Episode 8: Why Your Gut Moves Too Slow
Could Your Upper Bloating Be Gastroparesis? Signs, Testing, and Support
Dr. Whitney Baxter, ND, Dr. Christina Carew, ND and Dr. Dominique Vanier, ND discuss gastroparesis as an often missed cause of upper abdominal bloating.
Symptoms include: early fullness, nausea, reflux that doesn’t respond to medication, vomiting, and pain above the belly button, describing it as delayed stomach emptying that can be influenced by diabetes, GLP/GIP medications, PPIs, opioids, stress, hormonal cycles, and conditions like dysautonomia/POTS, Ehlers-Danlos, post-viral illness, mold/mycotoxin exposure, and tick-borne disease.
They note overlap with functional dyspepsia and histamine-related symptoms, and limitations and long waits for gastric emptying tests (e.g., scintigraphy). Suggested supports include tracking timing/patterns, maintaining routine and nutrition, avoiding excessive food restriction, using smaller or blended meals, screening mental health and micronutrients, considering anti-nausea options, prokinetics and neuromodulators with monitoring, and integrative therapies like CBT, hypnotherapy, breathing, acupuncture, and manual therapy, plus guidance on how to discuss “gastric emptying/motility” with practitioners and use downloadable checklists.
00:00 Welcome
01:43 What Is Gastroparesis
02:52 Emptying Times and Criteria
03:51 Causes Beyond Diabetes
07:23 Symptoms and Red Flags
08:17 Overlap and Testing Challenges
11:56 Food Texture and Meal Strategies
19:17 Nervous System and Vagus Nerve
23:46 Differentiating From FODMAP Bloating
26:23 Treatment Steps and Nutrition
31:45 Medications Prokinetics and Safety
37:25 Non Drug Therapies and Escalation
39:09 Talking to Your Practitioner
40:48 Resources and Final Takeaways
44:47 Closing and Next Episode
Team Gut Girls Transcript Episode 8: Why Your Gut Moves To Slow
Dr. Christina Carew, ND: Awesome. So welcome back, listeners. today we’re
talking about a concern that… a motility concern that can cause bloating, but in the upper part of the body versus the lower part of the body, which is a lot of the things that we’ve talked about so far. And so let me set the stage for you. You’re eating a normal meal, nothing unusual.
It’s not a buffet. It’s not all-you-can-eat. And, very shortly after, you still feel bloated, uncomfortable, nauseous, and you feel like your stomach hit a pause button, like there’s a heaviness or sensation in the stomach.
What Is Gastroparesis
Dr. Christina Carew, ND: And so this could be one indicator that one of the considerations for your bloating might be something called gastroparesis.
And gastroparesis is a motility issue, and it’s often missed or under-diagnosed, so the actual data is about one in [00:02:00] 10 people with it have been diagnosed correctly with it. and it’s often brushed off as reflux or anxiety ’cause it’s not really well understood, and we know that it affects only about 1% to 3% of the population currently.
However, there’s a lot of data that suggests that this is a growing area of concern, because more people have diabetes than have had in the past, and this can be a complication of diabetes. But in addition to that, we see a lot of the GLP medications and the GIP medications also have this as a bit of a side effect.
And so I think we’re gonna see more of this more often. And so if any of this kind of hits home, it might be worth investigating a little bit more quick, way to think about gastroparesis is that it’s a par-paralysis or a motility paralysis in the stomach.
Emptying Times and Criteria
Dr. Christina Carew, ND: And so if we’re thinking about, the way that our food gets digested, it should be about, twenty [00:03:00] to twenty-five minutes from the time that you eat something that enters into the stomach, and then once it’s in the stomach, it should be there for about, twenty minutes to an hour on average.
pe- sometimes medications that people are taking, PPIs, opioid medications, GLP medications, delay the onset of the emptying of the stomach. And so that time may range between, one and four hours. Gastroparesis is considered any time the stomach empties less, than 60%… Or more than 60% of the stomach contents should be left within two hours.
And if it is a longer period, so four hours, there should only be maybe 10% of the stomach contents left. So if there’s more than that, it’s considered a delay in the emptying or, what’s this condition called, gastroparesis.
Causes Beyond Diabetes
Dr. Christina Carew, ND: And the traditional medical system is often educated on this as it’s a step in [00:04:00] advanced diabetes.
And 25% of the cases are generally found currently in people that have diabetes as a complication of diabetes. And so this is one of the myths that sort of exists in the system, is that, only people that diabetes– have diabetes can have this, and that people can only have it all the time.
And so what we often see in actual clinical practice is that this might be a condition where people are having it some of the time or with certain times of, cycle, like hormonal or certain types of, times when there’s more stress in their life. So it’s a multilayer type condition, and it’s not just related to diabetes.
