Gastroparesis & Eating Disorders: Understanding the Connection and Management

Eating disorders impact nearly every system in the body—but one of the most distressing and persistent complications is gastroparesis, a condition where the stomach empties more slowly than normal. For individuals in recovery from an eating disorder, gastroparesis can mimic relapse, complicate nutrition restoration, and reinforce food-related fears.

In this post, we’ll explore what gastroparesis is, how it intersects with eating disorders, and the evidence-based strategies for compassionate management.

What Is Gastroparesis?

Gastroparesis is a condition where the stomach’s muscles and nerves don’t function properly, causing delayed gastric emptying without a physical blockage. Food moves sluggishly from the stomach into the small intestine, leading to symptoms like:

• Early fullness (satiety)

• Nausea

• Vomiting undigested food

• Abdominal bloating

• Upper stomach pain

• Unpredictable appetite

• Weight loss

In people with eating disorders, especially those involving restriction, purging, or prolonged malnutrition, gastroparesis may be either functional (due to slowed motility) or secondary to nutritional depletion and hormonal dysregulation.

How Are Gastroparesis and Eating Disorders Connected?

1. Malnutrition Slows Digestive Function

Chronic undernourishment leads to:

• Reduced stomach muscle tone

• Altered motility hormones (e.g., ghrelin, motilin)

• Delayed gastric emptying as the body conserves energy

This can occur in:

• Anorexia nervosa

• Bulimia nervosa (particularly with vomiting)

• ARFID with long-standing restriction

2. Gastroparesis Can Fuel Disordered Eating

When eating causes discomfort, fullness, or nausea, individuals may:

• Begin to fear eating or restrict further

• Misinterpret symptoms as “proof” they don’t need food

• Feel discouraged or hopeless in early recovery

This creates a dangerous cycle:
Restriction → slowed digestion → symptoms → more restriction

3. It’s Often Misdiagnosed or Dismissed

Because gastroparesis shares symptoms with disordered eating, providers may assume complaints are psychosomatic or manipulative. But functional GI changes are real and measurable—and need to be taken seriously.

“Gastrointestinal distress in eating disorders is often dismissed as psychological, but many patients experience medically significant motility changes that deserve clinical attention.”
— Mehler & Andersen, Eating Disorders: A Guide to Medical Care

Diagnosing Gastroparesis

If suspected, a provider may order:

• Gastric emptying study (GES) – a 4-hour scan measuring how quickly food leaves the stomach

• Upper GI endoscopy – to rule out blockages or ulcers

• SmartPill (wireless motility capsule) – for comprehensive transit time data

• Abdominal ultrasound or labs – to rule out other causes

Diagnosis must be carefully evaluated in eating disorder patients, as symptoms can overlap with refeeding effects or psychological distress.

Managing Gastroparesis in the Context of Eating Disorder Recovery

1. Nutrition Support: Small, Frequent, Gentle Meals

• Eat 5–6 small meals per day instead of 2–3 large ones

• Focus on low-fat, low-fiber, soft-texture foods that are easier to digest

• Try liquid calories (smoothies, milkshakes, broths) for nutrient density

• Avoid carbonated drinks, high-fat fried foods, and tough meats when symptoms flare

• Sit upright for 1–2 hours after eating to help gastric emptying

Important: Even if appetite is low, scheduled eating remains vital for recovery and GI motility.

2. Medical and Pharmacologic Management

• Prokinetics (e.g., metoclopramide, erythromycin, domperidone*) can stimulate stomach contractions

• Antiemetics may help with nausea (e.g., ondansetron)

• In severe cases, temporary feeding tubes or enteral nutrition may be considered
  (*Note: Some prokinetics have side effects and require monitoring)

Always work with a gastroenterologist and an eating disorder-informed medical team.

3. Gentle Movement and Lifestyle Modifications

• Light activity (e.g., walking) after meals may help motility

• Avoid lying down after eating

• Manage constipation, hydration, and electrolyte balance carefully

• Practice stress reduction, as anxiety worsens gut motility (use breathing techniques, mindfulness, therapy)

4. Psychological Support

• Validate the distress of gastroparesis without fueling fear

• Address food-related trauma or anxiety that may be compounded by symptoms

• Use exposure-based therapy to slowly reintroduce feared foods

• Avoid rigid “safe food” lists that reinforce long-term restriction

• Incorporate ARFID or health-anxiety strategies when relevant

What to Avoid

• Over-relying on restrictive “gastroparesis diets” long-term

• Eliminating entire food groups without medical necessity

• Skipping meals because “I’m not hungry”

• Using symptoms as a reason to delay recovery efforts

• Ignoring signs of worsening malnutrition or dehydration

Hope for Healing

The good news: gastroparesis related to eating disorders is often reversible.

As nutritional rehabilitation progresses and digestive function restores, many individuals report:

• Improved gastric emptying

• Fewer symptoms

• Reconnection with hunger and satiety cues

• Less fear of food

However, this takes time, consistency, and patience. Healing the gut is part of healing the whole body—and it doesn’t follow a perfect linear timeline.

Final Thoughts

Gastroparesis can be a frustrating, painful, and deeply discouraging experience in eating disorder recovery—but it doesn’t mean healing isn’t possible.

When met with integrated medical, nutritional, and psychological care, individuals can gradually rebuild both trust in food and comfort in their bodies.

Support your recovery by listening to your symptoms—but also to your resilience, your hunger for life, and the hope that healing brings.

References

• Hasler, W. L. (2009). Gastroparesis—current concepts and considerations. Medscape General Medicine, 11(1), 16.

• Bharucha, A. E., Kudva, Y. C., & Prichard, D. O. (2020). Diabetic gastroparesis. Endocrine Reviews, 41(2), 131–156.

• Mehler, P. S., & Andersen, A. E. (2015). Eating Disorders: A Guide to Medical Care and Complications. Johns Hopkins University Press.

• American Neurogastroenterology and Motility Society (ANMS). (2022). Gastroparesis Guidelines.

• Staller, K. (2017). Gastrointestinal symptoms and eating disorders. Clinical Gastroenterology and Hepatology, 15(9), 1272–1279.