How to Use the Paleo Diet to Treat Gastroparesis, the “Tired Gut Syndrome” 9

Tired gut syndrome, known in the medical literature as gastroparesis (GAS-tro-pa-RE-sis), is a condition tens of millions of people have and almost nobody has ever heard about. In this all too common condition, the digestive tract moves food very slowly. The stomach holds food too long, so that eating a second meal too soon after the first (and “too soon” sometimes is on the same day) results in searing, burning, acid burps, heartburn, and gastroesophageal reflux.

intestinesWhen the stomach finally empties digested food into the small intestine, the duodenum and then the ileum and then the jejunum, food tends to accumulate. It presses against the walls of the small intestine, causing them to send out an SOS to the pancreas to release insulin. Ordinarily, when diners overindulge, pressure in the small intestine gives the pancreas advance warning that a massive amount of digested glucose is on its way into the bloodstream, and the extra insulin will keep blood sugar levels in the normal range. When gastroparesis has partially paralyzed the small intestine, however, the digested sugars don't actually arrive, so blood sugar levels fall, the appetite is stimulated, and there is an impulse to eat more food even when the belly is full. And gastroparesis in the colon results in the familiar condition known as constipation, typically accompanied by smelly gas.

Gastroparesis is different from other gastrointestinal complaints in that it is a disorder of the nervous system, particularly of the vagus nerve that acts as a kind of natural pacemaker for the movement of digested food downward, rather than upward, through the digestive tract. The paleo diet is a great way to bring gastroparesis under control. You'll lose weight, of course, but you can also begin to get control over burping, belching, heartburn, bloating, constipation, nausea, vomiting, unusual stimulation of appetite, and flatulence in the process. Certain aspects of the paleo approach, however, are more important than others.

With Gastroparesis, It's the “Whole” in Whole Grains That's the Biggest Problem

Nothing in the non-paleo diet causes more problems for more gastroparesis sufferers than whole grains. It's the fiber in whole grains that is the major problem. Fiber slows down the passage of food through the gastrointestinal tract. Whole grains contain more fiber than milled grains with their supposedly lower nutritional value. Of course, if you are on the paleo diet plan, for you it's no grains at all, whole or otherwise, and certainly no bran flakes, groats, oats, or high-fiber bread.

If you don't eat your whole grains, are you really missing anything important? Well, it's not actually you that might have to make a major adjustment, it's the probiotic, friendly bacteria in your lower digestive tract. They feed on some of the fibers that appear in abundance in whole grains. But they actually prefer some fiber-like compounds known as fructooligosaccharides, or FOS. The fibers that feed your friendly bacteria without slowing down the passage of food through your colon include radicchio, chicory, endive, kiwis, bananas, asparagus, garlic, leeks, onions, jicama, and especially Jerusalem artichokes, which are also known as sunchokes.

You don't have to eat these vegetables or the kiwis or bananas medicinally to keep your healthy gut bacteria well fed. Just eat a serving or two or at least two or three foods on that list every week. And if you can't fit these healthy foods into your diet when you are on holiday or you are snowed in or you just can't make it to the market, you can take a product like kiwi extract (for example, Xtend-Life's Kiwi Cleanse) to keep your bacteria happy without filling your belly with fiber. The particularly positive finding of the clinical study of kiwi fiber for gut problems is that it works when it's needed, but it tends to leave an already-healthy gut alone. It provides enough fiber for the friendlies without providing so much fiber you get stopped up.

How Soy Can Annoy a Sluggish Gut

If you can't adhere to a paleolithic diet perfectly, probably one of the most important things you can do to help your tired gut heal is to avoid soy products. Soybeans are uniquely high in the amino acid leucine. They contain more than twice as much leucine as an equivalent amount of beef. People who focus on soy as a part of a healthy eating style tend to load up on it—and why not, since it's high in protein and low in fat, they say. But it's that high in protein, particularly that high in leucine, part that's the problem.