In fact, in my clinical practice, I deal with a lot of, patients that have complex chronic illness. They have multiple things on top of each other, and, they’re often struggling because every specialist has a different take on it. And so a lot of the work that I do is, [00:05:00] how do we put these all together?
And there’s a whole set of, clinical reasons that we could also see this. people have mycotoxin or mold toxicity, people have Lyme or tick-borne illnesses, because in these cases, these types of infections They create lots of inflammation, but also can create autonomic nervous system dysregulation.
And so your stomach is something you should never feel. You should never feel that it’s something is happening in it or not happening in it. And if you are feeling that, it means, your nervous system is wired in a way where you’re starting to notice it because things aren’t moving as well as they should.
It should be something that just happens without you thinking about it. You don’t have to be like, “Oh, now I have to think about my stomach needs to turn on.” It just happens. And so other types of conditions we can see this in are things like Ehlers-Danlos, so hyperflexibility of the connective tissue, in particular like the veins, [00:06:00] and the arteries.
We see it often in people who have POTS, so dysautonomia, meaning that the body is having a dysregulation of blood pressure, and so that also creates a change in how our nervous system functions about how we get blood in different parts of our body. we’ll see it also post-viral illness, so we’re seeing people that have just this ton of inflammation that’s going on, and so that actually creates a disruption in the signaling.
And we do have a episode where we talk about disorders of the gut-brain interaction, and this may be one that’s considered within that pool, because there is some belief that there is a signaling issue from the brain tell the gut, in this case in the stomach versus the intestines, where the signaling isn’t happening quite as often as it should.
So anything that affects the nervous system can affect the signaling, and so when we think about things along these [00:07:00] lines, we need to also think that, all this inflammation or this anxiety or this, low, hormone production that I’m having may actually be affecting my body in other ways. And so it’s not just a digestion issue, it’s a chronic issue.
Okay, so that’s like the beginning. Like a tip.
Symptoms and Red Flags
Dr. Christina Carew, ND: Okay, so how do you actually feel? I would say the most common symptoms that people show up as, is, having chronic bloating, early fullness, so just feeling like they can’t eat very much or they don’t eat very much at all and then they feel quite full, and then the other being, reflux, that doesn’t respond to medication.
So reflux just meaning, it doesn’t feel like there’s, space for the food to come down. Sometimes that, re- results in nausea. Sometimes it results in nausea with vomiting, [00:08:00] and certainly any kind of upper abdominal pain. So we’re thinking about things that are, like, above the belly button, by the rib cage, and this, full sensation Okay.
Questions so far?
Overlap and Testing Challenges
Dr. Dominique Vanier, ND: Well, it’s interesting ’cause, so Christina and I both spoke at a conference yesterday in Toronto, and Whitney, we missed you because you were all the way in BC. But, what we talked about was Christi- so Christina did a great presentation on gastroparesis, but we can see an overlap with gastroparesis and, like we talked about, disorders of gut-brain interactions, specifically like functional dyspepsia, where they can look exactly the same, ’cause functional dyspepsia being like burning, belching, early satiety, fullness, nausea without vomiting.
So gastroparesis, it doesn’t always… It, it, can look like other things as well.
Dr. Christina Carew, ND: For sure. And you can have more than one thing at a time.
Dr. Dominique Vanier, ND: Yes.
Dr. Christina Carew, ND: And so-
you can have [00:09:00] overlapping conditions that share some commonalities, and maybe some things are different slightly, which is why it becomes super confusing even when you’re Chat GPT-ing all your symptoms, because it’s starting to give you these, the spectrum of things that might be happening.
and so I think part, of the reason is that our go-tos in this space in the body usually are things like, proton pump inhibitors, H2RA, so things like Pepcid or famotidine. we’re really good at treating acid, but we’re really bad at thinking about things that are beyond that. So H.
pylori, gastroparesis, any kind of, lower esophageal sphincter that’s not operating properly, hiatal hernia. And so there are lots of conditions that can cause this type of symptomatic, kind of sensation in people. It’s just that it’s not always top of mind because they’re [00:10:00] more rare pr- potentially, or maybe just under-diagnosed, and so not rare at all, but people just aren’t thinking about them.
Dr. Whitney Baxter, ND: Or it gets lost in, the treatment algorithm, too, ’cause often patients will come in and, like you said, we’re good at treating acids or proton pump inhibitors, the first step in the trial. And then if that doesn’t work, we’re maybe not always thinking about gastroparesis, these other functional things that could be happening.
We’re thinking more of, the reflux hypersensitivity or the disorders of gut-brain action, interaction side of that spectrum.
