So I’ve been receiving a number of these questions over the past couple of months among my fellow type 1 diabetics which made me start to wonder…is there a connection between gastroparesis and type 1 diabetes or could it be just another condition all together?
Gastroparesis (also called delayed gastric emptying) is a progressive disorder that causes food to remain in the stomach for longer than normal periods. Because the nerves that move food through the digestive tract are damaged, the muscles do not work as they normally would. As a result, food often sits in the stomach undigested. So what are the signs and symptoms of gastroparesis and are you more prone as a type 1 diabetic, lets take a closer look!
Symptoms Of Gastroparesis:
The following are the most common symptoms associated with gastroparesis:
- vomiting of undigested food
- early fullness after a small meal
- weight loss
- stomach spasms
- blood glucose levels that are hard to stabilize
- loss of appetite
- acid reflux
What Causes Gastroparesis:
While a high percentage of gastroparesis has been reported in people with type 1 diabetes (40%) and type 2 diabetes (10% to 20%), per the Mayo Clinic, it’s not always clear what leads to gastroparesis. In many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve).
The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can’t send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested.
The vagus nerve can be damaged by certain diseases (Parkinson’s and MS for example), and diabetes in particular, or by surgery to the stomach or small intestine. As for diabetics, the fact that we deal with higher than normal blood sugars, over time these high blood glucose levels can damage the vagus nerve.
Its should also be noted that for reasons that gastroparesis is more commonly found in women than in men. Researchers believe that this is possibly due to the effect of hormones on the GI tract, particularly estrogen and progesterone, and those seem to delay stomach emptying, but more research is still needed. You can check out the study here.
How Is Gastroparesis Diagnosed:
Gastroparesis is diagnosed by upper gastrointestinal x -rays, and a gastroscopy which allows the doctor to look into the stomach with a scope that contains a tiny camera. Other tests may be initiated.
All of these will help rule out other diseases such as ulcers, gastritis, and stomach cancer.
It is thought that as many as 50% of diabetics may show signs of gastroparesis, but only a small percentage of those people develop symptoms that need intervention.
Types Of Foods You Can Eat:
While its recommended to avoid hard to chew foods (such as broccoli and and corn) a diet high in fiber (in most cases) should also be avoided as fiber binds together and can cause a blockage in the stomach leading to further stomach problems. You should also avoid certain types of foods. Fruits for example (apples, figs, oranges and certain berries should be avoided). Also certain seeds and nuts as well as legumes and beans and whole grain cereals as they can all negatively impact the digestive process. Food you should take a look at?
Per the Gastroparesis Clinic dietary recommendations for gastroparesis include the following:
- Eat a soft diet: Soft foods are easier for the stomach to digest. If you are having difficulty eating a normal diet, avoid tough meat, crunchy fruit/vegetables and fresh bread and instead select casseroles, soft-cooked vegetables, soft pasta, porridge, stewed fruits and dairy desserts like low fat yogurt or mousse.
- Severe cases: Some patients with severe gastroparesis will need to have a pureed diet where most food is passed through the blender before eating, and others may even need to have a purely liquid diet made up of soups, smoothies and special nutrition supplements such as Organic Balanced Meal. If you feel your gastroparesis is severe enough to need a pureed or liquid diet, ask your doctor for a Dietitian referral to make sure you are getting adequate nutrients in your diet.
- Diabetes: If your gastroparesis is caused by diabetes, improving your blood sugar control will help improve your symptoms. Avoid excessive dietary sugars, try to spread your carbohydrate intake evenly throughout the day, and aim to be physically active most days if you are able.
- Vitamin and mineral supplements: As people with gastroparesis often need to restrict their diet, a vitamin/mineral supplement may be recommended to avoid the development of nutritional deficiencies. A general multivitamin can be a good start, but requesting that your doctor check your nutrient status or refer you to a Dietitian is important if you are avoiding a number of foods.
As for other diets?
Non-medical professionals, well-meaning friends or some websites may advocate other diets for gastroparesis, including those that limit or cut out dairy, gluten, food chemicals, or FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols).
While these diets may be appropriate for some individuals with additional food intolerances, they are not an effective treatment for gastroparesis, and can be overly restrictive. If you notice particular foods which trigger or worsen your symptoms, start a food and symptom diary and see a Dietitian to discuss this.
Also, reducing the meal size reduces the distention of the stomach from the meal. By eating smaller meals, you may not feel as full or bloated and the stomach may empty faster. With the reduction in meal size, increasing the number of meals to 4−6 per day is needed to maintain adequate nutritional intake.
Treatment begins with a renewed commitment to tight blood glucose control as hyperglycemia aggravates gastroparesis. As we are all well aware, this is easier said than done as food is absorbed at unpredictable times, making control difficult (story of our lives, right!).
High blood glucose levels can slow stomach emptying and that adds to the problem. If you take insulin, you may be asked to up the number of injections you take daily or even increase your basal rates if you use an insulin pump. You will also have to check your blood glucose levels more frequently after you eat to help bring them down sue to the increase of insulin.
Your doctor may also suggest that you eat small meals throughout the day rather than a few larger ones as this helps your stomach from becoming overfilled. You will be told to cut back on fatty foods because fat slows stomach emptying. Also as mentioned above, you may also need to cut back on difficult-to-digest foods such as legumes, lentils, and citrus fruits.
Food difficult to digest, may form “tumors of food” known as bezoars. These bezoars will worsen symptoms of fullness, nausea, and abdominal discomfort, and they can be very difficult for a doctor to remove.
Now comes the difficult decision for people with diabetes who suffer from diarrhea or constipation who are advised to eat a high fiber diet (by now your saying…Chris, you just said not to eat high fiber foods). Yes, you are correct and this is an option that you will have to discuss with your doctor.
You may have to decide which problem, the stomach symptoms, or the diarrhea and constipation is worse when deciding whether or not to eat a high-fiber diet as fiber greatly helps combat symptoms of diarrhea as soluble fiber can actually absorb excess fluid in the bowel and thus act to firm up a loose stool.
Medical treatments are also another option that you can discuss with your physician especially for those of you with significant symptoms but this is why setting up an appointment with your dietitian is so important, they will certainly be able to come up with a game plan to help you out.
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