Find us on Google+ Gastroparesis: April 2018

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Monday, April 9, 2018

Addressing Emails Written to Me



I wanted to thank everyone for their emails. I am so sorry it's taken me so long to get back to you and to answer them. I am currently trying to answer as many as I can tonight, but will spend tomorrow trying to get you answers as well, if you still need them. I have emails going back to August. I want to apologize to all who have sent me emails. I hate making excuses but maybe if you understand what I'm going through, you'll understand.

I had to have several back surgeries. Because I bend repetitively to vomit, which is a reflex I cannot stop, I have slipped a disc, which lead to sciatica. It was very painful and resulted in a series of Facet Injections and then I had an RFA done on both sides of my spine to burn the nerves. It did help, greatly! The sciatica went away and I felt much better but I was having procedure after procedure because the doctor wanted to be safe and not do the RFA at the same time for both sides.

On top of all of that, my Gastroparesis has been really rough. I fell about two weeks ago, because my cat jumped on the bed and clawed my leg really hard and it startled me, so I jumped and hit my head on my nightstand and hurt myself pretty bad. I landed on my lamp and destroyed it, cutting myself on the bulb and glass shards. I also ripped the battery of my Spinal Cord Stimulator out of the pocket my doctor made for it. The battery is supposed to lay flat, but with me, it's protruding out of my back at about a 45 degree angle and is rather painful. So, I am working on getting this fixed.











These images made me laugh and I wanted to share them, especially the Simpson's one. I do feel like I'm under construction, but I'm going to fight through these surgeries and my Gastroparesis, and come out STRONGER!










Even though I have a lot going on - I Promise that I WILL check my email at: emilysstomach@gmail.com at least once a week on Mondays, if not more. I will definitely promise that. I am still catching up on emails and have already written some of you back. Please don't stop emailing me. If you have a question, I will do my best to answer it or refer you to someone who can. I love getting your emails. If I don't reply right away, please just be patient with me.










For those who have sent me their TIMELINES: http://www.emilysstomach.com/2013/05/progressional-timeline-of-gastroparesis.html


I have them and thank you so much for taking the time to do them and send them to me! I have a lot of them to go through but I cannot wait to go through them and let you guys know if I find any patterns or anything interesting. I know it's subjective because it's not medical records, and people's memories can be tricky, but it might spark a conversation or inspire doctors to do a research project like this regarding Gastroparesis.


So, from the bottom of my heart, thank you!


Heidelberg pH Test

What is a Heidelberg pH Test? A friend mentioned he had this test on a comment on one of my pages on Facebook. I had never heard of this test before, so I wanted to do some research into it. As it turns out, this test really does encompass a wide range of things it tests for. It reminds me of the Smart Pill test, in a way, but broadened. So, after reading about it, below is the information I found concerning the test.




According to Heidelberg Medical,

"What is a Heidelberg pH Test?

The Test will accurately verify the presence of a common Digestive Disorder

The Physician will require a complete Medical History before the Test

There will be a Transceiver that is placed over the Patient’s stomach during the test.

The pre test instructions will help achieve the most accurate results.

There is no discomfort during a Heidelberg pH test. Patients are relaxed and comfortable.

Remember to grab a good old fashioned distraction to pass the time.

Due to wireless interference, cell phones and personal electronic devices may need to be powered off.

The results are immediate so the Physician may have the post test consultation the same day.






Image Source: http://www.phcapsule.com/physicians/system-configurations/





Heidelberg pH Diagnostic Test will accurately verify the presence of low stomach acid production, high stomach acid production, no acid in the stomach, Dumping Syndrome, Acute or sub Acute Gastritis, Heavy Mucus in the stomach, and Pyloric insufficiency.

The Test is accomplished by measuring the time it takes for the acid producing cells (Parietal Cells) in the stomach to produce the required Hydrochloric acid. The strength of the acid (pH) is also measured during the test.

Patients are required to complete a consent form for the Physician’s Office Staff. If you have reservations about having a pH test, please discuss them with the Physician. Mental anguish and stress will only alter the test results.

The Technician will calibrate the pH Capsule to ensure it accurately records the pH values. The Technician will then place a transceiver over the Patient’s stomach. The transceiver receives and transmits the information from the pH Capsule and sends it wirelessly to the computer where the information is displayed. The nurse will rinse the pH Capsule and give it the Patient to swallow with a sip of water.

There is no discomfort during a Heidelberg pH Test. Patients are asked to relax and get comfortable while the test is being done. Remember to grab a good old fashioned distraction to pass the time.

Results are ready for the Physician to review as soon as the Technician ends the Test. Many Physicians opt to have a post test consultation as soon as the test is complete. In many cases the doctor will establish a treatment protocol on the same day. In many instances, after testing and treatment, patients stated that they feel better and healthier in just two or three days.


Unlike other procedures, the Heidelberg pH diagnostic test is an in-office procedure that does not require sedation or the use of a stomach tube.

There is no trauma or discomfort associated with our test, and the results of the Heidelberg test are available to the doctor as soon as the test is complete. Why go through an unpleasant procedure like the nasal-gastric intubation, when you can have a Heidelberg Diagnostic test?




Physicians

As the examining Physician, you will always hear a wide spectrum of complaints from your patients. By adding The Heidelberg pH Diagnostic System to your method of testing, you can be assured of having a comprehensive overview of the patients’ first stage of digestion. We believe you will find that the results of your treatment protocols will be enhanced from the pH data, which this test provides. There is no guess work involved and the test results are reproducible.

When the total digestive system is in pH balance, You can expect higher levels of conversion and absorption of ingested foods and medications. In addition, you can expect an appreciable enhancement of the patient’s immune systems! This is a very encouraging step for all aspects of successful treatment! The digestive system supports the immune system. Without proper conversion and absorption of the foods, medications, and supplements, the immune system cannot function at its optimum level. The Heidelberg pH Diagnostic System can be used to bring the first stage of digestion to its optimum performance level for good conversion and absorption.





Researchers

The Heidelberg Diagnostic technology has been used over the past 39 years by Researchers and Pharmaceutical companies throughout the world.

Some of the recognized Pharmaceutical companies are; Pfizer (Global Research and Development), Boehringer Ingelheim, Tap Pharmaceuticals, Bayer, Merck, Glaxo, SmithKline and Novo Nordisk (Denmark).

When a pharmaceutical company develops a new medication, they use the Heidelberg diagnostic system to perform pharmacokinetic studies to determine the activity of the medication on the human body. This is where, in many cases, the Heidelberg technology becomes a valuable research tool, in assuring the safety of a newly developed medication. These studies are use to determine bodily absorption, distribution, metabolism and excretion of drugs.

Before testing newly developed medications on humans, many pharmaceutical companies test their products on animals. Tests on animals include the use of swine, dogs, monkeys, etc. As part of their approval process, the Food and Drug Administration (FDA) requires testing of many newly developed medications in humans before being approved for use in the open market.

Researchers in many medical teaching colleges and research facilities use the Heidelberg Diagnostic system for testing the side effects of drugs. They also monitor the body pH when testing new vaccines to counter the effect of contagious diseases.

The Pharmaceutical Grade Heidelberg Diagnostic system can be configured to test from 1 to 8 subjects at the same time without interaction. Custom built systems can be configured to test 16 or more subjects at the same time without interaction.

Our current Bibliography of research studies contains over 150 published studies, conducted by researchers, pharmaceutical companies, clinicians, medical teaching colleges and hospitals. A copy of these studies are available upon request.





