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Diagnosing Gastroparesis – Part 5

Diabetes Solution
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 5 Chapter 22
Gastroparesis

Super Papaya Enzyme Plus has been praised by many of my patients for its rapid relief of some of the physical symptoms of gastroparesis— bloating and belching, for example. Some claim that it also helps to level off the blood sugar swings caused by gastroparesis. The product consists of pleasant-tasting chewable tablets that contain a variety of enzymes (papain, amylase, proteases, bromelain, lipase, and cellulase) that digest protein, fat, carbohydrate, and fiber while they are still in your stomach. You would normally chew 3–5 tablets during and at the end of each meal. The tablets are available in most health food stores and are marketed by American Health, (631) 567-9500, Ronkonkoma, NY 11779. Some of my kosher patients use a similar product called Freeda All Natural Parvenzyme, which is distributed by Freeda Vitamins, 36 East Forty-first Street,New York, NY 10017, (800) 777-3737, and on the Web at freedavitamins.com. The small amount of sorbitol and similar sweeteners contained in these products should not have a significant effect on your blood sugar if consumption is limited to the above dose.

Tegaserod maleate (Zelnorm,Novartis Pharmaceuticals) This medication was developed for the treatment of irritable bowel syndrome. I have found it to be very effective for treating mild to moderate gastroparesis.  It can be used concurrently with other medications listed in this chapter. I prescribe one 6 mg tablet, 1 hour before breakfast and supper. There is a catch, however—for some users this product stops working after about one month.

Domperidone (Motilium, Janssen Pharmaceutica) is not yet available in the United States. It can be purchased in Canada, the U.K., and perhaps some other countries. Pharmacies in Canada are no longer permitted to ship medications to the United States unless they are prescribed by a Canadian physician. It therefore may be necessary to purchase it elsewhere via the Internet.* Since it is not available as a liquid, we ask patients to chew 2 tablets (10 mg each) 1 hour before meals and to swallow with 8 ounces of water or diet soda. I limit dosing to 2 tablets because larger doses can cause sexual dysfunction in men and absence of menses in women. These problems resolve when the drug is discontinued. Since it works by a mechanism different from those of the preceding products, its effects can be additive (that is, useful with other preparations, not addictive). Janssen may market a liquid form of this product in the United States at some time in the future. In the meantime, some gastroenterologists may be able to prescribe it, as an investigational drug.

* A number of Canadian pharmacies for an additional charge of $5 can secure prescriptions for distant foreign patients from Canadian physicians. One of these is Murray Shore Pharmacy, (800) 201-8590.

Metoclopramide syrup may possibly be the most powerful stimulant of gastric emptying. It works in a fashion similar to domperidone, by inhibiting the effects of dopamine in the stomach. Because it can readily enter the brain, it can cause serious side effects, such as somnolence, depression, agitation, and neurologic problems that resemble Parkinsonism. These side effects can appear immediately in some individuals or only after many months of continuous use in others. Because gastroparesis often requires doses high enough to cause side effects, I use this medication infrequently and limit dosing to no more than 2 teaspoons 30 minutes before meals.

If you use metoclopramide, you should keep on hand the antidote to its side effects—diphenhydramine elixir (Benadryl syrup). Two tablespoons usually work. If side effects become serious enough to warrantuse of the antidote, the metoclopramide should be immediately and permanentlydiscontinued.

Abrupt discontinuation of metoclopramide has been reported to cause psychotic behavior in two patients after continuous use for more than three months. This information might suggest to your physician that it be gradually tapered off if it is to be discontinued after even two months of continuous use.


We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.

Copyright © 2005 by Richard K. Bernstein, M.D. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Author’s Note:
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.

For more information on Dr. Bernstein’s and to purchase his books, CD’s or get access to his free monthly webinars, visit his website at DiabetesBook.com.