Dr. Christina Carew, ND: And, the testing for this isn’t fabulous, so this is another part of the problem, is that there are hospitals that can do manometry type testing or, scintigraphy testing.
And generally what happens is they, the patient gets a radiolabeled egg salad sandwich, and they take imaging as the sandwich transitions through the intestinal system to see, like, how long is something there. [00:11:00] But the challenge is, like a true gastroparesis is more than four hours having more than 10% of the stomach contents, but someone can have it for three hours before it empties and still have this delay and this uncomfortable sensation, but not be diagnosed as having this true, claimable position.
And this is part of the issue is just that, how long is long enough? And if you’re having symptoms, even if it’s perhaps not all the way to this kind of end extreme, there are things that can be done. You don’t have to wait until it’s worse to get better, and I think that’s hopefully what we’re communicating in the podcast series for people is that, there are all kinds of things on a spectrum that don’t involve a surgery or, aggressive medication that still can be fixed.
Okay.
Food Texture and Meal Strategies
Dr. Christina Carew, ND: So let’s think about like areas that [00:12:00] we think about when we think in this area and what some of the misconceptions are. so what do you guys think some of the, sort of areas where people are like, “How do I know if this is it or not?”
Dr. Dominique Vanier, ND: Okay, so maybe the gastroparesis is a stomach motility problem and not a digestion problem?
Dr. Christina Carew, ND: Yeah. So it’s, it is, like how f- it’s, not a matter of what you’re eating. And so I would say, as a clinician, we often see people come in and they say, “I can barely eat anything,” or, “I can only have something that’s liquid.” and so some of that in their mind is that the food they’re trying to eat, they’re trying to eat chicken, and it’s the chicken that is causing the issue, not that the structure or the function of the digestive system is what’s causing the issue.
And [00:13:00] it’s not about taking more foods out in this instance that’s gonna make anything feel better. It’s in fact sometimes, smaller meals that make a difference. Or I ha- I have a patient that, literally blends potatoes, chicken-
and carrots together in this very sl- almost sludgy type, drink, and that is literally how he gets his food in to be able- Yeah
to get protein and things like potassium, which are in potato, and, some of the nutrients that are in carrots. And, that is the way he gets his food in because he has such a long delay, so he’s the most of the work that the stomach does has actually nothing to do with absorption.
It has everything to do with making the meal more palatable for the intestines to be able to absorb things out of it. So if we can make it less dense and less hard to break down, we’re actually giving the [00:14:00] stomach a little bit of a break. and hopefully that helps with the improvement in the emptying time.
Dr. Whitney Baxter, ND: Kind of like going back to the simple lifestyle tips and tricks to help your bloating is to chew, one research paper said 40 times, but as much as you can to really turn it into more of that mush, ’cause then that’s, saliva has some, and there’s some, d- digestive enzymes starting in your mouth.
So when it gets- to the stomach it doesn’t have to do as much work to get it into that-
Dr. Dominique Vanier, ND: And like- … really sludgy form But personally that would, just significantly affect somebody’s quality of life, right? If it gets to the point where they have to make their food into, a sludge type of texture.
Yeah.
Dr. Christina Carew, ND: Yeah. Yeah. As a clinician, one of the screening, screening tools that we suggest that, the healthcare providers that are seeing patients that are experiencing this do is to, do a lot of anxiety and depression screening. It’s like-
your life is [00:15:00] really dramatically changed. And lots of times, the medical system is reliant on a couple of medications to make a difference, and if that doesn’t help, people are left with this idea that this is how they’re gonna feel forever.
and there are lots of things that fall outside of the medical treatment system that can be helpful, so to know that there’s things beyond pharmaceuticals that can be helpful. And this is also a growing industry. And so there’s, 12 or 13 different pharmaceutical medications currently in clinical testing to try to see if there’s other ways that we can…
A- and as well as tools, like things like, almost like pacemakers for the stomach to help to- trigger with emptying. and so this translates to bloating, so back to our topic of bloating, because, it feels like everything is stuck for a long time, and just because it’s stuck in the stomach doesn’t actually mean that once it leaves that place that it moves easier in the rest of the [00:16:00] intestine.
So we notice it in the stomach, and this idea of, just feeling like food is sitting and stuck and heavy and maybe causing some nausea, but then it also is gonna be delayed throughout the rest of the system. And so very common that this patient population has a lot of constipation, has a lot of, additional, more abdominal bloating, because it’s also, everything is fermenting as it sits there for so long in a space where we don’t expect it to ferment as much as it is.
So we’re getting a lot more- So are
Dr. Whitney Baxter, ND: people noticing, higher, more distension bloating? ‘Cause everything’s just- Yeah … stuck and building in that upper-
Dr. Dominique Vanier, ND: Yeah … yeah.
