blood sugar control. To reduce acid reflux and improve blood sugar control, we removed excess sugars from her diet from banana bread and baked goods by replacing them with lower-sugar, wheat-free zucchini breads and other similar recipes. Stevia worked well as a sweetener for her.
  • Underweight. Several measures helped increase the client’s weight. We added 10 minutes of easy walking with light weight lifting, which helped boost her appetite and promote higher calorie consumption. The small addition of well-tolerated fats, such as almond butter, coconut oil, tahini, olives, and salmon, also increased weight. Finally, we added another one-half of a shake after dinner, with enough time to digest before bed.

With a total weight gain of 8 lbs in four months (and still climbing) and a major improvement in her quality of life, my client appeared healthier, stronger, and more vibrant. Energy levels and sleep improved, and her gastroparesis complications were 90% resolved.

Gastroparesis can be a complicated condition to work with; thus, it’s important to focus on all aspects of the condition while building a plan specific to your client’s needs and taste preferences. I hope by sharing my approach and this positive client outcome I will help other dietitians successfully care for their gastroparesis patients.

— Rachel Cuomo, RD, is founder of Kiwi Nutrition Counseling, a private practice in Princeton, New Jersey, where she’s been improving the health and digestion of her patients for the past five years.

5 Comment

  1. How’d you do on this diet? I’ve avoided Orgain because I can’t deal with some of the ingredients. The regular protein shake has milk and whey proteins – not great for lactose intolerance. Yeah you can take the pills, but frankly, my GI tract thinks there’s just something evil about whey. Whey protein concentrate can have anywhere from 10% – 55% lactose (as opposed to 3.7% – 5.1% for regular milk). And heck with the gellan and locust bean gums… it has inulin! =8-Q Never, ever, will I willingly consume THAT again.

    The Clean Protein is milk protein and agave (boo another FODMAP) plus locust bean and gellan gums. Plant-Based Protein Shake’s first 3 ingredients (other than water) are pea protein, erythritol and acacia gum. I want something without extra fiber, gums and sugar alcohols. And others have warned against pea and hemp protein, so I’m looking for something that at least has some variety.

  2. DId anyone check to see if she actually had excess acid before prescribing an acid-blocker? Often what seems like GERD can actually be a deficiency of stomach acid combine with drinking too much liquid with a meal.

  3. Thanks for sharing! I am about to graduate with me B.S. in food science + nutrition with a concentration in dietetics…someday I will be an RD! Anyway I suffered for 6 years with gastroparesis, that is until I got my microbiome back in balance. It all started with my nutrition and chronic disease class when my professor said the way to ensure a healthy microflora is by eating plenty of fiber. Overnight I cut out high fat foods and animal products (no fiber = not gonna heal my digestion). It worked. I went from feeling drugged and throwing up every day, to thriving and not feeling any stomach discomfort. I went form eating 15 grams of fiber a day to 60+. I also notice a huge difference in my digestion by making sure I drink plenty of water. I still find my body tends to need way more water than my friends, I’m not sure why but I just have to make sure I drink a ton of water a day! Anyway I recommend you look into the research on the microbiome and foods that help the gut heal (fiber that feeds bacteria that produces SFAs which feed colonocytes), and foods that cause dysbiosis and inflammation like animal protein and oils. I tried the low FODMAP diet before as well, and I just didn’t understand why cutting out healthy prebiotic rich foods could help my gut bugs thrive….but I realized it was mainly a band aid approach to managing GP, which is great for a bad flare, but not long term care! Hope this helps a little and over time more and more people can have relief, because being miserable all day every day is not a way to live!

    1. Kaylyn, how exactly did you increase your fibre intake so drastically? My daughter has severe GP and she is struggling at even 10 grams of fibre per day… Did you take any special prebiotics, probiotics or herbal remedies?

  4. Thank you for this super informative article, Rachel! I especially liked the level of detail you shared to help fellow dietitians with similar clients.

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