Malnutrition and Gastroparesis

– by Rita Griffin and Jim Sliney Jr.

A major consequence of gastroparesis can be malnutrition. This is a direct result of the inability to properly absorb nutrients from food, or from minimal food intake. In severe cases of gastroparesis hospitalization may be required to correct the debilitating effects of dehydration and malnutrition.

The National Institutes of Health says that symptoms of malnutrition “may include fatigue, dizziness, and weight loss. Or, you may have no symptoms. To diagnose the cause of the problem, your doctor may do blood tests and a nutritional assessment. Treatment may include replacing the missing nutrients and treating the underlying cause.”

One of the greatest challenges of gastroparesis is learning how to maintain a nutritionally balanced diet through flare-ups. When suffering frequent flare-ups it is a struggle to figure out what can and can’t be eaten in order to meet vital nutritional needs. It is easy to get frustrated and lose hope.

Fortunately there are proactive adjustments one can make that can reduce the risks of becoming malnourished. According to the International Foundation for Functional Gastrointestinal Disorders (IFFGD) you can:

  • Work with a registered dietitian (RD) or nutrition support specialist (nurse or doctor) to design a dietary plan to meet your individual needs; understand how to use and maintain dietary and nutritional therapies.
  • Eat frequent, small meals that are low in fat and fiber. Fat, fiber, and large meals can delay stomach emptying and worsen symptoms.
  • Keep hydrated and as nutritionally fit as possible.
  • If you have diabetes, maintain good glucose control. Irregular stomach emptying can negatively affect blood sugar levels. Keeping your blood sugar under control may help stomach emptying.

Additionally, you can introduce multivitamins or liquid nutritional supplements (i.e. Ensure, Boost) to help meet nutritional needs.

Diet may be the most important discussion to have with your gastroparesis doctor. If your doctor is not well versed in diet and nutrition ask for a referral to a dietitian. Your gastroenterologist/dietitian can instruct you on foods to avoid, and the adequate amounts of vitamins and minerals certain foods can provide. It depends on each individual as to what form of diet can be tolerated. According to International Foundation for Functional Gastrointestinal Disorders, “Cooked or juiced vegetables are usually well tolerated. Consider adding nutritional supplements, such as caloric drinks, protein powder or protein bars.” Maintaining proper nourishment is the key.

The Liquid Diet

A full liquid diet is often used as a step between a clear liquid diet and a regular diet. Some GP patients unfortunately can only tolerate liquids.

Dr. Frank W. Jackson of states that, “the purpose of the diet is to reduce symptoms and maintain adequate fluids and nutrition.” He goes on to discuss a 3 step diet plan:

  • STEP ONE DIET – Liquids – the goal is to prevent dehydration and keep the body supplied with vital salts and minerals. It consists of saltine crackers, fat free bouillon, Gatorade-type nutrient drinks and soft drinks. This diet has sodium and potassium but is otherwise not nutritionally sound. Step One shouldn’t last more than 3 days.
  • STEP TWO DIET – Fats – adding small amounts of fat and calories to the diet at less than 40 grams each day. Usually once Step One is completed, patients can tolerate Step Two. It can include skim milks, low fat cheese, eggs, peanut butter, some non-whole grain breads, well-cooked vegetables, and nutrient beverages as in Step One. Low in vitamins A, C, and Iron.
  • STEP THREE DIET – Long term – generally add fat with a limit of 50 grams a day. Still no fibrous foods, but fats can be increased to 50 grams a day. Also low in vitamins A, C, and Iron.

The information goes on to say that full liquid diets are usually low in iron, vitamin B12 and thiamine, as well as vitamins A and C and should be supplemented with a multivitamin. While the most common nutrient deficiencies seen in patients with gastroparesis (whatever their diet) are iron, vitamin B12, vitamin D, and calcium.

The The Gastroparesis Dysmotility Association in cooperation with Carol Rees Parish, RD and the University of Virginia, proposes a dietary plan based on “Food Zones”. The Food Zones seem to be an effective way to manage the changes needed when a flare up comes on. Beginning with clear liquids, as symptoms improve you can move up to full liquids, then to blended foods, then to soft foods, then to lower fat, full or solid foods. If a flare-up occurs, move back to the first zone (clear liquids) and begin moving back into each zone as you can tolerate.



You shouldn’t try to manage all your nutritional needs on your own. The resources exist and your doctor or dietitian can help you tremendously. Remember to always monitor your diet, keep notes (that will help you and your medical team) and consult with your doctor about your specific nutritional needs.


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