Quick Start Guide to Gastroparesis...
Transcript of Quick Start Guide to Gastroparesis...
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© 2012, 2015, 2018, 2019 by Crystal Saltrelli, CHC
All rights reserved. No part of this document may be reproduced or
transmitted in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without prior written permission.
Disclaimer: The information contained in this book is for educational
purposes only. It is not intended as nor should it be considered a substitute
for treatment by or the advice of a doctor or other healthcare provider. The
author shall not be held responsible for loss or damage of any nature
suffered as a result of reliance on any of this book’s contents or any errors
or omissions herein.
This book contains Amazon Affiliate links. The author will receive a
commission for products purchased through these links at no additional
cost to the reader.
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CONTENTS Contents ..................................................................................................................... 3
Welcome .................................................................................................................... 6
Using this Book ....................................................................................................... 8
Understanding the Comprehensive Management Plan ...................................... 10
Dietary Modifications....................................................................................... 10
Nutrition & Supplementation .......................................................................... 11
Lifestyle Practices ............................................................................................. 11
Complementary Therapies & Treatments ....................................................... 12
Medical Treatment........................................................................................... 12
Emotional Wellbeing ........................................................................................ 12
Before We Get Started ......................................................................................... 13
Understand the Diagnosis ................................................................................ 13
Take a Look at Your Choices ............................................................................ 14
Take a Breath ................................................................................................... 14
Be Patient ......................................................................................................... 15
Stage One ................................................................................................................. 16
Dietary Modification ............................................................................................ 16
Reduce meal size & increase frequency .......................................................... 16
Reduce fat to 40 grams per day ....................................................................... 17
Nutrition & Supplementation .............................................................................. 17
Consider Taking a Multivitamin ....................................................................... 17
Lifestyle ................................................................................................................ 18
Walk 20-30 minutes per Day ............................................................................ 18
Keep a Journal .................................................................................................. 19
Complementary Therapies & Treatments ........................................................... 19
Try Ginger ......................................................................................................... 19
Medical Treatment .............................................................................................. 20
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Confirm the Diagnosis ...................................................................................... 20
Find a Doctor You Trust.................................................................................... 20
Emotional Wellbeing ............................................................................................ 21
Get Off Social Media ........................................................................................ 21
Stage Two ................................................................................................................. 22
Dietary Modification ............................................................................................ 22
Reduce fiber to 15 grams per day .................................................................... 22
Reduce hard to digest foods ............................................................................ 23
Nutrition & Supplementation .............................................................................. 23
Supplement with Nutrient-Rich Liquids ........................................................... 23
Consider a Magnesium Supplement ................................................................ 24
Lifestyle ................................................................................................................ 25
Reduce & Better Manage Stress ...................................................................... 25
Complementary Therapies & Treatments ........................................................... 26
Try OTC & Natural Remedies for Nausea ......................................................... 26
Use Heat for Pain ............................................................................................. 26
Medical Treatment .............................................................................................. 26
Investigate Underlying or Contributing Factors ............................................... 26
Emotional Wellbeing ............................................................................................ 28
Educate Your Family & Friends ........................................................................ 28
Enlist Support ................................................................................................... 29
Stage Three .............................................................................................................. 30
Dietary Modifications .......................................................................................... 30
Reduce FODMAPs ............................................................................................ 30
Supplementation ................................................................................................. 31
Consider b-12 supplementation ...................................................................... 31
Focus on Nutrient-Rich Foods .......................................................................... 31
Lifestyle ................................................................................................................ 32
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Quit Smoking .................................................................................................... 32
Practice relaxation exercises 10 minutes per day ............................................ 32
Complementary Therapies & Treatments ........................................................... 33
Try Complementary Treatments ...................................................................... 33
Medical Treatment .............................................................................................. 33
Explore medical options ................................................................................... 33
Investigate bacterial overgrowth ..................................................................... 35
Emotional Wellbeing ............................................................................................ 35
Address food related anxiety ........................................................................... 35
Work on Acceptance ........................................................................................ 36
What’s Next? ............................................................................................................ 37
Keep Tweaking ..................................................................................................... 37
Continue Learning ................................................................................................ 37
Celebrate & Share Your Success .......................................................................... 38
Quick Start Checklists ............................................................................................... 38
Stage One ......................................................................................................... 39
Stage Two ......................................................................................................... 40
Stage Three ...................................................................................................... 41
About the Author ..................................................................................................... 42
Other Books by Crystal ......................................................................................... 43
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WELCOME Hi, there. If you’re reading this book, chances are you were recently diagnosed
with gastroparesis. Or maybe you were diagnosed quite some time ago, but you
just can’t seem to get a handle on symptom management. Either way, I know how
you feel. My life was turned upside down when I was diagnosed with idiopathic
gastroparesis in 2004 at the age of 23.
If you’re like I was, you’ve been searching the internet for information, pouring
over blog posts, videos, and Facebook groups for something that will help you.
You’re likely feeling disheartened and at least a little bit scared by what you’ve
seen. You may be worried that your life will never be “normal” again, that your
health will continue to decline, and there’s nothing you can do about it.
Well I’m here to tell you that’s not the case. In fact, there are steps that you can
take right now to start decreasing your symptoms and improving your quality of
life.
How do I know? From personal experience, for starters. As I said, I was diagnosed
with gastroparesis over fifteen years ago. A few years in, I was at my lowest of
lows. I was eating little more than applesauce and Saltines, yet dealing with pain
and nausea so bad that I was making frequent trips to the ER and sleeping only
three or four hours a night. I’d lost nearly 50 pounds. I was malnourished and
exhausted. I couldn’t work. I had no social life. My marriage was suffering. My
family was worried. I was frustrated, scared, confused, and overwhelmed.
Thankfully, things changed drastically for me when I went back to school to study
holistic health and nutrition and started looking at symptom management in a
whole new way. Today, life looks totally different. I’m a healthy, happily married,
mama of one, with a successful and fulfilling career and I’m truly living well
despite having gastroparesis.
It’s not just personal experience that this guide is based on, however. It’s primarily
a result of my decade of work as a Certified Health Coach specializing in
gastroparesis management. Through one-on-one coaching, group programs, my
website, and the books I’ve written, I’ve had the honor of seeing the information
I’ll be sharing in this guide improve the lives of thousands of other people with
gastroparesis around the world.
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If it sounds too good to be true, it’s not. Let me be clear: there’s no silver bullet or
cure-all here. If I knew of one, I’d shout it from the rooftops. But I don’t. This is
simply about educating yourself and doing the work to create and implement what
I call a comprehensive gastroparesis management plan.
While I’ve talked about the concept of a comprehensive management plan in my
Living (Well!) with Gastroparesis book, on my blog, and in numerous videos, I’ve
noticed that it’s often difficult for people to begin implementing a plan of their
own. That’s why I created this guide.
What you’ll find in the next 40-plus pages will take you through creating a basic
gastroparesis management plan. Think of it as a roadmap to put you firmly on the
path to improving your symptom management and your quality of life -- ASAP.
Now I don’t want to mislead you in any way. I am not promising to cure you of
gastroparesis, nor am I saying that following the steps outlined in this guide will be
all you’ll ever need in order to live well with gastroparesis. It probably won’t
change your experience overnight and it certainly won’t mean that you’ll never
have flare-ups or bad days.