Dr. Christina Carew, ND: Things that- Your left … people will say is just, I can’t eat anything,” or, “I can’t eat anything until a certain time of day.” it feels Or, so I, at the conference I, told, I have two patients in particular around the eating piece that’s really, distinct for them. So one, can only eat an [00:17:00] egg on half a piece of English muffin in the morning as long as it’s before 8:00 AM, and then after 8:00 AM she cannot eat anything.
she’s not able to, digest and move anything at all. Before 8:00 AM, no problem. She can eat that. That’s feels like a safe food for her. It’s easy to, for her to digest, so she’s still getting nutrition from it, some. She’s losing a tremendous amount of weight, which is part of the problem.
but she could eat then.
I have a guy, another guy, who’s the exact opposite. He can actually only eat at 8:00 at night And so he finds that, if he tries to eat anything during the day, he just feels really unwell and sick. But for whatever reason, by the time night falls, he’s more relaxed, food is easier, and he doesn’t have to blend his food.
He eats, a generally a regular meal, it’s just at 8:00 at night. And so some of this is, that gut-brain piece, right? Like, how is the body getting the signaling? What else is happening? What’s the role of [00:18:00] stress and anxiety, around eating, things that people have tried. So it’s not that there isn’t also a component where the body isn’t sending the signal for it, but it’s a component where the body isn’t ready to send that signal because there are all these other confounding factors in the way.
Dr. Dominique Vanier, ND: Mm-hmm. Yeah, it’s really about when they feel most safe to have that meal, and therefore, the nervous system agrees a little bit more and supports digestion. Yeah.
Dr. Christina Carew, ND: Yeah, so we see, upstream bloating, like reflux, nausea, upper abdominal bloating. Some people will often say, this starts even under the breasts.
and then we may also see the lower bloating, more gas, more distension because everything’s quite delayed. this is also sometimes a person that might say, “Oh, I vomited eight hours after I ate and the food still came out.”
Dr. Dominique Vanier, ND: Yes.
Dr. Christina Carew, ND: We see some of those people in clinic. [00:19:00] or they’ll say, “I had a bowel movement and I saw the food that I ate two days ago.”
they’re not getting that breakdown, so it’s not just about what you’re eating, but are you even getting nourishment from that food?
Nervous System and Vagus Nerve
Dr. Christina Carew, ND: Um, one of the questions actually that one of the people in the audience asked was around this, connection between this and, the vagus nerve and the nervous system.
and could things like, care from like a osteopath, would that be something that could be helpful? And so we know that the vagus nerve is really the innervation piece. It’s a coordination of a lot of the systems in our body, and typically we don’t also have to be like, “Oh, I need to turn my vagus nerve on.”
it should be just functioning, and so it’s an automatic function, but we know that those automatic functions get dis- derailed at times. And I would [00:20:00] say a common thing that I see in a lot of these patients is because they feel anxious, not just because of not being able to eat or being worried about eating and then vomiting, they also are feeling very anxious because they don’t have a lot of nutrients in their body.
Dr. Dominique Vanier, ND: And so
Dr. Christina Carew, ND: the… when we are more nervous or we have, feel more anxiety, we tend to breathe more from the upper part of our body, and so our diaphragm actually doesn’t get that full range of movement. And so if we think about our diaphragm in relationship to the stomach, the esophagus, runs through the diaphragm, which is then the stomach’s on one side and the diaphragm, becomes this like umbrella, like one of those big balloons over top of it.
I think about the hot air balloon kind of material. and so the esophagus is running up and down, but if the diaphragm is too tight, then we’re also not getting that flexibility of movement, which is also gonna affect our motility, but also make us [00:21:00] feel like things are even more stuck than they are because we’re actually not getting movement inside our abdominal cavity.
And so there are things like manual therapists that may be very helpful in helping people to move things forward, just from a relaxation of all the other things that are discoordinated when something doesn’t feel good.
Dr. Dominique Vanier, ND: Interesting, ’cause you see this overlap too with constipation, right? And s- and sometimes, we’re gonna see multiple things, like you said, in one patient where they may be more likely to have constipation, and then we know that the diaphragm, the diaphragmatic breathing, the diaphragm movement, and even the pelvic floor support is really important for those individuals.
so yeah, it’s really not … It’s, not, black and white, right? we c- can’t always tease apart all these kind of different conditions.
Dr. Christina Carew, ND: And different things are gonna work for different people. Mm-hmm. So if the paralysis is due to a medication, we might see that, as the day [00:22:00] wears on, the medication wears off, that things change, right?
Or, if it’s due to a stress trauma or a viral illness, we may see that changes based on how the immune system’s operating or what’s going on in the environment. So it’s one of these things where it’s like it maybe affects you in different ways at different times, and as a person who’s experiencing it, you’re trying to look for all these clues because you’re like, it must be because I ate strawberries and it was 2:00,” right?
