Nutritional therapy for the management of diabetic gastroparesis: clinical review

Figures & data

Table 1 Summary of nutritional interventions for diabetic gastroparesis

Decrease volume of meals ➢ Eat smaller, more frequent meals Prefer liquid vs solid meals ➢ Chew the food thoroughly and take 20–30 minutes to finish your meal ➢ Try solid meals in the morning, switch to semi-liquid and liquid meals over the course of the day ➢ Any food can be blended with water, vegetable juice, or broth to make a puree Glycemic control ➢ Monitor the need to change the meal timing, form of carbohydrate (simple, complex) according to the anti-diabetic medications/insulin Fat ➢ Fat in liquid is well-tolerated; maintain the intake of 20%–30% of calories from fat ➢ Implement #1–3 before fat restriction Fiber ➢ Identify the high fiber foods increasing the upper gastrointestinal symptoms and individualize the sources of fiber ➢ Delayed gastric emptying in the gut could lead to fermentation and alleviate the symptoms ➢ If bezoar formation is a concern, avoid foods causing bezoar like oranges, berries, coconut, legumes, fiber supplement ➢ Treat bacterial overgrowth if suspected/symptomatic Monitor and replace micronutrients as needed: iron, B12, vitamin D and calcium ➢ Avoid caffeine, alcohol, tobacco and stress ➢ Eat nutritious foods first before filling up on “empty calories” ➢ High fiber foods should be avoided as they may be more difficult on the stomach and may cause bezoar formation ➢ Avoid chewing gum, which increases air swallowing ➢ Avoid foods that lower oesophageal sphincter pressure: pepper-mint, chocolate, fat, and caffeine ➢ Chew well and eat slowly (30 minute meals) ➢ Do not lie down immediately after eating ➢ Lose weight if you are overweight ➢ On days when symptoms are worse; try taking just liquids to let the stomach rest ➢ Any food can be blenderized with water, vegetable juice or broth to make a puree ➢ Check weight twice a week, if the weight is decreasing increase the amount of liquid supplements

Table 2 Foods high in fiber

➢ Whole grains and whole grain products Bran cereals, oat bran, wheat bran, multigrain breads, granola, high-fiber bread. ➢ Beans and legumes Whole beans, dried beans, fava beans, kidney beans, baked beans, black beans, peas. ➢ Nuts and seeds Almond, flaxseed, sunflower seeds, pumpkin seeds. ➢ Fruits Berries, dried fruits (figs, dates, apricot, prunes), guava, apples. ➢ Vegetables Green leafy vegetables, green beans, broccoli, Brussels sprouts, squash.

Table 3 General guidelines for diabetic gastroparesis

➢ Avoid caffeine, alcohol, tobacco, and stress. ➢ Eat nutritious foods first before filling up on “empty calories.” ➢ Avoid chewing gum, which increases air swallowing. ➢ Avoid foods that lower esophageal sphincter pressure: pepper-mint, chocolate, fat, and caffeine. ➢ Chew well and eat slowly (30 min meals). ➢ Do not lie down immediately after eating. ➢ On days when symptoms are worse, try taking just liquids to let the stomach rest. ➢ Check weight twice a week. If the weight is decreasing, increase the amount of liquid supplements.