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© 2012, 2015, 2018, 2019 by Crystal Saltrelli, CHC

All rights reserved. No part of this document may be reproduced or

transmitted in any form or by any means, electronic, mechanical,

photocopying, recording, or otherwise, without prior written permission.

Disclaimer: The information contained in this book is for educational

purposes only. It is not intended as nor should it be considered a substitute

for treatment by or the advice of a doctor or other healthcare provider. The

author shall not be held responsible for loss or damage of any nature

suffered as a result of reliance on any of this book’s contents or any errors

or omissions herein.

This book contains Amazon Affiliate links. The author will receive a

commission for products purchased through these links at no additional

cost to the reader.

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CONTENTS Contents ..................................................................................................................... 3

Welcome .................................................................................................................... 6

Using this Book ....................................................................................................... 8

Understanding the Comprehensive Management Plan ...................................... 10

Dietary Modifications....................................................................................... 10

Nutrition & Supplementation .......................................................................... 11

Lifestyle Practices ............................................................................................. 11

Complementary Therapies & Treatments ....................................................... 12

Medical Treatment........................................................................................... 12

Emotional Wellbeing ........................................................................................ 12

Before We Get Started ......................................................................................... 13

Understand the Diagnosis ................................................................................ 13

Take a Look at Your Choices ............................................................................ 14

Take a Breath ................................................................................................... 14

Be Patient ......................................................................................................... 15

Stage One ................................................................................................................. 16

Dietary Modification ............................................................................................ 16

Reduce meal size & increase frequency .......................................................... 16

Reduce fat to 40 grams per day ....................................................................... 17

Nutrition & Supplementation .............................................................................. 17

Consider Taking a Multivitamin ....................................................................... 17

Lifestyle ................................................................................................................ 18

Walk 20-30 minutes per Day ............................................................................ 18

Keep a Journal .................................................................................................. 19

Complementary Therapies & Treatments ........................................................... 19

Try Ginger ......................................................................................................... 19

Medical Treatment .............................................................................................. 20

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Confirm the Diagnosis ...................................................................................... 20

Find a Doctor You Trust.................................................................................... 20

Emotional Wellbeing ............................................................................................ 21

Get Off Social Media ........................................................................................ 21

Stage Two ................................................................................................................. 22

Dietary Modification ............................................................................................ 22

Reduce fiber to 15 grams per day .................................................................... 22

Reduce hard to digest foods ............................................................................ 23

Nutrition & Supplementation .............................................................................. 23

Supplement with Nutrient-Rich Liquids ........................................................... 23

Consider a Magnesium Supplement ................................................................ 24

Lifestyle ................................................................................................................ 25

Reduce & Better Manage Stress ...................................................................... 25

Complementary Therapies & Treatments ........................................................... 26

Try OTC & Natural Remedies for Nausea ......................................................... 26

Use Heat for Pain ............................................................................................. 26

Medical Treatment .............................................................................................. 26

Investigate Underlying or Contributing Factors ............................................... 26

Emotional Wellbeing ............................................................................................ 28

Educate Your Family & Friends ........................................................................ 28

Enlist Support ................................................................................................... 29

Stage Three .............................................................................................................. 30

Dietary Modifications .......................................................................................... 30

Reduce FODMAPs ............................................................................................ 30

Supplementation ................................................................................................. 31

Consider b-12 supplementation ...................................................................... 31

Focus on Nutrient-Rich Foods .......................................................................... 31

Lifestyle ................................................................................................................ 32

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Quit Smoking .................................................................................................... 32

Practice relaxation exercises 10 minutes per day ............................................ 32

Complementary Therapies & Treatments ........................................................... 33

Try Complementary Treatments ...................................................................... 33

Medical Treatment .............................................................................................. 33

Explore medical options ................................................................................... 33

Investigate bacterial overgrowth ..................................................................... 35

Emotional Wellbeing ............................................................................................ 35

Address food related anxiety ........................................................................... 35

Work on Acceptance ........................................................................................ 36

What’s Next? ............................................................................................................ 37

Keep Tweaking ..................................................................................................... 37

Continue Learning ................................................................................................ 37

Celebrate & Share Your Success .......................................................................... 38

Quick Start Checklists ............................................................................................... 38

Stage One ......................................................................................................... 39

Stage Two ......................................................................................................... 40

Stage Three ...................................................................................................... 41

About the Author ..................................................................................................... 42

Other Books by Crystal ......................................................................................... 43

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WELCOME Hi, there. If you’re reading this book, chances are you were recently diagnosed

with gastroparesis. Or maybe you were diagnosed quite some time ago, but you

just can’t seem to get a handle on symptom management. Either way, I know how

you feel. My life was turned upside down when I was diagnosed with idiopathic

gastroparesis in 2004 at the age of 23.

If you’re like I was, you’ve been searching the internet for information, pouring

over blog posts, videos, and Facebook groups for something that will help you.

You’re likely feeling disheartened and at least a little bit scared by what you’ve

seen. You may be worried that your life will never be “normal” again, that your

health will continue to decline, and there’s nothing you can do about it.

Well I’m here to tell you that’s not the case. In fact, there are steps that you can

take right now to start decreasing your symptoms and improving your quality of

life.

How do I know? From personal experience, for starters. As I said, I was diagnosed

with gastroparesis over fifteen years ago. A few years in, I was at my lowest of

lows. I was eating little more than applesauce and Saltines, yet dealing with pain

and nausea so bad that I was making frequent trips to the ER and sleeping only

three or four hours a night. I’d lost nearly 50 pounds. I was malnourished and

exhausted. I couldn’t work. I had no social life. My marriage was suffering. My

family was worried. I was frustrated, scared, confused, and overwhelmed.

Thankfully, things changed drastically for me when I went back to school to study

holistic health and nutrition and started looking at symptom management in a

whole new way. Today, life looks totally different. I’m a healthy, happily married,

mama of one, with a successful and fulfilling career and I’m truly living well

despite having gastroparesis.

It’s not just personal experience that this guide is based on, however. It’s primarily

a result of my decade of work as a Certified Health Coach specializing in

gastroparesis management. Through one-on-one coaching, group programs, my

website, and the books I’ve written, I’ve had the honor of seeing the information

I’ll be sharing in this guide improve the lives of thousands of other people with

gastroparesis around the world.

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If it sounds too good to be true, it’s not. Let me be clear: there’s no silver bullet or

cure-all here. If I knew of one, I’d shout it from the rooftops. But I don’t. This is

simply about educating yourself and doing the work to create and implement what

I call a comprehensive gastroparesis management plan.

While I’ve talked about the concept of a comprehensive management plan in my

Living (Well!) with Gastroparesis book, on my blog, and in numerous videos, I’ve

noticed that it’s often difficult for people to begin implementing a plan of their

own. That’s why I created this guide.

What you’ll find in the next 40-plus pages will take you through creating a basic

gastroparesis management plan. Think of it as a roadmap to put you firmly on the

path to improving your symptom management and your quality of life -- ASAP.

Now I don’t want to mislead you in any way. I am not promising to cure you of

gastroparesis, nor am I saying that following the steps outlined in this guide will be

all you’ll ever need in order to live well with gastroparesis. It probably won’t

change your experience overnight and it certainly won’t mean that you’ll never

have flare-ups or bad days.

