Gastroparesis and Constipation
How those two conditions are related
And what to do about it

Many individuals who suffer from gastroparesis are also constipated.

In this article, we cover the relationship between those two health problems in details, and we provide natural remedies to reduce your risk of constipation while improving your stomach functions.

Those natural remedies should help you to better manage your condition overall.

What is gastroparesis?

The stomach is a bit like a washing machine. During digestion, it spends time churning the food and mixing it up with gastric acids and digestive enzymes. It then delivers the food to the duodenum (the first part of the intestine) for the next phase of digestion.

When the stomach is done with its job, the pyloric sphincter separating the stomach from the duodenum opens and expels the current batch. It then moves on to processing the next batch of food. This expulsion process is called “gastric emptying”.

If gastric emptying is consistently too slow, you have gastroparesis. Your stomach will fill-up quickly, and food will stagnate there. Stagnation leads to fermentation, as yeast and bacteria ingested with the food will start to feed on stagnating food and release gases.

Delayed gastric emptying is diagnosed in 0.02% of the population (so a fairly low incidence), but is actually estimated to occur in 1.8% of the population and remain undiagnosed for a lot of individuals(1).

The common symptoms of gastroparesis are early satiety, bloating with gas, abdominal pain, nausea with sometimes vomiting, heartburn and acid reflux. The person is unable to eat more than a small quantity of food at a time, and is forced to eat several small meals a day. Some follow a “low residue” diet, avoiding fibers, fats and other foods hard to digest.

The longer term impact may be loss of weight due to the inability to eat normal portions, lack of energy due to the inability to absorb nutriment well, and issues with blood glucose variations due to diet limitation.

What causes it

Certain physiological issues may be common to both gastroparesis and constipation:

• Hypothyroidism, which slows down the overall gastrointestinal tract. The thyroid gland, which regulates the overall metabolism of the body, is running too low, making everything slow.
• Diabetes, which damages the nerves (diabetic neuropathy) which could affect both the upper and lower gastrointestinal tract. The gastrointestinal tract organs are not getting the proper signaling from the nerves.
• Certain conditions like scleroderma, Lupus or Parkinson’s may also damage the nerves controlling the gastrointestinal tract at all levels.

Very often, in both gastroparesis and constipation, the root of the problem seems to be neurological. The nerves are not signaling the muscles of the digestive organs properly, which slows down the progression of food through the gut.

What I find striking is the similarity between what happens in the stomach and the colon. In the colon:

• The food residues are also churned to reclaim fluids to prevent dehydration;
• The food residues are then moved forward until they reach the anus, via an intricate network of nerves and muscles.

It thus seems logical that an impairment of the nerves and muscles affecting the upper digestive tract (the stomach - gastroparesis) may also affect the lower digestive tract (the colon - constipation).

Whatever the causes are, the following section provides tips to stimulate this deficient intestinal tract.

Recommended Protocol

As a gastroparesis sufferer, you had to adjust your nutritional habits drastically. Your inability to eat normal quantities of food, or to deal with certain types of foods, means you have a tendency to stay away from nutrients that may be key to a good transit. We will review those next.

We will also cover medicinal plants and supplements that could help your situation.

1. Good fats

Fats are hard to digest, no doubt. Some gastroparesis sufferers cut most of the fats out of their diet. But fats stimulate the gallbladder to release bile, our natural laxative. Fats, therefore, contribute to a good transit. Good fats include olive oil, coconut oil, egg yolks, fats from fatty fishes like salmon, organic pasture butter, etc.

Other than slowly reintroducing good fats in the diet, try the olive oil anti-constipation protocol located on the olive oil page, which consists of taking a certain quantity of olive oil upon an empty stomach.

2. Water

You may have heard that drinking during meals disturbs the digestion. This is true, as diluting your digestive juices and enzymes when you have serious digestive problems is the last thing you want to do. Do not drink right before, during or after your meal during digestion.

But drink plenty of fluids between meals, upon an empty belly. You may also want to consume magnesium rich waters as explained in the magnesium article.

3. Fruits and vegetables

Some gastroparesis sufferers follow a “low residue” diet that contains very little fruits and vegetables, as those foods are “bulky”. Their fiber content makes them filling very quickly. But fruits and vegetables are key components of a healthy transit.

If fruits and vegetables only represent a small portion of your diet, try to increase their consumption very gradually and giving yourself time to readjust to the increased quantity.

I do not recommend taking concentrated fibers supplements like psyllium husk or other bulk laxatives as replacement. They tend to make things worse.

4. Exercise

Gastroparesis often leads to malnutrition and weight loss. You may be concerned about losing too much weight and therefore shying away from physical activities.

We have already discussed in other articles the fact that physical exercise facilitates transit through the lower gastro-intestinal tract. The best exercises are those that are gentle and can be practiced every day, rather than those requiring you to wait for the week-end for instance.