And so you’re trying to figure out what’s the pattern. and so it becomes really challenging because in that you just start to vilify things that you’re like, I can’t eat this meal,” or, “I can’t eat standing up,” or, “I can’t eat at this person’s house.” My grandma actually, I think that she actually had some level of gastroparesis because she would tell me, that she couldn’t eat chicken at a restaurant because it would feel like it got stuck.
But she’d eat chicken at [00:23:00] home.
And it was, like, really interesting, and I think that it was, like, the anxiety of being in a restaurant was, like, part of that. She was older. She didn’t have a lot of stomach acid. She probably had a hiatal hernia. she had all these other contributors, but she would always be like, “I vomit up the chicken if I eat at a restaurant.”
It was like … But then I was like Also, did she teach herself that? it happened one time, and then she con- consistently remembered that. She also liked to not- watch TV with the, sound on, and so she’d be like, “That yogurt makes people run to the bathroom.” And I was like, “Actually, they’re running to the gym.”
And I was like, “Why would they put that on a commercial?” She’s “I don’t know.” So grandmas are fun. Okay.
Differentiating From FODMAP Bloating
Dr. Christina Carew, ND: Um, so we have some early sy- satiety, we have nausea and food aversion. It’s a little bit, different from, some of the bloating we’ve talked about earlier. a FODMAPs [00:24:00] type bloating where we’re getting, a food that’s creating more overgrowth, so maybe SIBO or other things, that usually would be more fast.
only because, in a gastroparesis situation, the stomach still has the food in it, where in a FODMAP situation, it’s getting to the small intestine. So that might be a kind of a little bit of a different, histamine-
Dr. Whitney Baxter, ND: And with that, it is more reproducible. you can do a low FODMAP diet and see some patterns in the foods that you’re eating, whereas gastroparesis, not necessarily with the foods, more that timing of the one to four hours after your meal.
That’s the pattern. I will
Dr. Dominique Vanier, ND: say there’s a caveat to it, ’cause if it actually is functional dyspepsia, then we will- Yeah … probably see an improvement with FODMAP. And the dyspepsia can look just like gastroparesis. Yes. And this is where it’s messy.
Dr. Whitney Baxter, ND: Yes. Yeah.
Dr. Christina Carew, ND: Yeah. 100%. and, the histamine piece is also a bit of a crossover because we know that histamine aggravates or inflames the system, which we can see in [00:25:00] dyspepsia, we could also see in gastroparesis, and we can also see just with a histamine issue.
And so histamine might be bothering someone. That’s why sometimes when someone’s given, a famotidine or a Pepcid, they suddenly feel like things are a little bit better, ’cause the, stomach is the highest amount of histamine 2 receptors.
But it can also go the opposite, that they feel it’s much worse because now we’re taking another layer of that digestive piece out of it, which is where everything is already blocked and stuck.
Yeah. So it’s not easy. not easy at all, and not super easily treatable. So we can send people for that, motility kind of patterning, and at least even just get the data to look at it ourselves to say, “Okay, is there a delay?” I know where I practice that, the time to wait for that test is between 8 and [00:26:00] 10 months.
that’s a long time for people not to eat, ’cause there’s not a lot of places currently that are doing it. so it might be different wherever you are, listeners, but, also just to keep in mind that some of these testing options are very, rare, and so they are… do have longer lists of waiting for people.
Dr. Whitney Baxter, ND: Mm-hmm.
Dr. Christina Carew, ND: Okay.
Treatment Steps and Nutrition
Dr. Christina Carew, ND: So I would say, what can we tell people in terms of things that might be able to help them as a way to see if could they make some headway while they’re waiting for testing or to find a practitioner that knows a bit about this to help? and I would say there are some things, in the research that might be, useful, which is, not having a lot of restrictions because we know that restrictions, as we’ve talked about in other podcasts, have definitely worsened motility ’cause we’re now not getting, all the nutrients necessarily [00:27:00] that would help us to make motors move.
certainly things like that. we know that in a lot of the types of s- of symptoms that we see, that having routine and pattern is actually really important to people. And so having the body know that this time of day, no different than babies, this is the time of day you’re getting your nap. This is the time of day that you’re eating.
This is the time of day that we go to bed. so if we get out of pattern where we’re skipping meals or we’re having long periods of time where we’re not even trying to eat food, we get out of this rhythm that our body now feels, more deprived and deprivation. So certainly that can be a piece.