But I do promise that if you follow the steps outlined in this guide and make self-

care your number one priority, you will begin to feel better physically, mentally,

and emotionally. It’s helped me and many, many others with gastroparesis… and

I’m confident that it can help you, too!

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USING THIS BOOK

This Quick Start Guide is divided into three “stages,” with each stage organized

according to the sections of a comprehensive gastroparesis management plan.

There are one or two steps that you’ll take in each section in order to build your

own management plan. This step-by-step approach mimics how I work with clients

one-on-one and will allow you to progress steadily, creating an effective plan

without adding to the stress or overwhelm that you already feel.

You might be tempted to jump ahead or to tackle all of the stages at once. Please

don’t. Your results will be better if you take it one step at a time and give yourself

enough time to implement and acclimate to the recommendations in each stage

before moving on to the next. I recommend that you plan on at least a week or

two per stage. If that seems like a long time, rest assured that you’ll most likely

start feeling better soon after you get started and your quality of life will be

improving along the way.

I’ve included a checklist for each stage to help you keep track of the steps you’ve

taken and your results as you go. These start on page 37 and I recommend that

you print them out to keep track of your progress.

Please note that you may find that some recommendations within each stage work

really well for you and others do not. That’s to be expected. Gastroparesis is a

highly individualized condition and experiences vary widely in terms of severity

and symptoms. Listen to your body and do what’s right for you. That is truly an

essential part of any good management plan.

Lastly, keep in mind that this is designed as a “quick start” guide for those who

want to get on the path to better symptom management right away. It doesn’t

provide a lot of in-depth explanations, and it isn’t meant to answer all of your

questions or cover all aspects of life with gastroparesis.

Throughout the guide, however, I’ve included links to recommended reading and

additional sources of information if you’re ready to dive deeper into the concepts

and expand your understanding of gastroparesis and GP management.

Tip: If you are reading this on a computer, hold the Ctrl button while you click the

links to make them open in a new tab. For a complete list of all links in this eBook,

as well as printable PDFs of the checklists, visit LivingWithGastroparesis.com/QS.

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UNDERSTANDING THE COMPREHENSIVE MANAGEMENT PLAN

When I started working as a Health Coach specializing in gastroparesis

management, it didn’t take me long to realize that the standard approach to

managing the condition – a combination of medication and a generic low-fat, low-

fiber diet – just didn’t work very well. Most people following this two-pronged

plan continued to experience erratic and often debilitating symptoms that

compromised not only their physical comfort, but also their quality of life and

overall well-being.

My background is in holistic health and nutrition, and I found that the more I

encouraged my clients to implement a holistic approach to gastroparesis

management, one that went far beyond just basic dietary changes and/or

medication, the greater the benefits they experienced in all aspects of their lives.

Eventually that evolved into what I now call the comprehensive gastroparesis

management plan, the six parts of which are the foundation of this guide. We’ll

talk a bit about each of them below.

MORE INFO: THE GASTROPARESIS SYMPTOM BUCKET (BLOG POST)

MORE INFO: EVALUATE YOUR MANAGEMENT PLAN (ARTICLE/WORKSHEET)

DIETARY MODIFICATIONS

Many people consider dietary modification to be the basis of gastroparesis

management, and for good reason. Eating is what typically precedes symptoms,

after all. But you must keep in mind that dietary changes are a symptom

management tool, not a cure. Following a gastroparesis-friendly diet is certainly

helpful, but it will not usually eliminate symptoms on its own.

Restricting your diet too much, however, will likely negatively impact nutrition

without providing additional symptom management benefit. This is a fine line that

each person must learn to navigate on an individual basis. While creating your

management plan, the goal is to make the most effective dietary changes possible

without compromising your overall health and nutrition (or sanity!).

MORE INFO: PURPOSE AND LIMITATIONS OF A GASTROPARESIS-FRIENDLY DIET (VIDEO)

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NUTRITION & SUPPLEMENTATION

The typical low-fat, low-fiber, processed diet prescribed for gastroparesis is quite

poor nutritionally. Unfortunately, the less nutrition your body receives the more

difficult it becomes for it to repair itself and function normally. What’s more, there

are a variety of nutrients that are vital for normal digestion. I strongly believe that

lack of proper nutrition often contributes to the worsening of symptoms and

decline in overall health that many people with gastroparesis seem to experience

over time.

The steps in this guide emphasize the importance of nutrition and aim to enhance

nourishment through smart dietary choices and the use of high-quality

supplements.

Please note, there are a wide variety of manufacturers and formulations for each

supplement you’ll find listed in this book. It may be necessary to experiment in

order to find the one that’s best for you. Chewable, sublingual and liquid

formulations are often better tolerated than tablets. You may need to start with a

smaller dose than recommended — some is always better than none.

The information provided in this guide is not medical advice. Talk with your doctor,

pharmacist or other healthcare provider if you have any questions about which

supplements are right for you.

LIFESTYLE PRACTICES

Lifestyle practices and habits are commonly overlooked when it comes to

gastroparesis management, perhaps because they just seem too simple. It might

be counter-intuitive that basic things like physical activity and adequate sleep

could have a significant impact on such a complex disorder. But guess what? They

do! And you have more control over this aspect of GP management than any

other. It all comes down to priorities: how you choose to spend your time and

energy. A good management plan must prioritize self-care.

If you’re still unsure about the importance of this area of the management plan, be

sure to read The Gastroparesis Symptom Bucket, if you haven’t already.

MORE INFO: THE GASTROPARESIS SYMPTOM BUCKET (BLOG POST)

MORE INFO: PRIORITIZE SELF-CARE (BLOG POST/VIDEO)

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COMPLEMENTARY THERAPIES & TREATMENTS

There are a number of complementary therapies and remedies – treatments used

in conjunction with traditional medical treatment – that may alleviate the

symptoms of gastroparesis and enhance the functioning of the digestive system.

This guide will introduce you to the ones that tend to be the most helpful, as well

as the easiest to access. Be sure to talk with your health care provider(s) about all

complementary therapies and treatments that you’re considering.

MEDICAL TREATMENT

Appropriate medical treatment – including proper testing and diagnosis – is an

important part of gastroparesis management, but you’ll notice that medication

isn’t mentioned until stage three of this guide. In part that’s because I’m not a

doctor and medicine is not my specialty. In addition, the medical treatment

currently available for gastroparesis is limited and is not effective for everyone.

There are, however, medical options for symptom management that can be very

helpful.

The most important thing when it comes to medical treatment and your

management plan is to be an informed patient and an educated self-advocate.

Always remember that you hire your doctors, and you have the right and the

responsibility to find the ones that best suit your needs and support your goals.

EMOTIONAL WELLBEING

As difficult as gastroparesis is to manage from a physical standpoint, the stress,

anxiety, overwhelm, and frustration that often comes along with the condition can

be just as – and sometimes even more – challenging. Learning to alleviate the

emotional suffering can go a long way toward improving your experience,

regardless of what’s going on with your physical symptoms.

Over the last several years, I have been focusing more and more on this aspect of

the management plan, both personally and professionally, as I’ve found that it is

often the “missing piece” when it comes to quality of life and truly living well.

