Gastroparesis: When Food 'Just Sits' in Your Stomach

If you suffer from a bloated belly, you're not alone. For the past eight years, my clinical practice has seen a steady parade of patients coming in with the very same complaint: abdominal bloating.

While there are many reasons a person might feel the internal discomfort and fullness that we collectively refer to as bloating, there's one particular cause I'd like to highlight: gastroparesis, or delayed stomach emptying. It's one of the top 10 causes for abdominal bloating that I've written about in my upcoming book, "The Bloated Belly Whisperer," and it affects about 2 percent of Americans.

I often tell my patients to imagine their stomach's job in the body as that of a blender. It liquefies food using acid, enzymes and strong muscular contractions. Once liquefied, your recently eaten meal is then able to be squirted out of a small muscular opening at the bottom of your stomach in order to continue on its digestive journey into the intestines.

But what would happen if your stomach blender's motor wasn't functioning properly? What if instead of whirring quickly and efficiently to puree food, it was sputtering slowly and erratically, leaving meals to sit there for far longer than normal before becoming liquefied enough to empty? This is essentially what's happening in the case of gastroparesis: The pacemaker cells that govern your stomach's muscular contractions aren't operating normally, and as a result, your stomach doesn't empty nearly as quickly as it should.

[See: What to Eat, Drink and Do to Relieve Constipation.]

The symptoms of a slow-to-empty stomach can be pretty miserable, and I've found that my patients with gastroparesis really struggle with quality of life issues as a result. Imagine rarely to never feeling hungry, but knowing you need to eat anyway because you feel weak from low blood sugar or have to get your body's basic protein and vitamin needs met. Imagine constantly struggling with a low-grade level of nausea, and feeling uncomfortably full after just a few bites of your favorite foods. Imagine knowing that you might vomit if you eat just one bite too many, indulge in a favorite high-fat treat or even eat a healthy, high-fiber salad.

People with gastroparesis also struggle with figuring out what to order when they go out to eat that won't make them feel sick, and often feel like their meals just "sit there" for hours after eating. Some may lose the ability to take pleasure from eating entirely. To add insult to injury, many have to deal with comments from friends and family about how "lucky" they are that they won't gain weight because they can't overeat. These are the daily struggles that accompany gastroparesis for many of my patients.

There is no cure for gastroparesis, only medications and other procedures to help stimulate the sluggish stomach to empty faster and alleviate some of the symptoms. Contrary to internet lore, taking digestive enzyme supplements won't speed up your stomach's emptying time, nor will using apple cider vinegar. That's because the problem isn't a lack of acid or enzymes; the problem is a lack of movement. Rather, diet change is the primary way to control the difficult symptoms of gastroparesis. An experienced registered dietitian can do wonders to help you maximize your quality of life if you've been diagnosed with gastroparesis, but if you want to get started right away, here are a few of my best tips:

1. Don't avoid fiber entirely, just eat it in smoother forms.

If you have gastroparesis, anything you can do to "pre-blenderize" food will expedite its journey out of a stomach. People are often told to avoid all fiber when they have gastroparesis because it delays stomach emptying. As a result, they often limit themselves to a bland diet of white rice, bananas, potatoes and bread. However, in reality, it's the particle size of the fiber that has the greatest impact on emptying time.

For many people, roughage like kale and seedy fruits like berries can be enjoyed and tolerated well in smoothie form; and a veggie-heavy blended soup or soft veggie burger should be tolerated far better than its nutritional equivalent, the raw salad. Nuts-turned-nut butters and beans-turned-hummuses are all ways that many people with sluggish stomach emptying can enjoy the health benefits of nutritious, fiber-rich foods (and avoid raging constipation from a low-fiber diet). It may take some trial and error to learn which fiber-containing foods you can continue to enjoy and in what forms and portions, but the upside is a more varied and healthy diet.

[See: 5 Healthy -- and Tasty -- Smoothie Ingredients.]

2. Eat small, well-spaced meals.

The "textbook" diet recommendation is to eat six to eight small meals or snacks per day with gastroparesis, but in reality, I've yet to meet a patient who can comfortably handle more than five -- and for most people, four is really the limit. Most of my patients need a full four hours between meals, which doesn't leave enough hours in the day to squeeze in six to eight meals. The trick to optimal meal spacing with gastroparesis is to start with a meal soon after waking so you have enough waking hours to get it all in. While many people don't wake with much of an appetite, a liquid breakfast -- think protein-spiked fruit smoothies -- sipped gradually over an hour or so can often go down pretty well.

3. Leverage liquids.

In order to squeeze a day's worth of nutrition into small meals, you may need to increase the nutritional quality of your liquids. Filling up on water and tea for hydration means you're occupying precious stomach real estate with no vitamins, minerals, protein or calories to show for it. Protein-spiked coconut waters and cold brews, clear liquid protein drinks, green juices or other cold-pressed veggie juice combos are great ways to make sure you're multitasking as you hydrate.

[See: 8 Ways to Stay Hydrated This Summer Without Drinking Water.]

If you suspect you may have a slow-to-empty stomach, consult a gastroenterologist to share your concerns and discuss diagnostic testing. If you're living with gastroparesis, I recommend seeking out support from others. At times, it can be a tough condition to live with, and online support groups are a terrific resource for recipes, meal ideas, symptom management tricks and -- importantly -- a sympathetic ear from others who truly understand. Finally, find a great dietitian to keep in your corner for help planning your diet and navigating bumps in the road that may arise as you learn to live with your stomach's limitations.

Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian and America's Trusted Digestive Nutrition Expert. Her first book, "The Bloated Belly Whisperer," publishes in December 2018 and is now available for pre-order; it includes a quiz to help you determine why you're bloated, plus 50 belly-friendly recipes. Duker Freuman's clinical practice in New York City specializes in managing digestive disorders through diet. More information is available on her website, TheBloatedBellyWhisperer.com.