But I do promise that if you follow the steps outlined in this guide and make self-
care your number one priority, you will begin to feel better physically, mentally,
and emotionally. It’s helped me and many, many others with gastroparesis… and
I’m confident that it can help you, too!
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USING THIS BOOK
This Quick Start Guide is divided into three “stages,” with each stage organized
according to the sections of a comprehensive gastroparesis management plan.
There are one or two steps that you’ll take in each section in order to build your
own management plan. This step-by-step approach mimics how I work with clients
one-on-one and will allow you to progress steadily, creating an effective plan
without adding to the stress or overwhelm that you already feel.
You might be tempted to jump ahead or to tackle all of the stages at once. Please
don’t. Your results will be better if you take it one step at a time and give yourself
enough time to implement and acclimate to the recommendations in each stage
before moving on to the next. I recommend that you plan on at least a week or
two per stage. If that seems like a long time, rest assured that you’ll most likely
start feeling better soon after you get started and your quality of life will be
improving along the way.
I’ve included a checklist for each stage to help you keep track of the steps you’ve
taken and your results as you go. These start on page 37 and I recommend that
you print them out to keep track of your progress.
Please note that you may find that some recommendations within each stage work
really well for you and others do not. That’s to be expected. Gastroparesis is a
highly individualized condition and experiences vary widely in terms of severity
and symptoms. Listen to your body and do what’s right for you. That is truly an
essential part of any good management plan.
Lastly, keep in mind that this is designed as a “quick start” guide for those who
want to get on the path to better symptom management right away. It doesn’t
provide a lot of in-depth explanations, and it isn’t meant to answer all of your
questions or cover all aspects of life with gastroparesis.
Throughout the guide, however, I’ve included links to recommended reading and
additional sources of information if you’re ready to dive deeper into the concepts
and expand your understanding of gastroparesis and GP management.
Tip: If you are reading this on a computer, hold the Ctrl button while you click the
links to make them open in a new tab. For a complete list of all links in this eBook,
as well as printable PDFs of the checklists, visit LivingWithGastroparesis.com/QS.
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UNDERSTANDING THE COMPREHENSIVE MANAGEMENT PLAN
When I started working as a Health Coach specializing in gastroparesis
management, it didn’t take me long to realize that the standard approach to
managing the condition – a combination of medication and a generic low-fat, low-
fiber diet – just didn’t work very well. Most people following this two-pronged
plan continued to experience erratic and often debilitating symptoms that
compromised not only their physical comfort, but also their quality of life and
overall well-being.
My background is in holistic health and nutrition, and I found that the more I
encouraged my clients to implement a holistic approach to gastroparesis
management, one that went far beyond just basic dietary changes and/or
medication, the greater the benefits they experienced in all aspects of their lives.
Eventually that evolved into what I now call the comprehensive gastroparesis
management plan, the six parts of which are the foundation of this guide. We’ll
talk a bit about each of them below.
MORE INFO: THE GASTROPARESIS SYMPTOM BUCKET (BLOG POST)
MORE INFO: EVALUATE YOUR MANAGEMENT PLAN (ARTICLE/WORKSHEET)
DIETARY MODIFICATIONS
Many people consider dietary modification to be the basis of gastroparesis
management, and for good reason. Eating is what typically precedes symptoms,
after all. But you must keep in mind that dietary changes are a symptom
management tool, not a cure. Following a gastroparesis-friendly diet is certainly
helpful, but it will not usually eliminate symptoms on its own.
Restricting your diet too much, however, will likely negatively impact nutrition
without providing additional symptom management benefit. This is a fine line that
each person must learn to navigate on an individual basis. While creating your
management plan, the goal is to make the most effective dietary changes possible
without compromising your overall health and nutrition (or sanity!).
MORE INFO: PURPOSE AND LIMITATIONS OF A GASTROPARESIS-FRIENDLY DIET (VIDEO)
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NUTRITION & SUPPLEMENTATION
The typical low-fat, low-fiber, processed diet prescribed for gastroparesis is quite
poor nutritionally. Unfortunately, the less nutrition your body receives the more
difficult it becomes for it to repair itself and function normally. What’s more, there
are a variety of nutrients that are vital for normal digestion. I strongly believe that
lack of proper nutrition often contributes to the worsening of symptoms and
decline in overall health that many people with gastroparesis seem to experience
over time.
The steps in this guide emphasize the importance of nutrition and aim to enhance
nourishment through smart dietary choices and the use of high-quality
supplements.
Please note, there are a wide variety of manufacturers and formulations for each
supplement you’ll find listed in this book. It may be necessary to experiment in
order to find the one that’s best for you. Chewable, sublingual and liquid
formulations are often better tolerated than tablets. You may need to start with a
smaller dose than recommended — some is always better than none.
The information provided in this guide is not medical advice. Talk with your doctor,
pharmacist or other healthcare provider if you have any questions about which
supplements are right for you.
LIFESTYLE PRACTICES
Lifestyle practices and habits are commonly overlooked when it comes to
gastroparesis management, perhaps because they just seem too simple. It might
be counter-intuitive that basic things like physical activity and adequate sleep
could have a significant impact on such a complex disorder. But guess what? They
do! And you have more control over this aspect of GP management than any
other. It all comes down to priorities: how you choose to spend your time and
energy. A good management plan must prioritize self-care.
If you’re still unsure about the importance of this area of the management plan, be
sure to read The Gastroparesis Symptom Bucket, if you haven’t already.
MORE INFO: THE GASTROPARESIS SYMPTOM BUCKET (BLOG POST)
MORE INFO: PRIORITIZE SELF-CARE (BLOG POST/VIDEO)
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COMPLEMENTARY THERAPIES & TREATMENTS
There are a number of complementary therapies and remedies – treatments used
in conjunction with traditional medical treatment – that may alleviate the
symptoms of gastroparesis and enhance the functioning of the digestive system.
This guide will introduce you to the ones that tend to be the most helpful, as well
as the easiest to access. Be sure to talk with your health care provider(s) about all
complementary therapies and treatments that you’re considering.
MEDICAL TREATMENT
Appropriate medical treatment – including proper testing and diagnosis – is an
important part of gastroparesis management, but you’ll notice that medication
isn’t mentioned until stage three of this guide. In part that’s because I’m not a
doctor and medicine is not my specialty. In addition, the medical treatment
currently available for gastroparesis is limited and is not effective for everyone.
There are, however, medical options for symptom management that can be very
helpful.
The most important thing when it comes to medical treatment and your
management plan is to be an informed patient and an educated self-advocate.
Always remember that you hire your doctors, and you have the right and the
responsibility to find the ones that best suit your needs and support your goals.
EMOTIONAL WELLBEING
As difficult as gastroparesis is to manage from a physical standpoint, the stress,
anxiety, overwhelm, and frustration that often comes along with the condition can
be just as – and sometimes even more – challenging. Learning to alleviate the
emotional suffering can go a long way toward improving your experience,
regardless of what’s going on with your physical symptoms.
Over the last several years, I have been focusing more and more on this aspect of
the management plan, both personally and professionally, as I’ve found that it is
often the “missing piece” when it comes to quality of life and truly living well.