MORE INFO: DO CIRCUMSTANCES CAUSE SUFFERING (PODCAST INTERVIEW)

MORE INFO: FINDING PEACE (PODCAST INTERVIEW)

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BEFORE WE GET STARTED

Before we get started, there are a few things that you can do to ensure that you

get as much out of this guide as possible.

UNDERSTAND THE DIAGNOSIS

In order to manage gastroparesis, you have to understand what you’re dealing

with. Unfortunately, there’s a great deal of misinformation floating around out

there, even among some members of the health care community.

Here are a few things you need to know:

• Gastroparesis is also called delayed gastric emptying. A gastroparesis

diagnosis means that the stomach does not empty as quickly as it should --

it’s slow. It usually does not mean that the stomach is completely

paralyzed, nor does the diagnosis itself indicate the severity of the delay or

the severity of the symptoms.

• Gastroparesis is what’s called a functional motility disorder. There is no

obstruction, physical abnormality, or other visible defect. The problem is

due to dysfunction of the muscles and/or the nerves within the stomach.

• While some people have motility issues throughout the GI tract, a

diagnosis of gastroparesis is specific to stomach. It does not indicate that

other parts of the GI tract are or will become delayed.

• Gastroparesis is not caused by – and likely will not be cured by – eating or

not eating certain foods. While certain foods may exacerbate symptoms by

increasing the existing delay, the underlying delay in gastric emptying will

be present regardless of what you eat or don’t eat.

• Nutrition is a vital part of gastroparesis management. Ignoring this fact

may contribute to feeling sicker – and having increasing health issues –

over time.

• Medication and/or dietary changes alone are often inadequate when it

comes to symptom management and improved quality of life. The most

effective way to manage gastroparesis is via a comprehensive

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management plan.

• Though there is no medical cure for gastroparesis, the condition can

improve – or even resolve – over time. It is possible to live WELL with

gastroparesis and people have recovered.

MORE INFO: UNDERSTANDING GP AND THE GP MANAGEMENT PLAN (VIDEO)

TAKE A LOOK AT YOUR CHOICES

I can’t tell you how many clients I’ve worked with who started our first session by

saying, “it doesn’t matter what I do; I always feel horrible.” Inevitably, a week or

two later, they’re telling me that they never realized how much their day-to-day

choices were contributing to how they felt over time. While we certainly don’t

have complete control in this (or any) area, our everyday choices and actions can

have a significant impact on how we feel. Once you acknowledge, your ability to

manage your symptoms consistently over time will improve.

This may require you to change your priorities, define new limitations, and set

aside your expectations, at least for the short term. But by doing all of that, you’re

much more likely to get a handle on your physical and mental well-being sooner

rather than later, and minimize the abnormality, discomfort, and interruption

gastroparesis causes in your life.

MORE INFO: THE GASTROPARESIS SYMPTOM BUCKET (AUDIO – 15 MINS)

MORE INFO: MAKE A CHOICE TO MAKE A CHANGE (FREE CLASS)

TAKE A BREATH

In my Living (Well!) with Gastroparesis Program, I share a poem about a bumble

bee that finds itself stuck inside a room with two windows. The bee is frantic to get

outside and continually runs itself into the closed window, never pausing or

looking around long enough to notice the open window just across the room.

After a gastroparesis diagnosis, many of us act like that bee. We want so badly to

find a “way out” that we allow ourselves to become frantically consumed by

gastroparesis. We scour the internet incessantly, trying everything we read, yet

end up not actually making any progress… it’s as if we’re banging our head against

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a closed window, feeling more and more desperate and hopeless with each

attempt.

If that sounds like you, please stop for a minute and take a breath. Look around.

Promise yourself that you’re going to do everything you can to improve your

situation, but you’re going to do it in a meaningful, effective way. This eBook has

everything you need to get started and it’s organized in a way that’ll make it as

simple as possible.

If you find yourself feeling more stressed or overwhelmed as you go through the

process, take a step back and reassess. Are you trying to create a “perfect”

management plan? Are you trying to do everything all at once? Are you putting

too much pressure on yourself? Please hear me: there’s no such thing as a perfect

management plan and sometimes doing less is more beneficial, especially if it

leads to a quieter mind and a calmer state of being.

BE PATIENT

Learning to manage gastroparesis is a process. There’s a learning curve. While

you’re setting yourself up to “figure this out” much more quickly than you might

otherwise, it still takes time to implement the suggestions in a meaningful way.

You’ll likely have missteps and set-backs. Some things simply won’t work for you.

You’ll have days where you don’t want to deal with it and days where you can’t

help but think, “why me?!” That’s okay. It’s normal. But don’t get stuck there.

That’s just your brain throwing out habitual thoughts. Be kind to yourself and be

patient with the process, but keep moving forward.

The most important step in any journey is the first one, so let’s take that step now!

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STAGE ONE In this stage, we’re taking basic steps to lay the foundation for each aspect of your

management plan. Remember to spend some time, at least a week, implementing

and adjusting to the recommendations in each section of this stage before moving

on to stage two.

DIETARY MODIFICATION

REDUCE MEAL SIZE & INCREASE FREQUENCY

Volume is the number one determinant of how long it takes a meal to empty from

the stomach, so it makes sense that eating smaller meals helps to alleviate

symptoms caused by slow gastric emptying. In fact, many you may find that how

much you eat is just as (or more!) important as what you eat. By reducing portion

sizes and overall volume, many of my clients are able to maintain greater normalcy

in their diet.

While the specific amount tolerated depends on several factors and varies from

person to person, a general guideline is half of a normal sized meal, or about 1-1/2

cups of total food, per meal. Your plate should still look like you’re eating a meal

and be filled with a variety of foods…just in smaller portions.

To compensate for the decrease in meal size, both in terms of nutrition and

hunger, it’s usually necessary to increase the number and frequency of meals. Four

to six mini-meals per day tends to work best.

Again, the ideal duration between meals varies from person to person, but a

general guideline is to eat every two to three hours. Eating more frequently than

that can actually exacerbate fullness and other symptoms. Eating less frequently

may prevent adequate calorie intake and/or cause erratic blood sugar levels, even

for non-diabetics.

Start with eating a mini-meal every 2 ½ hours and tweak your volume and timing

from there.

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REDUCE FAT TO 40 GRAMS PER DAY

Higher fat foods digest more slowly than lower fat foods, so reducing the amount

of fat that you eat will help the stomach empty as quickly as possible. (This is true

for everyone, not just people with gastroparesis.)

Based on my work, people with gastroparesis tend to tolerate somewhere

between 25-50 grams of fat per day. However many people end up over-restricting

or underestimating the amount of fat they can tolerate, so I encourage you to start

by reducing your intake to around 40 grams per day. This is well within the range

of a “low-fat” diet.

Remember that even if you eliminated all fat from your diet, it wouldn’t eliminate

the underlying delay. Your stomach is not slow because you eat dietary fat. What’s

more, dietary fat is essential for brain function, hormone production, the

absorption of fat-soluble vitamins, and many more processes within the body.

Rather than filling your diet with fat-free and low-fat packaged food products, try

choosing lower-fat versions of the real food you already eat. For example lean

ground meats, skinless white-meat poultry, white fish, egg whites, cooked

vegetables, fruit smoothies, lower-fat milk or yogurt (2% or skim), etc.

You’ll also want to avoid fried foods, fatty meats, and junk food like chips and

pastries, which pack a significant amount of fat and offer little in the way of

nutrition.

