What is the best diet for patients with gastroparesis?

Best Diet for Gastroparesis

For patients with gastroparesis, the best diet consists of small, frequent meals (5-6 per day) that are low in fat and fiber, with increased liquid calories and foods with small particle size to optimize gastric emptying. 1, 2

Dietary Principles for Gastroparesis

Food Composition

• Low-fat foods: Fat delays gastric emptying and should be limited 1, 2
• Low-fiber foods: Fiber is difficult to digest and can contribute to bezoar formation 1, 2
• Complex carbohydrates: Provide sustained energy without rapid blood sugar fluctuations 1
• Energy-dense liquids: Easier to digest and provide necessary calories 1, 2

Meal Structure

• Small, frequent meals: Divide food into 5-6 small meals throughout the day 1, 2
• Liquid calories: Increase proportion of liquid calories which empty more easily 1, 2
• Small particle size: Foods with smaller particles improve key symptoms 2, 3

Foods to Include

Based on patient experiences and clinical evidence, these foods are generally better tolerated 3:

• Bland, starchy foods: Saltine crackers, graham crackers, white rice, potatoes
• Clear liquids: Ginger ale, tea, clear soups, popsicles
• Soft, cooked foods: White fish, salmon, applesauce, sweet potatoes
• Jello and other soft desserts
• Gluten-free options (for some patients)

Foods to Avoid

These foods have been reported to worsen gastroparesis symptoms 3:

• Fatty foods: Fried chicken, sausage, pizza, bacon, roast beef
• Acidic foods: Orange juice, oranges, tomato juice, coffee
• Roughage/high-fiber foods: Cabbage, peppers, onions, lettuce, broccoli
• Spicy foods: Salsa, peppers
• Carbonated beverages (except potentially ginger ale)
• Alcohol

Nutritional Considerations

Patients with gastroparesis are at high risk for nutritional deficiencies, including vitamins B6, C, folate, niacin, thiamine, calcium, iron, magnesium, and zinc 4. Therefore:

• Monitor nutritional status regularly
• Consider multivitamin supplementation to prevent specific deficiencies (iron, folate, calcium, vitamins D, K, and B12) 1
• Early dietitian involvement is strongly recommended for patients with severe or refractory gastroparesis to avoid overly restrictive diets 1

Progression of Dietary Management

For patients with worsening symptoms or inadequate oral intake, consider this stepwise approach 5:

1. Solid food with modifications as outlined above
2. Blended or pureed foods if solids are not tolerated
3. Liquid diet with oral nutritional supplements
4. Enteral nutrition via jejunostomy tube (bypassing the stomach) for severe cases 1
5. Parenteral nutrition as a last resort for those who cannot tolerate enteral feeding

Special Considerations for Diabetic Gastroparesis

For patients with diabetic gastroparesis, additional considerations include:

• Careful glycemic control is essential, as hyperglycemia can further delay gastric emptying 1
• Avoid GLP-1 receptor agonists which can worsen gastroparesis symptoms 1, 2
• Consider DPP-4 inhibitors as alternative diabetes medications 2
• Insulin therapy may need adjustment to match altered absorption patterns 6

Medication Considerations

Certain medications can worsen gastroparesis and should be avoided or minimized 1, 2:

• Opioids
• Anticholinergics
• Tricyclic antidepressants
• GLP-1 receptor agonists
• Pramlintide
• Possibly dipeptidyl peptidase 4 inhibitors

For patients with severe symptoms despite dietary modifications, prokinetic medications like metoclopramide may be considered, though their use should be limited to 12 weeks due to risk of tardive dyskinesia 1, 2, 6.

By following these dietary principles and making appropriate medication adjustments, most patients with gastroparesis can achieve improved symptom control and maintain adequate nutrition.