MORE INFO: DO CIRCUMSTANCES CAUSE SUFFERING (PODCAST INTERVIEW)
MORE INFO: FINDING PEACE (PODCAST INTERVIEW)
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BEFORE WE GET STARTED
Before we get started, there are a few things that you can do to ensure that you
get as much out of this guide as possible.
UNDERSTAND THE DIAGNOSIS
In order to manage gastroparesis, you have to understand what you’re dealing
with. Unfortunately, there’s a great deal of misinformation floating around out
there, even among some members of the health care community.
Here are a few things you need to know:
• Gastroparesis is also called delayed gastric emptying. A gastroparesis
diagnosis means that the stomach does not empty as quickly as it should --
it’s slow. It usually does not mean that the stomach is completely
paralyzed, nor does the diagnosis itself indicate the severity of the delay or
the severity of the symptoms.
• Gastroparesis is what’s called a functional motility disorder. There is no
obstruction, physical abnormality, or other visible defect. The problem is
due to dysfunction of the muscles and/or the nerves within the stomach.
• While some people have motility issues throughout the GI tract, a
diagnosis of gastroparesis is specific to stomach. It does not indicate that
other parts of the GI tract are or will become delayed.
• Gastroparesis is not caused by – and likely will not be cured by – eating or
not eating certain foods. While certain foods may exacerbate symptoms by
increasing the existing delay, the underlying delay in gastric emptying will
be present regardless of what you eat or don’t eat.
• Nutrition is a vital part of gastroparesis management. Ignoring this fact
may contribute to feeling sicker – and having increasing health issues –
over time.
• Medication and/or dietary changes alone are often inadequate when it
comes to symptom management and improved quality of life. The most
effective way to manage gastroparesis is via a comprehensive
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management plan.
• Though there is no medical cure for gastroparesis, the condition can
improve – or even resolve – over time. It is possible to live WELL with
gastroparesis and people have recovered.
MORE INFO: UNDERSTANDING GP AND THE GP MANAGEMENT PLAN (VIDEO)
TAKE A LOOK AT YOUR CHOICES
I can’t tell you how many clients I’ve worked with who started our first session by
saying, “it doesn’t matter what I do; I always feel horrible.” Inevitably, a week or
two later, they’re telling me that they never realized how much their day-to-day
choices were contributing to how they felt over time. While we certainly don’t
have complete control in this (or any) area, our everyday choices and actions can
have a significant impact on how we feel. Once you acknowledge, your ability to
manage your symptoms consistently over time will improve.
This may require you to change your priorities, define new limitations, and set
aside your expectations, at least for the short term. But by doing all of that, you’re
much more likely to get a handle on your physical and mental well-being sooner
rather than later, and minimize the abnormality, discomfort, and interruption
gastroparesis causes in your life.
MORE INFO: THE GASTROPARESIS SYMPTOM BUCKET (AUDIO – 15 MINS)
MORE INFO: MAKE A CHOICE TO MAKE A CHANGE (FREE CLASS)
TAKE A BREATH
In my Living (Well!) with Gastroparesis Program, I share a poem about a bumble
bee that finds itself stuck inside a room with two windows. The bee is frantic to get
outside and continually runs itself into the closed window, never pausing or
looking around long enough to notice the open window just across the room.
After a gastroparesis diagnosis, many of us act like that bee. We want so badly to
find a “way out” that we allow ourselves to become frantically consumed by
gastroparesis. We scour the internet incessantly, trying everything we read, yet
end up not actually making any progress… it’s as if we’re banging our head against
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a closed window, feeling more and more desperate and hopeless with each
attempt.
If that sounds like you, please stop for a minute and take a breath. Look around.
Promise yourself that you’re going to do everything you can to improve your
situation, but you’re going to do it in a meaningful, effective way. This eBook has
everything you need to get started and it’s organized in a way that’ll make it as
simple as possible.
If you find yourself feeling more stressed or overwhelmed as you go through the
process, take a step back and reassess. Are you trying to create a “perfect”
management plan? Are you trying to do everything all at once? Are you putting
too much pressure on yourself? Please hear me: there’s no such thing as a perfect
management plan and sometimes doing less is more beneficial, especially if it
leads to a quieter mind and a calmer state of being.
BE PATIENT
Learning to manage gastroparesis is a process. There’s a learning curve. While
you’re setting yourself up to “figure this out” much more quickly than you might
otherwise, it still takes time to implement the suggestions in a meaningful way.
You’ll likely have missteps and set-backs. Some things simply won’t work for you.
You’ll have days where you don’t want to deal with it and days where you can’t
help but think, “why me?!” That’s okay. It’s normal. But don’t get stuck there.
That’s just your brain throwing out habitual thoughts. Be kind to yourself and be
patient with the process, but keep moving forward.
The most important step in any journey is the first one, so let’s take that step now!
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STAGE ONE In this stage, we’re taking basic steps to lay the foundation for each aspect of your
management plan. Remember to spend some time, at least a week, implementing
and adjusting to the recommendations in each section of this stage before moving
on to stage two.
DIETARY MODIFICATION
REDUCE MEAL SIZE & INCREASE FREQUENCY
Volume is the number one determinant of how long it takes a meal to empty from
the stomach, so it makes sense that eating smaller meals helps to alleviate
symptoms caused by slow gastric emptying. In fact, many you may find that how
much you eat is just as (or more!) important as what you eat. By reducing portion
sizes and overall volume, many of my clients are able to maintain greater normalcy
in their diet.
While the specific amount tolerated depends on several factors and varies from
person to person, a general guideline is half of a normal sized meal, or about 1-1/2
cups of total food, per meal. Your plate should still look like you’re eating a meal
and be filled with a variety of foods…just in smaller portions.
To compensate for the decrease in meal size, both in terms of nutrition and
hunger, it’s usually necessary to increase the number and frequency of meals. Four
to six mini-meals per day tends to work best.
Again, the ideal duration between meals varies from person to person, but a
general guideline is to eat every two to three hours. Eating more frequently than
that can actually exacerbate fullness and other symptoms. Eating less frequently
may prevent adequate calorie intake and/or cause erratic blood sugar levels, even
for non-diabetics.
Start with eating a mini-meal every 2 ½ hours and tweak your volume and timing
from there.
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REDUCE FAT TO 40 GRAMS PER DAY
Higher fat foods digest more slowly than lower fat foods, so reducing the amount
of fat that you eat will help the stomach empty as quickly as possible. (This is true
for everyone, not just people with gastroparesis.)
Based on my work, people with gastroparesis tend to tolerate somewhere
between 25-50 grams of fat per day. However many people end up over-restricting
or underestimating the amount of fat they can tolerate, so I encourage you to start
by reducing your intake to around 40 grams per day. This is well within the range
of a “low-fat” diet.
Remember that even if you eliminated all fat from your diet, it wouldn’t eliminate
the underlying delay. Your stomach is not slow because you eat dietary fat. What’s
more, dietary fat is essential for brain function, hormone production, the
absorption of fat-soluble vitamins, and many more processes within the body.
Rather than filling your diet with fat-free and low-fat packaged food products, try
choosing lower-fat versions of the real food you already eat. For example lean
ground meats, skinless white-meat poultry, white fish, egg whites, cooked
vegetables, fruit smoothies, lower-fat milk or yogurt (2% or skim), etc.
You’ll also want to avoid fried foods, fatty meats, and junk food like chips and
pastries, which pack a significant amount of fat and offer little in the way of
nutrition.