NUTRITION & SUPPLEMENTATION

CONSIDER TAKING A MULTIVITAMIN

Regardless of how well balanced a GP-friendly diet is, it will likely be deficient in

certain nutrients. A multi-vitamin/multi-mineral supplement can help to fill in the

gaps.

Liquid vitamins, chewable tablets or gummy vitamins are often better tolerated

than tablets or capsules. Look for a product that does not contain artificial dyes,

sweeteners or flavors. Take it with food to prevent/minimize stomach upset and

aid in absorption.

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A complete formulation should contain vitamins A, C, D, & E; niacin; folic acid; B6;

B12; pantothenic acid; thiamin, riboflavin; calcium, chromium, copper, iodine,

magnesium, manganese, and zinc.

While some products may be more complete than others, what matters most is

that you can take it consistently day after day. If you find a less complete formula

that you tolerate, that’s a better choice than the perfectly complete formula that

you don’t.

Note that products containing iron may exacerbate constipation. Men and post-

menopausal women are unlikely to need supplemental iron.

MORE INFO: FAQ: SHOULD I TAKE VITAMINS (BLOG POST)

CRYSTAL’S FAVORITE: SMARTYPANTS MULTIVITAMIN

LIFESTYLE

WALK 20-30 MINUTES PER DAY

Mild to moderate physical activity can increase the rate of gastric emptying and it’s

one of few things, aside from medication, that can do so. It’s also been found to

reduce anxiety and depression, increase energy levels even among people with

chronic illness, and aid in weight maintenance – including weight gain for those

who are underweight.

Walking is an easy, versatile, and accessible form of physical activity that can be

extremely effective for symptom management. Take a 20 to 30 minute walk after

breakfast or dinner, depending on your most symptomatic time of the day. If

you’re completely sedentary, start with just 10 minutes and work your way up.

Every little bit helps.

MORE INFO: BENEFITS OF WALKING (BLOG POST)

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KEEP A JOURNAL

One of the best tools I can recommend, especially at this stage in your journey, is a

simple journal. It doesn’t have to be complicated or time consuming. You don’t

need to track nutritional information or write down everything you eat or do.

You simply want to track how you’re feeling overall (I recommend writing down a

daily “symptom score” from 1-5, 1 being symptom-free and 5 being horrible

symptoms), and make a note of the factors that might contribute. Things to keep

track of include: new or different foods, new supplements and medications,

changes in physical activity, your menstrual cycle, viruses/colds/flus, flare ups in

other illnesses, travel, and stress (good or bad).

Having all of this down on paper makes it much easier to discover connections,

even if you don’t think any exist, as well as evaluate your progress over time.

COMPLEMENTARY THERAPIES & TREATMENTS

TRY GINGER

Ginger is a time-tested remedy for nausea. It’s also a natural prokinetic, meaning it

speeds up gastric emptying. While ginger ale may be fine for quelling an upset

stomach (make sure it actually contains ginger…not all of them do!), you’ll need

something a little stronger to get the gastric emptying benefit.

Try drinking a cup of strong ginger tea about 30 minutes before meals to stimulate

gastric juices or after meals to aid emptying and digestion. You can make your

own with fresh ginger or use purchased tea bags.

MORE INFO: GASTROPARESIS SUPER FOOD-GINGER (BLOG POST)

CRYSTAL’S FAVORITE: TRADITIONAL MEDICINALS ORGANIC GINGER TEA

Ginger-filled capsules, which are inexpensive and readily available, are another

option. If you’re able to easily swallow and absorb pills, then taking 1,000 mg of

ginger two to three times a day is one of the easiest ways to reap the prokinetic

benefits. If you find that you taste the ginger all day, try taking the capsules only at

bedtime. This can be helpful for middle-of-the-night and morning nausea, as well.

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Be sure to talk with your doctor before using ginger as a supplement. In higher

doses it acts a blood thinner and may not be appropriate for those with certain

conditions or those who are pregnant.

CRYSTAL’S FAVORITE: SOLARAY ORGANIC GINGER ROOT CAPSULES

MEDICAL TREATMENT

CONFIRM THE DIAGNOSIS

Before you dive too far into your gastroparesis management plan, it’s important to

ensure that you do in fact have the condition. That might sound obvious, but I’ve

heard from many people who initially thought they had GP, only to find out

something else was going on. If your symptoms are not the result of gastroparesis

(or a closely related diagnosis like functional dyspepsia) the advice in this guide

probably won’t adequately alleviate them.

If you’ve not been formally diagnosed with gastroparesis, your first task is to

schedule an appointment with a gastroenterologist and ask for a gastric emptying

study, preferably a four-hour one. Note that gastroparesis cannot be definitively

diagnosed via endoscopy, CT scan, or x-ray. If you have been diagnosed with

gastroparesis via one of these other means, consider a second opinion.

MORE INFO: DIAGNOSING GASTROPARESIS (VIDEO)

FIND A DOCTOR YOU TRUST

Part of your ongoing management plan will be to build a “Dream Team” of health

care professionals that you trust and feel comfortable with. For now it’s important

to have at least one doctor that you can consult about testing and initial treatment

options. While it’s ideal if this doctor is a gastroenterologist (a doctor who

specializes in disorders of the gastrointestinal tract), a good primary care doctor

who is willing to do some research and learn along with you may also fit the bill.

Never hesitate to switch doctors or get a second opinion if the fit isn’t right.

MORE INFO: LIVING (WELL!) WITH GASTROPARESIS, PAGES 17-21

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EMOTIONAL WELLBEING

GET OFF SOCIAL MEDIA

If I could offer you one piece of personal advice at this stage, it would be this:

avoid the gastroparesis Facebook groups, Instagram accounts, and online message

boards until you have a good handle on your experience with the condition and

your management plan.

Much of what you’ll read about gastroparesis on these platforms is based solely on

each person’s experience. Gastroparesis is a highly individualized condition,

however, and what works for one person doesn’t always work for another. It can

be confusing and overwhelming to read all of the contradicting information.

What’s more, social media is often rampant with competitive suffering and it tends

to be a showcase of the worst-case scenarios. After all, those who are living well

with gastroparesis don’t usually take the time to post about it on these sites.

They’re out living their lives! So the stories are disproportionately dire and may

foster fear and hopelessness.

Trust that the information in this guide is plenty to get you started with

understanding gastroparesis and addressing your symptoms in a comprehensive

and empowering way. Devote the next several weeks to your own experience

before re-visiting online accounts and communities.

MORE INFO: MEDICAL HEXING (BLOG POST)

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STAGE TWO In this stage, we’re building on to your management plan, taking each section a

step or two further. Once again, give yourself ample time – at least a week – to

fully implement these steps before moving on to stage three.

DIETARY MODIFICATION

REDUCE FIBER TO 15 GRAMS PER DAY

High-fiber foods take longer to break down and digest than lower fiber foods. This

is true for everyone, not just people with gastroparesis. Most of my clients seem to

do well with around 15 grams of fiber per day, divided fairly evenly between

meals.

