Gastroparesis

12 Gastroparesis

• Nutritional Supplements such as: Carnation Breakfast Anytime Boost Plus Calories o o Boost Ensure o o Boost Diabetic Ensure High Protein o o

o Boost Fruit Beverage o Ensure Plus o Boost High Protein o Glucerna

How can I puree or “blenderize” my foods? Pureed foods can sometimes be easier for your body to digest. Refer to the Gastroparesis

HHS “Pureed Diet” handout to learn about how to blenderize your foods.

What is gastroparesis (gas-tro-pear-ee-sis)? Sample diet The following is a sample diet for someone who is following stage 3 Gastroparesis is a condition where food moves through your stomach of the Gastroparesis Diet. slower than normal and takes longer to digest (breakdown).

• Breakfast: 1 cup cream of wheat, 1 slice white toast and 1 tablespoon What causes gastroparesis? peanut butter, ½ cup skim milk, ½ cup juice The cause of gastroparesis is not always clear, but it is believed that • Snack: 6 ounces low fat yogurt and ½ banana or 1 cup nutritional there might be damage to a nerve that controls stomach muscles. supplement It can occur suddenly or as a result of: • Lunch: 1 cup pasta, 1 tablespoon fat-free parmesan cheese and 1 tablespoon low fat margarine, ½ cup applesauce, ½ cup skim milk • diabetes or 4 ounces nutritional supplement • stomach surgery or nerve injury such as after bariatric gastric Or surgery ½ turkey sandwich with 1 Tbsp low fat mayonnaise with ½ cup • chicken noodle soup, ½ cup applesauce, ½ cup skim milk medications, such as narcotics • Snack: ½ cup canned peaches and ¼ cup low-fat cottage cheese o ask your doctor if any of your medications slow down Or stomach emptying smoothie with ½ cup Gatorade or carbonated beverage • nervous system diseases like Parkinson’s Disease, • Dinner: 2 ounces skinless chicken or fish, ½ cup cooked squash Multiple Sclerosis, or Amyotrophic Lateral Sclerosis (ALS) and ½ cup cooked mashed potatoes with no skin, 1 tsp butter, • infection, such as viral gastroenteritis ½ cup skim milk, ½ cup canned peaches • certain cancer treatments • Snack: 1 cup low-fat pudding or frozen yogurt, ½ cup carbonated • beverage collagen vascular disorders such as scleroderma • Liquids: vegetable juice, crystal light, water, fruit juice, skim or • lupus 1% milk • hypothyroidism • gastroesophageal reflux disease

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What are the symptoms of gastroparesis? Food Group Recommended Items Items to Avoid Beverages Gatorade/soft drinks (small Alcohol Your symptoms may include: amounts at a time) All others not listed in • a feeling of fullness after a few bites Flavoured coffee recommended items Tea • belching or burping Hot chocolate • bloating or abdominal distension Water, lemonade, Kool-Aid • nausea and vomiting Nutritional supplements Soups Same as Stage 2 plus all soups Soups made with cream • food or fluid from the stomach moving back into your mouth made with all milks Broths containing fat – this is called regurgitation or heartburn Sweets Same as Stage 2 plus: Same as Stage 2 • decreased appetite which may lead to weight loss and poor Angel food cake nutrition Low fat cookies such as arrowroot, social tea, graham • constipation crackers Other Same as Stage 2 If you have diabetes, you may also have abnormal sugar (glucose) levels in your blood. What do I do if my symptoms get worse? What are the complications of gastroparesis? • Try drinking nutritional supplements and pureed foods before you take liquids with small amounts of nutrients, like coffee, tea and pop. Complications of gastroparesis could include: • On days when your symptoms are worse, rest your stomach by taking • weight loss fluids or pureed foods only (this does not have to be as strict as stage 1 of the gastroparesis diet, see list below). Small portions • abdominal discomfort (around 1 cup) or having sips through out the day may help you to • bacterial overgrowth better tolerate them. • food that stays in the stomach too long can start to ferment, causing bacteria to grow List of fluids and pureed foods: • bezoar • Broth, cream or pureed soups o A bezoar is a mixture of food residues/materials that can • Juice (apple, cranberry, grape, prune) accumulate or build up in the stomach and does not • Sprite, gingerale empty well. A bezoar can block food from going into the • Tomato juice/V8 small intestine. • Milk • blood sugar fluctuations • Eggnog • o For people with diabetes, blood sugars may be harder to Kefir control as food is digested at inconsistent times. • Yogurt • dehydration (not enough fluid in your body) • Milkshakes, pudding, smoothies and custards • • electrolyte imbalance Baby food • Oral rehydration solutions, such as: Gastrolyte or Pedialyte • Powerade/Gatorade

