Question: I need help! I have been on insulin for 51 years and have always tried to have lots of fiber in my diet. Now I have been diagnosed with severe gastroparesis and have been told by my certified diabetes educator to try to limit fiber in my diet to 10 to 15 grams per day. I now feel guilty every time I eat a tossed salad, a banana, some strawberries, or a piece of whole-grain bread. I have also been told not to drink orange juice with "lots of pulp." I am dismayed because it seems all the things I have loved and felt right about eating are now off my list.
I take one teaspoon of Reglan before every meal and at bedtime. My blood sugars are in a lower range now that I have been on this program for two months. I have been on the pump for almost three years, which has also helped. My A1Cs are in the 6 percent range.
I would like some help on how to change my diet, what to avoid, and how much I can eat of these now-forbidden foods.
Beverly L. Bennett
Bradenton, Fla.
Kathleen E. Stanley, C.D.E., R.D., responds: Fiber content in a diabetes meal plan has been an area of continuous debate for years. Overall, for good nutrition, 20 to 35 grams of fiber each day is recommended.
There are two main classes of fiber: soluble and insoluble. Soluble fiber from plants like oat bran, rice bran, dried beans, and other legumes (peas, corn, all dried beans, lentils) absorbs water and slows down the passage of foods in the digestive tract and has been shown to help lower blood cholesterol. Insoluble fiber from whole-grain products, wheat bran, brown rice, seeds, fresh fruit, and vegetables contains indigestible plant components, which aid digestion by speeding up the passage of food in the digestive tract. This helps prevent constipation.
Gastroparesis is a condition in which the stomach has abnormal emptying, causing the passage of foods to be delayed. Large amounts of processed food may pass into the lower intestines at abnormal rates, which causes bloating and cramping. High-fiber foods may make this condition worse.
Reglan helps you to properly empty your stomach. Your symptoms (such as stomach fullness, vomiting, heartburn, cramping, diarrhea, or constipation) will often be the best indicator of how much fiber your can tolerate. Overall, people with gastroparesis have fewer symptoms with a low-fiber diet.
When you're grocery shopping, read the nutrition labels so you can identify foods low in fiber. Your best bets include plain processed cereals without nuts, seeds or whole grain products; canned fruits and vegetables; white bread, crackers, and white flour products; jellies rather than jams; and clear juices without pulp. Also, pay attention to symptoms that may result from eating salads (start with small portions); this may help guide your portion sizes and tolerance limits.
Fruits and vegetables are not necessarily prohibited. If peeled, cored, and de-seeded, some fresh vegetables and fruits could still be worked into your meal plan. Cooking peeled vegetables until they're soft creates an opportunity to be creative with seasoning. Try a bit of lemon juice (no pulp!), onion powder, or other refined spice blends. Stewing fruit softens the fiber and makes delicious side dishes or desserts.
When you change your diet to include more fiber, you should do so gradually. That's because sudden changes may aggravate your symptoms, or cause constipation. Review your favorite foods with your certified diabetes educator or registered dietitian and talk about your options.
Lastly, your pump is an advantage, as you can adjust your bolus delivery times to account for the extra time it takes for you to empty your stomach. In time, you will be able to master your meal plan and perhaps discover new favorite foods to add to your list.
Copyright © 2003 American Diabetes Association, From DIABETES FORECAST, February 2003, Reprinted with permission from The American Diabetes Association.