Image Source: https://sites.google.com/a/wyckoffschools.org/food-lab/digestion-and-ph






Heidelberg pH Diagnostic Systems

The Portable Heidelberg pH Diagnostic System is an innovative system that is ideal for any busy practice, where a stationary desktop computer system would have it’s limitations. It can be transported from one room to another, or from one facility to another. The dedicated laptop computer, and a compact micro-jet printer, is placed on a movable medical grade laboratory cart that has lockable casters, with an Uninterrupted Power Supply (UPS system), with an 8 foot electrical cord. The laboratory cart has a built security feature that allow you to safely store your computer, printer and other equipment in a lockable storage cabinet, when they are not being used. The portable Heidelberg pH Diagnostic System can be used for single, or multiple, patient pH Diagnostic Testing.

The standard clinical grade Heidelberg Diagnostic systems can be configured to test from 1 to 8 patients simultaneously without interaction. Our custom built systems can be configured to test from 1 to 16 patients at the same time without interaction.




Image Source: http://www.phcapsule.com/





Exclusivity

The FDA requires that system operators (nurses or technicians) be training in the use of the system and do testing under the supervision of a licensed physician. Third party reimbursement depends on individual states and individual insurance companies, and the form in which the CPT coding is submitted.

The Heidelberg pH Capsule package insert reads: CAUTION: Federal law restricts this device to sale only by, or on the order of a qualified physician. A patient history and examination are required before administering this diagnostic test.

Example: Crohn’s Disease, or any history of intestinal blockage, adhesions and/or history of bleeding.


We are active with clinical pharmacology and pharmacokinetic research studies with major universities and major American and European pharmaceutical companies.

View our testing software simulation.


Included…

Medical Grade Lab Cart
Dedicated Laptop Computer
Heidelberg Interface Module
Heidelberg Digital Transceiver
Portable Ink Jet Printer
Comprehensive Technical Training Videos
Comprehensive Technical Training Manual
Heidelberg Testing Program CD Package
Capsule Calibration Test Fixture
1 Pint (500 mL) pH 1 Calibration Solution
1 Pint (500 mL) pH 7 Calibration Solution
Uninterrupted Power Supply(UPS System)
Additional Equipment…


pH Capsule Locator

The per test disposables are pH capsules, distilled water and Saline. Everything else necessary, for over a hundred pH tests, is included with the system purchase."






Image Source: http://www.phcapsule.com/patients/faqs/

Cortisol: Understanding and Coping with Stress

Some people may not be aware that your body stores a hormone called Cortisol. This hormone in your body, as explained to me by an Emergency Room doctor, is your body's main stress hormone. It controls your mood, fear, and motivation. Since I was only given a brief explanation of cortisol in the Emergency Room, I decided to write an article about it to help spread the knowledge around, but also give techniques and coping mechanisms to help you in times of stress.


According to an article from The Mayo Clinic,

"Chronic Stress puts your health at risk

Chronic stress can wreak havoc on your mind and body.

Your body is hard-wired to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today, but that doesn't mean that life is free of stress.

On the contrary, you undoubtedly face multiple demands each day, such as shouldering a huge workload, making ends meet and taking care of your family. Your body treats these so-called minor hassles as threats. As a result you may feel as if you're constantly under assault. But you can fight back. You don't have to let stress control your life.



Understanding the natural stress response

When you encounter a perceived threat — a large dog barks at you during your morning walk, for instance — your hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol.

Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.

Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.

When the natural stress response goes haywire
The body's stress-response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels, and other systems resume their regular activities.

But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all your body's processes. This puts you at increased risk of numerous health problems, including:

Anxiety
Depression
Digestive problems
Headaches
Heart disease
Sleep problems
Weight gain
Memory and concentration impairment
That's why it's so important to learn healthy ways to cope with the stressors in your life.


Why you react to life stressors the way you do


Your reaction to a potentially stressful event is different from anyone else's. How you react to stressors in your life is affected by such factors as:

Genetics. The genes that control the stress response keep most people on a fairly even keel, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes.

Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be particularly vulnerable to stress. The same is true of people who have experienced violent crime, airplane crash survivors, military personnel, police officers and firefighters.

You may have some friends who seem laid-back about almost everything and others who react strongly at the slightest stress. Most reactions to life stressors fall somewhere between those extremes.



Learning to react to stress in a healthy way

Stressful events are a fact of life. And you may not be able to change your current situation. But you can take steps to manage the impact these events have on you.

You can learn to identify what stresses you and how to take care of yourself physically and emotionally in the face of stressful situations.



Stress management strategies include:

Eating a healthy diet and getting regular exercise and plenty of sleep
Practicing relaxation techniques such as trying yoga, practicing deep breathing, getting a massage or learning to meditate
Taking time for hobbies, such as reading a book or listening to music
Fostering healthy friendships
Having a sense of humor
Volunteering in your community
Seeking professional counseling when needed
The payoff for learning to manage stress is peace of mind and — perhaps — a longer, healthier life."




Source: Cortisol Pathway




According to the American Psychological Association,


"Stress Weakens the Immune System


What the Research Shows

Stressed out? Lonely or depressed? Don't be surprised if you come down with something. Psychologists in the field of "psychoneuroimmunology" have shown that state of mind affects one's state of health.

In the early 1980s, psychologist Janice Kiecolt-Glaser, PhD, and immunologist Ronald Glaser, PhD, of the Ohio State University College of Medicine, were intrigued by animal studies that linked stress and infection. From 1982 through 1992, these pioneer researchers studied medical students. Among other things, they found that the students' immunity went down every year under the simple stress of the three-day exam period. Test takers had fewer natural killer cells, which fight tumors and viral infections. They almost stopped producing immunity-boosting gamma interferon and infection-fighting T-cells responded only weakly to test-tube stimulation.

Those findings opened the floodgates of research. By 2004, Suzanne Segerstrom, PhD, of the University of Kentucky, and Gregory Miller, PhD, of the University of British Columbia, had nearly 300 studies on stress and health to review. Their meta-analysis discerned intriguing patterns. Lab studies that stressed people for a few minutes found a burst of one type of 'first responder' activity mixed with other signs of weakening. For stress of any significant duration - from a few days to a few months or years, as happens in real life - all aspects of immunity went downhill. Thus long-term or chronic stress, through too much wear and tear, can ravage the immune system.

The meta-analysis also revealed that people who are older or already sick are more prone to stress-related immune changes. For example, a 2002 study by Lyanne McGuire, PhD, of John Hopkins School of Medicine with Kiecolt-Glaser and Glaser reported that even chronic, sub-clinical mild depression may suppress an older person's immune system. Participants in the study were in their early 70s and caring for someone with Alzheimer's disease. Those with chronic mild depression had weaker lymphocyte-T cell responses to two mitogens, which model how the body responds to viruses and bacteria. The immune response was down even 18 months later, and immunity declined with age. In line with the 2004 meta-analysis, it appeared that the key immune factor was duration, not severity, of depression. And in the case of the older caregivers, their depression and age meant a double-whammy for immunity.

The researchers noted that lack of social support has been reported in the research as a risk factor for depression, an insight amplified in a 2005 study of college students. Health psychologists Sarah Pressman, PhD, Sheldon Cohen, PhD, and fellow researchers at Carnegie Mellon University's Laboratory for the Study of Stress, Immunity and Disease, found that social isolation and feelings of loneliness each independently weakened first-year students' immunity.

In the study, students got flu shots at the university health center, described their social networks, and kept track of their day-to-day feelings using a handheld computer (a new technique called "momentary ecological awareness"). They also provided saliva samples for measuring levels of the stress hormone cortisol. Small networks and loneliness each independently weakened immunity to a core vaccine component. Immune response was most weakened by the combination of loneliness and small social networks, an obvious health stress facing shy new students who have yet to build their friendship circles.



