Gastroparesis – Delayed Gastric Emptying

What Is Delayed Gastric Emptying?

[dropcap]D[/dropcap]elayed gastric emptying is a stomach motility or movement disorder characterized by abnormally slow movement of gastric contents from the stomach through the pyloric sphincter into the duodenum, causing dyspepsia.

Q: What determines how fast the stomach empties?

A: How fast the stomach empties depends on the pressure of strong coordinated muscle contractions in the top region of the stomach propelling chyme against resistance at the pylorus (base region of the stomach).

Chyme is food that has been dissolved and thoroughly mixed with stomach secretions.

In the digestion of carbohydrate, protein and fat, protein leaves the stomach first (1 hour), then carbohydrates (1 1/2 to 2 hours), and fat takes longest to digest (2-4 hours). Plain water is able to pass through the pylorus within 5 minutes.

What Is Delayed Gastric Emptying In Celiac Disease and/or Gluten Sensitivity?

• Delayed gastric emptying is an atypical digestive symptom of celiac disease causing the stomach to feel full too early after eating with other symptoms of dyspepsia.
• Impaired gastric function tends to be accompanied by impaired gall bladder function.¹

How Prevalent Is Delayed Gastric Emptying In Celiac Disease and/or Gluten Sensitivity?

Delayed gastric emptying is frequently present in 50% of patients with untreated celiac disease. Autonomic tests were positive in 45% of study patients.²

What Are The Symptoms Of Delayed Gastric Emptying?

Delayed gastric emptying is marked by these symptoms because food is not being properly digested and is staying in the stomach longer than it should:

• Early fullness after eating.
• Eructation (belching).
• Nausea.
• Vomiting.
• Heartburn.
• Indigestion.
• Abdominal pains that can be temporary or missing in some patients.
• Gas.

How Does Delayed Gastric Emptying In Celiac Disease and/or Gluten Sensitivity Develop?

• Delayed gastric emptying results from unclear etiology involving gluten. Extrinsic motor neuropathy (impairment of nerves that supply the muscles that churn food in the stomach) may play a role, although other pathophysiological mechanisms are likely.³
• Low stomach acid production is a cause of delayed gastric emptying.

Does Delayed Gastric Emptying Respond To Gluten-Free Diet?

Yes. Celiac disease-related gastric emptying improves on gluten free diet.⁴

Note: Black pepper is best avoided because it inhibits gastric emptying and gastric transit time. Further on the digestive tract, pepper irritates the intestines. The same effects are produced by green, red and white pepper which are various preparations of the same pepper seeds.⁵

6 Steps To Improve Delayed Gastric Emptying In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both gastroparesis and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

A diet low in fat and fiber, taken in small, frequent meals, has been advocated, although different diets have not been rigorously compared in patients with gastroparesis. Puree foods can help digestion. Indigestible solids should be avoided to lessen the risk of bezoar formation (fiber stays in stomach and accumulates.)⁷

[box type=”shadow” ]Here Are  Major  Inflammatory Food Types:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁸
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁸
• Bad Fats. Includes deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁸.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁸
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁸
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁸[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 for examples such as ginger.

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• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely: 

[box type=”shadow” ]Certain prescription drugs deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect on these drugs if you have been prescribed for delayed gastric emptying. These drugs are called prokinetics. Do not stop prescribed medications without supervision.

• The prokinetics metoclopramide and domperidone are reported to improve disturbances of the gastric electrical rhythm, and might provide greater symptomatic relief than the more potent prokinetic erythromycin, which can increase gastric dysrhythmias (spasms).⁷
• Metoclopramide produces side effects, including extrapyramidal nervous reactions, that are not uncommon. Tardive dyskinesia is a severe effect that represents a potentially irreversible side effect.⁹[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Chelated magnesium 250 mg for adults per day can be used to improve muscle strength. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage Note for Supplements: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet or the fridge – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies:

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Puree any foods that cannot be thoroughly chewed. Cook vegetables and meats well or make them into soups and stews.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets stimulate and improve digestion and are easily digested.
• Cabbage stimulates and improves digestion and is also a liver decongestant.
• Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Fennel is good for indigestion.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley relieves colic, gas and indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.
• Caraway seeds are very good for indigestion simply chewed (about 15 seeds).
• Fennel seeds are very good for indigestion when simply chewed (about 10 seeds).

Carminative Spice Remedies:

• Cloves are antispasmodic.
• Nutmeg is also useful for abdominal bloating, indigestion and colic (no more than 1/8th teaspoon in hot water due to toxicity).
• Ginger is good for indigestion.[/box]

[box type=”shadow” ]Exercise Helps: Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Delayed Gastric Emptying in Celiac Disease?

RESEARCH STUDY SUMMARIES

“Gallbladder contraction, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI.” Study assessing gallbladder contraction, gastric emptying, and antral motility in untreated celiac patients and healthy controls using a single MRI examination found that using MRI, multiple parameters related to upper gastrointestinal function in celiac disease can be measured in a single noninvasive study, whereas previously three separate visits would have been required. Celiacs have increased fasting gallbladder volumes and tend to have slower gastric emptying.

Fasting gallbladder volume and the volume of bile ejected after meals were increased in celiacs. Gastric emptying tended to be slower in celiacs. Three celiac patients with severe postprandial dyspepsia and total villous atrophy had pathologically delayed gastric emptying and increased fasting gallbladder volume. Antral contractions (upper stomach) were absent in five out of 14 patients (36%) five minutes after the meal, but in none of 10 volunteers in whom the antrum could be visualized.¹

“Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease.” Study investigating upper gut-motor activity in 30 untreated Celiac Disease patients and exploring the role played by the autonomic nervous system in motility disturbances demonstrated that delayed gastric emptying correlated with manometric post prandial (after meal) hypomotility (low contractions).²

Sources:

1. Marciani L, Coleman NS, Dunlop SP, Singh G, Marsden CA, Holmes GK, Spiller RC, Gowland PA. Gallbladder contraction, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI. J Magn Reson Imaging. 2005 Nov;22(5):634-8. [↩] [↩]
2. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩] [↩]
3. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩]
4. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩]
5. Dudhatra GB, Mody SK, Awale MM, Patel HB, Modi CM, Kumar A, Kamani DR, Chauhan BN. A comprehensive review on pharmacotherapeutics of herbal bioenhancers. ScientificWorldJournal. 2012;2012:637953. doi: 10.1100/2012/637953. Epub 2012 Sep 17. [↩]
6. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
7. Rayner CK, Horowitz M. New Management Approaches for Gastroparesis. Nat Clin Pract Gastroenterol Hepatol. 2005;2(10):454-462. [↩] [↩]
8. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
9. Rayner CK, Horowitz M. New Management Approaches for Gastroparesis. Nat Clin Pract Gastroenterol Hepatol. 2005;2(10):454-462. [↩]