Eating for Gastroparesis: Guidelines 1-5 Living (Well!) with - PowerPoint PPT Presentation

Eating for Gastroparesis: Guidelines 1-5 Living (Well!) with Gastroparesis Program Class 5

Points to Remember  No studies have been conducted to determine the best diet for managing gastroparesis  Following a GP-friendly diet is a symptom management tool for gastroparesis  These factors affect gastric emptying time in all people, not just those with gastroparesis  Eating something that is not “GP -friendly ” will not make the condition worse overall – it’s okay to experiment!  There is a point at which further restricting your diet will not further alleviate your symptoms  Dietary tolerances differ from person to person: what’s gastroparesis- friendly may not be <your name here>-friendly  Personal symptoms and tolerances may vary from day-to-day and as other aspects of your management plan change – be flexible!

Symptom Score Journal Best way to figure out what does/doesn’t work over time  Helps avoid over-restriction  Include time, food eaten, approximate portions  Not necessary to track calories or other nutritional info  Jot down anything that might be affecting your digestion on any given day: menstrual cycle, sleep disruption, increase in stress  Tracking symptoms throughout the day is optional  At the end of the day, write down a daily symptom score (1-5)  Watch for patterns between the severity of your symptoms and what, when, how, and/or how much you eat

10 Principles of Eating for Gastroparesis 6. Supplement with nutrient- 1. Eat smaller meals. rich liquids, as necessary. 2. Eat less fat. 7. Chew thoroughly. 3. Eat less fiber. 8. Eat slowly, calmly, and in a 4. Limit foods with relaxed environment. indigestible parts. 9. Reduce/eliminate foods 5. Choose a variety of GP- that impair gut health and friendly, nutrient-rich digestion. foods. 10. Do what works for you.

1. Eat Smaller Meals  Volume is the largest determinant of emptying time.  Smaller meals empty more quickly than larger meals.  Eat 4-6 well-balanced mini-meals/snacks each day.  Aim for 1/2 - 1/3 of a “normal” sized meal (approximately 1 to 1.5 cups of food).  Avoid or minimize constant snacking/grazing.  Follow instructions on Meal Experimentation worksheet to find out what works best for you.

2. Eat Less Fat  The more fat in a meal, the longer it will take to empty from the stomach  Even if you removed all of the dietary fat from your diet, your stomach would still empty slowly  Low-fat does not mean no-fat: approximately 35-45 grams of fat per day is typically well-tolerated (some people tolerate up to 50-60 grams of fat per day; some do better around 30-35 grams)  Higher fat foods will not make gastroparesis worse overall  Consume a fairly consistent amount of fat throughout the day (example: 8 grams of fat per meal for 5 meals per day)  You may tolerate slightly more fat in the morning or in the evening  Any kind of fat can be considered GP-friendly in small amounts  Avoid trans-fats for overall health

Dietary Fat & Fullness  May not realize how much fat you’re eating (or not eating!) over the course of the day  If you’re never satisfied  gradually increase fat intake  Sugar cravings  gradually increase fat intake  A high-fat meal or snack may affect your ability to eat at subsequent mealtimes  Thick liquids “count” too for most people, contributing to fullness (milkshakes, ice cream, yogurt)  Too full at dinnertime  reduce fat at breakfast/lunchtime  Too full for breakfast  reduce fat at dinner time

3. Eat Less Fiber  Dietary fiber increases gastric emptying time of a meal  Can increase feelings of fullness, distention and bloating  Amount tolerated varies: about 10-15 grams of fiber per day  Avoid raw fruits and vegetables, legumes, and large amounts of whole grains (small amounts, ¼- ½ cup per meal, of whole grains like quinoa or millet may be well-tolerated)  Choose lower-fiber or easier to digest versions of fruits, veggies, and grains: well-cooked, juiced or pureed fruits/veggies; soaked, cooked grains

What about “Whole Grains”?  “Whole Grains” is largely a marketing buzz word; not necessarily for overall health  Does not mean a product is healthy  “Contains Whole Grains!” often means grain flour  Whole grain flour is not the same as a whole grain  Examples: corn flour, oat flour, quinoa flour, buckwheat flour  Check the fiber content on the nutrition label  Check for non-GP-friendly ingredients (nuts, seeds, dried fruit, etc.)  Gluten-free whole grains (millet, buckwheat, quinoa) may be well-tolerated in small amounts, especially if soaked/sprouted

Specific Fiber Concerns  Soluble vs insoluble fiber  When choosing packaged foods, look at serving size, ingredient list, and fiber content  Experiment by slowly replacing some of the GP-friendly “empty foods” in your diet with well-cooked and/or pureed GP-friendly fruits and veggies  Be sure to drink adequate amounts of water as you increase your fiber intake  Fiber supplements aren’t recommended for GPers

4. Limit Foods with Indigestible Parts  Solid food particles in the stomach slow down gastric emptying and have the potential to cause bezoars  Foods that are hard to chew fully or contain indigestible parts include: • dried fruit • raw vegetables • whole nuts and seeds • skins, peels, and hulls • legumes and dried beans • berries and grapes • corn and broccoli • popcorn  Tolerances to these foods vary

Bezoars  Food that is poorly digested can collect in the stomach and form a mass called a bezoar  Affects approximately 20% of GPers  Specific foods associated with bezoar formation include: apples, berries, broccoli, Brussels sprouts, coconuts, corn, green beans, figs, oranges, persimmons, potato peels, and sauerkraut  Fiber supplements such as Metamucil, Peridem, Benefiber, Fibercon and Citrucel should also be avoided

Pureeing Foods  Some tolerate “non -GP- friendly” foods if they are pureed (berries, beans, green vegetables)  Good way to experiment with personal tolerances  Moderation is still very important (example: 1/4 cup of blueberries in a smoothie may be well-tolerated; 1 cup may not be well tolerated)  Vitamix or Blendtec blenders are the best for pureeing foods with skins, seeds, etc. A regular blender may not work as well.

5. Choose a Variety of GP-Friendly, Nutrient-Rich Foods  Your body cannot function properly without proper nourishment  Nutrition is about more than just calories  Malnutrition is about more than your weight  Early satiety makes it’s essential to pack lots of nutrition into small volumes  Choose nutrient-rich foods and liquids whenever possible  Limit foods that take up space but provide little nutrition (example: crackers, cereal, pudding, jello, ice cream, frozen yogurt, white bread, white pasta, white rice)  Variety is important as different types of foods provide different nutrients

Action Steps 1. Review the 10 Principles of Eating for Gastroparesis handout and/or the Eating for Gastroparesis eBook (2014 edition). 2. Try tracking your fat and fiber consumption for 3-4 days this week to see if you are within a “GP - friendly” range. The website www.MyFitnessPal.com is a good resource for this. 3. Complete the Meal Pattern worksheet.

Class 5 Notes: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Questions for Office Hours: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________