What the Research Means

Emerging evidence is tracing the pathways of the mind-body interaction. For example, as seen with the college students, chronic feelings of loneliness can help to predict health status -- perhaps because lonely people have more psychological stress or experience it more intensely and that stress in turn tamps down immunity. It's also no surprise that depression hurts immunity; it's also linked to other physical problems such as heart disease. At the same time, depression may both reflect a lack of social support and/or cause someone to withdraw from social ties. Both can be stressful and hurt the body's ability to fight infection.

All of these findings extend what we know about how stress management and interpersonal relationships can benefit day-to-day health, doing everything from helping us combat the common cold to speeding healing after surgery. The research is in synch with anecdotal reports of how people get sick in stressful times, but understanding exactly how psychology affects biology helps scientists to recommend the best ways we can build up immunity.



How We Use the Research

Managing stress, especially chronic or long-term stress (even if it's not intense), may help people to fight germs. When burdened with long-term stressors, such as caring for an elderly parent or spouse with dementia, health can benefit from conscientious stress management.

Kiecolt-Glaser and Glaser confirmed this hopeful option by comparing the immune function of exam-stressed medical students given hypnosis and relaxation training with that of students without training. At first, the immune responses of the two groups appeared to both go down. However, closer inspection revealed that some students took this exercise more seriously than others. Those who didn't take relaxation training seriously didn't fare so well; those who practiced conscientiously did actually have significantly better immune function during exams than students who practiced erratically or not at all.

Finally, the newest findings on social stress underscore the value of good friends; even just a few close friends can help someone feel connected and stay strong. Social ties may indirectly strengthen immunity because friends - at least health-minded friends -- can encourage good health behaviors such as eating, sleeping and exercising well. Good friends also help to buffer the stress of negative events.



Sources & Further Reading

Edwards, K.M., Burns V.E., Reynolds, T., Carroll, D., Drayson, M., & Ring, C. (2006). Acute stress exposure prior to influenza vaccination enhances antibody response in women. Brain, Behavior, and Immunity, 20:159-68.

Glaser, R., Sheridan, J. F., Malarkey, W. B., MacCallum, R. C., & Kiecolt-Glaser, J. K. (2000). Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosomatic Medicine, 62, 804-807.

Glaser, R., Robles, T. F., Malarkey, W. B., Sheridan, J. F., & Kiecolt-Glaser, J. K. (2003). Mild depressive symptoms are associated with amplified and prolonged inflammatory responses following influenza vaccination in older adults. Archives of General Psychiatry, 60, 1009-1014.

Kiecolt-Glaser, J. K., Glaser, R. (1993). Mind and immunity. In: D. Goleman & J. Gurin, (Eds.) Mind/Body Medicine (pp. 39-59). New York: Consumer Reports.

Kiecolt-Glaser, J. K., & Glaser, R. (2002). Depression and immune function: Central pathways to morbidity and mortality. Journal of Psychosomatic Research, 53, 873-876.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T., & Glaser, R. (2002). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70, 537-547.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T., & Glaser, R. (2002). Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosomatic Medicine, 64, 15-28.

Pressman, S. D., Cohen, S., Miller, G.E., Barkin, A., Rabin, B. S., Treanor, J. J. (2005). Loneliness, Social Network Size and Immune Response to Influenza Vaccination in College Freshmen, Health Psychology, 24, pages.

Robinson-Whelen, S., Tada, Y., MacCallum, R. C., McGuire, L., & Kiecolt-Glaser, J. K. (2001). Long-term caregiving: What happens when it ends? Journal of Abnormal Psychology, 110, 573-584.

Segerstrom, S. C. and Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, Vol. 130, No. 4."




Source: Cortisol Effects.





According to the Cleveland Clinic,

"Understanding and Managing Gastroparesis


Description

Gastroparesis is rapidly becoming a common diagnosis. This mysterious illness reduces the ability of the stomach to empty its contents. It can be especially detrimental to people with diabetes.

Gastroparesis is caused by damage to the vagus nerve. In its normal state, the vagus nerve contracts (tightens) the stomach muscles to help move food through the digestive tract. In cases of gastroparesis, the vagus nerve is damaged by diabetes and/or high blood pressure. This prevents the muscles of the stomach and intestines from working properly, which keeps food from moving from the stomach to the intestines. Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease, but you can manage it and keep it under control.



About the Speaker

Michael Cline, DO, was appointed to Cleveland Clinic in 2012 with the department of Gastroenterology and Hepatology. Dr. Cline completed medical school at Ohio University College of Osteopathic Medicine in Athens, Ohio. His specialty is gastroparesis, and he offers treatments such as colonoscopy, gastric pacemaker, gastric pacer, and other general treatments and services for gastrointestinal diseases.




Let’s Chat About Gastroparesis

The Bottom Line


SamSeven: What is gastroparesis?

Michael_Cline,_DO: If you split gastroparesis into two words, it is by definition: Gastro (stomach) paresis (paralyzed) = slow stomach.

MapleLeaf: What are the symptoms of gastroparesis?

Michael_Cline,_DO: The typical systems are nausea, vomiting, abdominal pain, bloating and belching.

keroppi: Can gastroparesis cause pain on the left side, about an inch under your rib, that tends to worsen after eating? I've had this for years since I've been diagnosed. (Ultrasound, MRI and PET scan were done around that time, and were all normal.)

Michael_Cline,_DO: Gastroparesis can cause pain in some patients, but other sources including neurologic causes need to be ruled out.

Tests and Diagnosis
Fullmoon: Are their certain tests that will confirm I have gastroparesis? Are these tests accurate?

Michael_Cline,_DO: Basically, nuclear gastric emptying and a test called the wireless motility capsule are used. There can be a problem with the nuclear test, depending on how it is done. To be accurate, it really has to be a four-hour test done with scrambled eggs and nothing else.

ycco: Is a gastric emptying test not sufficient to diagnose gastroparesis? I had an abnormal one more than ten years ago and was told I just had "slow motility". Fast forward to three years ago when my health (not just my stomach) took a turn for the worse, I learned about gastroparesis, and it makes me wonder why I was never given the diagnosis back then, as I had the "classic symptoms" and an abnormal gastric emptying test. Thank you.

Michael_Cline,_DO: The gastric emptying test, if it is done the right way (four hours and with solid food), is one of the better tests we have. The problem is it does not coordinate with symptoms, so if it is abnormal, the numbers don't really mean anything.

holleywilliams: What is a good indicator of the need to move ahead to enteral feeding, a percent of weight loss over a defined period of time? Or would it be the length of time without adequate oral intake?

Michael_Cline,_DO: Typically, we don't want patients to lose more than 10 percent of their ideal body weight in three to six months. Another parameter is abnormal lab work suggesting malnutrition.

Fremont: Is the gastric emptying study the only way to diagnose gastroparesis? I've had it three times by three different providers. Two diagnosed mild gastroparesis, the third said it was normal (Mayo Clinic). I understand this test only represents how your stomach empties that particular day. I have pretty major symptoms and get so full so fast, can really only eat one meal and graze the rest of the day. I've also had obstructions just below the stomach. Is this related? Are there other tests that can accurately diagnose this condition?

Michael_Cline,_DO: Your history of having had multiple tests with various outcomes is fairly consistent with what we see regularly. That is one of the problems with the nuclear emptying test, especially when it’s borderline normal/abnormal, in proving whether or not someone truly has gastroparesis.

holleywilliams: Can you be more specific about what you mean by "global dysmotility" and "diffuse dysmotility”? What tests other than gastric emptying should be performed?

Michael_Cline,_DO: By global motility or diffused motility, I mean more than one area of the intestine. The most direct way to rule it out would be the smart pill. For more information, please read: Gastroparesis: ‘Smart’ Pill Uncovers This Mysterious Stomach Condition.