If you are a muscle builder, you probably are surprised that anyone would issue a warning about leucine. After all, leucine is an amino acid that muscle builders know has a privileged position in the creation of new muscle tissue. It even has its own molecular “door” into muscle cells when they absorb the amino acids they need to remodel themselves after exercise.

In the gut, however, leucine can overwhelm the intestine's ability to transport other essential amino acids. And since gastroparesis is a condition of slow movement of digested food through the digestive tract, when you eat soy, more can actually be less. Your body will absorb the leucine and leave other amino acids inside the, to use a polite term, soup in your gut either to be swept our with bowel movement or feeding pathogenic bacteria, which need leucine, too. The smaller bulk of meat is beneficial for absorption (assuming it's well-chewed, of course).

Some people who have especially serious gut problems find that they get a reaction to soy a lot like people who have celiac disease get to wheat, namely bloating, gas, and painful inflammation. If this happens to you, soy is an absolute no-no. Otherwise, soy is OK in the amounts that many Asian people actually eat it, up to 15 grams (half an ounce) a day, at only one meal. This provides your body with all the phytoestrogens it can actually absorb, without aggravating gastroparesis or interfering with your paleo diet plan.

How Not to Have to Worry About Bezoars

Bezoars are the human's equivalent of a cat's hairballs. No, we aren't suggesting that your diet should be so “paleo” that you eat actual hair (although there is a medical condition in which people who eat hair have to have literal hairballs removed, called Rapunzel syndrome). Human bezoars typically form from fibers in plant foods, especially the fibers in persimmons (by far the most common source of the problem), potato peels, sauerkraut, figs, Brussels sprouts, and fiber supplements such as Benefiber, Citrucel, Fibercon, Peridem, and Metamucil.

While bezoars typically accumulate in the stomach, it's the small intestine's failure to move digested food downstream that causes them to accumulate there. About 1 in 5 people who has gastroparesis eventually has a bezoar, so don't pig out on fiber-rich foods, even if they are on your diet, especially not persimmons.

Is The Answer a Liquid Paleo Diet?

Some people who have gastroparesis deal with their problem by tossing their meals in a blender so they can just drink them down. Usually this is a bad idea. Meal replacement drinks are almost always a problem in gastroparesis, and liquified meals are not an improvement.
There are two problems with drinking your diet. One is that it is harder to estimate portion sizes when consuming food in liquid form. It is easy to consume too large a volume of food in too short a time. The other issue is that the stomach takes longer to empty when it has to digest proteins, whether they are solid, liquid, or just well-chewed. Protein foods have to be eaten in smaller quantities if you have gastroparesis, no matter what form they are in. This also applies to protein supplement powders, by the way.

So What Can I Do on a Paleo Diet to Make My Gastroparesis Symptoms Better?

Here are the Ten Commandments for paleo diet success when you have gastroparesis, which are the same as the Ten Commandments for gastroparesis relief with the paleo diet. The rules aren't hard, but they are rigid.

