Gastroparesis Diet for Delayed Stomach Emptying

Author: Frank W. Jackson, M.D.

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Purpose

Gastroparesis is the medical term for delayed stomach emptying. During the process of digestion, the stomach must contract to empty itself of food and liquid. Normally, it contracts about three times a minute. This empties the stomach within 90-120 minutes after eating. If contractions are sluggish or less frequent, stomach emptying is delayed. This results in bothersome and sometimes serious symptoms, as well as malnutrition, because food is not being digested properly.

Gastroparesis may be caused by various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs. Often however, no cause can be found although a viral infection is suspected in some. Usually, the physician prescribes medication to stimulate the stomach to contract. The purpose of the gastroparesis diet is to reduce symptoms and maintain adequate fluids and nutrition. There are three steps to the diet.

	STEP 1 DIET consists of liquids, which usually leave the stomach quickly by gravity alone. Liquids prevent dehydration and keep the body supplied with vital salts and minerals.
	STEP 2 DIET provides additional calories by adding a small amount of dietary fat -- less than 40 gm each day. For patients with gastroparesis, fatty foods and oils should be restricted, because they delay stomach emptying. However, patients at the Step 2 level are usually able to tolerate this amount.
	STEP 3 DIET is designed for long-term maintenance. Fat is limited to 50 gm per day, and fibrous foods are restricted, because many plant fibers cannot be digested.

Nutrition Facts

The STEP 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium. It should not be continued for more than three days without additional nutritional support. STEP 2 and STEP 3 Gastroparesis Diets may be inadequate in Vitamins A and C, and the mineral iron. A multi-vitamin supplement is usually prescribed.

Special Considerations

Diets must be tailored to the individual patient. This is because the degree of gastroparesis may range from severe and long-standing to mild and easily corrected. Patients may also have various medical conditions to be considered. For example, diabetes patients with gastroparesis are allowed sugar-containing liquids on the Step 1 diet, because that is their only source of carbohydrate. On the Step 2 and Step 3 diets, these patients should avoid concentrated sweets. These are noted with an asterisk (*) on the food lists.
On all of the diets, liquids and food should be eaten in small, frequent meals. This helps to maintain nutrition.

Step 1 Food Groups
Group	Recommend	Avoid
Milk & milk products	none	all
Vegetables	none	all
Fruits	none	all
Breads & grains	plain saltine crackers	all others
Meat or meat substitutes	none	all
Fats & oils	none	all
Beverages	Gatorade and soft drinks (sipped slowly throughout the day)	all others
Soups	fat-free consommé and bouillon	all others

Sample Menu Step 1
Breakfast	Lunch	Dinner
Gatorade 1/2 cup ginger ale 1/2 cup bouillon 3/4 cup saltine crackers 6	Gatorade 1/2 cup Coke 1/2 cup bouillon 3/4 cup saltine crackers 6	Gatorade 1/2 cup Sprite 1/2 cup bouillon 3/4 cup saltine crackers 6

This Sample Diet Provides the Following
Calories	790	Fat	9 gm
Protein	11 gm	Sodium	3531 mg
Carbohydrates	156 gm	Potassium	244 mg

Step 2 Food Groups
Group	Recommend	Avoid
Milk & milk products	skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses	whole milk products, creams (sour, light, heavy, whipping), half & half
Soups	fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables	soups made with cream, whole milk, or broths containing fat
Bread & grains	breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers	oatmeal; whole grain rice, cereal, bread
Meat & meat substitutes	eggs, peanut butter (maximum 2 Tbsp/day)	beef; poultry; fish; pork products; dried beans, pea, & lentils
Vegetables	vegetable juice (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams)	all raw vegetables; cooked vegetables with skins; beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Fruits	apple juice, cranberry juice, grape juice, pineapple, prune juice, canned fruits without skins (applesauce, peaches, pears)	citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums, persimmons)
Fats & oils	any type of fat, but only in small amounts	none
Sweets & desserts*	hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups	high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
Beverages	Gatorade, soft drinks (sipped slowly throughout the day)	all others, except allowed juices
*Concentrated sweets

Sample Menu Step 2
Breakfast	Lunch	Dinner
skim milk 1/2 cup poached egg 1 white toast slice apple juice 1/2 cup	mozzarella cheese 2 oz saltine crackers 6 chicken noodle soup 3/4 cup Gatorade 1/2 cup	peanut butter 1 Tbsp saltine crackers 6 vanilla pudding 1/2 cup grape juice 1/2 cup
Morning Snack	Afternoon Snack	Evening Snack
ginger ale 1/2 cup canned pears 1/2 cup	skim milk 1/2 cup cornflakes 1/2 cup sugar 2 tsp	frozen yogurt 1/2 cup saltine crackers 6

This Sample Diet Provides the Following
Calories	1343	Fat	35 gm
Protein	52 gm	Sodium	2639 mg
Carbohydrates	206 gm	Potassium	1411 mg

Step 3 Food Groups
Group	Recommend	Avoid
Milk & milk products	skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses	whole milk products, creams (sour, light, heavy, whipping), half & half
Soups	fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables	soups made with cream, whole milk, or broths containing fat
Fruits	fruit juices, canned fruits without skins (applesauce, peaches, pears)	all fresh & dried fruits, canned fruits with skins (apricots, cherries, plums, blueberries, fruit cocktail, oranges, grapefruit, pineapple, persimmons)
Meat & meat substitutes	eggs, peanut butter (2 Tbsp/day), poultry, fish, lean ground beef	fibrous meats (steaks, roasts, chops), dried beans, peas, lentils
Fats & oils	any type of fat, but only in small amounts	none
Breads & grains	breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers	oatmeal; whole grain rice, cereal, bread
Vegetables	vegetable juices (tomato V-8), well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summers quash, strained tomato sauce, yams)	all raw vegetables; cooked vegetables with skins: beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini
Sweets & desserts*	hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups	high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves
Beverages	Gatorade, soft drinks (sipped slowly throughout the day), coffee, tea, water (note: non-caloric beverages should be limited if patient cannot maintain adequate caloric intake)	all others, except allowed juices
*Concentrated sweets

Sample Menu Step 3
Breakfast	Lunch	Dinner
skim milk 1/2 cup cream of wheat 1/2 cup sugar 2 tsp orange juice 1/2 cup white toast 1 slice margarine 1 tsp jelly 1 Tbsp	tuna fish 2 oz low-fat mayonnaise 2 Tbsp white bread 2 slices canned peaches 1/2 cup Gatorade 1.2 cup	baked chicken 2 oz white rice 1/2 cup cooked beets 1/2 cup dinner roll 1 skim milk 1/2 cup margarine 2 tsp
Morning Snack	Afternoon Snack	Evening Snack
low-fat yogurt 1/2 cup Sprite 1/2 cup	chocolate pudding 1/2 cup gingerale 1/2 cup	ice milk 1/2 cup pretzels 2