NUTRITION & SUPPLEMENTATION
CONSIDER TAKING A MULTIVITAMIN
Regardless of how well balanced a GP-friendly diet is, it will likely be deficient in
certain nutrients. A multi-vitamin/multi-mineral supplement can help to fill in the
gaps.
Liquid vitamins, chewable tablets or gummy vitamins are often better tolerated
than tablets or capsules. Look for a product that does not contain artificial dyes,
sweeteners or flavors. Take it with food to prevent/minimize stomach upset and
aid in absorption.
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A complete formulation should contain vitamins A, C, D, & E; niacin; folic acid; B6;
B12; pantothenic acid; thiamin, riboflavin; calcium, chromium, copper, iodine,
magnesium, manganese, and zinc.
While some products may be more complete than others, what matters most is
that you can take it consistently day after day. If you find a less complete formula
that you tolerate, that’s a better choice than the perfectly complete formula that
you don’t.
Note that products containing iron may exacerbate constipation. Men and post-
menopausal women are unlikely to need supplemental iron.
MORE INFO: FAQ: SHOULD I TAKE VITAMINS (BLOG POST)
CRYSTAL’S FAVORITE: SMARTYPANTS MULTIVITAMIN
LIFESTYLE
WALK 20-30 MINUTES PER DAY
Mild to moderate physical activity can increase the rate of gastric emptying and it’s
one of few things, aside from medication, that can do so. It’s also been found to
reduce anxiety and depression, increase energy levels even among people with
chronic illness, and aid in weight maintenance – including weight gain for those
who are underweight.
Walking is an easy, versatile, and accessible form of physical activity that can be
extremely effective for symptom management. Take a 20 to 30 minute walk after
breakfast or dinner, depending on your most symptomatic time of the day. If
you’re completely sedentary, start with just 10 minutes and work your way up.
Every little bit helps.
MORE INFO: BENEFITS OF WALKING (BLOG POST)
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KEEP A JOURNAL
One of the best tools I can recommend, especially at this stage in your journey, is a
simple journal. It doesn’t have to be complicated or time consuming. You don’t
need to track nutritional information or write down everything you eat or do.
You simply want to track how you’re feeling overall (I recommend writing down a
daily “symptom score” from 1-5, 1 being symptom-free and 5 being horrible
symptoms), and make a note of the factors that might contribute. Things to keep
track of include: new or different foods, new supplements and medications,
changes in physical activity, your menstrual cycle, viruses/colds/flus, flare ups in
other illnesses, travel, and stress (good or bad).
Having all of this down on paper makes it much easier to discover connections,
even if you don’t think any exist, as well as evaluate your progress over time.
COMPLEMENTARY THERAPIES & TREATMENTS
TRY GINGER
Ginger is a time-tested remedy for nausea. It’s also a natural prokinetic, meaning it
speeds up gastric emptying. While ginger ale may be fine for quelling an upset
stomach (make sure it actually contains ginger…not all of them do!), you’ll need
something a little stronger to get the gastric emptying benefit.
Try drinking a cup of strong ginger tea about 30 minutes before meals to stimulate
gastric juices or after meals to aid emptying and digestion. You can make your
own with fresh ginger or use purchased tea bags.
MORE INFO: GASTROPARESIS SUPER FOOD-GINGER (BLOG POST)
CRYSTAL’S FAVORITE: TRADITIONAL MEDICINALS ORGANIC GINGER TEA
Ginger-filled capsules, which are inexpensive and readily available, are another
option. If you’re able to easily swallow and absorb pills, then taking 1,000 mg of
ginger two to three times a day is one of the easiest ways to reap the prokinetic
benefits. If you find that you taste the ginger all day, try taking the capsules only at
bedtime. This can be helpful for middle-of-the-night and morning nausea, as well.
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Be sure to talk with your doctor before using ginger as a supplement. In higher
doses it acts a blood thinner and may not be appropriate for those with certain
conditions or those who are pregnant.
CRYSTAL’S FAVORITE: SOLARAY ORGANIC GINGER ROOT CAPSULES
MEDICAL TREATMENT
CONFIRM THE DIAGNOSIS
Before you dive too far into your gastroparesis management plan, it’s important to
ensure that you do in fact have the condition. That might sound obvious, but I’ve
heard from many people who initially thought they had GP, only to find out
something else was going on. If your symptoms are not the result of gastroparesis
(or a closely related diagnosis like functional dyspepsia) the advice in this guide
probably won’t adequately alleviate them.
If you’ve not been formally diagnosed with gastroparesis, your first task is to
schedule an appointment with a gastroenterologist and ask for a gastric emptying
study, preferably a four-hour one. Note that gastroparesis cannot be definitively
diagnosed via endoscopy, CT scan, or x-ray. If you have been diagnosed with
gastroparesis via one of these other means, consider a second opinion.
MORE INFO: DIAGNOSING GASTROPARESIS (VIDEO)
FIND A DOCTOR YOU TRUST
Part of your ongoing management plan will be to build a “Dream Team” of health
care professionals that you trust and feel comfortable with. For now it’s important
to have at least one doctor that you can consult about testing and initial treatment
options. While it’s ideal if this doctor is a gastroenterologist (a doctor who
specializes in disorders of the gastrointestinal tract), a good primary care doctor
who is willing to do some research and learn along with you may also fit the bill.
Never hesitate to switch doctors or get a second opinion if the fit isn’t right.
MORE INFO: LIVING (WELL!) WITH GASTROPARESIS, PAGES 17-21
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EMOTIONAL WELLBEING
GET OFF SOCIAL MEDIA
If I could offer you one piece of personal advice at this stage, it would be this:
avoid the gastroparesis Facebook groups, Instagram accounts, and online message
boards until you have a good handle on your experience with the condition and
your management plan.
Much of what you’ll read about gastroparesis on these platforms is based solely on
each person’s experience. Gastroparesis is a highly individualized condition,
however, and what works for one person doesn’t always work for another. It can
be confusing and overwhelming to read all of the contradicting information.
What’s more, social media is often rampant with competitive suffering and it tends
to be a showcase of the worst-case scenarios. After all, those who are living well
with gastroparesis don’t usually take the time to post about it on these sites.
They’re out living their lives! So the stories are disproportionately dire and may
foster fear and hopelessness.
Trust that the information in this guide is plenty to get you started with
understanding gastroparesis and addressing your symptoms in a comprehensive
and empowering way. Devote the next several weeks to your own experience
before re-visiting online accounts and communities.
MORE INFO: MEDICAL HEXING (BLOG POST)
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STAGE TWO In this stage, we’re building on to your management plan, taking each section a
step or two further. Once again, give yourself ample time – at least a week – to
fully implement these steps before moving on to stage three.
DIETARY MODIFICATION
REDUCE FIBER TO 15 GRAMS PER DAY
High-fiber foods take longer to break down and digest than lower fiber foods. This
is true for everyone, not just people with gastroparesis. Most of my clients seem to
do well with around 15 grams of fiber per day, divided fairly evenly between
meals.