AOddone: What's included in a full gastroparesis/motility work-up?

Michael_Cline,_DO: There is a battery of lab tests looking for autoimmune antibodies that could be related to the motility disorder. Typically, patients will have an EGD or an x-ray of the intestine to rule out anatomic problems. If we are working-up a generalized motility problem, we would go to the smart pill test.









Multiple Maladies

AngelaOddone: What experience do you have treating patients whose gastroparesis is caused by Ehlers-Danlos syndrome in which there are multiple causes. These include poor vagal tone, stretchy tissues in the circulatory and gastrointestinal systems, mast cell activation syndrome causing inflammation, SIBO, leaky gut and endocrine issues such as adrenal fatigue and Graves or Hashimoto's resulting in hypothyroidism?

Michael_Cline,_DO: Ehlers-Danlos syndrome is not an uncommon cause of gastrointestinal dysmotility, and frequently leads to a diffuse motility disorder, not just gastroparesis. SIBO (small intestinal bacterial overgrowth) is a marker of small bowel dysmotility also.

DizzyGirl: I have gastroparesis related to POTS (postural orthostatic tachycardia syndrome) and EDS3 (Ehlers-Danlos syndrome type 3). The only thing that has been suggested for me is to "occasionally" take domperidone. I am a little nervous about taking it with my current drugs for POTS, and I really want something that will help me every day. Are there any other options or natural remedies that can be used to reduce the pain and nausea I have every day?

Michael_Cline,_DO: There are no real natural remedies that seem to be effective. It is very important when you have POTS and EDS3 that you rule out global dismotility.

sonjat: Good Morning. I was wondering if you see a lot of gastroparesis in patients with Sjogren's or other autoimmune conditions. Also, what symptoms do you typically see with this condition? Would excessive bloating and constipation be included? Would this condition cause shortness of breath or "air hunger" symptoms? Thank you.

Michael_Cline,_DO: The gastroparesis is directly linked to the autoimmune disease. We have to make sure, especially in someone who has constipation, that the entire gut is not involved. Typically, gastroparesis does not affect breathing or the heart. The autoimmune disease can, but gastroparesis won't.

keroppi: Is SFN (small fiber neuropathy) a known cause of gastroparesis? Is there any way to prevent the progression of gastroparesis if you don't know the cause? What if you just have idiopathic SFN, or mito issues?

Michael_Cline,_DO: There is an association with SFN and gastroparesis. Typically, SFN has to be fairly advanced to get gastroparesis, and unfortunately, there is no way to prevent it from affecting your stomach.

vateton: I was diagnosed with gastroparesis after a very slow stomach emptying test (eight percent vs. 50 percent normal), but I also have confirmed small fiber neuropathy. Is it possible that the diagnosis is incorrect, and I should consider dysautonomia? What tests will help me differentiate these diseases?

Michael_Cline,_DO: I think this will be best worked-up by a neurologist who specializes in small fiber neuropathy, because gastroparesis can be present in both.

WaveWolf: I am a T9 incomplete paraplegic and also have diagnoses of multi-systemic sarcoidosis (cause of paralysis), RA and several other autoimmune conditions. I have steroid-induced diabetes, which is managed with a strict diet and a chromium supplement. I eat small meals, but try to include fiber as part of managing my bowels and avoiding constipation. In eight years, I have not achieved a regular bowel program. I cannot maintain stool consistency, have a lot of gas and pain (from gas or from partial obstruction), but do not have much nausea or any vomiting unless I eat too much fat, too much food, or sweets. Should I be tested for gastroparesis?

Michael_Cline,_DO: Given the complexity of your history, it is best served to see you in the clinic. Appointment information will follow the chat.

Diet and Digestion
A-Aron: What are the basics of a gastroparesis diet?

Michael_Cline,_DO: It includes low-fat and low-fiber foods and frequent, small meals. Depending on the severity of symptoms, we use liquid nutrition as well.

DizzyGirl: Is the low-FODMAP diet at all beneficial for people with gastroparesis?

Michael_Cline,_DO: I am not a fan of the low-FODMAP diet. It goes in and out of favor, but had never really shown to do much for gastroparesis. It is also a very restrictive diet and is very difficult for patients to stay on long-term.

DizzyGirl: For mild gastroparesis linked to POTS and EDS3 (I am able to eat smaller amounts of solid foods, but have lots of pain and nausea), are there any "diets" that can help?

Michael_Cline,_DO: Stick to a low-fat, minimum fiber diet.

lgmac: How can my obese husband lose weight and keep his bowels moving? He bulks up with kidney beans and rye/wheat bread to keep his bowels going now. He has internal hemorrhoids, gastroparesis, paruresis, history of DVT, and CIDP, and won't eat any "rabbit" food. He says he can't take Miralax. Help!

Michael_Cline,_DO: When a person has gastroparesis, keeping the bowels moving is difficult because the diet becomes primarily carbohydrates. The rabbit food is much harder to digest, and if the stomach is not emptying it, it could make things dramatically worst. I would recommend a nutrition evaluation for weight loss along with a full gastroparesis/motility work-up followed by treatment of whatever is found.

liesel: I am a 77-year-old female. I live a very healthy life; I eat healthy and exercise daily. I do have heart disease and high blood pressure and take metoprolol ER 25mg and Losartan 50mg. I do NOT have diabetes. As long as I can remember, I have had problems with constipation. For the last year, I have constant difficulty with emptying completely. I always have the feeling that I need to go again. I go at exactly the same time every morning, right after one cup of coffee. But in the evening, I have the urge again and feel as if I am constipated to the point that I have been using glycerin suppositories, sometimes with good results and other times with more pain than stool. I do take a daily dose of Miralax and also drink plenty of water. Is there anything else I could be doing?

Michael_Cline,_DO: Given the complexity of your history, it is best served to see you in the clinic. Appointment information will follow the chat.









Talking Treatments

vateton: I started monthly IVIG infusions for small fiber neuropathy caused by sarcoidosis and found it positively impacted my gastroparesis. Is this ever used expressly for this purpose?

Michael_Cline,_DO: IVIG has now been shown to be effective in gastroparesis when there is a co-existing autoimmune disorder. We are using it more and more for gastroparesis.

Agurene: Dysautonomia and gastroparesis often appear together in patients. What is your recommendation for treating or managing gastroparesis in dysautonomia patients who cannot be exposed to neurotoxins in certain medications such as Reglan? What natural options are there – diet, supplements, lifestyle changes, etc. – that could help such patients?

Michael_Cline,_DO: Dysautonomia and gastroparesis frequently occur together. In dysautonomia patients, we have to rule out a global dismotility. We need the entire intestine, not just the stomach. There are very few natural substances that have been looked at. Ginger is used to help with gas, and there is a natural supplement called Imerogest that has been shown to be of some benefit to people. In dysautonomia, the biggest thing is to make sure we have the right diagnosis.

bafke: Is there any treatment that would help the vagus nerve work as close to normal as possible?

Michael_Cline,_DO: Unfortunately, not at this time. There is some research going on across the world in what's called vagal pacing.

DizzyGirl: I've heard some people mention that they have used Iberogast to manage their gastroparesis symptoms. Is that something you think would work or would recommend?

Michael_Cline,_DO: It is not well-studied, but has shown in case reports to be effective. There is really no harm in trying it. It's not going to hurt you, but it would really be trial-and-error process to see if it works for you.

Medication Messages
Iodine: What are some effective treatments for someone with EDS-related overall GI dysmotility, including gastroparesis?