I particularly like biking because it forces the upper legs to exert pressure on the belly area, thus stimulating the region. Walking and swimming can be very good too.

Regular, gentle physical activity can only be beneficial in the long run. It keeps our bones and muscle in top shape, forces us to go outside to get enough sun exposure, and acts as general stress reliever.

5. Medicinal plants

There are two kinds of medicinal plants that I will recommend to you here.

Bitter plants

Bitter plants act as tonics to the whole digestive tract. They stimulate the release of more digestive enzymes, they make sure the smooth muscles and sphincters of the gastro-intestinal tract contract nicely. They may therefore help your stomach with its gastric emptying issues.

You do not need to take large doses of bitters. Here is how things work with bitters: our taste buds detect the bitter taste, then send a signal to the brain. The brain in turn will signal the digestive tract to work more efficiently. So taste matters, not quantity.

• My favorite bitter is gentian, take 10 to 15 drops in a bit of water 15 minutes before meals. For liquid plant extracts, I like the Herb Pharm and Rose Mountain Herb products, which I have been using in my naturopathic clinic for years.

• Alternately, I have also used Sweedish Bitter mixes with good success, following the same dosage and timing.

Warming and stimulating plants

The stomach, as an organ, needs a good blood supply. Blood brings function. When an organ is not performing optimally, we sometimes say in energetic terms that it is “cold”. It needs to be warmed up, stimulated.

To achieve this, I know of no better plant than ginger. Research has shown that ginger stimulates gastric emptying(2), which is just what you need. The study mentioned here used 1200 mg of ginger per individual, given 1 hour before meals.

You can start with a slightly lower dose, say around 1000 mg in capsule format. Also make sure you take it before your start eating, giving your stomach enough time to get the benefit of ginger before starting your meal. I recommend taking it 30 minutes before you eat, then taking the bitters 15 minutes later.

6. Supplements

• Magnesium is one of my favorite supplements for constipation. The magnesium for constipation page contains lots of information on that topic, along with product recommendations.
• Digestive enzymes can make a huge difference in how well your stomach process food. I highly recommend you try taking them with every meal. I highly recommend the Life Extension Foundation digestive enzymes, which I have been using quite extensively in my clinic.
• Multivitamins: you should take a multivitamin to make sure the gastrointestinal tract is not missing any key nutrient to perform its function. Moreover, studies have shown that gastroparesis sufferers are deficient in several vitamins and minerals (vitamins A, B6, C, K, iron, potassium, and zinc)(3). For my family and in the context of my clinic, I have been using the Life Extension Foundation “two per day” multivitamins.
• Probiotics: studies have shown that “Small Intestinal Bacterial Overgrowth” (SIBO) is very common in gastroparetics with predominance of abdominal pain and bloating(4). In order to correct that bacterial imbalance in your gut, I recommend that you take quality probiotics for a duration of 3 months. I have used the Jarrow brand in my clinic.

In addition to re-establishing the good bacterial strains, you can make sure the bad strains are kept at bay. The best plant to accomplish this is raw garlic, but it will likely be too much for your sensitive stomach.

A good alternative is to take Oregon Grape root, which has the same anti-bacterial effect. Take 5 drops before each meals in a little bit of water.

Conclusion

In this article, we have seen that gastroparesis sufferers are often confronted with constipation. We have outlined a simple and natural protocol to help with constipation.

This protocol will also stimulate the upper gastrointestinal tract and help with gastric emptying.

With this list of options, I hope you will be able to experiment and see what works best for your gastroparesis situation. Note that you may need to adjust the timing and dosage of the medicinal plants according to your constitution and lifestyle.

Finding the right natural remedies requires patience and determination. But I can assure you that in the long run, nutrition and plants always beat medications, and without the side effects.

References

(1) Rey E, Choung RS, Schleck CD, Zinsmeister AR, Talley NJ, Locke GR 3rd. Prevalence of hidden gastroparesis in the community: the gastroparesis "iceberg". J Neurogastroenterol Motil. 2012 Jan;18(1):34-42.

(2) Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, Chiu YC, Chiu KW, Hu TH. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011 Jan 7;17(1):105-10.

(3) Parkman HP, Yates KP, Hasler WL, Nguyan L, Pasricha PJ, Snape WJ, Farrugia G, Calles J, Koch KL, Abell TL, McCallum RW, Petito D, Parrish CR, Duffy F, Lee L, Unalp-Arida A, Tonascia J, Hamilton F; NIDDK Gastroparesis Clinical Research Consortium. Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis. Gastroenterology. 2011 Aug;141(2):486-98, 498.e1-7.

(4) Reddymasu SC, McCallum RW. Small intestinal bacterial overgrowth in gastroparesis: are there any predictors? J Clin Gastroenterol. 2010 Jan;44(1):e8-13.

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