It might be finding some really interesting ways to make food taste better or more accessible. So it might be smaller meals, it might be more blended meals, it might be having, really concentrated, protein drinks or having really [00:28:00] dilute protein drinks, having things that are more small food particles.
these are types of things in the research that seem to help. because eating less is unfortunately just just drives the system further into a state where it can’t find its way.
So how, what would this look like if you’re getting treated? And I think that this is always helpful for patients just to understand what happens. and so I would say there’s I, think about it as steps. So step one is, making sure that any of the medications that you’re taking are not causing this issue.
making sure that all of the symptoms that you’re experiencing are tracked so that you can see if interventions are helping, even if that means that you can’t, eat a big meal all the time. You were able [00:29:00] to eat it three times this week, right? There are some improvements. making sure that mental health and eating disorders are, looked at because certainly our mental wellbeing affects our physical wellbeing.
A- And looking at micronutrients. So because the diet is, very limited for many of these people, certainly things like iron, B12, vitamin D, zinc, calcium, fat-soluble vitamins, like all those can become very low. And so in some cases, as much as withholding some of that seems like it feels better, in withholding it, we actually end up in a situation where we make things much worse.
It’s if we think about it as relationships. someone bugs you. Your husband bugs you ’cause he puts his socks wherever, whenever, something basic, right? And then over time you’re like, “Oh, and then there’s this, and then there’s this, and then there’s this,” and then you have the massive blowout.
and then [00:30:00] sometimes those are repairable, and sometimes they’re not repairable based on, how long had it taken for you to discuss all the things that have been building up. And so when we think about conditions and the more things that we do to feel better, we also have to learn how to undo all of those things in order to, be able to get back to the healthy state that we were in.
Dr. Dominique Vanier, ND: It’s challenging, right? Because when we take out foods, or at least in so many discussions with patients taking out foods, it’s like their first attempt at control and- supporting themselves, right? And it’s really easy to go down that rabbit hole of “Oh, it’s this food. Now it’s this food, and I’m sensitive to this food,” and the thought being, “Okay, I just need to take it out and things will improve.”
But we even know like lower down in the digestive tract, when we remove food for long periods of time, we can affect the microbial community there. So then we can start seeing like an upper and lower GI issue.
Dr. Christina Carew, ND: Yeah, one thing causes another. Another domino falls down. [00:31:00]
I would say-
Dr. Whitney Baxter, ND: Yeah, and it goes into that loop too.
It’s, there’s… we’ll talk about this I’m sure in one of our episodes, but there’s like a whole separate eating behaviors category called avoidant restricted food, ARFID food disorder, where you’re a f- it’s a fear of the food, not of the weight, and it just becomes, like Dominique said, a piece of control, and maybe you feel better some days.
“Okay, I got it. I got my system. I can go out to eat. I can take a breath and live my life.” so we, but we get into these patterns without noticing it too. And you don’t even notice the foods that you’re sticking with might be low in certain nutrients, so it is good to take a step back and do the screening- and track it a little bit.
Dr. Christina Carew, ND: Mm-hmm.
Medications Prokinetics and Safety
Dr. Christina Carew, ND: And I would say part of the reason that the food becomes a big com- a big component of this is that nausea, vomiting sensation is fairly, significant for people. Yeah. And anyone that may have, tried a [00:32:00] GLP-1 may have also felt that. That’s actually one of the common side effects of it because of the delay the GLP-1 creates in the intestinal tract.
It actually purposely causes some motility issues so that people feel full longer, and in doing that, you feel sometimes more nauseous. but we have lots of antiemetics, so anti-nausea medications. We use them often in pregnant women. We can use them in situations where people have chronic nausea and vomiting, so this is an area you definitely can talk to your medical practitioners about.
they exist in pharmaceutical, and they also exist in things like acupuncture and acupressure and vitamins that may help. And so all of those might be things to consider. and depending on where you live, cannabis may or may not be legal, and for some people, cannabis has an impact on lowering nausea.
We see it sometimes in cancer patients that are s- experiencing nausea from, treatments. We also can see the other way, [00:33:00] that, cannabis hyperemesis, meaning, that cannabis can induce this sort of vomiting syndrome that happens every morning, nauseous vomiting syndrome. and so being cautious, like how much you’re using and is it helping or not helping?
I’d say that would be one area. I would say, the delayed emptying and early satiety, so m- meaning that people just aren’t eating very much, is another area. And so we have a whole classification of, medications that are called prokinetics. They help with motility and movement. There are varying degrees of, hazards behind them or risks behind them, so certainly talking with a professional about that and not buying them on the internet would be super important.
and if you do buy them on the internet, you’re telling someone about it so that, we can make sure that you’re being, tracked appropriately because, I, have a patient that was left on, one of these [00:34:00] medications for more than, since she was 20, and she’s almost 80. Wow. and one of the side effects of, one of the medications is that you get QT prolongation, so you get changes in the heart rhythm.