Michael_Cline,_DO: When someone had general dismotility, the medical treatment options are limited. Two specific drugs we have available through the FDA are domperidone and Propulsid. They are drugs that have been designed to move more than just the stomach.

AOddone: Is domperidone FDA approved now? It wasn't a few years ago.

Michael_Cline,_DO: Domperidone is not FDA approved. We do have, however, through the FDA, a program to prescribe domperidone in the United States. It will not be covered by insurance and requires frequent office visits every eight weeks for the first year you're on the drug.

crystalclear: After being diagnosed with gastroparesis ten or 12 years ago, I took omeprazole every day until I read in 2016 that it could be linked to an increased risk of dementia. I have since read that those test results were inconclusive. What is your opinion about those test results? For a while (about a year), I seemed to be doing OK without the omeprazole, until about a month ago when the bloating returned. Should I risk taking the omeprazole again? It's been ten or 12 years since I've seen the gastroenterologist. Once one has been diagnosed with gastroparesis, do they always have gastroparesis?

Michael_Cline,_DO: Once you've been diagnosed with gastroparesis, it is very rare for it to go away. However, it may fluctuate in how severe the symptoms are. The article on dementia showed an association between Prilosec and dementia, but not a cause. In addition, that article used elderly patient and not young patients. So, the best answer would be to use the omeprazole as needed or as infrequently as you can to control the symptoms.





Diabetes Dimension

keroppi: Does gastroparesis affect hypoglycemic patients? Is it likely to cause more hypoglycemic episodes if it takes longer for food to digest and be converted to energy? If you're experiencing a hypoglycemic episode, will it take longer to correct and bring the blood sugar back to normal if digestion is slowed down?

Michael_Cline,_DO: It will make blood sugar control more difficult if you have gastroparesis, and it can activate hypoglycemia. So, it can mess with blood sugars significantly.

BEACHBABIES: Why and at what "stage" is gastroparesis linked to diabetes?

Michael_Cline,_DO: Typically, people with types 1 and 2 diabetes will have had diabetes for more than ten years prior to diagnosis. The more uncontrolled the diabetes, the higher the risk. One important factor with diabetes is the better the blood sugar control, the better the control of gastroparesis symptoms. Gastroparesis is almost never the initial complication of diabetes. Typically, the patient will have other neuropathy.






Specific Circumstances

gatorfrog: Six years ago, I had a subtotal colectomy because my food would not travel through. I don't know if that was gastroparesis or not, but since then, my food takes forever to digest, especially if I eat meat. I have Type 2 diabetes and am wondering what should I be doing or eating because of that? Is there something I should be looking out for and/or not eating? Thank you for any help.

Michael_Cline,_DO: Given the problems with the colon, the fact that you’re still experiencing symptoms and you have the risk factor of Type 2 diabetes, it will be a good idea to get the smart pill study to look at the motility movement of the entire GI tract.

keroppi: In the first few years of my gastroparesis diagnosis, my stomach puffing out after eating was one of the main symptoms. Once the food was digested, usually by the next morning, my stomach would be flat. Now, years later, I'm still waking up with the bloated/puffy belly, though it's smaller than the night before, it's still there, and the bigger the meal I've eaten the night before, usually the bigger the "morning belly”. Is it possible for gastroparesis to progress like this, where the food seems undigested even if it's been 17 hours after eating? I know it can be progressive in other ways, and I was wondering if this was the start? (I have mitochondrial dysfunction and presumed SFN.)

Michael_Cline,_DO: It is possible for it to progress, but more importantly, a work-up needs to be done to evaluate for more than just gastroparesis.

linbow: I had a Nissen Fundoplication (NF) in 2007. In 2009, I began losing weight (80 pounds total in almost a year), and was told my vagus nerve was damaged and was diagnosed with gastroparesis. In 2015, my heartburn and reflux returned, and I had a second NF done in June 2017. My stomach never seems to feel comfortable. Is this mainly due to my diet?

Michael_Cline,_DO: When there is post-surgical gastroparesis, the best approach would be further surgery on the stomach to allow it to empty faster. Typically, medication therapy is not very effective in post-surgery gastroparesis. Your condition probably is not diet related. A high-fiber diet will make symptoms worse, but you’re not going to manage the gastroparesis just by diet.

Clinic Connection
DizzyGirl: What is your normal regimen for patients you see with mild gastroparesis?

Michael_Cline,_DO: First, we do lab work and frequently follow up with tests to rule out causes of gastroparesis. Then, we will institute the four-stage diet with our multidisciplinary clinic. The patients will be evaluated for surgical options and pain management if they have pain issues. Also, we will consider behavioral medicine for non-pharmacological treatment and various medications based on other co-existing diseases and personal health.






Closing

That is all the time we have for questions today. Thank you, Dr. Cline, for taking time to educate us about Gastroparesis.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org."







Source:http://www.tothegrowlery.com/blog/2017/4/18/six-different-types-of-grounding-exercises-for-anxiety-intense-emotions





Source: (in addition to being on the image itself)https://twitter.com/pookyh/status/882951668882710528









According to Living Well,



"Grounding exercises

Grounding exercises are things you can do to bring yourself into contact with the present moment – the here and now. They can be quick strategies (like taking three deep 'belly breaths') or longer, more formal exercises (like meditation). Different strategies work for different people, and there is no 'wrong' way to ground yourself. The main aim is to keep your mind and body connected and working together.

People who have experienced childhood sexual abuse or adult sexual assault can sometimes be confronted by flashbacks or intense memories of what was done, to the point that they are feel as if they are back there, re-living the abuse all over again. A flashback is an example of being in the 'there and then' rather than the 'here and now,' so grounding exercises can help to bring you back.




Grounding exercises are a way for you to firmly anchor yourself in the present

Grounding exercises are helpful for many situations where you find yourself becoming overwhelmed or distracted by distressing memories, thoughts or feelings. If you find yourself getting caught up in strong emotions like anxiety or anger, or if you catch yourself engaging in stressful circling thoughts, or if you experience a strong painful memory or a flashback, or if you wake up from a nightmare with a pounding heart, grounding exercises can help bring you back down to earth.

It can be helpful to have a selection of grounding exercises that you can draw upon at different times. Just like no one technique works for all people, we often find that not all techniques work at all times. One thing you can do is look over some lists of grounding exercises and write down all the ones you think might work for you. Carry your personal list with you. Then, when you find yourself needing relief, you can run your eyes down your list and pick out the strategy that will be most helpful in that situation.

Speaking of lists, we have one of our own below.

The following grounding exercises are about using our senses – sight, hearing, smell, taste, touch – to reconnect our mind and body in the present. It is our basic human senses that remind us we are here now, and we are safe.

In working through the grounding exercises suggested here, you might find one or two that work for you. Keep in mind to only to use the exercises that you feel comfortable with.



List of grounding exercises

Remind yourself of who you are now. Say your name. Say your age now. Say where you are now. Say what you have done today. Say what you will do next.

'My name is ________, and I am 54 years old. I am in my living room, in my home, in Woolloongabba, in Brisbane, in Queensland. I woke up early today. I had a shower and fed my dog. I just finished my coffee and toast. Soon I am going to walk to the train station and go in to work. I am going to walk down ______ street and then turn left at the bike shop. Then I am going to….'

Take ten slow breaths. Focus your attention fully on each breath, on the way in and on the way out. Say number of the breath to yourself as you exhale.

Splash some water on your face. Notice how it feels. Notice how the towel feels as you dry.

Sip a cool drink of water.

Hold a cold can or bottle of soft drink in your hands. Feel the coldness, and the wetness on the outside. Note the bubbles and taste as you drink.