While it’s common to decrease fiber by filling the diet with white or refined foods,
I really don’t recommend this approach. Instead, opt for lower-fiber but nutrient-
rich GP-friendly choices, such as:
• Hot cereal: cream of brown rice or cream of buckwheat
• Veggies: peeled, well-cooked veggies like carrots, turnips, parsnips,
potatoes, sweet potatoes, spinach, and mushrooms
• Fruit: bananas, cantaloupe, honeydew, or watermelon; applesauce or
other peeled and stewed/cooked fruits; canned pears or peaches
• Bread: spelt bread with 2 grams of fiber or less per slice; French or
sourdough bread with fewer than 5 ingredients
• Lean protein: animal protein does not contain fiber, unless it’s added (in
certain dairy products, for example)
When buying packaged food, always look at the nutrition panel. You’ll generally
want to choose products with 3 grams of fiber or less per serving. This depends on
how many servings you’re likely to eat at one time and what else you’ll be eating
with it, of course.
MORE INFO: LIVING (WELL!) WITH GASTROPARESIS, PAGES 50-55
MORE INFO: THE GASTROPARESIS-FRIENDLY SHOPPING LIST (FREE PDF)
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REDUCE HARD TO DIGEST FOODS
In addition to reducing overall fiber, it’s usually helpful to reduce foods that are
difficult for the stomach to break down and/or digest completely. These hard-to-
digest foods may further slow digestion and/or lead to masses of hardened food in
the stomach, called bezoars.*
These include:
• Seeds
• Nuts (whole; nut butter is fine)
• Skins, hulls, and peels
• Beans and legumes
• Raw vegetables
• Raw fruits with skins and/or seeds (berries, grapes, etc.)
*Most people with gastroparesis will never get a bezoar. However specific foods
that are thought to contribute to bezoar formation are: apple peels, berries,
broccoli, Brussel sprouts, coconuts, corn, green beans, figs, oranges, persimmons,
potato peels, and sauerkraut. These foods should be avoided if you have
previously had a bezoar or are particularly prone to them for another reason.
NUTRITION & SUPPLEMENTATION
SUPPLEMENT WITH NUTRIENT-RICH LIQUIDS
While most people with gastroparesis do not and will not need to follow an all-
liquid diet long-term, nutrient-rich liquids can play an important role in a healthy
gastroparesis-friendly diet. In most cases, liquids empty from the stomach more
quickly than solids, so alternating solid meals with liquid ones can help to alleviate
fullness and increase overall nutrition and calorie intake.
Try substituting one meal or snack per day, perhaps at your most symptomatic
time of the day, with a meal replacement drink or homemade smoothie.
Please keep in mind that many of the common meal replacement shakes are full of
hard-to-digest chemicals and additives. These are not health promoting in my
opinion and may actually exacerbate symptoms for some people. On the other
hand, many of the shakes marketed as “healthy” have added fiber and other
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slower-to-digest ingredients that make them a poor choice for people with
gastroparesis, as well.
I most often recommend products from Orgain, Plant Fusion, and Kate Farms, or
making your own smoothies with fruit and protein powder.
MORE INFO: CHOOSING A MEAL REPLACEMENT DRINK (VIDEO)
MORE INFO: VEGAN ORGAIN VS. PLANT FUSION (VIDEO)
CONSIDER A MAGNESIUM SUPPLEMENT
Magnesium plays a role in over 300 processes within the body and is essential for
the proper functioning of nerves and muscles. It’s also known as the relaxation
mineral. Since gastroparesis is typically a result of dysfunction with the nerves
and/or muscles within the GI tract and is exacerbated by stress, increasing
magnesium intake can be helpful for those with gastroparesis.
A typical GP-friendly diet is low in magnesium. What’s more, sugar, processed
foods, and chronic stress all decrease the magnesium already stored in our body.
Deficiency symptoms include poor digestion, anxiety, constipation, headache,
insomnia, irritability, muscle weakness or cramping, and irregular heartbeat.
You can find magnesium in pill or powder form. A typical dose is 400-1,000mg per
day. Avoid magnesium carbonate, sulfate, oxide, and gluconate, which are poorly
absorbed by the body and may exacerbate digestive symptoms. My advice with all
supplements, unless suggested otherwise by your healthcare provider, is to start
with the lowest recommended dose.
Magnesium is also easily absorbable through the skin. If you’ve experienced any
digestive upset from oral magnesium, you might consider magnesium lotion,
magnesium flakes, or even plain old Epsom salt baths.
Note: If you have heart or kidney disease, be sure to consult a doctor prior to use.
CRYSTAL’S FAVORITE: ANCIENT MINERALS MAGNESIUM BATH FLAKES
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LIFESTYLE
REDUCE & BETTER MANAGE STRESS
Stress is probably one of the touchiest subjects when it comes to gastroparesis
management. While I understand why – so many of us are initially told that their
symptoms are “in their heads” or “just stress” – I think that we’re doing ourselves
a disservice by not paying more attention to it.
Stress does not cause gastroparesis, but it most certainly exacerbates the
symptoms. Simply put, the gut is highly sensitive to stress. This is not new
information. Think about it: gastroparesis aside, what happens when people are
anxious, upset, or get bad news? They often get a stomach ache, feel “butterflies”
in their belly, or even throw up.
That’s because stress triggers our fight-or-flight response. Among other things, this
response shuts down all non-essential processes. That means blood flow to the GI
tract decreases, the production of digestive enzymes is reduced, and the muscles
of the stomach stop churning. Digestion basically stops!
If this only happened occasionally, when faced with a life and death situation like
nature intended, it wouldn’t be much of an issue. But when we’re under chronic,
everyday stress our digestive processes are constantly impaired, further
exacerbating any underlying dysfunction already present in the gut.
You cannot properly manage gastroparesis if you are constantly in a state of fight-
or-flight, so consider the gastroparesis diagnosis an “excuse” to make this a
priority. Take an honest look at the sources of chronic stress in your life, especially
in terms of your ability to learn to navigate life with gastroparesis. You may need
to temporarily decrease your hours or responsibilities at work, to distance yourself
from negative people, or better delegate at home in order to take better care of
yourself.
While gastroparesis itself is a source of stress for many, especially in the beginning,
rest assured that the better able you are to manage the condition using all of the
steps in this guide, the less stressful it will become.
MORE INFO: GASTROPARESIS AND STRESS (VIDEO)
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COMPLEMENTARY THERAPIES & TREATMENTS
TRY OTC & NATURAL REMEDIES FOR NAUSEA
While they won’t eliminate severe nausea, over-the-counter remedies can quell
the constant queasy feeling that many people experience due to GP. There are
several such products on the market, everything from chewable tablets to
essential oils to pressure point wristbands. You may have to experiment to find
what works best for you. A couple of my favorites are below.
CRYSTAL’S FAVORITES: NAUZENE AND QUEASEEASE
There are also herbal remedies that may help to alleviate nausea. These tend to
have mild effects, but having them on hand can provide peace of mind and
increase comfort when you’re out and about and not feeling your best.
CRYSTAL’S FAVORITE: ST. CLAIRE’S ORGANICS TUMMY SOOTHERS
USE HEAT FOR PAIN
Heat can be a very effective remedy for the abdominal and chest pain associated
with gastroparesis. I highly recommend investing in a reusable hot/cold pack or a
good heating pad. Heat draws blood into the digestive organs, helping them work
more effectively and aiding in digestion. Heat also helps to relax and alleviate any
cramping or spasms, which often causes pain within the GI tract.
