If you frequently feel full quickly and have trouble with your stomach emptying very slowly, you may be experiencing gastroparesis. In this condition, your stomach takes too long to empty its contents leading to food sitting in your stomach, causing bloating, indigestion, a full feeling quickly with eating, nausea, vomiting, a loss of appetite, and other complications such as imbalances in your blood sugar.
This slow emptying of the stomach can be caused by several factors and may be temporary or long-lasting. Gastroparesis affects around 0.9% overall and 1.3% of diabetic individuals globally.
Treatment of this condition aims to allow your stomach to empty and ensure adequate nutrition and hydration. A functional medicine approach incorporates regular laboratory testing that can help monitor factors that are contributing to the slow emptying and guide treatment to ensure your body has the balance of nutrients and blood sugar it needs.
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What is Gastroparesis?
Gastroparesis means that the stomach is paralyzed or not working the way it should empty food into the rest of the digestive tract. This occurs because the nerves to the stomach are not working normally to stimulate muscles in the stomach that contract to propel food into the small intestine to be digested and absorbed in a timely manner.
The vagus nerve (cranial nerve ten) is the main nerve of the parasympathetic division of the autonomic nervous system, which works largely autonomously, without your conscious input, to control the "automatic" functions of the body that you do not consciously think about, including digestion. The vagus nerve innervates and stimulates your stomach muscles to propel food through the digestive tract via muscular movements known as peristalsis.
When the vagus nerve does not function normally, the movement of the stomach is slowed down or does not work at all. This results in food not leaving the stomach as quickly as it should, causing delayed gastric emptying or gastric dysmotility. This leads to symptoms of bloating, abdominal pain, nausea, and vomiting. This condition can also cause imbalances in blood sugar and nutrient levels.
What Causes Gastroparesis?
Although it is sometimes difficult to pinpoint the exact underlying cause, gastroparesis is usually caused by damage or malfunction of the vagus nerve. When the vagus nerve does not work properly, the stomach muscles do not receive proper signals to contract and empty, which can cause food to remain in your stomach longer than it should.
This can occur due to conditions that can damage the vagus nerve and its branches, including diabetes or abnormal control of blood sugar since consistently high glucose can cause vagus nerve damage (autonomic neuropathy).
In other cases, these nerves are damaged by surgery to the esophagus, stomach, or small intestine or by viral or bacterial infections. Hypothyroidism, connective tissue diseases like scleroderma or lupus, and disorders of the nervous system like Parkinson's disease, multiple sclerosis, traumatic brain injury, and stroke can also impair stomach emptying. Another reason gastroparesis can develop is due to malnutrition which may occur for several reasons, including as a result of eating disorders such as anorexia nervosa and bulimia.
Certain medications, including opioid pain medications, some antidepressants, high blood pressure and allergy medications, and tobacco, can slow the rate of stomach emptying to make gastroparesis worse or cause similar symptoms.
Gastroparesis Symptoms
Gastroparesis involves delayed emptying of the stomach, which can cause symptoms that can vary in severity, including:
- Pain in the upper abdomen
- Bloating
- Loss of appetite
- Nausea
- Vomiting
- Acid reflux, heartburn, or regurgitation
- Quickly feeling full after eating only a little food
- Unintended weight loss
When your stomach doesn’t empty properly, it can interfere with normal appetite, intake, and digestion. Over time, this can lead to complications involving imbalanced blood sugar levels and absorption of various nutrients. Unpredictable blood sugar levels often occur with gastroparesis due to an unstable rate and amount of food passing into the small intestine.
Malnutrition and dehydration may occur due to poor appetite and intake, as well as reduced absorption and ongoing vomiting. Since food sits longer than normal in the stomach, bezoars or collections of undigested food can collect, which hardens and remain in the stomach where they can block food from passing through.
Similarly, the slowed-down transit through the digestive tract can contribute to the development of dysbiosis and the development of small intestinal bacterial (SIBO) or fungal (SIFO) overgrowth.
What Are The Benefits of Regular Lab Testing For Patients Who Suffer From Gastroparesis?
Regular functional medicine laboratory testing can help analyze and monitor underlying factors that contribute to the slow stomach emptying that occurs in gastroparesis. In addition, regularly evaluating blood sugar and nutrient levels can help to guide treatment approaches to ensure your body has the balance of nutrients and blood sugar it needs to feel its best.