Yep. Oh. And she actually came to me because she had changes in heart rhythm, and I was like, “Holy smokes, you’ve been on this medication for 50 years which causes this.” And so the medication was causing the issue which w- layered another medication on top of that, another medication on top of that, and I was like, “Oh, this is just a side effect of this medication you probably shouldn’t still be on.”
Yeah. and so I think sometimes it’s like being mindful of how long you’re using these tools for, and as long as they’re helping, that’s great. but maybe they’re not doing what they once did, and medications aren’t always for life. And so being able to talk to your pharmacist or talk to your professionals that are in your life about those is really important.
Dr. Dominique Vanier, ND: Yeah, [00:35:00] certainly, yeah, reevaluating at the appropriate times- Yeah … and then really having, targeted outcomes. is this helping? What’s it supposed to be helping with? Can we decrease the dose? Is there still an effective response if we decrease the dose or switch the medication or what have you, right?
Dr. Christina Carew, ND: Is there a safer drug now that- Yeah … has better effectiveness at a lower dose, less side effects?
Dr. Dominique Vanier, ND: Yeah.
Dr. Whitney Baxter, ND: It’s always nice to have fresh eyes on these things that you think are so standardized. oh, there’s just my medication list. your m- doctor knows or … But to have fresh eyes on it and really just sift through, ’cause life changes.
gut health changes all the time.
Dr. Dominique Vanier, ND: PPIs is a great example of that, right? Like, how many times do we see people on PPIs where they were supposed to stop somewhere between eight weeks to six months, and then they’ve been on it for a decade.
Dr. Christina Carew, ND: Yeah.
Dr. Dominique Vanier, ND: Yeah. Yeah.
Dr. Christina Carew, ND: Yeah. And then, PPIs are one of the causes, potentially, of gastroparesis, and so- full circle. I’d say the second kind of category in this sort of early satiety [00:36:00] but also some of that hypersensitivity or, feeling, everything feeling that we get at stuck would be, neuromodulators, which Dominique, you did lots about that recently.
and so neuromodulators are just medications that can help our brain to rework some of the wiring.
They sometimes are also considered medications that fall into the antidepressant or anti-anxiety category, but also pain relief category. And sometimes if your practitioner suggests this to you and you’re familiar with it for one reason, it’s good to ask them, “Why are we using this?
What do you expect to happen? How else can this work?” because they m- may be thinking of it in many different ways but haven’t actually communicated that to you.
Dr. Dominique Vanier, ND: Mm-hmm,
Dr. Christina Carew, ND: yeah. So it isn’t all in your head, but there are some pieces that, if regulated better, may actually help. [00:37:00]
Dr. Dominique Vanier, ND: Yeah, neuromodulators are pretty cool.
they’re, they are, I would say, they’re pretty … Th- they have a lot of attention now in the research because previously, especially, the tricyclic antidepressants, at certain doses they have been used for, more of, the antidepressant, anti-anxiety category, and now at lower doses they’re seen to actually have a big impact on some gut conditions.
Yeah, like the hypersensitivity part like you spoke about.
Non Drug Therapies and Escalation
Dr. Christina Carew, ND: Yeah, we see other types of things outside of the pharmaceutical world, right? Like hypnotherapy, and mindfulness, and CBT, and breathing, and osteopathy. acupuncture actually has some really good evidence for helping, with getting emptying and movement of the systems.
And TCM, Chinese medicine, may actually have, other pieces within that around, is the body hot or cold in terms of, like, how things are moving. And then there’s lots of botanicals that work in this area. So there are herbs, [00:38:00] so if medications aren’t working or aren’t working well enough, or combining a medication with a herb makes you be able to keep it at a lower dose or for a shorter period of time.
These are all ones that could be considered. and then if things aren’t getting better, you should definitely talk to your practitioner about, getting more help. So there are, enteral nutrition, so getting, feeding tubes. That might be helpful even for a short period of time, just to get your strength back up.
having integrated practitioners, so naturopaths with your GI doc, with your dietician, with your psychologist. And, monitoring your symptoms, so things like weight are big ones. Nutrition is a big one. Participating in life is a big one. and making sure that, things are helping that you’re doing, and you’re not just creating more stress by having a longer list of things that you need to do every day [00:39:00] in order to feel like you, you can get moving or get things moving.
Talking to Your Practitioner
Dr. Christina Carew, ND: Um, so how would you guys want your patients to come in and talk to you about this? So what are ways that they could, bring up some of the suggestions in terms of, how would you start a conversation or how would you want someone to start a conversation about this?
