Why can gastroparesis patients gain weight while struggling to eat?

Gastroparesis, a condition characterized by delayed gastric emptying, significantly alters the way individuals digest food. Patients often experience symptoms like nausea, vomiting, bloating, early satiety, and upper abdominal pain making it challenging to consume adequate food. Ironically, despite their struggle with eating, many gastroparesis patients find themselves gaining weight. Let’s explore this perplexing phenomenon.

Gastroparesis affects the stomach muscles and their ability to function properly. This impairment can lead to a gradual accumulation of food in the stomach, causing discomfort and reduced appetite. As a result, many patients turn to foods that are easier to digest, often those high in carbohydrates. These “starchy” foods like pasta, rice, and bread start dissolving or “melting” in the mouth due to enzymes in saliva.

When carbohydrates are consumed in excess, especially in a sedentary lifestyle often resulting from the fatigue and discomfort of gastroparesis, the pancreas produces insulin which then stores them as fat. Moreover, a diet low in protein—common with a carbohydrate-heavy focus—can lead to muscle loss, which further exacerbates the cycle of weight gain.

In patients with gastroparesis, hormonal changes also play a crucial role in this weight gain. The disrupted communication between the stomach and brain due to delayed gastric emptying can affect appetite-regulating hormones, which can lead to increased cravings for high-calorie comfort foods. Therefore, even when patients feel full, the hormonal signals may still drive an urge to eat, resulting in consuming more calories than the body needs. Breaking this cycle can be very challenging but is still possible with medication and/or surgery.

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