Top Labs To Run Bi-Annually On Patients With Gastroparesis
Since gastroparesis can impact the balance of microbes in the digestive tract, impact how the body regulates blood sugar, and impact levels of nutrients that are consumed and absorbed, functional medicine testing can help to monitor what is happening in the body to guide appropriate treatment.
Comprehensive Digestive Function
The Gut Zoomer stool test evaluates microbes in the digestive tract to assess overall balance and evaluate functional digestive status, which looks for signs of conditions like SIBO and metabolic imbalances that can occur with gastroparesis.
Similarly, a comprehensive stool test like the GI Effects reflects the overall health and balance of the digestive tract by assessing the levels of microbes and intestinal health markers. This test can help uncover dysbiosis, including overgrowth of Candida albicans that can occur when SIFO develops as a complication of gastroparesis. Retesting a few months after treatment can guide an individualized approach.
Small Intestinal Bacterial Overgrowth (SIBO)
The dysfunctional movement of the digestive tract that occurs in gastroparesis can set the stage for developing dysbiosis from bacterial imbalances like SIBO. A 3-hour SIBO assessment measures hydrogen and methane in the breath to detect the overgrowth of bacteria in the small intestine that can cause symptoms like bloating and nausea.
Blood Sugar Balance
Research shows that high blood glucose levels increase the risk for gastroparesis and gastroparesis by contributing to inflammation and damage to the vagus nerve. It can also make it more difficult to manage blood glucose levels since the slowed emptying can interrupt the regular, controlled release of glucose into your bloodstream.
Several laboratory tests can help look at how the body handles sugars, including fasting glucose and fasting insulin, and C-peptide, a marker that the body is producing insulin. In addition, hemoglobin A1c measures average blood sugar level over the previous six weeks and has been shown to correlate with the presence of gastroparesis.
Nutrition Status
Gastroparesis increases the risk of malnutrition and nutritional deficiencies due to decreased appetite, impaired digestion, and prolonged vomiting. This can contribute to increased comorbidities such as weight loss, electrolyte imbalances, and vitamin and mineral deficiencies.
Functional medicine laboratory testing can evaluate areas of concern. The NutraEval FMV measures antioxidants, fatty acids, vitamins, minerals, and other biomarkers to determine nutritional deficiencies and imbalances that can be targeted with nutrition changes and/or supplementation.
Additional Labs to Check
There are several ways to measure how quickly the stomach empties its contents into the small intestine that may be done to establish a diagnosis of gastroparesis. In some cases, these may be periodically repeated to monitor the condition and treatment progress.
Several methods are used to track how long it takes food to move through the stomach and intestinal tract.
With a gastric emptying breath test, you eat a specific food or liquid like lactose and later test to see if substances produced during digestion can be detected in your breath over several hours.
Scintigraphy is a scan that measures how the stomach is emptying. You eat a light meal with a small amount of radioactive material, and a scanner is used to follow the movement of the food through the gastrointestinal tract.
An upper Gi barium series (barium swallow) is another way to look at the movement of the stomach and how it is emptying.
A smart pill or wireless motility capsule is another alternative test to look at the inside of the gastrointestinal tract and track how long it takes things to move through.
An upper GI endoscopy uses a small camera on a scope to visualize the esophagus and stomach to assess the stomach and rule out other conditions that have similar symptoms to gastroparesis, such as peptic ulcer disease or pyloric stenosis.
In order to look at the functioning of the vagus nerve and branches to the stomach, electrical testing of nerve impulses to the stomach can be completed with an electrogastrogram (EGG).
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Summary
When the vagus nerve is not functioning optimally to stimulate the stomach muscles, food can take too long to empty out of the stomach. This condition is known as delayed gastric emptying or gastroparesis. Common causes of damage to the vagus nerve include diabetes, surgery, infections, or other medical conditions like hypothyroidism. As a result of the malfunction of stomach emptying, early fullness with eating, bloating, abdominal pain, nausea, and vomiting may occur.
Over time, this can lead to malnutrition and problems with regulating blood sugar levels. Functional medicine laboratory testing can help to monitor how the body is handling sugars and if levels of electrolytes, vitamins, and minerals are adequate. Regular testing can also help monitor underlying causes contributing to gastroparesis, like blood sugar imbalances or nutritional issues. In addition, functional medicine testing can help guide treatment for any related complications like SIBO or SIFO.
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