Gastroparesis Nutrition Strategies

Most of what we recommend when it comes to gastroparesis nutrition therapy is based on what we know about human physiology and how the stomach normally works and empties.

Gastroparesis is a chronic condition characterized by improper functioning of the muscles of the digestive tract, causing delayed stomach emptying and certain symptoms such as nausea, a feeling of fullness after eating only a small amount of food, vomiting undigested food— sometimes several hours after a meal, gastroesophageal reflux (GERD), abdominal pain, bloating, and a lack of appetite.  Causes of gastroparesis generally can be classified into three main categories: Diabetic (29%), post-surgical (13%), and idiopathic (36%); however there are other etiologies.(1)

The severity of gastroparesis (GP) varies from person to person so a “one-size fits all” dietary approach is not recommended nor useful in practice. If you have GP then it is essential to find out what works best for you. It is also important to keep in mind that GP is not a static condition, meaning symptoms can vary from week-to-week or even day-to-day. For example, during a “GP flare” one may experience a period of time where all he or she can take is liquids while previously solid foods were fine.

The treatment of GP often includes medications, dietary strategies, and lifestyle changes.  Regarding diet, what and how one eats can influence symptoms. There are various dietary modifications that can be used to help manage symptoms and ensure nutrient needs are met.

Some common and helpful gastroparesis nutrition strategies include:

*Pay attention to portion sizes: It is good to start with eating smaller, more frequent meals and snacks and monitoring symptoms. Avoid eating large meals as this will take longer to empty from the stomach and generally increases symptoms. Eating or drinking smaller, more frequent amounts throughout the day can not only help improve GI symptoms, but can help a person consume adequate nutrients (vitamins, minerals, calories) throughout the day. I would highlight that small, frequent meals does not equal grazing/snacking all day long. While this might work for some, in practice I have found this typically backfires and leads to overeating snack foods, reducing appetite at meals, and/or increases symptoms in the evenings.  Instead, try giving some time to digest food by spacing meals/snacks out by a couple of hours. The portion size of a meal is going vary from person to person and their specific tolerance, but I often suggest starting with ~1 to 1.5 cups of food per sitting and adjusting from there.

*Changing up the consistency of food: “Particle size” of food/meals is another important dietary strategy for those with GP. Small particle size meals have been shown to improve symptoms compared to large particle size meals in those with gastroparesis.(2,3)  Particle size refers to the consistency of foods. A small particle diet consists of foods that are “easy to mash with a fork into small pieces”.(2)  Some examples of small particle foods/meals: Pureed fruits & vegetables, vegetable pâté, fruit compote, hummus, smooth soups, smoothies, shakes, pudding, minced meat, a timbale, sauces, gravy, Shepherd’s pie, baked egg, silken tofu, mashed avocado, almond flour.(3)  Example of large particle size foods that were allowed in one study included “whole meat, seafood, cheese slices, almonds and nuts,  pasta, rice, grated vegetables, raw vegetable salad, wok vegetables, fresh fruit and bread with whole grain and / or sourdough”. (2)  The two studies that looked at the particle size of foods and symptoms, found small particle size foods/meals to be better tolerated than large particle size meals in people with diabetic GP. (2,3)  These studies highlighted low glycemic index (GI) foods, which are typically recommended  to those who have diabetes for blood glucose control, were tolerated when the food consistency was changed. Reducing particle size can be a helpful strategy to increasing nutrient-dense, lower GI foods if/when eating them in whole food form increases GI symptoms.

*Regarding diabetic GP: Optimizing blood sugar control is essential. High blood sugar (hyperglycemia), blood glucose >200 mg/dL, has been shown to worsen the symptoms of diabetic GP. (4) Additionally, wide fluctuations in blood glucose (ex: high blood sugars and after-meal low blood sugars) worsens gastric emptying more than continuously high blood glucose levels.(4) To improve glucose control: Check blood sugars regularly, keep a medication, food and blood sugar log, have good communication with an endocrinologist, certified diabetes educator, and dietitian. For more information on what to eat when you have gastroparesis and diabetes, check out my post: Managing Diabetes and Gastroparesis: Key Dietary Considerations

*Write it down: Try keeping a food and symptom journal to identify what foods are well tolerated and which ones are not. This is something you can show to your dietitian who can assess your overall nutrient intake and make recommendations based on types and timing of foods. If someone has diabetic GP then including blood sugars in this log is essential.

*Lower fat and lower fiber intake: High fat  foods & high fiber foods take longer to empty from the stomach than low fat foods and low fiber foods. Important: A lower fat, lower fiber diet does not mean you need to eat a fat free and/or fiber free diet.  For fat:  Liquid beverages with fat are easier to tolerate then solid fats and can be a good way to increase calories. For example: 2% or whole milk, soy milk, or oral supplements, small amounts of liquid oils (olive oil, canola oil, avocado oil). Avoiding/limitings fried foods and high fat meats such as bacon, hot dogs, salami, bologna, and sausage can be helpful to reducing symptoms. Regarding fiber: Fiber is found in whole grains, fruits, vegetables, nuts, seeds, and beans/peas. To make these nutrient-dense foods easier to tolerate try peeling of thick skins, cooking until fork-tender, limiting to ~1/2 cup per meal or snack, blending into a smoothie, trying canned versions and fruit/veggie squeeze pouches. Choose refined grains instead of whole grains and creamy nut butters versus crunchy.