While it’s common to decrease fiber by filling the diet with white or refined foods,

I really don’t recommend this approach. Instead, opt for lower-fiber but nutrient-

rich GP-friendly choices, such as:

• Hot cereal: cream of brown rice or cream of buckwheat

• Veggies: peeled, well-cooked veggies like carrots, turnips, parsnips,

potatoes, sweet potatoes, spinach, and mushrooms

• Fruit: bananas, cantaloupe, honeydew, or watermelon; applesauce or

other peeled and stewed/cooked fruits; canned pears or peaches

• Bread: spelt bread with 2 grams of fiber or less per slice; French or

sourdough bread with fewer than 5 ingredients

• Lean protein: animal protein does not contain fiber, unless it’s added (in

certain dairy products, for example)

When buying packaged food, always look at the nutrition panel. You’ll generally

want to choose products with 3 grams of fiber or less per serving. This depends on

how many servings you’re likely to eat at one time and what else you’ll be eating

with it, of course.

MORE INFO: LIVING (WELL!) WITH GASTROPARESIS, PAGES 50-55

MORE INFO: THE GASTROPARESIS-FRIENDLY SHOPPING LIST (FREE PDF)

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REDUCE HARD TO DIGEST FOODS

In addition to reducing overall fiber, it’s usually helpful to reduce foods that are

difficult for the stomach to break down and/or digest completely. These hard-to-

digest foods may further slow digestion and/or lead to masses of hardened food in

the stomach, called bezoars.*

These include:

• Seeds

• Nuts (whole; nut butter is fine)

• Skins, hulls, and peels

• Beans and legumes

• Raw vegetables

• Raw fruits with skins and/or seeds (berries, grapes, etc.)

*Most people with gastroparesis will never get a bezoar. However specific foods

that are thought to contribute to bezoar formation are: apple peels, berries,

broccoli, Brussel sprouts, coconuts, corn, green beans, figs, oranges, persimmons,

potato peels, and sauerkraut. These foods should be avoided if you have

previously had a bezoar or are particularly prone to them for another reason.

NUTRITION & SUPPLEMENTATION

SUPPLEMENT WITH NUTRIENT-RICH LIQUIDS

While most people with gastroparesis do not and will not need to follow an all-

liquid diet long-term, nutrient-rich liquids can play an important role in a healthy

gastroparesis-friendly diet. In most cases, liquids empty from the stomach more

quickly than solids, so alternating solid meals with liquid ones can help to alleviate

fullness and increase overall nutrition and calorie intake.

Try substituting one meal or snack per day, perhaps at your most symptomatic

time of the day, with a meal replacement drink or homemade smoothie.

Please keep in mind that many of the common meal replacement shakes are full of

hard-to-digest chemicals and additives. These are not health promoting in my

opinion and may actually exacerbate symptoms for some people. On the other

hand, many of the shakes marketed as “healthy” have added fiber and other

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slower-to-digest ingredients that make them a poor choice for people with

gastroparesis, as well.

I most often recommend products from Orgain, Plant Fusion, and Kate Farms, or

making your own smoothies with fruit and protein powder.

MORE INFO: CHOOSING A MEAL REPLACEMENT DRINK (VIDEO)

MORE INFO: VEGAN ORGAIN VS. PLANT FUSION (VIDEO)

CONSIDER A MAGNESIUM SUPPLEMENT

Magnesium plays a role in over 300 processes within the body and is essential for

the proper functioning of nerves and muscles. It’s also known as the relaxation

mineral. Since gastroparesis is typically a result of dysfunction with the nerves

and/or muscles within the GI tract and is exacerbated by stress, increasing

magnesium intake can be helpful for those with gastroparesis.

A typical GP-friendly diet is low in magnesium. What’s more, sugar, processed

foods, and chronic stress all decrease the magnesium already stored in our body.

Deficiency symptoms include poor digestion, anxiety, constipation, headache,

insomnia, irritability, muscle weakness or cramping, and irregular heartbeat.

You can find magnesium in pill or powder form. A typical dose is 400-1,000mg per

day. Avoid magnesium carbonate, sulfate, oxide, and gluconate, which are poorly

absorbed by the body and may exacerbate digestive symptoms. My advice with all

supplements, unless suggested otherwise by your healthcare provider, is to start

with the lowest recommended dose.

Magnesium is also easily absorbable through the skin. If you’ve experienced any

digestive upset from oral magnesium, you might consider magnesium lotion,

magnesium flakes, or even plain old Epsom salt baths.

Note: If you have heart or kidney disease, be sure to consult a doctor prior to use.

CRYSTAL’S FAVORITE: ANCIENT MINERALS MAGNESIUM BATH FLAKES

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LIFESTYLE

REDUCE & BETTER MANAGE STRESS

Stress is probably one of the touchiest subjects when it comes to gastroparesis

management. While I understand why – so many of us are initially told that their

symptoms are “in their heads” or “just stress” – I think that we’re doing ourselves

a disservice by not paying more attention to it.

Stress does not cause gastroparesis, but it most certainly exacerbates the

symptoms. Simply put, the gut is highly sensitive to stress. This is not new

information. Think about it: gastroparesis aside, what happens when people are

anxious, upset, or get bad news? They often get a stomach ache, feel “butterflies”

in their belly, or even throw up.

That’s because stress triggers our fight-or-flight response. Among other things, this

response shuts down all non-essential processes. That means blood flow to the GI

tract decreases, the production of digestive enzymes is reduced, and the muscles

of the stomach stop churning. Digestion basically stops!

If this only happened occasionally, when faced with a life and death situation like

nature intended, it wouldn’t be much of an issue. But when we’re under chronic,

everyday stress our digestive processes are constantly impaired, further

exacerbating any underlying dysfunction already present in the gut.

You cannot properly manage gastroparesis if you are constantly in a state of fight-

or-flight, so consider the gastroparesis diagnosis an “excuse” to make this a

priority. Take an honest look at the sources of chronic stress in your life, especially

in terms of your ability to learn to navigate life with gastroparesis. You may need

to temporarily decrease your hours or responsibilities at work, to distance yourself

from negative people, or better delegate at home in order to take better care of

yourself.

While gastroparesis itself is a source of stress for many, especially in the beginning,

rest assured that the better able you are to manage the condition using all of the

steps in this guide, the less stressful it will become.

MORE INFO: GASTROPARESIS AND STRESS (VIDEO)

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COMPLEMENTARY THERAPIES & TREATMENTS

TRY OTC & NATURAL REMEDIES FOR NAUSEA

While they won’t eliminate severe nausea, over-the-counter remedies can quell

the constant queasy feeling that many people experience due to GP. There are

several such products on the market, everything from chewable tablets to

essential oils to pressure point wristbands. You may have to experiment to find

what works best for you. A couple of my favorites are below.

CRYSTAL’S FAVORITES: NAUZENE AND QUEASEEASE

There are also herbal remedies that may help to alleviate nausea. These tend to

have mild effects, but having them on hand can provide peace of mind and

increase comfort when you’re out and about and not feeling your best.

CRYSTAL’S FAVORITE: ST. CLAIRE’S ORGANICS TUMMY SOOTHERS

USE HEAT FOR PAIN

Heat can be a very effective remedy for the abdominal and chest pain associated

with gastroparesis. I highly recommend investing in a reusable hot/cold pack or a

good heating pad. Heat draws blood into the digestive organs, helping them work

more effectively and aiding in digestion. Heat also helps to relax and alleviate any

cramping or spasms, which often causes pain within the GI tract.