If you wake during the night, remind yourself who you are, and where you are. Tell yourself who you are and where you are. What year is it, what age are you now? Look around the room and notice familiar objects and name them. Feel the bed you are lying on, the warmth or coolness of the air, and notice any sounds you hear.

Feel the clothes on your body, whether your arms and legs are covered or not, and the sensation of your clothes as you move in them. Notice how your feet feel to be encased in shoes or socks.

If you are with other people, and you feel comfortable with them, concentrate closely on what they are saying and doing, and remind yourself why you are with them.

If you are sitting, feel the chair under you and the weight of your body and legs pressing down onto it. Notice the pressure of the chair, or floor, or table against your body and limbs.

If you are lying down, feel the contact between your head, your body and your legs, as they touch the surface you are lying on. Starting from your head, notice how each part of your body feels, all the way down to your feet, on the soft or hard surface.

Stop and listen. Notice and name what sounds you can hear nearby. Gradually move your awareness of sounds outward, so you are focusing on what you can hear in the distance.

Hold a mug of tea in both hands and feel its warmth. Don’t rush drinking it; take small sips, and take your time tasting each mouthful.

Look around you, notice what is front of you and to each side. Name and notice the qualities of large objects and then smaller ones.

Get up and walk around. Take your time to notice each step as you take one, then another.

Stamp your feet, and notice the sensation and sound as you connect with the ground.

Clap and rub your hands together. Hear the noise and feel the sensation in your hands and arms.

Wear an elastic band on your wrist (not tight) and flick it gently, so that you feel it spring back on your wrist.

If you can, step outside, notice the temperature of the air and how much it is different or similar to where you have just come from.

Stretch.

Notice five things you can see, five things you can hear, five things you can feel, taste, or smell.

If you have a pet, spend some time with them. Notice what is special and different about them.

Run your hands over something with an interesting texture.

Get a sultana, a nut, or some seeds, etc. Focus on how it looks, feels and smells. Put it in your mouth and notice how that feels, before chewing mindfully and noticing how it feels to swallow.

Put on a piece of instrumental music. Give it all of your attention.

If you have a garden or some plants, tend to them for a bit. Plants, and actual soil, can be an excellent 'grounder!'"





Source: https://www.slideshare.net/ShannonCayer/grounding-techniques-explained



A while back, my doctor at the Mayo Clinic gave me print outs on relaxation techniques. These are breathing exercises but they can be found here: http://www.emilysstomach.com/2013/07/relaxation-breathing-techniques-from.html

The grounding technique is also used to not only help with anxiety, but to help people with PTSD. I have never tried grounding techniques before but I will be glad to try them for a week and then keep a comprehensive journal so that I can report my findings and if it helped me or not. The breathing exercises tend to help me when I am having a really bad panic attack and/or to calm down after I vomit due to Gastroparesis.


For more information about Cortisol, please check out this presentation from Pharmaphedia: https://www.youtube.com/watch?v=EFQS7e75vxc




Gastroparesis and Eating Disorders Part Deux: What is the Difference?

I was watching a documentary about Amy Winehouse, and I had so much going on personally when she was going through her own troubles, that I did not give her a lot of thought. I was really sick, and knew there was something really wrong with me but the doctors who were testing me for different things could not find an answer, until 2012, when I was finally diagnosed with Gastroparesis. I had never heard of Gastroparesis before then and made it my mission to find out more about it, start my blog to keep track of research, and start Facebook pages and groups to help others who may have been diagnosed with the same.

I have been really sick the past week because of allergies to things growing, so I have a lot of mucus production, plus the nausea that comes with the mucus draining down my throat, and the throwing up of mucus and stomach acid because I have not been able to eat. I watch movies and listen to music to distract myself from the nausea, and I also use it to get me through the vomiting attacks. That sounds weird, I know, but it helps me to have something else to focus on. Because I have been sick for the past week, I've finally gotten to see Amy. I want to say that I have written about Gastroparesis vs Eating Disorders in the past, and you can read it here: http://www.emilysstomach.com/2015/04/gastroparesis-vs-eating-disorders.html.

I loved Amy Winehouse's music and her voice was a welcomed change at the time from the other voices already on the scene. She was not a part of a girl group, she did not look like a carbon copy of anyone, and she maintained her individuality. That is a feat that is hard to do in the entertainment industry when people are trying to market you, and are concerned with sales. I wanted to talk about her because something in her documentary bothered me more than anything else that was mentioned. She went to her mother and father, telling them about a diet she found where she could eat anything, and then vomit it all back up later. Her parents can be heard in the film saying they thought it would pass. However, it would not pass because it was bulimia.

According to National Eating Disorders (NEDA)

"Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.



Image Source: http://www.geronguide.com/gallery/index.php/Bulimia-Nervosa/bulimia-06




DIAGNOSTIC CRITERIA

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.




WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

Emotional and behavioral

In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Appears uncomfortable eating around others

Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

Skips meals or takes small portions of food at regular meals

Disappears after eating, often to the bathroom

Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others

Steals or hoards food in strange places

Drinks excessive amounts of water or non-caloric beverages

Uses excessive amounts of mouthwash, mints, and gum

Hides body with baggy clothes

Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

Shows unusual swelling of the cheeks or jaw area

Has calluses on the back of the hands and knuckles from self- induced vomiting

Teeth are discolored, stained

Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

Withdraws from usual friends and activities

Looks bloated from fluid retention

Frequently diets

Shows extreme concern with body weight and shape

Frequent checking in the mirror for perceived flaws in appearance

Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)

Extreme mood swings

Physical

Noticeable fluctuations in weight, both up and down

Body weight is typically within the normal weight range; may be overweight

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body

Thinning of hair on head, dry and brittle hair (lanugo)

Cavities, or discoloration of teeth, from vomiting**

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a 'true' period)

Poor wound healing


Impaired immune functioning





Image Source: https://anorexianervosaforpharmacists.weebly.com/eating-disorders.html





Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

Self-injury (cutting and other forms of self-harm without suicidal intention)
Substance abuse
Impulsivity (risky sexual behaviors, shoplifting, etc.)
Diabulimia (intentional misuse of insulin for type 1 diabetes)
Learn more about co-occurring conditions





Image Source: https://www.fullcirclehealthcareinc.com/eating-disorders.html





HEALTH CONSEQUENCES OF BULIMIA NERVOSA

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body."
**You can get the same dental effects from Gastroparesis, see my article: http://www.emilysstomach.com/2017/12/gastroparesis-effects-on-dental-health.html





Image Source: https://it.123rf.com/photo_71030037_la-bulimia-%C3%A8-un-disturbo-alimentare-binge-eating-e-tentativi-di-sbarazzarsi-del-cibo-consumato-segni-e.html




Image Source: http://gi-north.com/are-you-at-risk-for-gastroparesis/


I found this article while I was doing research on eating disorders and Gastroparesis. I thought it would bring hope to those who have both, or maybe just have an eating disorder. According to Mirror Mirror, Eating Disorder Help,

"GI Symptoms in Eating Disorders

Gastrointestinal (GI) complications are commonly seen with anorexia, bulimia and binge eating disorder. Heartburn, gas, bloating, early fullness, nausea, abdominal distention, rectal pain, constipation or diarrhea might be considered simply 'irritable bowel syndrome' – potentially delaying rapid diagnosis and treatment of an underlying eating disorder. Often referred to as functional gut disorders, there is an impairment in the body’s normal 'functioning,' such as delayed movement of food through the digestive tract, hypersensitivity of intestinal nerve cells, and the way in which a person’s brain responds to these stimuli (1). Re-feeding and in turn, recovery, is difficult physically as well as emotionally.