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Food Group Recommended Items Items to Avoid How is gastroparesis treated? Vegetables Same as Stage 2 Same as Stage 2 • Taking medication to help: Fruits Peeled fresh fruit such as Fruits with skins, seeds and banana, apple, pear, peaches, membranes such as: berries, o Food move through your stomach plums, melons pineapple, grapes, oranges, o Reduce nausea and vomiting Apple/cranberry/grape/prune pomegranates • Changing your diet to help improve your symptoms and prevent juice Dried fruit such as coconut, figs, Canned fruits without skins raisins, prunes, cranberries, poor nutrition. (applesauce, peaches, pears, apricots, currants, dates • Controlling your blood sugar levels if you have diabetes. apricots, mandarin oranges) Citrus juices with pulp All fruits and juices not listed in Canned fruits with skin such as items to avoid cherries Avocado What diet and lifestyle changes can I make to help control Grains and Same as Stage 2 Same as Stage 2 my symptoms? Starches Egg and ramen noodles To help improve your symptoms of gastroparesis: Meat and Eggs/egg whites Fibrous meats Alternatives Smooth peanut butter (maximum Steaks • Eat 6 or more small meals a day. Larger meals take longer to 2 tablespoons a day) Roasts digest and can make you feel full very quickly Poultry with no skin Bacon Fish, shellfish Sausage • Chew foods well. This helps your stomach digest food better. Lean beef Bologna, salami Pork Hot dogs Avoid foods that are not easily chewed such as broccoli, corn, Low fat deli meats Goose popcorn, nuts and seeds. Extra lean ground beef Duck Lean ground chicken/turkey Spare ribs • Eat healthy foods first. Choose foods with lots of nutrients Canned fish in water Organ meats before filling up on “empty calories” such as tea, coffee, water, Low fat deli meats Fish packed in oil pop and candies. Crunchy peanut butter Preparation: bake, broil, poach, Dried beans and peas • Avoid lying down after a meal. Stay sitting up for at least one BBQ Lentils hour after your meal. Going for a walk after your meal can also Nuts and seeds help the food move through your stomach faster. European frankfurters and other deli-made wieners/sausages with • Choose foods that are lower in fibre. Fibre is not digested and tough casings can stay in the stomach longer, slowing digestion. Fibre can also Deep fried meats make you feel more full, making it difficult to eat enough food to Fats and Oils Any type of fat but in small None get all of the nutrients you need. Cooking fruits and vegetables quantities Spray oils until soft can help you to digest them. Fat free gravy Low fat mayonnaise

