Gavin Guard, Medical Director
What’s wrong with my gut? - a guide for reflux, nausea, and gastroparesis
Gastroparesis is characterized by reflux, nausea, vomiting, and uncomfortable fullness after meals
It may be caused by an overgrowth of bacteria in your gut
Conventional medications may not be your best bet for treating gastroparesis
Fortunately, there are a few possible therapies to use to help with gastroparesis
How is your gut health?
Unfortunately, many people go their whole life not realizing that they are living in a fog. Operating at 70% is a new normal. There may be glimpses of increased energy, better mental clarity, and improved physical vitality, but these episodes seem to be short-lived.
What you may not know is that a state of sub-optimal gut health may be a main driver of why you don’t feel your best. Your gut has a far-reaching impact on your entire body’s physiology and function. From your brain chemistry, to your joint health, skin complexion, and mental acuity, your gut health dictates a lot of your overall health.
In this article, we are going to unpack what may be causing some common symptoms of an imbalanced gut. Perhaps you (or someone you know) are suffering from reflux, nausea, and bloating, belching, pain in your upper part of your abdomen, and maybe even vomiting. These are all characteristic of a condition called gastroparesis.
A consensus of 40 GI experts state that gastroparesis is a result of delayed stomach emptying absent of mechanical blockage. If you have low thyroid function, a history of bariatric surgery, have diabetes, or have had an short-lived stomach infection, then you may be at higher risk of having gastroparesis.
This can be a frustratingly difficult condition to diagnose and treat, and many patients suffer (an unnecessarily) long-time with these symptoms before finding an answer to their condition.
Fortunately though, there is new and exciting evidence that points us to:
A possible root cause of gastroparesis and associated symptoms
Multiple novel strategies to remediate this root cause
In this article, I will walk you through a tour of how you can solve these symptoms and eliminate the frustration and confusion that they may have led to in your current state of health.
An overgrowth of bacteria may lead to gastroparesis
It may be no surprise that our body’s actually harbor more live microbial cells than human cells. We have a plethora of bacteria, viruses, parasites, fungi, and even amoebas that call our gut home. Collectively, it’s called the “microbiome”.
Under normal conditions, most of the microbiome is isolated to your large intestine. Our small intestine, on the other hand, has only small amounts of microbes. However, there are times when the small intestine can become overrun with bacteria and other microbes. The name given to this situation is appropriately called “small intestinal bacterial overgrowth” or “SIBO” for short.
This imbalanced microbiome environment can ultimately contribute to symptoms associated with gastroparesis (nausea, reflux, bloating, belching, etc.).
In a study of 50 patients with gastroparesis, SIBO was found in 60% of individuals. Furthermore, SIBO was more likely the longer the patient had gastroparesis. Another study suggested that up to 39% of 700 gastroparesis patients also had SIBO. This association may be secondary to slowed gut motility that sets up a conducive environment for bacterial overgrowth.
However, it’s important to note that not all data agrees. In another study of 73 participants, there was NO association between the diagnosis of SIBO and delayed gastric emptying. Even though delayed gastric emptying is associated with the diagnosis of gastroparesis, this study did not look at the direct relationship between SIBO and gastroparesis. This study also used a different method for diagnosing SIBO (culture) as compared to the first study (breath testing).
All in all, it looks like SIBO may be associated and possibly contribute to gastroparesis but we don’t have a ton of research on this topic and more evidence is certainly needed.
SIBO is associated with Irritable Bowel Syndrome (IBS)
The next step in line for identifying possible solutions to gastroparesis and its symptoms is to acknowledge the association of SIBO and IBS.
Just like IBS, the symptoms associated with SIBO include abdominal discomfort, diarrhea and/or constipation, gas, and bloating.
SIBO is just one of many causes of IBS. With that said, SIBO comprises a large portion of IBS cases. Specifically, in a meta-analysis of 50 studies, more than ⅓ of IBS patients tested positive for SIBO. Furthermore, IBS patients are 5x more likely to have SIBO compared to healthy controls. This evidence points to the strong relationship with SIBO and IBS.
IBS therapies may also help gastroparesis
Some of these symptoms of SIBO and IBS also overlap with those of gastroparesis. Since we have a multitude of data points of successful therapies for SIBO, we may extrapolate that to suggest these therapies may also be helpful for gastroparesis as well.
Let’s take a closer look at some of these.
A Low FODMAP diet helps treat SIBO and IBS
Some types of food contain fermentable fiber (FODMAPs) that can feed bacterial imbalances in the gut. A low FODMAP diet reduces digestible fiber in the diet that can feed the overgrowth of bacteria associated with IBS and SIBO.
Many professional organizations endorse the use of a low FODMAP diet for SIBO and IBS. In a randomized controlled trial, 68% of those with IBS symptoms reported adequate control of symptoms after 4 weeks of a low FODMAP diet. A meta-analysis determined that the low FODMAP diet reduced overall digestive symptoms and abdominal pain, and increased quality of life. A second meta-analysis came to a similar conclusion.