Anorexia Nervosa, Restricting-Type

gastrointestinal symptoms eating disorders

Prolonged food restriction causes muscular atrophy of the entire digestive tract. This leads to slow stomach emptying (called Gastroparesis) and is a direct cause of the trapped gas, bloating and abdominal distention seen with anorexia. Post-meal pain, pressure and constipation can be quite severe.

Consumption of sugar-free products and high fiber fruits and vegetables to blunt hunger can add to GI discomfort. Sorbitol — found in sugar-free gums and mints, and fructose –found in many fruits — can increase gas production. Psychological factors such as depression and/or anxiety, as well as pelvic floor dysfunction, can lead to heightened awareness of pain sensations in the gut, making the problem feel even worse (2,3).

A rare but documented cause of severe abdominal pain can be seen in extremely malnourished individuals. It is called Superior mesenteric artery (SMA) syndrome and is caused by compression of the artery by the first portion of the intestines called the duodenum (4). This is a medical emergency and therefore is imperative that individuals struggling with overcoming any type of eating disorder work with medical professionals to safely guide and monitor them.



Bulimia Nervosa

Purging can lead to a condition known as acute sialadenosis, in which the parotid glands become swollen and painful. This condition will cause an individual to have a characteristic “chipmunk-like” appearance. Treatment involves warm compresses, tart candies, and anti-inflammatory medication (5). Individuals struggling with bulimia also experience gas, bloating, indigestion and constipation as well as gastritis, an inflammation of the lining of the stomach causing upper abdominal pain.

Upper GI symptoms of acid reflux occur due to repeated bouts of self-induced vomiting. The valve (called a sphincter) that controls the connection between the stomach and esophagus becomes floppy, allowing stomach acids and partially digested foods to back up through the esophagus and into the throat. This is involuntary and may cause erosion of the mucosa of the esophagus, leading to a condition known as Barrett’s esophagus, a pre-cursor to esophageal cancer (3). Repeated bouts of self-induced vomiting can ultimately cause tears in the esophagus, referred to as a Mallory Weiss Tears. Vomiting blood is a very frightening experience and requires emergency medical care. Daily vomiting can put tremendous strain on the heart muscle resulting in arrhythmias, palpitations and death (4).

Bloodwork may show characteristic abnormalities more commonly seen when purging becomes frequent and habitual. The pancreas and liver enzymes may be elevated without other symptoms and electrolyte levels may be abnormal (5,6)

Difficulty swallowing is another problem commonly seen in anorexia and bulimia and may be related to the loss of muscle tone in the esophagus. It is important to see a physician when a patient complains of difficulty swallowing while increasing nutrition.




Image Source: http://www.eatingdisorderpro.com/2013/02/28/diabulimia/





Other purging disorders – Laxatives, Diuretics and Exercise

Laxative abuse has been reported in more than 1/3 of patients with eating disorders. Patients believe they are purging calories to stay thin, when in fact, most absorption of calories occurs in the small intestine. Most commonly (though not exclusively) seen in patients with bulimia, laxative abuse causes the bowel to become dependent on laxative stimulation to pass a bowel movement. Individuals who use laxatives, diuretics or both (to purge calories) become severely and chronically dehydrated. Kidney function can then suffer impairment from chronic depletion of blood flow due to dehydration. Stimulant laxatives work by irritating the nerves that stimulate the colon to cause frequent watery stools, while bulk-forming laxatives work by increasing stool mass to the point the bowels force it out.

This chronic overstimulation can cause complete bowel shutdown which is referred to as cathartic colon. Once a patient’s colon becomes incapable of transporting fecal material, they may require partial or complete colon resection, or even require a colostomy bag (7,8). Additionally, stopping these behaviors ‘cold turkey’ can cause extreme fluid shifts, renal shutdown and life threatening electrolyte imbalance. This is referred to as Pseudo-Bartters syndrome. (5,6) Medical practitioners need to carefully monitor patients as they wean off laxatives and diuretics for this reason. Over exercise is another form of purging behavior.



Rectal Prolapse

Rectal prolapse occurs when the rectum protrudes outside the opening of the anus. Although not a common feature, rectal prolapse has been seen in patients who binge and purge, and in patients suffering from severe constipation and/or laxative abuse.

Increased intraabdominal pressure from vomiting, among other factors such as medication, poor diet and low fiber intake contribute to this condition. Surgical treatment is the definitive treatment for recurring prolapse but steps to prevent further constipation are essential. (5,6)




Binge Eating Disorder

Individuals who binge-eat tend to have erratic and irregular eating patterns around all meals, in turn causing a host of GI symptoms including constipation, gas, bloating and diarrhea.

Patients with anorexia who binge eat are at risk for acute gastric dilatation. This is due to slow gastric emptying and overeating large volumes in the face of weakened stomach musculature. The large quantity of food exceeds the stomach’s ability to empty which obstructs of blood flow to the stomach and intestines. The result is potential rupture of the stomach (4). Symptoms include vomiting, severe abdominal distention and pain.




Practical Suggestions to Reduce GI Discomfort While Recovering

It is advisable to see a physician to evaluate the many causes of gastrointestinal distress. Although many symptoms mentioned resolve with normal eating, it is important to rule out the potentially serious GI issues we see commonly with eating disorders.

The best long term relief for the discomfort accompanying normalized eating at the start of recovery is to schedule meals, snacks and fluids at regular intervals, and to sit calmly and mindfully while eating. Often referred to as “the rule of threes” (7,8) it is advisable to consume three meals and three snacks, at least three hours apart. Re-introducing foods as well as any type of nutritional supplementation should be done under the proper care and guidance of a physician and the dietitian to collaboratively treat these problems in a multidisciplinary approach.



GI Symptoms in Eating Disorders



Constipation Relief

For people with eating disorders, adequate fluids and fiber are the first line treatment for chronic constipation. It is advisable to increase fiber intake slowly to avoid additional gas and bloating. Examples of fiber-rich foods include whole grain breads and cereals, bran, nuts and seeds, lentils, beans and some fruits and vegetables.

Patients who are continuing to struggle with constipation should consult with their physicians for any potential medication needs. The fact remains that with continued good eating over time, many of these GI complains will resolve.



Gas, Bloating and Cramping

Physicians will recommend simethicone (Gas-X) to help with gas pain, and recent clinical guidelines by the American College of Gastroenterology suggest the use of metoclopramide (Reglan) to help with slow gastric emptying (9). Metoclopramide increases muscle contractions in the upper digestive tract and speeds up the rate at which the stomach empties into the intestines. This medication must be given with caution, however, as it can affect the heart rate of someone with anorexia.

One of the main goals in treating the GI symptoms of bulimia is to reduce and eliminate purging behavior. In cases where associated heartburn is frequent doctors will recommend a protein-pump inhibitor, a medication that protects the esophageal wall by reducing the stomach’s production of gastric acid.

In some cases, therapies to calm the gut including meditation or anti-anxiety meds, can be quite helpful. It is important to note that 'special' diets, or eliminating certain foods in an attempt to alleviate symptoms is not wise to try while in recovery. Dietitians need to individualize meal plans for the specific needs of each client.




Final Words

If you are in recovery or caring for someone in recovery, the abdominal discomfort with eating is very real. The body has gotten used to eating smaller amounts of food and the additional anxiety of increasing intake is truly distressing. As long as you’ve consulted a medical professional, the best treatment for GI upset is to continue following a plan of regular meals and snacks. Some patients have found heat pads or hot water bottles placed directly on the belly after meals to be helpful when pain is severe.





