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Q&A: Can a plant-based formula improve gastroparesis symptoms?
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There is no definitive cure for patients suffering from gastroparesis.
One of the most common treatment options for the rare disorder includes an alteration in eating habits that can help control gastroparesis symptoms and ensure patients get the right amount of nutrients, calories and liquids. Effectively altering eating habits can best treat malnutrition and dehydration, which are considered the disorder’s two main complications.
Additionally, some physicians may recommend oral or nasal tube feeding for patients to prevent malnutrition.
However, as Linda Nguyen, MD, director of GI motility and neurogastroenterology within the division of gastroenterology at Stanford University, notes, there is not much information available surrounding the treatment of gastroparesis.
As a result, Nguyen and colleagues are beginning the recruitment process for a pilot study to understand the impact of a plant-based formula on patients who have gastroparesis.
“I was asked to give a talk on diet and gastroparesis. As I went to go do a literature search, I was like, ‘There’s really nothing there,’” Nguyen told Healio Gastroenterology and Liver Disease. “The recommendations on a low-fiber diet were based on the idea that foods that are high in fat and high in fiber are harder to digest. So, it takes longer for the stomach to break it down. If you already have slow stomach emptying then eating high carbohydrates, or easy to digest food will go through your system faster.”
Nguyen spoke with Healio Gastroenterology and Liver Disease about the study she and her colleagues are conducting, as well as the significance of the study. – by Ryan McDonald
Healio: What led you and your colleagues to want to conduct this study?
Nguyen: The idea behind the study is that patients with gastroparesis who end up on a feeding tube are usually put on standard formulas that tend to be high in sugar and are highly processed. The formulas tend to be void of any whole-foods, vegetables, or anything that is plant-based.
We know that when you orally consume large amounts of sugar and processed foods, it can affect the microbiome. Our first thought was, if a patient switched from a traditional formula to a plant-based formula, does that improve tolerance and do patients have fewer symptoms. Even though patients are not technically eating, but rather getting formula infusions, they still complain a lot about bloating, cramping and diarrhea occasionally.
Healio: What are some endpoints that the team will be analyzing ?
Nguyen: Our hypothesis is that switching to a plant-based formula will be better tolerated so that patients will have less severe symptoms. Additionally, the exploratory endpoints of looking at the microbiome and inflammation hopefully may give us insight into treating patients with gastroparesis who don’t have a feeding tube, which is the larger proportion of patients with gastroparesis. When we look at general dietary recommendations for gastroparesis, it’s a low-fat, low-fiber diet and what that ends up being is a high carbohydrate diet and we know from different studies and different conditions, that high carbohydrate diets are not good for health.
We’ll be conducting analyses before and after to see if going from standard formula to a plant-based formula will change the microbiome.
Healio: What will the recruitment process consist of?
Nguyen: We’re looking to recruit 30 patients as quickly as possible, hopefully over the next several months to less than a year. Patients have to have gastroparesis; and it can be diabetic, idiopathic, or post-surgical and they have to have a feeding tube already placed. This study will not include someone new to tube feeds. This is for people who are already on tube feeds, but they are getting the standard traditional formula.
If they’ve had prior gastric surgery, including a gastrectomy, gastric bypass or bariatric surgery, they will be excluded from the study. They will also be excluded if they’ve had a bowel obstruction, are taking narcotics, if they have short bowel syndrome or if they have a diagnosis of bacterial overgrowth that has not been treated.
The reason we excluded patients taking narcotics is that it can affect not only gastric motility, but it can affect the small bowel and colon, so we didn’t want that as a contributing factor.
However, we’ll have to see with the narcotic exclusion whether we’ll be able to recruit enough patients, because a lot of patients with gastroparesis who need feeding tubes are on narcotic pain medication.
Healio: What is the significance of this study?
Nguyen: There’s really limited data on diet and the outcomes of diet manipulations in our patients, and to step back a little bit, when you query patients about how much they eat and what they’re eating, this was a study that came out of the gastroparesis consortium with Henry P. Parkman, MD, as the lead author, which noted that the majority of patients consume less than 60% of what is their estimated metabolic needs.
Despite that, when you look at different cohorts, about 30% of patients with gastroparesis are obese. How do you reconcile not eating enough with obesity and one of the exploratory things we’re looking at is whether or not inflammation and gastroparesis alters your resting energy expenditure so that your metabolic needs differ than somebody who has the same height and weight without those conditions. The other question is, is the gastroparesis diet as it is recommended now hurtful to patients? Taking away fiber which functions as a prebiotic to promote a good microbiome, if we’re taking away fiber, are we potentially making patients worse by medically changing their microbiome?
Disclosures: Nguyen reports no relevant financial disclosures. The study is being conducted using a plant-based formula from Kate Farms. A co-author reports receiving a grant from Kate Farms.