Dr. Whitney Baxter, ND: I think a really important point we talked about is taking the blame or the villain away from our foods- and just starting to notice your bloating pattern. So yeah, you ate, but then when did it start? How did it show up? And what does it feel like? So getting read- really detailed about the timing of your bloating, when does that fullness happening, what are the sensations you’re feeling, even if it’s with small meals.
And then you could say something like, “I’m wondering if gut motility or delayed stomach emptying could be contributing. Could we, explore that?” to your practitioner. [00:40:00]
Dr. Dominique Vanier, ND: Mm-hmm. Yeah. And then certainly, what tests can we do to better differentiate whether this is a stomach issue or another potential iss- potential issue.
Dr. Christina Carew, ND: Yeah. And I think that gastric, the words gastric emptying are helpful because the practitioner that you’re seeing may not be thinking about that. And so once you suggest the word, then they’re like, “Oh, wait a second. Maybe that is a part of it.” I just don’t think it’s high on our radar of potential diagnosises, but I think it should be.
and hopefully podcasts like this and people asking their doctors more, will help them to get some more of this information out.
Resources and Final Takeaways
Dr. Christina Carew, ND: And, for this episode, I actually made up bloating and motility pattern checklists that people can download. So you’re gonna go to the show notes, which is on our website, which is, [00:41:00] teamgutgirls.com.
You’re gonna go to this episode, and underneath it you can see, both the transcript, but you can also see some checklists. And taking that checklist with you to the doctor’s office can be really helpful. It’s something you can leave behind, and really tell them, what are the things that they’re, you’re experiencing so that it’s really clear for them.
because even if they’re going to write you a referral for some of these tests, they need to have a real clear understanding of, what is the symptom that you’re experiencing it, because writing it on the referral can make that referral happen faster. And so just being, like, exploring gastric motility may not be as effective as, say, exploring gastric motility because of rapid weight loss, because of- chronic nausea and vomiting. So the more descriptive we can get in the information that’s passed from specialist to specialist may actually help improve your case.
Dr. Dominique Vanier, ND: That’s really helpful. Christina, thank you for putting that together. I think what’s also [00:42:00] important- gastroparesis can occur in the absence of diabetes, right?
Yeah. So practitioners need to know that if your patient does not have diabetes, it doesn’t mean that they don’t have gastroparesis.
Dr. Christina Carew, ND: Yeah, it’s just like one of the reasons why people get it. in fact, it’s still only 25%, what, which is a large percentage, but there’s still 75% of people that are getting it that are not necessarily…
It’s not a first-line consideration because it’s thought to be, one of these diseases that happens because of diabetes So a huge part, for sure
Any other last thoughts?
Dr. Dominique Vanier, ND: I think we covered a lot of pillars today. but I think- reiterating, Whitney, your point, which is like s- sometimes getting a second set of eyes on this, because if somebody’s been experiencing these issues for so long, and they’ve been down the [00:43:00] rabbit hole of cutting out all the foods and maybe tried certain medications, and they’re just, their quality of life is so significantly affected still, or they’re just not seeing, the, they’re not seeing their symptoms improve to the way that they would expect is, you need somebody else to help you in your corner.
Dr. Whitney Baxter, ND: Yeah. Especially with this one, ’cause it could be as straightforward as a medication side effect.
Dr. Dominique Vanier, ND: Right.
Dr. Whitney Baxter, ND: Or you could be an individual with something more complex, like an autonomic dysfunction or chronic viral illness or even the connective tissue disorders, where you have all of these random symptoms, and no one’s really been able to- Put it all together
figure it out. And ’cause all of these, you’re seeing a lot of specialists, and this is one key piece that affects, a lot of hours of our days and our energy if you can’t eat properly. So yeah, I think it was really helpful just to re-listen to how to talk to your practitioner and be really specific with the terminology and timing and what you’re feeling.
Dr. Christina Carew, ND: And if your [00:44:00] practitioner says, “I don’t know anything about it,” just say, “Can you send me to someone that you think might?” Yeah. or you might even come in with that information because you’ve done some of your own research or someone has suggested it, whether that’s on Reddit or ChatGPT or in a Facebook group.
try not to take all of the information at face value, but recommendations of practitioners who people had good experiences with are great people to bring in and say, I’ve heard that this doctor has helped someone else with this. maybe you could send me to them.” that’s honestly how we get some of the best and most informed practitioner care, is knowing who the person is that we’re sending them to that has a specialty or a, an interest in this area.
Closing and Next Episode
Dr. Christina Carew, ND: thanks everyone for joining. So the show notes will be loaded up, and w- you can follow along and definitely pull things out. we are continuing to do [00:45:00] this series because we believe that gut health really does impact everything in your life. And the better that feels in your body, the better you feel.
And remember that better gut health changes everything, and we’ll see you again next week.
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