Today’s episode is a quick but informative one as I have a very packed week of client calls.

So, I wanted to do a mini episode on gastroparesis and delayed gastric emptying (stomach emptying) in hEDS and POTS patients, because as you probably know by now if you listen to my show, people with endo have a higher risk of having one or both of these conditions. (1)

Lately I’ve had a number of clients who I’ve suspected have delayed gastric emptying or gastroparesis and we’ve gone on to have positive diagnoses, so I wanted to bring this up on your radar as it can easily go misdiagnosed and often does.(2)

So delayed gastric emptying is essentially a delaye of food passing through the stomach into the small intestine. The delay can range from mild to severe, with the severe form being termed as gastroparesis.

People with hEDS and POTS may be more likely to suffer from delayed gastric emptying or gastroparesis, with one study of 218 hEDS finding that 42.8% had gastroparesis and a significant number also had accelerated gastric emptying or delayed gastric emptying.(3)

Delayed gastric emptying occurs in this demographic because with hEDS or HSD, the connective tissue is weak, fragile and stretchy, and this affects the muscles of the intestines, so they don’t function as they should.

POTS is caused by autonomic nervous system dysfunction, which is the part of our nervous system responsible for automatic functions in our body, such as blood pressure regulation, heart beat, digestion, etc. This dysregulation can affect the functioning and responsiveness of the digestive tract.

These aren’t the only reasons for delayed gastric emptying in these patients, but it’s two of the key theories/causes. (4)

So, what are the symptoms?

Remember, that delayed gastric emptying can range from mild to severe, so you may not have all of these symptoms but these are the key ones(5):

Poor appetite
Early satiety - feeling full early and so only eating few or small meals, there may be a special focus on foods they find easy to digest like simple carbs such as crisps (potato chips).
Nausea
Bloating - often client’s will say that it feels like their stomach just keeps stretching, and in the case of hEDS, this is very likely to be the case.
Vomiting

Unfortunately, diagnosis can be tricky and it can be a challenge to get doctors to investigate symptoms as the symptoms can be classified as other conditions, but the main test is a gastric emptying scintigraphy.

So, if you do have delayed gastric emptying or gastroparesis, that are your options?

Treatments

Medication(6)

So firstly, there are medications that GI doctors can prescribe, but some of them do come with side effects and don’t necessarily improve the symptoms, so speak to them about your options and the best one for you.

Prokinetics (6)

Prokinetics, which improve motility and gastric emptying, such as prucalopride (which we use in SIBO prevention of relapse) but also…

Ginger

Ginger is also a treatment for nausea, bloating and vomiting (7), so can really help with the symptoms, and it’s also a natural prokinetic(8). It can help to take ginger capsules or ginger chews typically 30 minutes before meals (use label dose) or 30 minutes to 1 hour after meals to aid with bloating and symptoms.

Peppermint oil capsules

Peppermint oil improves pressure in the stomach and gastric emptying times(9), and is being shown as a promising treatment for gastroparesis(10). It also improves cramping and bloating by relaxing muscles, and has been shown to improve all symptoms of IBS(9). Ideally, you want to use enteric coated or triple coated peppermint oil capsules otherwise the peppermint can cause relfux. Two good studied brands are IBGuard and Colpermin, but you can also find ginger and peppermint oil capsules combined.

Low Dose Naltrexone

LDN is also another prokinetic(11) we use for SIBO prevention of relapse, but is showing promise in gastroparesis(12). However, side effects are common including nausea, so you have to build up slowly and work with a practitioner who is well versed in the treatment.

Mindful fat and fibre intake

The typical dietary recommendation is to reduce fat and fibre intake because both slow down gastric emptying.(13) This can be a challenge to do both in terms of quality of life but also nutritional intake, so it really needs to be done with the support of a dietician or nutritionist.

Low FODMAP diet

Whilst the low FODMAP diet hasn’t as of yet been specifically studied for gastroparesis, it has been studied in functional dyspepsia which creates feeling of early fullness and bloating after meals, and was shown to improve symptoms in 67% of patients in one of the studies.(14)

It’s also a typical recommendation for people with HEDS and or POTS who also have gut symptoms, and I’ve already released a podcast episode on that so I’ve linked to that in the show notes.(15)

Blood sugar management

High blood sugar can slow down gastric emptying, so blood sugar management is also a recommendation.(16)

Easy to digest foods i.e. pureed, soft, etc.

Research has shown that liquid meals can be easier for this demographic to digest vs solid food, so think soups, stews, smoothies, etc.(17)

Small but frequent meals are also typically recommended in patients with POTS and/or hEDS and gastrointestinal symptoms, and in patients with delayed gastric emptying or gastroparesis. (18)

Digestive aids

Now this isn’t covered in the literature, but you could possibly try digestive aids like enzymes to help the process of breaking down food, making the movement of food easier. Clinically, patients report that these methods help a lot.

So, I wanted to highlight delayed gastric emptying and gastroparesis today because often, we might blame all of gut symptoms with hEDS and POTS on SIBO, because they do increase the risk of its occurrence. And whilst treating SIBO will help, it may not resolve all symptoms because when it comes to hEDS and POTS, there’s normally a few things affecting the gut, so for full symptom improvement, we need to investigate a few areas.

References:

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