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Dr. Bernstein Shares His Insights
Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., FCCWS, discusses the use of Semiliquid or Liquid Meals to balance glucose in patients with gastroparesis
Diabetes Solution Revised and Updated 2007
Complete Guide to Achieving Normal Blood Sugars
Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., FCCWS.
Chapter 22 Part 8
Other tools in controlling Gastroparesis – Part 8
Semiliquid or Liquid Meals
A last resort for gastroparesis is the use of semiliquid or liquid meals. I
say “last resort”because such a restriction takes much of the pleasure out
of eating, but it may be the only way to assure near-normal blood sugars.
With this degree of blood sugar improvement, the gastroparesis may
slowly reverse, as mine did. The restriction can then eventually be removed.
In this section I’ll try to give you some ideas that you can use to
create meal plans using semiliquid foods that still follow our guidelines.
Baby food. Low-carbohydrate vegetables and nearly zero carbohydrate
meat, chicken, and egg yolk protein meals are readily available as
baby food. Remember to read the labels. Also remember that for a typical
protein food, 6 grams of protein on the label corresponds to about
1 ounce of the food itself by weight. To avoid protein malnutrition,
you should consume at least 1 gram of protein for every kilogram (2.2
pounds) of ideal body weight. Thus, a slim person weighing 150
pounds (68 kilograms) should consume at least 68 grams of protein
daily. This works out to about 11 ounces of protein foods. People who
are still growing or who exercise vigorously must consume considerably
more than 1 gram per kilogram of ideal body weight.
When vegetables that only slowly raise blood sugar are ground or
mashed, they can raise blood sugar more rapidly. So how can we justify
using baby foods? The answer is that we recommend such foods only for people whose stomach already empties very slowly. Thus even
with baby food your blood sugar may still have difficulty keeping pace
with injected regular insulin. Later in this chapter I will show you
some tricks for circumventing this problem.
Below is a brief list of some typical baby foods that can be worked
into the meal-planning guidelines set forth in Chapters 10 and 11. Do
not exceed those guidelines for carbohydrate, since most of the Laws
of Small Numbers still apply, even if you have gastroparesis.
Beech Nut Green Beans (4.5-ounce jar) 8 grams
Beech Nut Garden Vegetables (4.5-ounce jar) 11
Heinz Squash (4.5-ounce jar) 8
Beef (3-ounce jar) 2.25 ounces
Chicken (3-ounce jar) 2.25
Ham (3-ounce jar) 2.25
Egg Yolks (3-ounce jar) 1.50 (plus 1 gram carbohydrate)
Unflavored whole-milk yogurt.
Some brands of whole-milk yogurt,
such as Erivan, Brown Cow Farm, or Stonyfield Farm, have no
added sugars or fruits. As noted previously, Erivan is sold at health
food stores and the other two at supermarkets throughout the United
States. Again, always specify “whole milk, unflavored.” Remember that
“low-fat” dairy foods usually contain more carbohydrate than the
whole-milk product.
Erivan yogurt contains 11 grams of carbohydrate and 2 ounces protein
per 8-ounce container. Stonyfield Farm and Brown Cow Farm
both contain 12 grams carbohydrate and 1.5 ounces protein.
Bland foods like plain yogurt can be made quite tasty by adding one
of the baking flavor extracts, the powder from truly sugar-free gelatin
desserts (i.e., without maltodextrin), Da Vinci sugar-free syrups, or
stevia with cinnamon. The amounts used should suit your taste.
Whole-milk ricotta cheese.
While not as liquid as yogurt or baby
food, ricotta cheese goes down better than solid foods. It can also be
put into a blender with some water or cream to render it more liquid.
Each 8-ounce serving of ricotta contains about 8 grams of carbohydrate
and 2 ounces protein. To my taste, ricotta is a very bland food,
but when flavored with cinnamon and stevia, it can be a real treat—a
meal that tastes like a dessert.
Liquid meals.
When semiliquid meals are not fully successful, the
last resort is high-protein, low-carbohydrate liquid meals. These are
sold in health food stores for use by bodybuilders. Only use those
made from egg white proteins or whey, if you wish to be assured of all
the essential amino acids. Similar products made from soy protein
may or may not contain these in adequate amounts. Many may contain
sterols similar to estrogen.
Possible Last Resorts for Treating Gastroparesis
One of my patients claims that a costly new treatment has helped considerably
both her gastroparesis and her neuropathic pain. It involves
the application of small electric currents to acupuncture points on her
limbs and is called STS therapy. The electronic device is designated
model STS and is manufactured by Dynatronics of Salt Lake City,
(800) 432-2924. The instrument costs about $4,000 and the treatment
must be performed for 45 minutes every day. Its effects begin after
about 2 months, and it may actually facilitate the healing of damaged
nerves. This device should not be used near an insulin pump or by
people with implanted electrical devices.
Another costly option is electrical gastric stimulation. This involves
surgical implantation through the skin of two electrodes that contact
the muscular wall of the stomach. The connecting wires enter a control
box that can be kept in a pocket or on a belt. The control unit can
be set to stimulate the stomach muscles after each meal.
Next Feature: TREATING LOW BLOOD SUGARS WHEN
Gastroparesis – Part 1
Delayed Stomach-Emptying –Part 2
Diagnosing Gastroparesis –Part 3
APPROACHES TO CONTROL OF GASTROPARESIS -- Part 4
More Medications that can help in controlling Gastroparesis – Part 5
APPROACHES TO CONTROL OF GASTROPARESIS – Part 6
Non-Medication APPROACHES TO CONTROL OF GASTROPARESIS Part 7
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We would like to thank the publisher Little Brown and Company and Dr. RichardK. Bernstein, for allowing us to provide excerpts from Diabetes Solution 2007 Edition
Copyright © 2007by Richard K. Bernstein, M.D.
All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.
Author’s Note
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.
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