New Research Ahead – The Role of the Intestinal Microbiota

New research on the role of the intestinal microbiota in anorexia and other eating disorders is exciting. This research looks at the enteric nervous system, comprised of more than 100 million nerve cells lining your entire GI tract. This neural complex is thought to be equivalent to “a second brain” affecting digestion, weight regulation and even mood. Entirely new treatments are on the horizon as we begin to understand the interactive regulation that now clearly exists between the gut and the brain (10). Hopefully, we will continue to find new treatments for the gastric distress that eating disorder sufferers encounter as they work towards meaningful recovery.




Image Source: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/eating-disorders/




About The Author:

Erica Leon, MS, RDN, CDN, CEDRD is the founder of Erica Leon Nutrition. She specializes in nutrition counseling for eating disorders and unhealthy eating patterns, as well as intuitive eating coaching.

Thank you so much to the following clinicians who kindly (and generously) reviewed this paper for accuracy of content:

Marcia Herrin, EdD, MPH, RDN, LD, FAED
Fellow, Academy of Eating Disorders
Author: The Parent’s Guide to Eating Disorders (Gurze Press, 2007) & Nutrition Counseling in the Treatment of Eating Disorders (Brunner-Routledge, 2013)

Patsy Catsos, MS, RDN, LD
Digestive Health Expert
Author: IBS—Free at Last! (2012)
Nutrition Works

References:

1) Janssen, P. Viewpoint, Can eating disorders cause functional gastrointestinal disorders? Neurogastroenterol Motil 2010; 22:1267-1269.

2) Wang, X, Luscombe, G, Boyd, C et al, Functional gastrointestinal disorders in eating disorder patients: Altered distribution and predictors using Rome III compared to Rome II criteria, World J Gastroenterol 2014; Nov 21; 20 (43): 16293 – 16299.

3) Sato, Y, and Fukudo, S, Gastrointestinal Symptoms and disorders in patients with eating disorders, Clin J Gastroenterol 2015; 8:255-263.

4) Norris, et al. Gastrointestinal Complications Associated with Anorexia Nervosa: A Systematic Review. Int J Eat Disord 2016; 49:3 216-237.

5) Mehler, S & Walsh, K, Electrolyte and Acid-Base Abnormalities Associated with Purging Behaviors. Int J Eat Disord 2016; 49:3 311-318.

6) Forney, J, Buchman-Schmitt, J et al, The Medical Complications Associated with Purging. Int J Eat Disord 2016; 49:3 249-259.

7) Herrin, M & Larkin, M, Nutrition Counseling in the Treatment of Eating Disorders, 2nd ed. Publ. Taylor & Francis, 2012.

8) Herrin, M & Matsumoto, N, The Parent’s Guide to Eating Disorders, 2nd Ed. Publ. Gurze Books, 2007.

9) Camilleri, M et al. Clinical Guideline: Management of Gastroparesis. Am J Gastroenterol, 2013; 108: 18-37.

10) Kleiman, S, Carroll, I, et al. Gut Feeling: A Role for the Intestinal Microbiota in Anorexia Nervosa? Int J Eat Disord 2015; 48 (5):449-451."


There is a wonderful documentary that looks into recovery of people who are facing an eating disorder. Even if you have Gastroparesis and no eating disorder, I would recommend this video highly. It brought me to tears. It's a really well done documentary:

https://youtu.be/mU6MT6Bzyw0



Eating disorders like Bulimia can lead to motility disorders like Gastroparesis. A lot of people have trouble understanding the difference between an eating disorder like Bulimia and a motility disorder like Gastroparesis, because both include vomiting and with Gastroparesis, there is the ability to get full easily because you retain food in your stomach because the stomach does not function normally.

People with Gastroparesis can gain weight instead of losing weight, but that does not mean they are not malnourished or vitamin deficient. A lot of people with Gastroparesis lose weight, and they do not want to lose the weight because they get down to scary levels of weight loss. Most people end up with a feeding tube at that point or TPN, because there is not much in the way of treatment for Gastroparesis. Bulimics can develop Gastroparesis and motility disorders because of the vomiting and weight loss. They can damage their vagus nerve, which controls so much in your body. if you do have an eating disorder and have been diagnosed with Gastroparesis, I do have a support group that you can join to talk to others and get support from others in the same position at: https://www.facebook.com/groups/GPandEDSupport/. You are NOT alone.

Gastroparesis, according to the Mayo Clinic, is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly. Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. There is no cure for Gastroparesis.

The Medscape Journal of Medicine has a really detailed, in depth look into Gastroparesis and what causes it. You can read the article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/, but I will post an excerpt here,

"Gastroparesis presents with symptoms of gastric retention and nongastrointestinal manifestations, with objective evidence of delayed gastric emptying in the absence of mechanical obstruction. Diabetic, idiopathic, and postsurgical gastroparesis are the most common forms, although many other conditions are associated with symptomatic delayed gastric emptying (Table 1). Gastroparesis is estimated to affect up to 4% of the US population[1] and may produce either mild, intermittent symptoms of nausea, early satiety, and postprandial fullness with little impairment of daily function, or relentless vomiting with total disability and frequent hospitalizations. A recent report estimated that inpatient costs for patients with severe gastroparesis approach $7000/month.[2]

Gastroparesis presents with a constellation of symptoms. In one study, nausea was reported by 93% of patients whereas early satiety and vomiting were noted by 86% and 68%, respectively.[3] In another series, nausea, vomiting, bloating, and early satiety were reported by 92%, 84%, 75%, and 60% of patients, respectively.[4] Many patients in both case series (89% and 46%) also reported abdominal pain (Table 2). Others experience heartburn from acid reflux into the esophagus that is facilitated by fundic distention which increases the rate of transient lower esophageal sphincter relaxations.[5] Although some gastroparetics with frequent vomiting lose weight and develop malnutrition, most patients were overweight or obese in one series, indicating that the disorder does not necessarily restrict food intake.[6] Phytobezoars are organized concretions of indigestible food residue that are retained within the stomach. These may increase gastroparesis symptoms or produce a palpable epigastric mass, gastric ulceration, small intestinal obstruction, or gastric perforation.[7] Bezoars are eliminated by endoscopic disruption and lavage, enzymatic digestion (papain, cellulose, or N-acetylcysteine), and dietary exclusion of high-residue foods. Variably delayed gastric emptying may cause unpredictable food delivery in diabetics with gastroparesis, affecting glycemic control and increasing risks of both severe hypo- and hyperglycemia.[8]

Gastroparesis has many causes. In a case series of 146 gastroparesis patients seen at a large US tertiary medical center, 29% had underlying diabetes, 13% developed symptoms after gastric surgery, and 36% were idiopathic.[4] The mean age of onset for gastroparesis is 34 years. Eighty-two percent of cases occur in women.[4]"



Image Source: http://studylib.net/doc/7356614/super-cereal-recipes



If you do have an eating disorder, and you want to get help - there are several ways you can do so. You can make an appointment with your primary doctor, who can refer you to a doctor who can help you. There are several numbers you can call for help and links below (click on the bold words):

Shoreline Eating Disorders.

Eating Disorder Hope.

National Eating Disorders.

Help Guide - Helping Someone with an Eating Disorder.

Selah House.

Magnolia Creek - Bulimia Help for Women.

National Eating Disorders Collaboration.

Bulimia.com - for 24/7 hour advisors to help you, call 1-866-578-1604.






Image Source: https://www.eatingrecoverycenter.com/blog/2016/04/30/eating-recovery-day-why-we-celebrate





I am not a doctor, I am a researcher. Please call your doctor if you have any questions or concerns so that they may decide the best care for you. Everyone is different. Everyone with Gastroparesis is different. I just wanted to distinguish between eating disorders and Gastroparesis, and to make sure people know that eating disorders can lead to Gastroparesis as well. Like I said before, if you have any questions or concerns, please consult your doctor.