Gastroparesis
I recently gave a presentation on gastroparesis and nutrition. In this blog post, you will learn important information about what this condition means, what may be causing it, and how to manage symptoms in both the short- and long-term.
What is it?
Gastroparesis is a functional disorder characterized by slow gastric motility due to impaired function of the nerves and muscles of the stomach. It is a diagnosis that can cause fear and frustration, but this can be mitigated with the right treatment plan and diet. Other conditions, such as functional dyspepsia are frequently misdiagnosed as gastroparesis, so it is important to work with a gastroenterologist to receive specialized care.
How does it happen?
Many cases of gastroparesis are idiopathic (an unknown cause) but a common cause is diabetes. In fact, around one-third of people with diabetes will develop gastroparesis (1). It may also be autoimmune-related or a complication from a gastric surgery (such as a Nissen fundoplication). Many drugs delay gastric emptying such as GLP-1 agonists (like Ozempic), proton pump inhibitors (like pantoprazole), antidepressants, antipsychotics, anticholinergics, stimulants, nicotine, and marijuana.
What are the signs and symptoms?
Common symptoms include early fullness, nausea, vomiting, upper abdominal bloating and pain, loss of appetite, acid reflux, and constipation. In severe cases, unintentional weight loss occurs and an elevated risk of a type of intestinal obstruction called a bezoar. In people with diabetes, gastroparesis can make it harder to control their blood sugar.
How can it be treated?
A physician will go over all of the treatment options such as prokinetic medications (like Domperidone) or sometimes surgery (such as per-oral pyloromyotomy). Dietary changes are an effective way to manage gastroparesis. A registered dietitian is the healthcare professional with the most specialized training on diet and nutrition and provides medical nutrition therapy, a combo of education and nutrition counseling.
What is a gastroparesis diet?
One of the reasons why I enjoy seeing patients with gastroparesis is how relieved they feel after just a few sessions both physically and emotionally. Too often someone is handed a list of “gastroparesis diet” foods, told to follow this diet indefinitely, and left on their own. A gastroparesis diet must be personalized, be adjusted as their condition changes, mitigate symptoms, and meet all of their nutrient needs. Like an elimination diet, once symptoms are manageable, new foods must be reintroduced slowly and purposefully, to achieve as little total food restriction as possible.
What foods delay gastric emptying?
Foods that take longer to break down in the stomach will typically be limited in the first phase of the gastroparesis diet. This includes insoluble fiber (skins of potatoes and apples, nuts, seeds, broccoli, etc.), saturated fat (butter, red meat, coconut oil, etc.), and fried foods. Unsaturated fat (avocados, olives, oil, peanut butter, etc.) also takes a while to digest, so it will need to be consumed in moderation.
Which foods are easier to digest in the stomach?
Liquids are absorbed readily in the stomach and sometimes a liquid diet must be followed for a period of time to achieve symptom relief. This is typically the case for more severe cases of gastroparesis. Then, pureed, soft, and solid foods are slowly reintroduced. Low-fiber carbohydrates (white rice, white bread, refined pasta, fruit juice, etc.) break down quickly in the stomach. The amount of optimal carbohydrates varies on an individual basis, especially if someone has diabetes, and this should be discussed under the supervision of a dietitian. Often, a small amount of soluble fiber can be tolerated at each meal, which may include foods such as oats, carrots, applesauce, canned peaches or pears, bananas, peeled potatoes or sweet potatoes, etc. Lean (meaning lower in fat) proteins are an important staple of a gastroparesis diet and might include chicken, Greek yogurt, fish and shellfish, tofu, boiled eggs, protein shakes, etc. In some cases, even lean red meats such as 93% lean ground beef or pork loin can be tolerated.
What else can help?
Eating several small meals a day can improve symptoms significantly and allows the stomach to be more efficient and reduce nausea and vomiting. A few supplements have been demonstrated to improve gastric motility such as ginger (2), berberine (3), and Iberogast (4). Physical activity and stretching can stimulate gastric emptying (5). A light walk after a meal can improve symptoms, it does not have to involve anything intense. The vagus nerve helps regulate digestion and gastrointestinal motility, and it may help to try approaches that increase activation of the ventral vagal parasympathetic nervous system (rest and digest mode) and decrease activation of the sympathetic nervous system (fight or flight mode). Basically, existing in a state of stress can reduce vagal tone which is associated with poor gastric motility. Practicing regular nervous system-based techniques (biofeedback, yoga, meditation, deep breathing, etc.) may help. By incorporating these practices, it is often that someone with gastroparesis can tolerate a greater variety of foods and more fat and fiber.
What’s the bottom line?
At the end of the day, it is important to seek professional help for gastroparesis with the guidance of practitioners such as a gastroenterologist and dietitian. They will work to offer someone the best treatment, management of symptoms, and quality of life. Consuming the right foods and beverages, practicing physical activity, and only taking the right supplements and medication all play a significant role in how someone with gastroparesis will feel and thrive.
References
Cleveland Clinic. (2025, February 12). Gastroparesis: Symptoms, causes, diagnosis & treatment. Retrieved June 2, 2025, from https://my.clevelandclinic.org/health/diseases/15522-gastroparesis
Wu KL, Rayner CK, Chuah SK, Changchien CS, Lu SN, Chiu YC, Chiu KW, Lee CM. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. 2008 May;20(5):436-40. doi: 10.1097/MEG.0b013e3282f4b224. PMID: 18403946.
Hou C, Liang H, Hao Z, Zhao D. Berberine ameliorates the neurological dysfunction of the gastric fundus by promoting calcium channels dependent release of ACh in STZ-induced diabetic rats. Saudi Pharm J. 2023 Mar;31(3):433-443. doi: 10.1016/j.jsps.2023.01.010. Epub 2023 Feb 2. PMID: 37026044; PMCID: PMC10071329.
Ottillinger B, Storr M, Malfertheiner P, Allescher HD. STW 5 (Iberogast®)--a safe and effective standard in the treatment of functional gastrointestinal disorders. Wien Med Wochenschr. 2013 Feb;163(3-4):65-72. doi: 10.1007/s10354-012-0169-x. Epub 2012 Dec 20. PMID: 23263639; PMCID: PMC3580135.
Pelvic Health & Wellness Center of New Jersey. (n.d.). Exercises for gastroparesis: Pelvic physical therapy guide. Retrieved June 2, 2025, from https://www.pelvichealthnj.com/pelvic-floor-blog/exercises-for-gastroparesis-pelvic-physical-therapy-guide/