CRYSTAL’S FAVORITE: MYCARE RICE HEATING PAD

MEDICAL TREATMENT

INVESTIGATE UNDERLYING OR CONTRIBUTING FACTORS

While stomach viruses, diabetes, connective tissue disorders, abdominal surgery,

and anorexia nervosa are among the known causes of gastroparesis, more than

one-third of all cases are considered “idiopathic” (no known cause). The following

factors should be considered when the cause of gastroparesis isn’t readily

identified.

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MEDICATIONS

Many medications are known to delay gastric emptying. These include narcotic

pain medications, tricyclic antidepressants, calcium channel blockers, clonidine,

dopamine agonists, lithium, nicotine, and progesterone.

If you were taking any of these medications prior to diagnosis, talk with your

doctor about a possible connection. If you have since been prescribed any of these

drugs, make sure that your doctor is aware of the existing gastroparesis and ask

about alternatives that will not further delay gastric emptying.

PROTON PUMP INHIBITORS

While this technically falls under “medications,” PPI use among those with

gastroparesis is so common that I feel it deserves extra explanation. Proton Pump

Inhibitors, such Prilosec and Nexium, are frequently prescribed to treat acid reflux

before gastroparesis is diagnosed and use is rarely reevaluated afterward.

Unfortunately suppressing the production of acid in the stomach can actually

cause food to sit there longer. In fact, PPIs have been found to delay gastric

emptying of solids in healthy volunteers.

If you have been prescribed PPIs, it’s important to talk with your doctor about

whether/how long you need to continue taking them. The good news is that the

better we manage gastroparesis overall, the less of a problem reflux is likely to be.

A natural alternative to relieve heartburn, and protect and soothe an irritated

esophagus and stomach is deglycyrrhizinated licorice (DGL).

CRYSTAL’S FAVORITE: ENZYMATIC THERAPY DGL ULTRA FRUCTOSE-FREE

MORE INFO: ACID REFLUX AND GASTROPARESIS (VIDEO)

HORMONE-BASED BIRTH CONTROL

As noted above, progesterone is known to delay gastric emptying. Some women

find relief from their symptoms after hormone-based birth control is discontinued

for two to three months. If you were taking birth control pills prior to your

gastroparesis diagnosis, you may wish to talk with your doctor about trying other

contraceptive options.

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HYPOTHYROIDISM

Hypothyroidism is a common but often undiagnosed condition, especially among

women. It can slow all systems within the body, including the digestive tract. If you

have other symptoms of hypothyroidism, such as fatigue, weight gain, dry skin,

constipation, and muscle soreness, talk with your doctor about testing.

CONSTIPATION

Constipation can impair adequate gastroparesis management by causing and/or

exacerbating symptoms like nausea, pain, bloating, and gas, and further

contributing to the delay in gastric emptying.

While constipation is a fairly common “side effect” of the typical gastroparesis diet

and lifestyle, if chronic constipation was present prior to a gastroparesis diagnosis,

evaluating and treating the root cause may improve gastric emptying and help to

alleviate overall symptoms.

MORE INFO: GASTROPARESIS & CONSTIPATION (VIDEO)

MORE INFO: UNDERSTANDING & ALLEVIATING CONSTIPATION (FREE CLASS)

EMOTIONAL WELLBEING

EDUCATE YOUR FAMILY & FRIENDS

As you become more comfortable with the gastroparesis diagnosis yourself, it’s

important to begin educating your family and close friends about the condition.

There are going to be changes in your priorities and your actions, and getting

everyone on the same page will help to prevent confusion and strained

relationships along the way.

If you’re worried about being seen as a “complainer,” keep in mind that telling the

truth is not the same as complaining. Simply explain the basics of the condition in

as matter-of-fact and relatable way as possible. You set the example. If you are

proactive and positive, most people will follow suit.

MORE INFO: HELPING FAMILY & FRIENDS UNDERSTAND (VIDEO)

MORE INFO: UNDERSTANDING & MANAGING GASTROPARESIS (ARTICLE)

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ENLIST SUPPORT

Once you’ve helped those closest to you better understand gastroparesis, take it a

step further by enlisting their support. Having never experienced the condition,

most people won’t know how to help you unless you tell them. Consider the

various areas in which you’re likely to need support as you go forward and assign

specific roles to specific people.

For example, your husband or wife may need to do more of the cooking or other

house work as you prioritize self-care. If you need help sticking to your physical

activity routine, ask a friend to walk with you each morning or take a yoga class

with you once a week. Make sure that you have someone to whom you can vent

when things get tough…but ask them in advance not to let you ruminate on your

troubles for too long.

It’s essential to have the right kind of support in order to be as successful in your

gastroparesis management plan as possible. Your needs may change as you go

along. Always ask for what you need. Your family and friends will most likely be

happy to help. After all, they want you to feel better, too!

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STAGE THREE In this stage, we’ll add another one or two steps to each section of your

management plan. Keep in mind that this is not the final stage of gastroparesis

management, just the final stage of this Quick Start guide. After you’ve spent some

time with these steps, check out the “What’s Next?” section for resources to help

you continue your progress.

DIETARY MODIFICATIONS

REDUCE FODMAPS

FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides, and Polyols.

Basically, FODMAPs are specific kinds of carbohydrates that are poorly absorbed in

the digestive tract and often exacerbate symptoms like bloating, gas, pain, and

bowel issues in people with functional GI disorders (like gastroparesis).

Many of the staples of a typical gastroparesis-friendly diet are high in FODMAPs,

which may be why some people continue having symptoms or even have

worsening symptoms despite following the prescribed diet.

Foods high in FODMAPs include:

• Apples, pears, peaches, mangoes, watermelon

• Cauliflower, broccoli, onions, garlic

• Honey and agave

• High-fructose corn syrup (found in soda and most packaged/processed

products)

• Lactose (found in ice cream, frozen yogurt, yogurt, cow’s milk)

• Soy

• Wheat (most pasta, cereals, cookies, crackers, breads – white and whole

wheat)

If you continue to experience bloating, gas, and belching despite making the other

dietary changes outlined in this guide, try reducing foods highest in FODMAPs,

such as wheat, dairy, the fruits/vegetables listed above, and packaged foods. If

you do not seem to react to these foods, there is no reason to eliminate them.

MORE INFO: FODMAP Q&A (AUDIO)

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SUPPLEMENTATION

CONSIDER B-12 SUPPLEMENTATION

Vitamin B-12 is essential for proper nerve function. It’s also known as the “energy”

vitamin. Because gastroparesis may be the result of impaired nerve function and

those with gastroparesis frequently lack energy, adequate B12 intake is important.

Unfortunately the typical gastroparesis-friendly diet is deficient in Vitamin B-12

and impaired absorption and/or depletion is common in those who use acid

suppressing drugs, including H-2 blockers and proton pump inhibitors, or those

who take Metformin for type-2 diabetes.

Deficiency symptoms include fatigue, muscle weakness, shortness of breath,

dizziness, numbness, heart palpitations, bleeding gums and mouth sores, nausea,

and poor appetite.

Supplementation is often necessary and beneficial. Vitamin B-12 can be taken as

sublingual (dissolvable) tablets or administered via injection from your doctor.

