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Diagnosing Gastroparesis – Part 7

Sep 10, 2015

Diabetes Solution
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 7 Chapter 22

Exercises That Facilitate Stomach-Emptying
The paretic stomach may be described as a flaccid bag, deprived of the rhythmic muscular squeezing present in a stomach that has a properly functioning vagus nerve. Any activity that rhythmically compresses the stomach can crudely replicate normal action. You may perhaps have observed how a brisk walk can relieve that bloated feeling. I therefore strongly recommend brisk walking for an hour immediately after meals — especially after supper.

A patient of mine learned a trick from her yoga instructor that eliminated the erratic blood sugar swings caused by her moderate gastroparesis.  The trick is to pull in your belly as far as you can, then push it out all the way. Repeat this with a regular rhythm as many times as
you can, immediately after each meal. Over a period of weeks or months, your abdominal muscles will become stronger and stronger, permitting progressively more repetitions before you tire. Eventually shoot for several hundred repetitions — the more the better. This should require less than 4 minutes of your time per hundred reps, a small price to pay for an improvement in your blood sugar profiles.

Another patient discovered an exercise that I call the “back flex.” Sit or stand while bending backward as far as you can. Then bend forward, about the same amount. Repeat this as many times as you can tolerate.

Although these exercises may sound excessively simple, even silly, they have helped some people with gastroparesis.

Mechanical Aids

Hand-held massager. One product of possible value is a variable speed hand-held massager that can be placed over the stomach (left side of the abdomen just below your ribs). A 15–30 minute massage might speed stomach-emptying. This product is called Programmable Percussion Massager with Heat #HF755 and is available from Sharper Image Corp., (415) 445-6000 or online at www.sharperimage.com. Use the largest of the five sets of removable heads.

Chewing Gum Can Make a Big Difference

The act of chewing produces saliva, which not only contains digestive enzymes but also stimulates muscular activity in the stomach and tends to relax the pylorus. Orbit is a delicious “sugarless” gum with a long-lasting flavor. It contains only 1 gram of sugar per piece and so will have little effect upon your blood sugar.* Chewing gum for at least 1 hour after meals is a very effective treatment of gastroparesis outside of major dietary changes. Don’t chew one piece after another, because the grams of sugar can add up.

Meal Plan Modifications, Utilizing Ordinary Foods
More often than not, changes in your meal plan will prove more effective than medication. The problem is that such changes are unacceptable to many patients. We usually proceed from most to least convenient in six stages:

1. Drinking at least two 8-ounce glasses of sugar-free, caffeine-free fluid while eating, and chewing slowly and thoroughly
2. Reduction of dietary fiber or first running fiber foods through a blender until nearly liquid.
3. Virtual elimination of unground red meat, veal, pork, and fowl
4. Reduction of protein at supper
5. Introduction of four or more small daily meals, instead of three larger meals
6. Semiliquid or liquid meals

In the paretic stomach, soluble fiber (gums) and insoluble fiber can form a plug at the very narrow pyloric valve. This is no problem for the normal stomach, where the pyloric valve is wide open. Many patients with mild gastroparesis have reported better relief of fullness and improved blood sugar profiles after modifying their diets to reduce fiber content or to render the fiber more digestible. This means, for example, that mashed well-cooked vegetables must be substituted for salads, and high-fiber laxatives such as those containing psyllium (e.g., Metamucil) should be avoided. Acceptable vegetables might include avocado, summer squash, zucchini, or mashed pumpkin (sweetened, if you like, with stevia and flavored with cinnamon). It also means that you would
have to give up one of our alternatives to toast at breakfast—bran crackers. You might want to try cheese puffs (page 178) instead.

Most people in the United States like to eat their largest meal in the evening. Furthermore, they usually consume their largest portion of meat or other protein food at this time. These habits make control of fasting blood sugars very difficult for people with gastroparesis. Apparently animal protein, especially red meat, like fiber, tends to plug up the pylorus if it’s in spasm. An easy solution is to move most of your animal protein from supper to breakfast and lunch.Many of my
patients have observed remarkable improvements when they do this. We usually suggest a limit of 2 ounces of animal protein, restricted to fish, ground meat, cheese, or eggs, at supper. This is not very much.Yet people are usually so pleased with the results that they will continue with such a regimen indefinitely (of course, as protein is shifted from one meal to another, doses of premeal insulin or ISA must also be shifted). With a reduction of delayed overnight stomach-emptying, the bedtime dose of longer-acting insulin or ISA may have to be reduced so that fasting blood sugar will not drop too low.

Some people find that by moving protein to earlier meals, they increase the unpredictability of blood sugar after these meals. For such a situation, we suggest, for those who do not use insulin, four or more smaller meals each day, instead of three larger meals. We try to keep these meals spaced about 4 hours apart, so that digestion and doses of ISA for one meal are less likely to overlap those for the next meal. This can be impractical for those who take preprandial insulin. Remember, you must wait 5 hours after your last shot of preprandial insulin before correcting elevated blood sugars.

Both alcohol and caffeine consumption can slow gastric emptying, as can mint and chocolate. These should therefore be avoided, especially at supper, if gastroparesis is moderate or severe.

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.