CRYSTAL’S FAVORITE: MYCARE RICE HEATING PAD
MEDICAL TREATMENT
INVESTIGATE UNDERLYING OR CONTRIBUTING FACTORS
While stomach viruses, diabetes, connective tissue disorders, abdominal surgery,
and anorexia nervosa are among the known causes of gastroparesis, more than
one-third of all cases are considered “idiopathic” (no known cause). The following
factors should be considered when the cause of gastroparesis isn’t readily
identified.
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MEDICATIONS
Many medications are known to delay gastric emptying. These include narcotic
pain medications, tricyclic antidepressants, calcium channel blockers, clonidine,
dopamine agonists, lithium, nicotine, and progesterone.
If you were taking any of these medications prior to diagnosis, talk with your
doctor about a possible connection. If you have since been prescribed any of these
drugs, make sure that your doctor is aware of the existing gastroparesis and ask
about alternatives that will not further delay gastric emptying.
PROTON PUMP INHIBITORS
While this technically falls under “medications,” PPI use among those with
gastroparesis is so common that I feel it deserves extra explanation. Proton Pump
Inhibitors, such Prilosec and Nexium, are frequently prescribed to treat acid reflux
before gastroparesis is diagnosed and use is rarely reevaluated afterward.
Unfortunately suppressing the production of acid in the stomach can actually
cause food to sit there longer. In fact, PPIs have been found to delay gastric
emptying of solids in healthy volunteers.
If you have been prescribed PPIs, it’s important to talk with your doctor about
whether/how long you need to continue taking them. The good news is that the
better we manage gastroparesis overall, the less of a problem reflux is likely to be.
A natural alternative to relieve heartburn, and protect and soothe an irritated
esophagus and stomach is deglycyrrhizinated licorice (DGL).
CRYSTAL’S FAVORITE: ENZYMATIC THERAPY DGL ULTRA FRUCTOSE-FREE
MORE INFO: ACID REFLUX AND GASTROPARESIS (VIDEO)
HORMONE-BASED BIRTH CONTROL
As noted above, progesterone is known to delay gastric emptying. Some women
find relief from their symptoms after hormone-based birth control is discontinued
for two to three months. If you were taking birth control pills prior to your
gastroparesis diagnosis, you may wish to talk with your doctor about trying other
contraceptive options.
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HYPOTHYROIDISM
Hypothyroidism is a common but often undiagnosed condition, especially among
women. It can slow all systems within the body, including the digestive tract. If you
have other symptoms of hypothyroidism, such as fatigue, weight gain, dry skin,
constipation, and muscle soreness, talk with your doctor about testing.
CONSTIPATION
Constipation can impair adequate gastroparesis management by causing and/or
exacerbating symptoms like nausea, pain, bloating, and gas, and further
contributing to the delay in gastric emptying.
While constipation is a fairly common “side effect” of the typical gastroparesis diet
and lifestyle, if chronic constipation was present prior to a gastroparesis diagnosis,
evaluating and treating the root cause may improve gastric emptying and help to
alleviate overall symptoms.
MORE INFO: GASTROPARESIS & CONSTIPATION (VIDEO)
MORE INFO: UNDERSTANDING & ALLEVIATING CONSTIPATION (FREE CLASS)
EMOTIONAL WELLBEING
EDUCATE YOUR FAMILY & FRIENDS
As you become more comfortable with the gastroparesis diagnosis yourself, it’s
important to begin educating your family and close friends about the condition.
There are going to be changes in your priorities and your actions, and getting
everyone on the same page will help to prevent confusion and strained
relationships along the way.
If you’re worried about being seen as a “complainer,” keep in mind that telling the
truth is not the same as complaining. Simply explain the basics of the condition in
as matter-of-fact and relatable way as possible. You set the example. If you are
proactive and positive, most people will follow suit.
MORE INFO: HELPING FAMILY & FRIENDS UNDERSTAND (VIDEO)
MORE INFO: UNDERSTANDING & MANAGING GASTROPARESIS (ARTICLE)
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ENLIST SUPPORT
Once you’ve helped those closest to you better understand gastroparesis, take it a
step further by enlisting their support. Having never experienced the condition,
most people won’t know how to help you unless you tell them. Consider the
various areas in which you’re likely to need support as you go forward and assign
specific roles to specific people.
For example, your husband or wife may need to do more of the cooking or other
house work as you prioritize self-care. If you need help sticking to your physical
activity routine, ask a friend to walk with you each morning or take a yoga class
with you once a week. Make sure that you have someone to whom you can vent
when things get tough…but ask them in advance not to let you ruminate on your
troubles for too long.
It’s essential to have the right kind of support in order to be as successful in your
gastroparesis management plan as possible. Your needs may change as you go
along. Always ask for what you need. Your family and friends will most likely be
happy to help. After all, they want you to feel better, too!
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STAGE THREE In this stage, we’ll add another one or two steps to each section of your
management plan. Keep in mind that this is not the final stage of gastroparesis
management, just the final stage of this Quick Start guide. After you’ve spent some
time with these steps, check out the “What’s Next?” section for resources to help
you continue your progress.
DIETARY MODIFICATIONS
REDUCE FODMAPS
FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides, and Polyols.
Basically, FODMAPs are specific kinds of carbohydrates that are poorly absorbed in
the digestive tract and often exacerbate symptoms like bloating, gas, pain, and
bowel issues in people with functional GI disorders (like gastroparesis).
Many of the staples of a typical gastroparesis-friendly diet are high in FODMAPs,
which may be why some people continue having symptoms or even have
worsening symptoms despite following the prescribed diet.
Foods high in FODMAPs include:
• Apples, pears, peaches, mangoes, watermelon
• Cauliflower, broccoli, onions, garlic
• Honey and agave
• High-fructose corn syrup (found in soda and most packaged/processed
products)
• Lactose (found in ice cream, frozen yogurt, yogurt, cow’s milk)
• Soy
• Wheat (most pasta, cereals, cookies, crackers, breads – white and whole
wheat)
If you continue to experience bloating, gas, and belching despite making the other
dietary changes outlined in this guide, try reducing foods highest in FODMAPs,
such as wheat, dairy, the fruits/vegetables listed above, and packaged foods. If
you do not seem to react to these foods, there is no reason to eliminate them.
MORE INFO: FODMAP Q&A (AUDIO)
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SUPPLEMENTATION
CONSIDER B-12 SUPPLEMENTATION
Vitamin B-12 is essential for proper nerve function. It’s also known as the “energy”
vitamin. Because gastroparesis may be the result of impaired nerve function and
those with gastroparesis frequently lack energy, adequate B12 intake is important.
Unfortunately the typical gastroparesis-friendly diet is deficient in Vitamin B-12
and impaired absorption and/or depletion is common in those who use acid
suppressing drugs, including H-2 blockers and proton pump inhibitors, or those
who take Metformin for type-2 diabetes.
Deficiency symptoms include fatigue, muscle weakness, shortness of breath,
dizziness, numbness, heart palpitations, bleeding gums and mouth sores, nausea,
and poor appetite.
Supplementation is often necessary and beneficial. Vitamin B-12 can be taken as
sublingual (dissolvable) tablets or administered via injection from your doctor.
