Gastroparesis, which literally means “stomach paralysis,” is a condition where the stomach takes much longer than normal to empty its contents into the small intestine. While gastroparesis can be caused by conditions like diabetes or viral infections, it’s also increasingly recognized in people struggling with eating disorders, particularly anorexia nervosa and bulimia nervosa. In these cases, the delayed gastric emptying may be a result of chronic malnutrition, electrolyte imbalances, and damage to the nervous system that regulates digestion.
In anorexia, the stomach—and the muscles and nerves that move food through the digestive tract—can weaken significantly due to prolonged calorie restriction and insufficient nutrients, particularly those that support nerve function (like thiamine, magnesium, and zinc). In bulimia, frequent purging through vomiting or laxative abuse can disrupt the gut’s coordination and damage the vagus nerve, which plays a key role in signaling the stomach to contract. Over time, this leads to symptoms like early satiety, bloating, nausea, reflux, and vomiting—hallmarks of gastroparesis.
While many people feel frustrated or discouraged by these symptoms, especially during the early stages of recovery when refeeding is already difficult, it’s essential to understand that this is often a functional and reversible problem—not permanent damage.
Nutritional Strategies for Managing Gastroparesis in Recovery
When working with clients recovering from anorexia or bulimia who are experiencing gastroparesis, nutrition must be carefully tailored. The goal is to maintain nutritional adequacy while minimizing discomfort. This often involves switching to small, frequent meals that are lower in fat and fiber, as these can slow gastric emptying further. Soft, well-cooked foods that are easy to digest—like mashed potatoes, broths, smoothies, scrambled eggs, and cooked cereals—are often tolerated better. Liquids tend to leave the stomach faster than solids, so incorporating high-calorie drinks (such as nutrient-rich shakes or medical nutrition supplements) can be helpful when intake is limited.
Importantly, healing the gut often parallels healing the eating disorder. As regular nourishment resumes and restrictive or purging behaviors stop, many people experience gradual improvement in gastric motility. Although the timeline varies from person to person, especially depending on the duration and severity of the eating disorder, the nervous system does have the capacity to regenerate and adapt over time. In some cases, medications that promote motility or reduce nausea may be used short-term, but nutritional restoration and behavioral recovery are the foundation of long-term healing.
Here is a sample menu for someone experiencing a gastroparesis flare-up, designed to be low in fat and fiber, gentle on the stomach, and nutritionally supportive—especially for individuals in eating disorder recovery. During a flare-up, the goal is to keep meals small, frequent (every 2–3 hours), and easy to digest, with an emphasis on hydration and caloric density without overloading the stomach.
Sample Gastroparesis Flare-Up Menu (6 Mini Meals/Day)
Upon Waking (Meal 1: Light Liquid Nutrition)
- 1 cup lactose-free or low-fat milk (or fortified almond/rice milk)
- ½ banana (mashed or blended)
- 1 scoop medical nutrition supplement (like Boost Breeze® or Kate Farms®)
Blended into a smoothie for easier digestion
Mid-Morning (Meal 2: Soft + Low-Fat)
- 1 small bowl of cream of wheat (made with water or lactose-free milk)
- 1 tsp sugar or maple syrup for flavor
- Weak herbal tea or warm electrolyte water
Lunch (Meal 3: Gentle Protein + Carb)
- ½ cup mashed potatoes (no skin, made with broth or low-fat milk)
- 1–2 oz poached or baked white fish or tender egg whites
- ¼ cup low-sodium broth
Mid-Afternoon (Meal 4: Easy-to-Digest Snack)
- ½ cup canned peaches or pears (packed in juice, not syrup)
- 4–6 saltine crackers
- Warm peppermint or ginger tea
Dinner (Meal 5: Blended or Pureed Option)
- 1 cup pureed vegetable soup (no chunks, made from peeled carrots, zucchini, or squash)
- 1 slice white toast with a thin layer of low-fat cream cheese or nut butter (if tolerated)
Evening (Meal 6: Nutritional Top-Off)
- 1 small rice pudding or lactose-free vanilla pudding
- Sips of electrolyte drink or warm water with lemon
Tips:
- Sit upright during and after meals (for at least 30–60 minutes).
- Avoid raw vegetables, high-fat meats, nuts, seeds, and carbonated drinks.
- Choose liquids or foods that liquefy at room temperature during flare-ups.
- Talk to a medical team about adding a prokinetic medication or anti-nausea aid if symptoms are severe.
Prognosis and Hope for Recovery
While gastroparesis symptoms can feel like a major roadblock to eating disorder recovery, they are often a sign of the body struggling to regain function after prolonged strain. The good news is that with consistent nourishment, medical oversight, and the cessation of harmful behaviors, many individuals see significant improvement in symptoms. Recovery takes time—and sometimes requires working around temporary discomfort—but the digestive system is incredibly resilient when given the right conditions to heal.
Call or visit the Nutrition Improvement Center for more information. We can help.
Sources:
- Norris ML, Harrison ME, Isserlin L, Robinson A, Feder S, Sampson M. Gastrointestinal disorders in children and adolescents with eating disorders: A review of the literature. Int J Eat Disord. 2016;49(3):216-232.
- Boyd C, Abraham S, Kellow J. Appearance and disappearance of functional gastrointestinal disorders in patients with eating disorders. Neurogastroenterol Motil. 2005;17(6):798-804.
- Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1589–1591.
- Zipfel S, Löwe B, Reas DL, Deter HC, Herzog W. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. 2000;355(9205):721-722.