A low FODMAP diet may also help gastroparesis
In a study of 45 gastroparesis patients, foods that worsen symptoms include some higher FODMAP foods (e.g. broccoli, onions, cabbage). Furthermore, foods that improved symptoms included low FODMAP foods. While more research needs to be performed, this current data suggests that a low FODMAP diet may be a good starting point for someone with reflux, nausea, and gastroparesis.
Probiotics are effective for SIBO/IBS, and possibly gastroparesis
Do probiotics even work?
Unfortunately, probiotics have not enjoyed the merit and credit that they deserve. Too many health pundits and even clinicians are doubting the efficacy of this therapy.
When we examine the research, we come across a multitude of studies on probiotics. In fact, there are over 2,600 trials looking at probiotics use in IBS patients. Let’s look at some of the evidence to show my point.
In a meta-analysis, the results of 20 placebo-controlled clinical trials were reviewed with a total of 1,400 subjects. The probiotic group showed improvement in global IBS symptoms when compared to the placebo group. This includes improvements in:
Also, many professional gastrointestinal medical organizations endorse the use of probiotics in IBS:
American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome
Many more meta-analysis and clinical trials support the use of probiotics in IBS (study, study, study, study, study, study, study)
To further my point, probiotics have shown to work better if a patient has both IBS and SIBO, compared to IBS without SIBO.
Probiotics may be useful in those with gastroparesis. This postulation is made on the fact that some studies using probiotics in those who are constipated showed faster gut transit time. For example, a meta-analysis of 17 studies and 1,500 patients, suggested that patients using probiotics experienced a shorter gut transit time by 12.36 hours compared to placebo.
Nonetheless, not all studies show beneficial effects of probiotics and some studies are limited in small sample sizes. However, the majority of evidence supports a trial of probiotics for many functional gastrointestinal disorders including gastroparesis.
An elemental diet is effective for SIBO/IBS and shows promise for gastroparesis
Think of a time that you strained a muscle or maybe even broke a bone. Perhaps you sprained your ankle while on a run. What would you think if you were to go to your doctor and they told you to “keep on running”? It would be a crazy idea, right?
In the same way we need to give a sprained ankle some rest and T.L.C., we should also give our gut a break from the constant slow drip of solid food that it needs to break apart, digest, and absorb. This is where the elemental diet comes in.
An elemental diet is a liquid diet formula of pre-digested fat, protein and carbohydrates. In other words, it is pre-digested food so your gut can rest and relax while it heals. It also contains all necessary vitamins and minerals to sustain a healthy diet.
It’s been studied heavily in the setting of inflammatory bowel disease and some research has been performed on IBS and SIBO patients.
One study showed that an elemental diet leads to:
80% resolution of SIBO
65% of participants improved IBS symptoms
Compared to other IBS and SIBO therapies, an elemental diet does not have as much rigorous data to support its efficacy. However, given its safety and practicality, it’s a very viable option for functional gastrointestinal disorders such as gastroparesis.
In one study, 12 patients with gastroparesis were studied on four separate days receiving one of four meals each day in a randomized order: high-fat solid, high-fat liquid, low-fat liquid, and low-fat solid meal. Of the 4 diets studied, the low-fat liquid diet showed the least amount of symptom severity. Another study in the Lancet endorses liquid nutrition in those with gastroparesis.
This suggests a liquid diet formula such as the elemental diet may be an effective therapy for gastroparesis.
Be cautious with medications
Typically, medications are used to control symptoms of gastroparesis in a conventional setting. However, common medications used for this condition may not be that effective and may even be harmful long-term.
Prucalopride is a common medication used to help speed up the gut’s motility system to prevent the symptoms of gastroparesis. In a smaller study of gastroparesis patients, prucalopride had gastric gastric emptying time but NO difference in symptoms when compared to placebo.
Another similar medication used for gastroparesis called metoclopramide has been cautioned not to use more than 12 weeks secondary to its side effects of movement disorders.
Finally, proton pump inhibitors (PPIs) such as Prilosec and Nexium have had some recent attention garnished to them due to some possible side effects and association with other conditions such as:
While some of these potential risks are not that high, it is still important to note the possible long-term health effects nonetheless.
As a result of some of these cautions, I am more in favor of trying to help my patients:
Identify the most upstream root cause of their symptoms (instead of just controlling symptoms)
Use more natural therapies to find lasting solutions to their health concerns
As an example, a patient has recently shared her story of resolving years of vomiting and nausea and coming off some medications.
The Bottom Line
Gastroparesis shares some characteristics of SIBO and IBS and there is a higher rate of SIBO in those with gastroparesis.
Even though some of these treatment strategies have not been used in studies looking specifically at those with gastroparesis, these therapeutics are very effective for the symptoms associated with gastroparesis.
Given the small amount of conventional therapies for those with gastroparesis that can be used long-term, I am in favor of pursuing other evidence-based and practical therapeutics shown to be effective for related disorders such as SIBO and IBS.
If used in a comprehensive and personalized manner, these therapies could very well mitigate and even reverse gastroparesis. This is exactly what I do at Roots Integrated Care.
If you or someone you know is suffering with bad gut health, then schedule a free health strategy session today to see how I can help you eliminate the guesswork and find lasting solutions to your health. I hope you found this information useful and helpful in your journey back to a healthier and happier life.
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