CRYSTAL’S FAVORITE: MARY RUTH’S B12 SPRAY

FOCUS ON NUTRIENT-RICH FOODS

Many easy-to-digest foods are also nutritionally empty. Consuming things like

white bread, sugary cereals, and calorie-laden sports drinks does absolutely

nothing to support health or healing. In fact, these may actually exacerbate

symptoms due to increased intake of FODMAPs and/or unstable blood sugar.

Make an effort to choose easier-to-digest foods that are also rich in nutrients,

including:

• Hot cereal (cream of buckwheat, cream of brown rice, ground oatmeal)

• Eggs (whole or egg whites; not Eggbeaters)

• Nut butters (1-2 tablespoons per meal; within total fat guidelines)

• Cooked and/or pureed lower-fiber vegetables (carrots, mushrooms,

cauliflower, spinach)

• Baked potatoes, sweet potatoes, and squash (no skin)

• Raw fruits without skins or seeds, whole or in smoothies (bananas, melons,

mango, papaya)

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• Cooked or canned fruits (pears, peaches)

• Lean animal protein (90%+ lean ground beef or turkey; turkey or chicken

breast; ham)

• White, flakey fish

• Juices and smoothies made from whole fruits and vegetables

MORE INFO: GP-FRIENDLY JUICING & BLENDING (EBOOK)

MORE INFO: THE BRIGHTER SIDE OF EATING FOR GASTROPARESIS (FREE CLASS)

LIFESTYLE

QUIT SMOKING

Nicotine delays gastric emptying, so people who have been diagnosed with

gastroparesis have one more reason to quit. In addition to all of the other health

risks and ill effects that you’re already aware of, smoking also weakens the muscle

between the stomach and esophagus (called the LES, lower esophageal sphincter),

exacerbating acid reflux and regurgitation of stomach contents.

PRACTICE RELAXATION EXERCISES 10 MINUTES PER DAY

As discussed in stage two, stress impairs proper digestion and can exacerbate

gastroparesis symptoms. In addition to reducing the overall stress in our lives, we

can help to rebalance our nervous system, get ourselves out of fight-or-flight

mode, and restore digestive function by practicing relaxation exercises.

This can be as simple as sitting quietly and focusing on your breath. Other forms of

relaxation exercises include meditation, prayer, tai chi, chanting, walking in nature,

and yoga. Explore some options or choose an activity that you already know you

enjoy and aim to incorporate 10 minutes of relaxation into your daily routine.

The key is to not make relaxation exercises another source of stress and

overwhelm. If you’re dealing with acute anxiety, focusing your breath for 10

minutes may seem like torture. Be willing to be stay flexible and pay attention to

what feels most helpful in the moment.

CRYSTAL’S FAVORITE: HEADSPACE (APP)

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COMPLEMENTARY THERAPIES & TREATMENTS

TRY A COMPLEMENTARY TREATMENT

There are several complementary treatments that those with gastroparesis have

found helpful for symptom management, including hypnotherapy, acupuncture,

and visceral manipulation.

Gut-directed hypnotherapy is a specific form of clinical hypnosis that has been

shown to reduce symptoms for those with functional GI disorders. It can be

especially helpful for alleviating pain.

MORE INFO: CLINICAL HYPNOSIS FOR GI SYMPTOMS (BLOG POST)

Numerous studies have demonstrated the efficacy of acupuncture for reducing

nausea and vomiting, as well as anxiety, pain, and insomnia.

MORE INFO: ACUPUNCTURE FOR GASTROPARESIS (VIDEO)

Visceral manipulation is a treatment I have used personally with great success,

particularly for acid reflux and abdominal pain. In recent years, I have heard from

both practitioners and many other patients who have also found it helpful.

MORE INFO: RELIEF FROM REFLUX & PAIN (BLOG POST)

Keep in mind that your experience and results may vary from practitioner to

practitioner. If one doesn’t work for you, try another before you decide the

therapy itself is of no benefit.

MEDICAL TREATMENT

EXPLORE MEDICAL OPTIONS

While many people are able to manage gastroparesis without medication (or

simply find that the limited options available do not work for them), others find

appropriate medical treatment both necessary and very helpful.

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MEDICATIONS TO INCREASE GASTRIC EMPTYING

There are currently only two medications available in the United States for the

treatment of gastroparesis itself. Neither of them are universally effective, nor

without risk of side effects or complications.

Reglan (metoclopramide) is a prokinetic and an antiemetic drug, meaning it speeds

up gastric emptying and alleviates nausea and vomiting. While some doctors

prescribe Reglan immediately upon diagnosis of gastroparesis, others do not

prescribe it at all due to the potentially permanent and serious neurological side

effects. Reglan currently carries a “black box” warning from the FDA due to the

risk of Tardive Dyskinesia. It’s necessary to talk with your doctor in order to way

the pros and cons of trying this medication.

Erythromycin is another prokinetic medication used in the treatment of

gastroparesis in the US. It is an antibiotic, which in very low doses stimulates

contractions of the stomach muscles. Unfortunately, the most common side

effects of erythromycin are nausea and abdominal pain. Erythromycin is best used

in cyclical fashion (example: six weeks on, two weeks off) in order to continue

providing relief.

Domperidone is a prokinetic and antiemetic medication that’s similar to Reglan but

doesn’t carry the same risk of neurological side effects. While it’s used in most

other countries around the world, it is not approved by the FDA. Domperidone

does carry the risk of cardiac complications, so patients should be monitored by a

physician while taking the drug.

MORE INFO: ALTERNATIVES TO REGLAN (VIDEO)

MEDICATIONS TO ALLEVIATE SYMPTOMS

While medications to treat gastroparesis itself are limited, there are a variety of

drugs available for the nausea and vomiting associated with GP. These are called

antiemetics and they include Zofran, Tigan, Compazine, and Phenergan. It’s

important to be aware that some antiemetics cause constipation, which may

further exacerbate delayed gastric emptying.

Talk with your doctor about the treatment options available and what might be

best for you.

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Please note that while there are also procedures, devices, and artificial nutrition

options, those are not typically considered until further down the road and

therefore not covered in this guide. You’ll find more information about those

options in the resources listed in the “What’s Next?” section.

INVESTIGATE BACTERIAL OVERGROWTH

It’s thought that more than half of people with long-term gastroparesis may

develop bacterial overgrowth in the digestive tract. Bacterial overgrowth

complicates gastroparesis management by exacerbating symptoms like bloating,

distention, and pain. If you feel that symptoms such as bloating and pain have not

improved at all despite the steps you’ve taken throughout these stages or you’re

experiencing diarrhea along with the gastroparesis symptoms, ask your doctor

about evaluation for bacterial overgrowth.

MORE INFO: BLOATING, SIBO & GASTROPARESIS (VIDEO)

MORE INFO: LEAKY GUT SYNDROME (VIDEO)

MORE INFO: SIBO, FODMAPS & GP (ARTICLE)

EMOTIONAL WELLBEING

ADDRESS FOOD RELATED ANXIETY

It’s common for people with gastroparesis to develop varying levels of anxiety

when it comes to food and eating, especially if you’ve tried to manage your

symptoms via diet alone. It’s important to address these feelings as soon as

possible because restricting your diet beyond what’s necessary for symptom

management compromises your nutrition and overall health. In addition, the

anxiety of expecting or anticipating symptoms before you eat can actually

exacerbate them by triggering the fight-or-flight response.