  1. No peels and rinds. Many people think eating the peel adds nutrients, and in a few cases, notably apples, and for a few nutrients, such as the allergy-fighting antioxidant quercetin, it really does. If you have gastroparesis, however, no peels for you. This cuts down on fiber, and helps food flow more easily through your digestive tract. It is especially important not to consume melon rinds, since their rough texture provides multiple hiding places for potentially pathogenic bacteria, and the slow transit time through your gut gives them many opportunities to grow.
  2. Use a strainer. If you are going to drink juice, which is something your diet will permit in moderation, avoid drinking pulp and fiber. Strain juice before you drink it.
  3. Ginger soothes nausea. Feeling sick to your stomach? Ginger is a proven herbal remedy for the nausea caused by gastroparesis. A cup of Organic Ginger Tea, or a piece of Seaband Ginger Gum, or a glass of seltzer water with Ginger Wonder Syrup can relieve nausea in minutes. When that doesn't work, try acupressure. Grasp the web of skin between either thumb and forefinger with the thumb and index finger of the opposite hand, and gently squeeze. This peculiar maneuver distracts your central nervous system from the sensations of nausea your brain is interpreting from signals from your stomach.
  4. Eating out is OK, if you know what you are going to order before you arrive and you ask for what you want. It can be very uncomfortable to have to search through a menu looking for stomach-friendly foods while you are sitting with friends or family at the table. Fortunately, most restaurants post their menus online. Make your choices ahead time. And don't be afraid to ask for exactly what you want, whether it is a side dish, from the children's menu, or a special request. If you eat in a restaurant on a regular basis, you might even give the owner a copy of the G-PACT card that briefly explains gastroparesis and the foods you can eat. The owner or manager of the restaurant may be aware of other offerings that meet your needs.
  5. Chew gum. Chewing gum helps relieve acid reflux. Chewing gum for about an hour after a meal helps force stomach acids to stay down in the stomach rather than rising up into the throat. The key to achieving actual relief of symptoms by chewing gum is to chew with your mouth closed, so you don't swallow air. The swallowed air can cause bloating, belching, and flatulence.
  6. Peppermint tea is helpful for some symptoms of gastroparesis. If you are plagued by abdominal pain, bloating, and gas, peppermint tea or peppermint oil capsules may just what you need to get past your tummy trouble. Peppermint oil capsules work, too, but don't use them if you have gastroesophageal reflux disease (heartburn).
  7. Drink chamomile tea. Chamomile tea also relieves the unpleasant symptoms of gastroparesis. It won't work, however, if it's made with boiling water. The active ingredients in the tea evaporate below the boiling point of water. It is important to brew the tea with hot, but not bubbling, water in an enclosed vessel, either in a teapot or in a cup covered by a saucer.
  8. Drink aloe vera juice. Aloe vera juice is “paleo” and especially helpful if you have a problem with constipation. Sometimes a lot of “belly fat” turns out to be impacted stool. Aloe vera juice sometimes produces astonishing diet results when constipation is relieved. If you can't get used to the taste of regular aloe vera juice, a beverage like Aloe Cherry Berry may be what you need.
  9. Relieve acid symptoms with licorice, but the right kind of licorice. Regular licorice isn't something you should use on a regular basis. It can change your potassium levels and increase your blood pressure, even if you don't have other problems that cause high potassium levels or hypertension. The substance in licorice that is the problem is a chemical called glycyrrhizin, so chewing gums or lozenges (which you don't have to spit out) made from deglycyrrhizinated licorice are what you need. Even if you take a lozenge, you still have to chew it. The mixture of the treated licorice and your saliva releases the chemical that relieves stomach problems.
  10. Add pineapple and papaya to your diet. The bromelain and the papain in papaya are meat tenderizers. While they won't tenderize the lining of your stomach, they will break down proteins in the food you eat so digested food moves more quickly through your stomach and intestines. Try to eat pineapple or papaya at the beginning of your meal so they will be more fully mixed with the meat.

About Andy Williams

Andy Williams has a Ph.D. in biology and a strong interest in health and nutrition. The Paleo Gut web site was created to explore the health benefits of the Paleo diet and see how it is changing lives. Also, get our free daily Paleo Gut newspaper delivered to your inbox. Please feel free to contact me and let me know about your Paleo experiences or favorite recipes.

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9 thoughts on “How to Use the Paleo Diet to Treat Gastroparesis, the “Tired Gut Syndrome”

  • notaquitter

    I am considering transitioning to a paleo diet and I have gastroparesis.  I would like to start running again and train for a half marathon in the spring. I have been doing more juicing to get my green veggies and using egg whites in smoothies for protein.  If drinking my protein is not recommended and I am to stick with small meals then how do you recommend I get the necessary amount of protein.

  • ThePaleoGut

    With gastroparesis, you aren’t going to be able to consume the massive amounts of protein some training gurus recommend–but that’s OK. The timing of your protein is at least as important as the amount of your protein. Your muscles need to have both glucose and amino acids available to repair themselves during the recovery phase, which begins roughly an hour after your workout. Consume some protein with a carbohydrate food–if you eat fruit, this is the time–when you’ve finished your cool-down, and don’t worry about how much. What “pumps up” your muscles, by the way, is glycogen, which your muscles make from glucose and water.