For more information on how to get in more fruits and vegetables when you have gastroparesis check out my ebook: Eating Fiber Containing Foods with Gastroparesis: A Comprehensive Guide.

*Chew foods thoroughly when eating solids: Digestion starts in the mouth, chewing food well reduces the amount of work the stomach has to do.

*Hydration: Drink adequate fluids during the day to meet hydration needs. If vomiting, sip on Pedialyte, Propel, or Gatorade to replace electrolytes.

*Nausea: For some, ginger can alleviate nausea. Try using ginger tea, ginger chews (ie Gin-Gins®), fresh ginger added to smoothies, cooking with powdered or fresh ginger, or taking ginger capsules.

*Dental health: Do not brush teeth immediately after vomiting. When stomach acid comes in contact with our teeth it weakens or softens the enamel and brushing during this time can cause damage, over time this can lead to tooth erosion. Instead of brushing rinse with “water, a diluted mouth rinse, or a mixture of water and 1 tsp. baking soda” and wait at least 30 minutes to brush.(5)

Gastroparesis nutrition resources I like and use in practice:

Please let me know your experiences and/or any questions.

Thanks for reading.



  1. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18-37.
  2. Olausson EA – Am J Gastroenterol (2014) A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis a randomized controlled trial.pdf
  3. Olausson EA, Alpsten M, Larsson A, Mattsson H, Andersson H, Attvall S. Small particle size of a solid meal increases gastric emptying and late postprandial glycaemic response in diabetic subjects with gastroparesis. Diabetes Res Clin Pract. 2008;80(2):231-7.
  4. Sadiya A. Nutritional therapy for the management of diabetic gastroparesis: clinical review. Diabetes Metab Syndr Obes. 2012;5:329-35.
  5. American Dental Association.

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  1. Hi Emily,
    Thank you for your help blog! I was diagnosed with Gastroparesis in Dec. 2017. I am 52 years old. I have a wheat allergy so I try to eat gluten free. I am allergic to cows milk so I try to limit dairy. If I want to eat strawberries, would it be best to add them to a smoothie, or could I cut them into tiny pieces? I also have severe constipation. The only thing my GI told me was to increase my fiber. It’s been a challenge for me to do this. What are some other ways I can increase my fiber?

    • Hi Jennifer, Thanks for reading and your comment! How do you do with eating other fruits and vegetables, are there some you can eat in whole-food form if peeled or chewed well? Depending on the severity of your GP will influence how I would suggest trying new foods. For strawberries, starting with them blended up in a smoothie is a more conservative approach. You could do this and assess how you feel. Then the next day, if desired, try eating 1 or 2 whole, chewed very well or cut into tiny pieces. Regarding fiber, I would look at how much you are currently taking in and your symptoms. If you can tolerate it, try adding a little bit of fiber at a time throughout the day and see if that is helpful. All fruits and veggies contain fiber, oats, chia seeds, ground flax, and grains. Fruit cups or canned peaches and pears, applesauce, and peeled kiwi may be helpful for constipation. Working with your GI on optimizing your bowel regimen may also help, if not already done. Lastly regarding the constipation, have you heard of a squatty potty? Some of my patients have really found these helpful. If you feel like your struggling to consume a balanced diet with your food allergies and GP I would highly suggest meeting with a GI dietitian.

  2. Bonnie Watts

    Thank you so much for your blog on Gastroparesis nutrition. I have never been able to take meds so just manage with diet. You have now opened my eyes to ways that I can experiment with fruits and especially vegetables. I miss them so much. I want to follow your site from now on. I started my journey years ago with Crystal Starelli. She wrote the only books back then.

    • Hi Bonnie,
      Happy to hear you’re inspired to experiment with getting some fruits and vegetables back into your diet. 🙂 I am also a fan of Crystal Saltrelli’s books.

  3. Brenda Reavis

    Hi Emily,
    Thanks for your blog! Your information is great! I was diagnosed with gastroparesis last summer. I found Crystal Saltrelli just by chance on pinterest soon after my doctor called me to tell me I had this thing called “gastroparesis” and he told me I should “eat low fat, low fiber, white bread.. well.. just look it up” . So while looking it up, I happened across her on pinterest. I have spent a lot of time educating myself and trying to figure this thing out. I have found ginger tea and hard ginger candy to be very helpful during the bad days. Also I have a QueaseEASE that is helpful. I appreciate your tips on frequency of meals and grazing. My GI doctor told me to graze, which actually does not work for me at all. I have a protein shake in the mornings, and I add kefir and a banana to that, which works very well for me. I also have found that the orgain shakes work well for me. I have those for lunch sometimes, especially on days when I’m feeling especially bad. I’m just always looking for more information on diet. I can only eat just very small amounts, so I am just always looking for ways to make sure I am getting enough nutrition without getting sick. I’m looking forward to your next post. Thanks!

    • Hi Brenda! Really glad to hear you have found things that work well for you like the ginger, QueaseEASE, and shakes!

  4. Hi Emily, my 19 year old daughter has been struggling with Gastroparesis for over a year. She’s lost a lot of weight and her overall health is suffering. Her gastroenterologist is not a gastroparesis expert. How would you vet a doctor to find out how successful they’ve been with gastroparesis patients and treatment?

  5. Hi there. Good info. Yea so hit and miss.. I’m at a loss for nutrients and solids. Things that work before don’t now.

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