CRYSTAL’S FAVORITE: MARY RUTH’S B12 SPRAY
FOCUS ON NUTRIENT-RICH FOODS
Many easy-to-digest foods are also nutritionally empty. Consuming things like
white bread, sugary cereals, and calorie-laden sports drinks does absolutely
nothing to support health or healing. In fact, these may actually exacerbate
symptoms due to increased intake of FODMAPs and/or unstable blood sugar.
Make an effort to choose easier-to-digest foods that are also rich in nutrients,
including:
• Hot cereal (cream of buckwheat, cream of brown rice, ground oatmeal)
• Eggs (whole or egg whites; not Eggbeaters)
• Nut butters (1-2 tablespoons per meal; within total fat guidelines)
• Cooked and/or pureed lower-fiber vegetables (carrots, mushrooms,
cauliflower, spinach)
• Baked potatoes, sweet potatoes, and squash (no skin)
• Raw fruits without skins or seeds, whole or in smoothies (bananas, melons,
mango, papaya)
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• Cooked or canned fruits (pears, peaches)
• Lean animal protein (90%+ lean ground beef or turkey; turkey or chicken
breast; ham)
• White, flakey fish
• Juices and smoothies made from whole fruits and vegetables
MORE INFO: GP-FRIENDLY JUICING & BLENDING (EBOOK)
MORE INFO: THE BRIGHTER SIDE OF EATING FOR GASTROPARESIS (FREE CLASS)
LIFESTYLE
QUIT SMOKING
Nicotine delays gastric emptying, so people who have been diagnosed with
gastroparesis have one more reason to quit. In addition to all of the other health
risks and ill effects that you’re already aware of, smoking also weakens the muscle
between the stomach and esophagus (called the LES, lower esophageal sphincter),
exacerbating acid reflux and regurgitation of stomach contents.
PRACTICE RELAXATION EXERCISES 10 MINUTES PER DAY
As discussed in stage two, stress impairs proper digestion and can exacerbate
gastroparesis symptoms. In addition to reducing the overall stress in our lives, we
can help to rebalance our nervous system, get ourselves out of fight-or-flight
mode, and restore digestive function by practicing relaxation exercises.
This can be as simple as sitting quietly and focusing on your breath. Other forms of
relaxation exercises include meditation, prayer, tai chi, chanting, walking in nature,
and yoga. Explore some options or choose an activity that you already know you
enjoy and aim to incorporate 10 minutes of relaxation into your daily routine.
The key is to not make relaxation exercises another source of stress and
overwhelm. If you’re dealing with acute anxiety, focusing your breath for 10
minutes may seem like torture. Be willing to be stay flexible and pay attention to
what feels most helpful in the moment.
CRYSTAL’S FAVORITE: HEADSPACE (APP)
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COMPLEMENTARY THERAPIES & TREATMENTS
TRY A COMPLEMENTARY TREATMENT
There are several complementary treatments that those with gastroparesis have
found helpful for symptom management, including hypnotherapy, acupuncture,
and visceral manipulation.
Gut-directed hypnotherapy is a specific form of clinical hypnosis that has been
shown to reduce symptoms for those with functional GI disorders. It can be
especially helpful for alleviating pain.
MORE INFO: CLINICAL HYPNOSIS FOR GI SYMPTOMS (BLOG POST)
Numerous studies have demonstrated the efficacy of acupuncture for reducing
nausea and vomiting, as well as anxiety, pain, and insomnia.
MORE INFO: ACUPUNCTURE FOR GASTROPARESIS (VIDEO)
Visceral manipulation is a treatment I have used personally with great success,
particularly for acid reflux and abdominal pain. In recent years, I have heard from
both practitioners and many other patients who have also found it helpful.
MORE INFO: RELIEF FROM REFLUX & PAIN (BLOG POST)
Keep in mind that your experience and results may vary from practitioner to
practitioner. If one doesn’t work for you, try another before you decide the
therapy itself is of no benefit.
MEDICAL TREATMENT
EXPLORE MEDICAL OPTIONS
While many people are able to manage gastroparesis without medication (or
simply find that the limited options available do not work for them), others find
appropriate medical treatment both necessary and very helpful.
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MEDICATIONS TO INCREASE GASTRIC EMPTYING
There are currently only two medications available in the United States for the
treatment of gastroparesis itself. Neither of them are universally effective, nor
without risk of side effects or complications.
Reglan (metoclopramide) is a prokinetic and an antiemetic drug, meaning it speeds
up gastric emptying and alleviates nausea and vomiting. While some doctors
prescribe Reglan immediately upon diagnosis of gastroparesis, others do not
prescribe it at all due to the potentially permanent and serious neurological side
effects. Reglan currently carries a “black box” warning from the FDA due to the
risk of Tardive Dyskinesia. It’s necessary to talk with your doctor in order to way
the pros and cons of trying this medication.
Erythromycin is another prokinetic medication used in the treatment of
gastroparesis in the US. It is an antibiotic, which in very low doses stimulates
contractions of the stomach muscles. Unfortunately, the most common side
effects of erythromycin are nausea and abdominal pain. Erythromycin is best used
in cyclical fashion (example: six weeks on, two weeks off) in order to continue
providing relief.
Domperidone is a prokinetic and antiemetic medication that’s similar to Reglan but
doesn’t carry the same risk of neurological side effects. While it’s used in most
other countries around the world, it is not approved by the FDA. Domperidone
does carry the risk of cardiac complications, so patients should be monitored by a
physician while taking the drug.
MORE INFO: ALTERNATIVES TO REGLAN (VIDEO)
MEDICATIONS TO ALLEVIATE SYMPTOMS
While medications to treat gastroparesis itself are limited, there are a variety of
drugs available for the nausea and vomiting associated with GP. These are called
antiemetics and they include Zofran, Tigan, Compazine, and Phenergan. It’s
important to be aware that some antiemetics cause constipation, which may
further exacerbate delayed gastric emptying.
Talk with your doctor about the treatment options available and what might be
best for you.
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Please note that while there are also procedures, devices, and artificial nutrition
options, those are not typically considered until further down the road and
therefore not covered in this guide. You’ll find more information about those
options in the resources listed in the “What’s Next?” section.
INVESTIGATE BACTERIAL OVERGROWTH
It’s thought that more than half of people with long-term gastroparesis may
develop bacterial overgrowth in the digestive tract. Bacterial overgrowth
complicates gastroparesis management by exacerbating symptoms like bloating,
distention, and pain. If you feel that symptoms such as bloating and pain have not
improved at all despite the steps you’ve taken throughout these stages or you’re
experiencing diarrhea along with the gastroparesis symptoms, ask your doctor
about evaluation for bacterial overgrowth.
MORE INFO: BLOATING, SIBO & GASTROPARESIS (VIDEO)
MORE INFO: LEAKY GUT SYNDROME (VIDEO)
MORE INFO: SIBO, FODMAPS & GP (ARTICLE)
EMOTIONAL WELLBEING
ADDRESS FOOD RELATED ANXIETY
It’s common for people with gastroparesis to develop varying levels of anxiety
when it comes to food and eating, especially if you’ve tried to manage your
symptoms via diet alone. It’s important to address these feelings as soon as
possible because restricting your diet beyond what’s necessary for symptom
management compromises your nutrition and overall health. In addition, the
anxiety of expecting or anticipating symptoms before you eat can actually
exacerbate them by triggering the fight-or-flight response.