If you’re struggling with food-related anxiety, I strongly encourage you to speak

with a counselor of some kind. It does not mean that your symptoms are in your

head or that you have an eating disorder. Gastroparesis is a difficult condition to

manage, both physically and mentally, and having someone to talk over your fears

and concerns with can be extremely helpful.

MORE INFO: GASTROPARESIS COPING, STRESS & ANXIETY SUMMIT (FREE CLASSES)

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WORK ON ACCEPTANCE

In order to properly manage gastroparesis over time, you must first accept the fact

that right now, for this moment, you have the condition. While that might sound

odd, you’re reading a guide about managing gastroparesis, after all, it’s usually one

of the most difficult and ignored aspects of the journey. It can take many months

or even longer in order to fully accept the reality of life with gastroparesis, but

once you do it will make it much, much easier to cope with the condition overall.

Be patient with yourself. Be kind to yourself. Give yourself some time and space to

get there, but do begin working on and practicing that acceptance.

MORE INFO: ALLEVIATING THE EMOTIONAL SUFFERING (ARTICLE)

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WHAT’S NEXT? First, congratulations on working your way through this guide! If you’ve completed

all of the stages, it’s likely been about six weeks since you first downloaded this

eBook and you’re hopefully feeling a lot more confident in terms of your ability to

manage the condition. You’ve made it through what is often the toughest part, just

figuring out where to begin. But this is still just that: the beginning.

If there’s one thing I’d like you to know about life with gastroparesis, it’s this: it

goes on! You can live WELL with the condition and here are some ways to keep

moving in that direction.

KEEP TWEAKING

Gastroparesis is not a static condition. Your symptoms will ebb and flow, your

ability to handle the challenges of life with GP will likely improve over time, the

circumstances in your life will change, and you’ll continue to learn what works and

what doesn’t work for you. As this happens, you’ll need to continue making

changes to your diet and your lifestyle, shifting your priorities, reevaluating your

responsibilities at work and at home, trying various complementary therapies and

remedies, meeting with different doctors, and perhaps trying different

medications or procedures.

Maybe that sounds like a lot of work, but speaking from personal experience, it’s

worth every minute, every penny, and every ounce of effort. Being flexible and

continuing to refine your comprehensive management plan as you go is what will

enable you to truly live well with gastroparesis long term (or until you get better!).

CONTINUE LEARNING

As I mentioned in the introduction, this is meant to be a “quick start” guide.

Believe it or not, the dozens of steps included in this eBook are only some of the

things that you can do to manage gastroparesis symptoms and improve your

quality of life.

There are many more options to explore and steps to add to your comprehensive

management plan. There’s a lot more work that can be done in terms of coping

with the changes in your life going forward, as well. Over the past several years,

38 | P a g e

I’ve created a number of other resources to help you not only manage

gastroparesis, but actually thrive despite the condition.

MORE INFO: FREE CLASSES

MORE INFO: BOOKS & EBOOKS

SPECIAL OFFER: SAVE 10% OFF ANY EBOOK BY USING CODE GUIDE.

CELEBRATE & SHARE YOUR SUCCESS

If you Google “gastroparesis,” which I’m sure you’ve done, you’ll find many more

defeating results than uplifting ones. But I know from working with and talking to

countless people with gastroparesis around the world that symptoms can improve,

others are living well, and, yes, people do recover!

The plethora of hopelessness out there isn’t helping to increase the odds, though.

A large part of living WELL with gastroparesis is believing that it’s possible to live

well with gastroparesis. After all, if you don’t believe it’s possible, you’re not likely

to do the work that makes it possible.

So I’m encouraging you to contribute to a message that uplifts and empowers all of

us to take control and learn to live WELL with gastroparesis. Let others know about

your successes with symptom management and how you’ve taken control of life

with gastroparesis. You can do this as a comment on my Facebook page, or by

submitting your story to my website. If you’re feeling better mentally or physically,

talk about it. Let’s celebrate each and every improvement!

CONNECT WITH ME: FACEBOOK

MORE INFO: LIVING WELL & GETTING WELL STORIES

QUICK START CHECKLISTS The checklists on the following pages are a quick reference of all of the

recommendations given throughout each stage of this guide. I recommend printing

them out so that you can chart your progress, make notes as to which things you’d

like to explore further, and keep track of what does and doesn’t work for you as

you go along.

39 | P a g e

STAGE ONE

DIETARY MODIFICATION

Reduce meal size and increase meal frequency.

Reduce fat to 40 grams per day.

NUTRITION & SUPPLEMENTATION

Add a multivitamin.

LIFESTYLE MODIFICATION

Walk 20-30 minutes per day.

Keep a journal.

COMPLEMENTARY THERAPIES

Try ginger.

MEDICAL TREATMENT

Confirm the diagnosis.

Find a doctor you trust.

EMOTIONAL WELLBEING

Get off of (or decrease your time on) GP social media/message boards.

NOTES

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STAGE TWO

DIETARY MODIFICATION

Reduce fiber to a maximum of 15 grams per day.

Reduce hard to digest foods.

NUTRITION & SUPPLEMENTATION

Supplement with nutrient-rich liquids.

Take a magnesium supplement.

LIFESTYLE MODIFICATION

Reduce and better manage stress.

COMPLEMENTARY THERAPIES

Try OTC and herbal nausea remedies.

Use heat for pain.

MEDICAL TREATMENT

Investigate underlying and contributing factors.

COPING/QUALITY OF LIFE

Educate your family and friends.

Enlist support.

NOTES

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STAGE THREE

DIETARY MODIFICATION

Reduce FODMAPs, if necessary.

NUTRITION & SUPPLEMENTATION

Consider B-12 supplementation.

Focus on nutrient-rich foods.

LIFESTYLE MODIFICATION

Quit smoking, if applicable.

Practice relaxation exercises for 10 minutes per day.

COMPLEMENTARY THERAPIES

Try acupuncture, visceral manipulation, or gut-direct hypnotherapy.

MEDICAL TREATMENT

Explore medical treatment options.

Investigate bacterial overgrowth.

COPING/QUALITY OF LIFE

Address food related anxiety.

Work on acceptance.

NOTES

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ABOUT THE AUTHOR

Crystal Saltrelli is an author, educator and Certified Health Coach. Diagnosed with

idiopathic gastroparesis in 2004, she has the unique perspective of both patient

and practitioner. Through her books, classes, and website, Crystal has helped

thousands of people worldwide learn to live (well!) with gastroparesis.

She has written two books, Eating for Gastroparesis and Living (Well!) with

Gastroparesis, and has been published in the American Journal of

Gastroenterology, Digestive Health Matters, and Digest.

Crystal is a graduate of Dartmouth College and the Institute for Integrative

Nutrition. She has completed continuing coursework through the Harvard School

of Medicine, Massachusetts General Hospital, and UCLA.

For more information, please visit www.LivingWithGastroparesis.com.

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OTHER BOOKS BY CRYSTAL

EATING FOR GASTROPARESIS:

GUIDELINES, TIPS & RECIPES

Available in: eBook, Kindle, and paperback

LIVING (WELL!) WITH GASTROPARESIS:

ANSWERS, ADVICE, TIPS & RECIPES FOR A HEALTHIER, HAPPIER LIFE

Available in: paperback and Kindle