Diet for Gastroparesis

Simple habits around meals can make a real difference.

• Eat slowly, sit upright and chew each mouthful thoroughly, because the stomach cannot grind food well.
• Stay upright for 1 to 2 hours after eating, and take a gentle 10 to 15 minute walk if you feel able; avoid lying flat after meals.
• Do not smoke and avoid alcohol, both of which slow emptying.
• Weigh yourself weekly and write down what you eat and when symptoms occur; take this to your appointments.
• If you have diabetes, check your blood sugar as advised and share the readings with your diabetes team.

The core idea is to make the stomach’s job easier: less food at a time, less fat and fibre, and softer textures. Fluids and blended foods leave the stomach more easily than solids. How strict you need to be depends on your symptoms, so work with a dietitian.

• Eat 4 to 6 small meals and snacks a day instead of 2 or 3 large ones, and do not skip meals.
• Choose lower-fat foods because fat slows emptying: grilled, baked, boiled or steamed foods instead of fried; skim or low-fat dairy; lean meat, chicken and fish. Small amounts of fat spread through the day are usually better tolerated than a fatty meal. Do not cut fat so much that you lose weight.
• Go low on fibre that is hard to break down: raw vegetables and salads, skins, seeds, whole nuts, bran, tough leaves, the membranes of oranges, and unripe fruit. These can stay in the stomach and, rarely, form a hard mass (a bezoar). Peeled, well-cooked vegetables and ripe soft fruit are better.
• Prefer soft, moist, well-cooked and small-particle foods: mashed or blended vegetables, thin porridge, eggs, minced or finely shredded chicken or fish, well-cooked white rice or pasta, soft bread without seeds, smooth yoghurt, and puréed or strained soups.
• On bad days, rely more on liquids and semi-liquids, which empty more easily: soups, smoothies made without skins or seeds, milk-based or lactose-free drinks, nutritional supplement drinks, and low-fat broths. Return to soft solids as you improve.
• Sip fluids through the day, and include drinks with salts and sugar (oral rehydration solutions, low-fat broths, diluted low-pulp juices) when you vomit or feel dry. Avoid fizzy drinks and alcohol.
• Protect your nutrition: ask your dietitian to check for low iron, vitamin B12, vitamin D, folate and other deficiencies, which are common because intake is low. A liquid or chewable multivitamin may be advised.
• If you have diabetes, do not change insulin or tablets yourself when you change your meals. Delayed stomach emptying can make mealtime insulin act before the food is absorbed, causing low sugar later; your diabetes team can adjust the plan, and may advise the timing of insulin or monitoring that suits you.

Medicines are described in our article on gastroparesis. In brief:

• Your doctor will first review medicines that slow emptying (for example opioids). Do not stop any medicine on your own.
• Medicines that help the stomach move food on, and anti-nausea medicines, may be used for limited periods; they have side effects and need medical follow-up.
• In diabetes, good blood-sugar control helps the stomach to work better.

Procedures are for people who do not respond to diet and medicine:

• Upper endoscopy and a gastric emptying study to confirm the diagnosis and exclude a blockage.
• Feeding through a tube placed into the small intestine (nasojejunal tube, or a feeding jejunostomy if long-term) when weight loss or admissions continue.
• Specialist treatments such as G-POEM or gastric electrical stimulation for carefully selected people in expert centres; evidence is still developing.