If you’re struggling with food-related anxiety, I strongly encourage you to speak
with a counselor of some kind. It does not mean that your symptoms are in your
head or that you have an eating disorder. Gastroparesis is a difficult condition to
manage, both physically and mentally, and having someone to talk over your fears
and concerns with can be extremely helpful.
MORE INFO: GASTROPARESIS COPING, STRESS & ANXIETY SUMMIT (FREE CLASSES)
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WORK ON ACCEPTANCE
In order to properly manage gastroparesis over time, you must first accept the fact
that right now, for this moment, you have the condition. While that might sound
odd, you’re reading a guide about managing gastroparesis, after all, it’s usually one
of the most difficult and ignored aspects of the journey. It can take many months
or even longer in order to fully accept the reality of life with gastroparesis, but
once you do it will make it much, much easier to cope with the condition overall.
Be patient with yourself. Be kind to yourself. Give yourself some time and space to
get there, but do begin working on and practicing that acceptance.
MORE INFO: ALLEVIATING THE EMOTIONAL SUFFERING (ARTICLE)
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WHAT’S NEXT? First, congratulations on working your way through this guide! If you’ve completed
all of the stages, it’s likely been about six weeks since you first downloaded this
eBook and you’re hopefully feeling a lot more confident in terms of your ability to
manage the condition. You’ve made it through what is often the toughest part, just
figuring out where to begin. But this is still just that: the beginning.
If there’s one thing I’d like you to know about life with gastroparesis, it’s this: it
goes on! You can live WELL with the condition and here are some ways to keep
moving in that direction.
KEEP TWEAKING
Gastroparesis is not a static condition. Your symptoms will ebb and flow, your
ability to handle the challenges of life with GP will likely improve over time, the
circumstances in your life will change, and you’ll continue to learn what works and
what doesn’t work for you. As this happens, you’ll need to continue making
changes to your diet and your lifestyle, shifting your priorities, reevaluating your
responsibilities at work and at home, trying various complementary therapies and
remedies, meeting with different doctors, and perhaps trying different
medications or procedures.
Maybe that sounds like a lot of work, but speaking from personal experience, it’s
worth every minute, every penny, and every ounce of effort. Being flexible and
continuing to refine your comprehensive management plan as you go is what will
enable you to truly live well with gastroparesis long term (or until you get better!).
CONTINUE LEARNING
As I mentioned in the introduction, this is meant to be a “quick start” guide.
Believe it or not, the dozens of steps included in this eBook are only some of the
things that you can do to manage gastroparesis symptoms and improve your
quality of life.
There are many more options to explore and steps to add to your comprehensive
management plan. There’s a lot more work that can be done in terms of coping
with the changes in your life going forward, as well. Over the past several years,
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I’ve created a number of other resources to help you not only manage
gastroparesis, but actually thrive despite the condition.
MORE INFO: FREE CLASSES
MORE INFO: BOOKS & EBOOKS
SPECIAL OFFER: SAVE 10% OFF ANY EBOOK BY USING CODE GUIDE.
CELEBRATE & SHARE YOUR SUCCESS
If you Google “gastroparesis,” which I’m sure you’ve done, you’ll find many more
defeating results than uplifting ones. But I know from working with and talking to
countless people with gastroparesis around the world that symptoms can improve,
others are living well, and, yes, people do recover!
The plethora of hopelessness out there isn’t helping to increase the odds, though.
A large part of living WELL with gastroparesis is believing that it’s possible to live
well with gastroparesis. After all, if you don’t believe it’s possible, you’re not likely
to do the work that makes it possible.
So I’m encouraging you to contribute to a message that uplifts and empowers all of
us to take control and learn to live WELL with gastroparesis. Let others know about
your successes with symptom management and how you’ve taken control of life
with gastroparesis. You can do this as a comment on my Facebook page, or by
submitting your story to my website. If you’re feeling better mentally or physically,
talk about it. Let’s celebrate each and every improvement!
CONNECT WITH ME: FACEBOOK
MORE INFO: LIVING WELL & GETTING WELL STORIES
QUICK START CHECKLISTS The checklists on the following pages are a quick reference of all of the
recommendations given throughout each stage of this guide. I recommend printing
them out so that you can chart your progress, make notes as to which things you’d
like to explore further, and keep track of what does and doesn’t work for you as
you go along.
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STAGE ONE
DIETARY MODIFICATION
Reduce meal size and increase meal frequency.
Reduce fat to 40 grams per day.
NUTRITION & SUPPLEMENTATION
Add a multivitamin.
LIFESTYLE MODIFICATION
Walk 20-30 minutes per day.
Keep a journal.
COMPLEMENTARY THERAPIES
Try ginger.
MEDICAL TREATMENT
Confirm the diagnosis.
Find a doctor you trust.
EMOTIONAL WELLBEING
Get off of (or decrease your time on) GP social media/message boards.
NOTES
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STAGE TWO
DIETARY MODIFICATION
Reduce fiber to a maximum of 15 grams per day.
Reduce hard to digest foods.
NUTRITION & SUPPLEMENTATION
Supplement with nutrient-rich liquids.
Take a magnesium supplement.
LIFESTYLE MODIFICATION
Reduce and better manage stress.
COMPLEMENTARY THERAPIES
Try OTC and herbal nausea remedies.
Use heat for pain.
MEDICAL TREATMENT
Investigate underlying and contributing factors.
COPING/QUALITY OF LIFE
Educate your family and friends.
Enlist support.
NOTES
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STAGE THREE
DIETARY MODIFICATION
Reduce FODMAPs, if necessary.
NUTRITION & SUPPLEMENTATION
Consider B-12 supplementation.
Focus on nutrient-rich foods.
LIFESTYLE MODIFICATION
Quit smoking, if applicable.
Practice relaxation exercises for 10 minutes per day.
COMPLEMENTARY THERAPIES
Try acupuncture, visceral manipulation, or gut-direct hypnotherapy.
MEDICAL TREATMENT
Explore medical treatment options.
Investigate bacterial overgrowth.
COPING/QUALITY OF LIFE
Address food related anxiety.
Work on acceptance.
NOTES
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ABOUT THE AUTHOR
Crystal Saltrelli is an author, educator and Certified Health Coach. Diagnosed with
idiopathic gastroparesis in 2004, she has the unique perspective of both patient
and practitioner. Through her books, classes, and website, Crystal has helped
thousands of people worldwide learn to live (well!) with gastroparesis.
She has written two books, Eating for Gastroparesis and Living (Well!) with
Gastroparesis, and has been published in the American Journal of
Gastroenterology, Digestive Health Matters, and Digest.
Crystal is a graduate of Dartmouth College and the Institute for Integrative
Nutrition. She has completed continuing coursework through the Harvard School
of Medicine, Massachusetts General Hospital, and UCLA.
For more information, please visit www.LivingWithGastroparesis.com.
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OTHER BOOKS BY CRYSTAL
EATING FOR GASTROPARESIS:
GUIDELINES, TIPS & RECIPES
Available in: eBook, Kindle, and paperback
LIVING (WELL!) WITH GASTROPARESIS:
ANSWERS, ADVICE, TIPS & RECIPES FOR A HEALTHIER, HAPPIER LIFE
Available in: paperback and Kindle