By Christine Bowen / Special to The Herald
It’s national Gastroparesis Awareness Month, so I thought it was a good time to teach you more about the condition called gastroparesis. “Gastro” means stomach and “paresis” means partially paralyzed. This condition means that the stomach is not able to do its typical job of breaking down our food and emptying itself out in a timely fashion. Gastroparesis is delayed stomach emptying without any other clear causes. It is usually caused by nerve damage that interrupts the function of the muscles of the stomach.
Symptoms of gastroparesis: This condition typically results in the feeling of staying full for a long time after eating or getting full quickly when eating. People with gastroparesis might also experience heartburn, reflux (where partially digested food comes back up into the esophagus or mouth), nausea, vomiting, abdominal pain and weight loss (due to poor appetite). Food sitting in the stomach too long can result in the food being fermented by bacteria which can also lead to gas and bloating.
Alarm symptoms: Seek immediate medical attention if you have bloody stool or vomit, fever, severe pain, intractable vomiting, weakness or passing out, unexplained weight loss, severe chest pain and trouble swallowing.
What causes this condition?
Most cases of gastroparesis are idiopathic. This means we don’t actually know what is causing it.
Diabetes is the second most common cause. High blood sugar can harm the nervous system of the stomach.
Damage to the vagal nerve from surgeries or procedures is the third most common cause.
Other causes of gastroparesis include but are not limited to:
• Medications: Tricyclic Antidepressants, Calcium Channel Blockers, Levodopa, Hyoscyamine, Bentyl, Levsin, narcotics (particularly opioids)
• Nervous system disorders: such as Parkinson’s, muscular dystrophy, stroke, and Traumatic Brain Injury (TBI)
• Low functioning thyroid (hypothyroid)
• Autoimmune diseases: Lupus, scleroderma, and some autoimmune connective tissue disorders
In holistic medicine, we have identified some additional possible causes or contributing factors to the development of gastroparesis.
SIBO, Small Intestine Bacterial Overgrowth, can create a lack of being able to break our foods down easily for digestion. The same things that cause SIBO (infections, nerve damage, low stomach acid) can also lead to gastroparesis.
Low stomach acid: Stomach acid helps to chemically break our food down, if there isn’t enough stomach acid, then food can sit there and ferment instead of being broken down and moved into to the small intestine for absorption.
Previous Infections: digestive or other acute or chronic infections can damage the nervous system and other structures of our body. (see my article – June 2022 on gut infections)
Environmental Toxins: some environmental contaminants like mold or chemicals can damage the nervous system and the immune system, which can put someone at risk for gastroparesis.
How do we test for this condition?
First, make sure your doctor is ruling out any medical conditions that could cause gastroparesis.
Make sure your provider is testing you for diabetes (fasting blood sugar and Hemoglobin A1c), thyroid conditions (TSH, Free T3, Free T4), autoimmune diseases (ANA with reflex), and celiac disease (true allergy to gluten).
A neurologist should be consulted if you suspect Parkinson’s, Multiple Sclerosis, or other autoimmune diseases of the nervous system
CT scan or MRI to rule out tumors or other causes of obstruction.
The definitive test for gastroparesis is called a gastric emptying study (also known as a Gastric Emptying Scintigraphy or GES) which requires that the patient eat some food that has contrast dye in it that allows the technician to see the food as it moves through our digestive tract. Food should move through our stomach in a predictable amount of time. If it moves too slowly, then this is consistent with gastroparesis.
What are the treatments for gastroparesis?
The treatments for gastroparesis depend on the cause(s). In Naturopathic Medicine, we have a rule that we follow, “Treat the Cause,” which means that we have to find the underlying cause of disorders and focus on treating the cause instead of treating for symptoms alone. If diabetes is the cause of gastroparesis, then managing the blood sugar is treating the cause.
Nutritional changes for gastroparesis?
One of the best ways to help control the symptoms of gastroparesis is to change your eating habits. Eating smaller meals ensures that there is less food in your stomach. This helps to reduce fullness and helps the food leave your stomach easier. Another important factor is the texture of food. You may have to increase the calorie content of these small meals to avoid unwanted weight loss. Your provider may recommend liquid or soft foods – broth, soup, pureed foods, elemental formulas, or foods with low roughage or fiber (low residue foods). For example, eating applesauce instead of whole apples reduces the hard-to-digest, insoluble fiber in the outer peel. Stopping eating several hours before bed or elevating the head of your bed can help to reduce nighttime heartburn.
Mindful Eating Practices: Eat while relaxed. Eat slowly. Chew your food until it is completely liquid before swallowing. Make sure to enjoy the sight and scent of your food. Avoid ice-cold drinks during meals but stay hydrated in general.
Some people may benefit from herbs or nutrients that can help with motility of the stomach (Prokinetics):
These are typically taken before eating: peppermint, ginger, probiotics, digestive enzymes, Iberogast®
Medications may also be used to improve the motion of the stomach
Reglan: causes your stomach muscles to contract to help move food out of your stomach. Side effects include diarrhea and, rarely, a serious neurological (nerve) disorder.
Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and the development of resistant bacteria from taking the antibiotic for a long time.
Antiemetics: These are drugs that help control nausea.
Surgery for gastroparesis may be considered if people do not benefit from other types of treatment approaches. Discuss your options with your specialist as appropriate.
If you suspect you are experiencing symptoms consistent with Gastroparesis – getting appropriate testing and a diagnosis can help to decide which treatments are right for you. Working with a provider who is knowledgeable in gastroparesis management is the key to getting the help you need
Christine Bowen of Everett is a licensed naturopathic doctor, keynote speaker, and author. In practice since 2005, Bowen specializes in holistic approaches for digestive health, autoimmunity, and complex cases. Go to www.bothellnaturalhealth.com for more information. Connect with her via Facebook drchristinebowen or Instagram @drchristinebowen