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What diet and lifestyle changes can I make to help control Food Group Recommended Avoid my symptoms? (continued) Beverages Gatorade/carbonated beverages Alcohol (small amounts at a time) All others, except allowed juices • Choose foods that are lower in fat. Foods that are high in fat Nutritional supplements take longer to digest. Although fat may slow stomach emptying in Lemonade, Kool-Aid some people, many can tolerate fat in the liquid form, such as fat in Soups Fat-free bouillon Soups made from milk, cream, or whole milk, milkshakes, smoothies and nutritional supplements. Soups made with skim milk broths containing fat Fat free soups made with Avoid all fried, fatty or greasy foods. pasta/noodles Strained/pureed cream soups Sweets Hard candies, gummy candies, High-fat desserts (cakes, pies, • Change the texture of your food. Liquids empty from the jelly beans, marshmallows, cookies, pastries, ice cream) stomach faster and more easily than solids. If you cannot tolerate caramels Cookies with nuts/dry fruit solid foods, then you may need minced, pureed or liquefied foods. Puddings and custards made Your dietitian will discuss the texture that is right for you. with 1% MF or skim milk Frozen yogurt Fruit ice/sorbets/sherbet • Limit your intake of alcohol. Alcohol can result in delayed Gelatin Ice milk emptying of food out of the stomach. Seedless jams and jellies Honey, syrups • Other Mustard, ketchup, vinegar, soy If you have diabetes, keep your blood sugar under control. sauce, teriyaki sauce, hot sauce, Uncontrolled blood sugars can change how your stomach barbeque sauce empties food.

Stage 3: Solid foods low in fat and fibre. Allows you to have a little more • Talk to your doctor or pharmacist about your medications. fat than Stage 2, and also limits foods containing a lot of fibre. Some medications can slow stomach emptying while others can help to improve your symptoms. Food Group Recommended Avoid

Milk and Same as Stage 2 plus: Regular cheese with >20% MF Alternatives 2% MF, homogenized and Regular sour cream chocolate milk Whipping cream (10 or 18% MF) Regular soy, rice, almond milk Milkshakes Eggnog Smoothies Kefir Buttermilk 1% or 2% MF cottage cheese Ice cream Fat free or 5% MF sour cream Evaporated milk (0 to 2% MF)

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Food Group Recommended Avoid What are some foods and medications I may want to avoid? Grains and White breads and rolls Oatmeal In general, you may want to avoid foods and medications high in fibre. Starches Refined cereals such as cream of High-fibre (over 5g fibre per Avoiding seeds, skins and membranes of fruits and vegetables, wheat and Rice Krispies, serving), whole-grain breads and Cheerios, Special K cereals such as removing the skin from an apple or having applesauce, White pasta Cereals containing nuts, seeds, will decrease your fibre intake. Also, cooking vegetables well, White rice and barley coconut, dried fruits, granola mix until they are soft, will also make them easier to digest. Low-fat crackers such as soda Whole grain pasta crackers Whole grain, brown and wild rice Pretzels Tea biscuits Waffles, pancakes Foods high in fibre: Sweet rolls • Croissants legumes/dried beans such as chick peas, kidney beans Donuts and lentils Muffins • high fibre breads and cereals Egg noodles • nuts and seeds Meat and Eggs/egg whites Beef Alternatives Low fat egg substitutes Poultry • dried fruits Fish Smooth low fat peanut butter • (maximum 2 tablespoons a day) Pork, bacon popcorn Legumes/dried beans such as • raw fruits, like berries chick peas, kidney beans and lentils • raw vegetables Nuts and seeds • high fibre vegetables such as corn, peas, broccoli, Fibrous meats brussel sprouts and cabbage Sausage Bologna, salami Hot dogs Goose Medications high in fibre: Duck • fibre supplements including Metamucil, Benefibre and Prodiem Spare ribs Organ meats Fish packed in oil Crunchy peanut butter If you are told that you have a bezoar: European frankfurters and other • Avoid foods that may cause a bezoar, such as figs, raisins, deli-made wieners/sausages with tough casings berries, apples, coconuts, persimmons, brussel sprouts, Deep fried meats green beans, corn, legumes, potato skins, tomato skins, seeds and sauerkraut. Fats and Oils Any type of fat but in small None quantities, limit to 3 tsp a day • Avoid high fibre medications listed above. Fat free salad dressing Fat free gravy

