Gastroparesis Diet Handout Pdf – 1 UVA Nutrition Services UVA Digestive Health Center Using Dietary Interventions for Gastroparesis Race Parrish MS, RD Nutrition Support Specialist University of Virginia Health System Digestive Health Excellence Center Charlottesville, VA Jane Keith-Ferris, RN, BScND5 /Dalergary2 President, AB T3A 1S9 Introduction Gastroparesis means paralysis of the stomach (gastro). Other terms used to describe this condition include gastric stasis, gastropathy, slow stomach, lazy stomach, and diabetic enteropathy (in patients with diabetes). Normally, the stomach is a flexible bag that stretches, contracts, mixes and breaks, eventually emptying food into the small intestine. The term gastroparesis is used when the patient’s stomach empties too slowly. Everyone’s stomach is unique, so the ability to empty the stomach can vary from patient to patient. Some can still eat small amounts of normal food. They need to eat frequently to get all the nutrients. Others may have periods when they only take liquids, while others may have periods when they cannot take anything. However, most patients swallow and empty their saliva (about 1 liter per day) as well as the natural gastric juice they make (about 2 to 3 liters per day). Symptoms may change from week to week or even day to day. The diet presented here is designed to provide advice on dietary changes. In addition, there are many recommendations for food and liquids. I want to make it clear that the recommendations are based on my experience with patients, not science, because there are no studies that show which foods are better tolerated by gastroparesis patients than others. Plus, any calorie is a good calorie, especially for someone who has lost a lot of weight and is now potentially on a feeding tube or IV. It may be time to postpone dietary restrictions until basic nutritional needs are met. Those with gastroparesis, but especially those with underlying medical conditions (such as diabetes or kidney disease), are recommended to consult with a nutritionist to maximize the benefits of the diet. To find a registered dietitian near you, contact the American Dietetic Association or visit their website at 1
2 Key Nutrients – Maintain Healthy Calories – Calories are energy provided by food. Just like putting gas in a car, your body needs calories (energy) to function every day. If you want to gain weight, you need more calories. If you need to lose weight, you need fewer calories. Protein, carbohydrates and fat are all different calories. Protein We need some every day to build and repair all tissues. Most people need about 60 grams of protein per day to meet their protein needs. Examples: meat, fish, poultry, milk, eggs, cheese (see Table 2) Carbohydrates – (starches and natural sugars) are our body’s source of energy and one of the most easily digestible nutrients. Take a little of each meal or snack. Examples: Toast, crackers, potatoes, rice, pasta Fat is another source of energy that provides essential nutrients to our body. Trans fats contribute to weight gain because they are the most concentrated source of calories. Examples: butter, mayonnaise, margarine, vegetable oil, water or liquids. We all need a certain amount of fluids each day to stay hydrated. You can get fluids from juice, milk, water, tea, coffee, soda and other liquids. Even if you are vomiting a lot, you still need to drink fluids. Vomiting can actually make things worse, just dehydration. Vitamins and minerals are found in a variety of foods and beverages and are essential for all of us. Vitamins and minerals do not provide energy, so even if you take vitamins, you must eat for energy and other nutrients. If you’re vomiting a lot and losing weight, your doctor or dietitian may recommend a simple blood test to check your levels of certain vitamins or minerals. If you need additional vitamins and/or minerals, you may tolerate chewable or liquid forms better. Specially fed patients who experience significant weight loss are at risk of several nutrient deficiencies. Some standard vitamins and minerals may be helpful during the supplementation phase. However, this should be done under the guidance of a physician and registered dietitian. The most common nutritional deficiencies in patients with gastroparesis are iron, vitamin B12 (cyanocobalamin), vitamin D, and calcium. Patients with gastroparesis from partial gastric resection are at greater risk for this type of nutrient deficiency. Dietary treatment – basal volume The larger the meal, the slower the gastric emptying. Feeling full early after a small meal (before nutritional needs are met) is a major problem for patients with gastroparesis. Calorie and protein needs, as well as vitamin, mineral and fluid needs, may not be met. Thus, patients should reduce the amount of food, but eat more to meet their nutritional needs. Smaller, more frequent meals (six or more if necessary) allow patients to better meet their needs. Liquid vs. Solids If cutting back on food intake and increasing the number of meals doesn’t work, the next step is to switch to liquid calories. Patients with gastroparesis tolerate fluids even if solids are poorly tolerated. Liquids empty the stomach differently than solids. Almost all liquids, even those high in calories, cause an empty stomach. Food becomes almost liquid after mixing with saliva and gastric juices and can be swallowed more easily than solid food. Test the liquid normally, then add 2
Gastroparesis Diet Handout Pdf
3 Contaminated pure foods can be prepared to meet the patient’s nutritional needs. Patients who feel full throughout the day prefer to eat a solid breakfast and switch to liquid foods throughout the day. Dietary fiber (found in many fruits, vegetables, and whole grains) slows gastric emptying in some patients and fills them so quickly that they cannot meet nutrient requirements. For patients with a history of bezoars (looks like cat hairballs), fiber restriction (including avoidance of anti-inflammatory fiber/bulking laxatives – see Table 1) is helpful. Patients requiring jejunal tube feeding can tolerate fiber-rich formulas because they pass through the stomach. Table 1 High-Fiber Foods/Drugs and Those Associated with Bezoar Formation High-Fiber Foods Beans/Dried Beans (Refried Beans, Baked Beans, Black-Eyed Peas, Lentils, Black, Pinto, Northern, Fava, Navy , kidney, soy (beans) beans/whole grains (eg nuts, raisins, whole wheat, granola) nuts and seeds (pumpkin seeds, soybeans, nut butters) fruits (blackberries, blueberries, (raspberries, strawberries , etc.) Dried fruits, apricots Dates, figs, prunes, raisins) Vegetables (green beans, broccoli) Popcorn foods associated with making Bezoors Apples, berries, Brussels sprouts, coconut, corn, figs, greens Beans, Peas, Oranges, Persimmon Peels, Sauerkraut, Tomatoes Examples of high fiber supplements/bulking agents include: Axia Fiber; Beneficial Citrucel; Fiber Choice Fibrcon; Consul; Metamucil Although dietary fiber, or any psyllium As a result, ghee slows gastric emptying in some patients, many can only consume ghee in liquid form. Although many doctors limit ghee, in my experience, ghee in liquid form (ie. Drinks as part of the lak (whole milk, shakes, nutritional supplements, etc.) are well tolerated by most. Removing fat from the diet of a severely malnourished patient removes a valuable source of calories. Fat should not be restricted unless foods or liquids containing fat cause problems. It is often well tolerated, tasty and an excellent source of low calories. Dental health because gastroparesis impairs the stomach’s ability to break down food and break it into smaller pieces to prepare for digestion, before pre-digestion becomes critical. In addition, repeated exposure to stomach acid during frequent vomiting can damage tooth enamel. See your dentist regularly and do your best to take good care of your teeth. Patients may try to sit up after eating, or even lying down depending on the symptoms. Medications There are many medications that can delay gastric emptying, ask your doctor if any medications you are taking can slow gastric emptying and make your symptoms worse. 3
Clinical Guideline: Management Of Gastroparesis.
4 Start eating six or more meals a day; Avoiding large meals. Avoid high-fat foods or add too much fat to foods (liquid fat in drinks is often tolerated). Eat nutritious foods first before filling up on empty calories. Chew your food well; Solid foods (such as meat)
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