  • AV

    I have gastroparesis and am considering doing Whole 30 with my husband and then plan to go paleo afterwards. I’ve already began slowly transitioning. My problem is that solid foods, even in small amounts, can make me feel full and bloated for 6-12 hours. This makes it difficult for me to even come close to a 1600 daily calorie intake, and I’m actually trying to gain weight (I’m 5’6″ and 109lbs). It’s easier to get calories from starches and refined carbs since they digest easily. What some recommendations?

    Btw, it seems that most doctors (even GI) don’t know much about food plans for gastroparesis.

  • Elle

    I have had gastroparesis for over two years now and have been paleo for about one year. I am very active but I deal with- sometimes- debilitating bloating and distension in my abdomen after eating most every meal. I think that people who really have diagnosed gastroparesis are probably pretty aware there is something seriously wrong and I just felt obligated to say that a lot of these recommendations would be completely ridiculous to add to a paleo diet while struggling with gastroparesis. Particularly chewing gum after a meal- that is most certainly not recommended at all. Unless of course you’re referring to some sort of homemade gum. Have you looked at the artificial sweeteners on a pack of gum recently? They could send someone like me running for the bathroom after only ten minutes. Also one of the major struggles is eating fruit and raw veggies. One of the things you had mentioned named a few veggies that with even a minimal amount of research would prove to be detrimental to someone who struggled with breaking down food like onions- cooked or raw. I was looking in hopes of finding some suggestions that would really aid in healthy eating but also maintaining the disease in general. I think there’s a lot of things not taken into consideration here. Gastroparesis can be a very serious thing not just a “lazy gut”. Those are the types of people looking for answers.

    • Angela Fickert


      Please help me. You’re the first person that sounds like they know something about this awful disease. I have tried to find a diet to follow and lose weight. My vagus nerve is damaged and my doctor just told me to look online for a diet but I get conflicting information. I’m ready to fix the problem with surgery. I have a physical disability that causes me problems to work out so I’m at a loss. Do you have any advice for me?

      Thank you,
      Angela Rose

  • Jess

    Seltzer water? Are you kidding me? I haven’t had anything carbonated in years. Just a sip would mean hours of fullness and nausea. Every doctor or “expert” I’ve ever spoken with acts like they actually understand gastroparesis. I’d love for you to feel as sick as I do every day and then make some of these ridiculous suggestions. Not to say there weren’t a few obviously fine, tried and true meal suggestions in here (ginger, aloe vera juice, small portions of protein, etc.), but the bulk of this piece feels like it was written by someone who knows very little about this disease.

    • Bethany Llewellyn

      I do agree. Especially— what is not mentioned is that gastroparesis can be SO different for each person depending on the severity. When I first got diagnosed I could not even keep the smallest amount of broth or even jello down. I would vomit up everything. Any food or smelling food would make me nauseous. That was over 6 months ago. While today, I can stomach food easier without vomiting, I still think some of these suggestions are bad advice. I can get nauseous at any given time. Having gastroparesis, I suggest you just have to learn what YOUR own stomach can handle and sadly it is by experience. No one can tell you what you can and can’t eat or digest. It’s different for everyone. There are the basic things to stay away from of course. But if you feel that some advice would not work for you, don’t do it. At least in my own personal experience with having gastroparesis.

  • Shari Whetton

    I have GP. And have been on the Medifast Diet. Which is based with Soy. So this isn’t a good idea? Would you suggest Paleo instead?

  • David Battel

    I was diagnosed with gastroparesis 5 years ago, and I was told that most people feel full all the time. I on the other hand am always hungry! This is the first article to mention hunger’s association with gastroparesis.
    Do you have any recommendations on how to feel full? My stomach will feel stuffed, but I will often still feel very hungry which inevitably leads to overeating and bloating.