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Stages of the Gastroparesis Diet Stage 2 – Mostly liquids and soft foods low in fat and fibre. Follow this diet when you are not vomiting. It includes a small amount of dietary fat. The Gastroparesis Diet will help you get enough nutrition and fluids Fatty foods and oils should be avoided because they slow stomach when you are finding it hard to eat enough food. The diet consists of emptying. Slowly introduce fats and track your body’s response. 3 stages: Food Group Recommended Avoid Stage 1 - Liquids. Liquids leave the stomach quickly and prevent Milk and Skim or 1% milk fat (MF) milk. Homogenized or 2% MF milk dehydration. Liquids can also provide you with salts and minerals that Alternatives Low fat soy milk, rice milk, Regular soy milk you need. You can follow this stage when you are nauseous and almond milk Regular yogurt vomiting. Low-fat yogurt (0 to 2% MF fat) Ice cream Frozen yogurt Sour cream • Only follow Stage 1 for 2 to 3 days, as it will not meet all of your Low fat/fat free cottage cheese Cottage cheese with 2% MF or nutritional needs. Contact your doctor if you think you need to be at Fat free sour cream more Buttermilk Regular/full fat cheese products this stage for longer. Evaporated milk (0 to 1% MF) with 20% MF or more Low fat cheeses with less than Food Group Recommended Items Items to Avoid 15% MF in small amounts Milk and Alternatives None All Vegetables Vegetable juice All raw vegetables Vegetables None All Well cooked soft vegetables Cooked vegetables with skins (cauliflower, eggplant without such as bean sprouts, beans such Fruits Apple juice All skin, parsnips, rutabagas, turnip, as green, wax and lima, peas, Grape juice bottled roasted red peppers, peppers, tomato seeds and skins, Cranberry juice squash, beets, carrots, potatoes corn without skin, yams, mushrooms) Stringy vegetables such as Grain and Starches Saltine crackers All others Smooth tomato sauce cabbage, sauerkraut, Brussels Meat and Alternatives None All sprouts, celery, fiddleheads, Fats and Oils None All sugar snap peas, okra, spinach, kale, swiss chard, bok choy, Beverages Sports drinks (Gatorade, All others bamboo sprouts Powerade) and carbonated Fried vegetables beverages (small amounts Creamed vegetables at a time) Coleslaw Boost Fruit beverage Popcorn Fruit flavoured drinks Olives Plain Tea, coffee Fruits Apple juice Citrus juices with pulp Soups Fat free bouillon All others Cranberry juice All fresh and dried fruits Grape juice Canned fruits with skin Other/desserts Flavoured gelatins such as Prune juice Jello Canned fruits without skins Popsicles (applesauce, peaches, pears, apricots, mandarin oranges)

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please turn over  ______

12 Gastroparesis

• Nutritional Supplements such as: Carnation Breakfast Anytime Boost Plus Calories o o Boost Ensure o o Boost Diabetic Ensure High Protein o o

o Boost Fruit Beverage o Ensure Plus o Boost High Protein o Glucerna

How can I puree or “blenderize” my foods? Pureed foods can sometimes be easier for your body to digest. Refer to the Gastroparesis

HHS “Pureed Diet” handout to learn about how to blenderize your foods.

How do I read a food label?

Reading the Nutrition Facts table is the best way to find out how much fat and fibre a food has. Below is a Nutrition Facts table for Rice Krispies Cereal.

Nutrition Facts Per 1 cup (28 g) Amount % Daily Value The amount listed is for the Calories 110 serving size given. Fat 0 g 0%

Saturated 0 g Remember, + Trans 0 g 0% foods lower in fat and fibre might be Cholesterol 0 mg 0% easier for you to tolerate. Sodium 190 mg 8% Carbohydrate 25g 8% Fibre 0 g 0% Sugars 3 g Protein 2 g

Vitamin A 0% Vitamin C 0%