Gastroparesis and Multiple Sclerosis: What You Need to Know

🤔 What Is Gastroparesis?

Gastroparesis is a condition that makes it more difficult for the stomach muscles to work properly, and therefore slower, when moving food in to the small intestine. This can lead to:

Nausea and vomiting
Bloating
Feeling full quickly
Nutritional deficiencies

Gastroparesis can develop in Multiple Sclerosis (MS) due to damage to the nerves that control the gastrointestinal tract, making it particularly difficult to treat.

💥 How MS Can Lead to Gastroparesis

MS is a neurological condition that damages nerve pathways throughout the body — including pathways that regulate digestion. The vagus nerve is your primary nerve and it coordinates contractions of the stomach.

When this nerve is affected by MS:

Stomach emptying slows down 🐢
Signals between the gut and brain get misinterpreted
Hormonal and chemical feedback loops may be disrupted

🧠 Neurogenic Gastroparesis: This form of gastroparesis is specifically due to neurological damage - this is what puts people with MS at risk.

Other factors that may contribute:

MS-related autonomic dysfunction (involves involuntary body functions)
Lesions in the brainstem or spinal cord
MS medications that slow gastric motility
Deconditioning or inactivity

🚨 Symptoms to Watch Out For

Gastroparesis symptoms can range from mild to debilitating. In people with MS, the signs might be mistaken for medication side effects or general fatigue — so it's important to know the full picture.

🔍 Core Symptoms:

Persistent nausea 🤢
Vomiting undigested food
Bloating and upper abdominal discomfort
Early satiety – feeling full after just a few bites
Poor appetite and unintentional weight loss
Acid reflux
Changes in blood sugar levels (especially dangerous if you also have diabetes)

🧭 Tip: Symptoms often flare up after high-fat or high-fiber meals.

🧠 MS + Gut: Understanding the Gut-Brain Axis

More and more research shows a deep connection between the brain, gut, and immune system — known as the gut-brain axis. MS and gastroparesis intersect here in several ways:

MS may alter gut bacteria (microbiome), contributing to inflammation and motility issues
GI dysfunction can lead to worsened fatigue, brain fog, and mood swings
Poor gut health affects medication absorption, reducing treatment effectiveness

🧬 Did you know? A disrupted microbiome might even worsen MS progression. Taking care of your gut may help your brain!

🧪 How Is Gastroparesis Diagnosed?

If your doctor suspects gastroparesis, they’ll likely start with noninvasive tests:

🧾 Common Diagnostics:

Gastric emptying scan (nuclear medicine test to track food digestion)
Upper endoscopy (to rule out blockages)
SmartPill capsule that measures pH and transit time
Barium swallow or upper GI series

🩺 Your neurologist and gastroenterologist may need to work together to rule out other causes like:

Peptic ulcers
Obstructions
Side effects of medications like opioids or anticholinergics

💊 Treatment Options: What Actually Helps?

There is a careful balance to managing gastroparesis through lifestyle, diet, and medication. It is particularly crucial for people with MS to consider how each treatment interacts with their other symptoms and medications.

🥗 Dietary Modifications

Often the first line of defense — and sometimes the most effective!

✅ Best practices:

Eat 5-6 small meals a day instead of 3 large ones
Choose low-fat, low-fiber foods (they’re easier to digest)
Opt for blended, pureed, or liquid meals (soups, smoothies)
Avoid carbonated beverages, beans, and raw vegetables
Sit upright or walk gently after meals

🥤 Hydration is crucial! Dehydration worsens MS fatigue and digestion.

💊 Medications

Prokinetics:

Metoclopramide (Reglan): speeds up stomach emptying but may have neurological side effects
Erythromycin: an antibiotic that mimics motilin (a digestive hormone)

Antiemetics:

Ondansetron (Zofran) or promethazine: reduce nausea and vomiting

⚠️ Always check with your neurologist before starting a new medication. Some can worsen MS symptoms or interact with your DMTs.

🛠️ Medical Devices & Procedures

In severe or refractory cases:

Gastric electrical stimulation: surgically implanted device to stimulate stomach contractions
Jejunostomy tube (J-tube): feeding tube bypassing the stomach
Botulinum toxin injections: sometimes used in the pyloric sphincter

🌿 Natural & Supportive Therapies

Many people with MS prefer integrative options — here are a few that may help:

Ginger tea: for nausea
Peppermint oil capsules: aid digestion
Acupuncture: may stimulate GI motility and reduce pain
Abdominal massage: gentle clockwise strokes can support movement
Breathwork and stress management: anxiety can worsen symptoms

Want supplements for people with MS? Click here.

🧘 Yoga and gentle stretching may also help with both gut mobility and MS spasticity.

🧘Lifestyle Support: Daily Life With MS and Gastroparesis

🧩 Build a personalized routine:

Track your meals and symptoms with a food journal
Create a mealtime schedule to avoid long fasting gaps
Use soft foods and meal prepping to reduce energy strain
Consider nutrition shakes with added electrolytes and vitamins

🏥 Speak with a dietitian who understands MS — they can help balance your nutritional needs with fatigue, GI issues, and mobility concerns.

❤️ Emotional & Mental Health Impact

Living with both MS and gastroparesis can be isolating. You may feel like:

Eating becomes a source of anxiety
You’re constantly managing symptoms instead of living your life
Friends or family don’t understand your food limitations

🫶 You’re not alone.

Connect with MS support groups that talk about GI issues
Talk to a therapist about food trauma, anxiety, or grief over body changes
Let friends know what support actually looks like for you (ex: no pressure to eat at social events)
Want an online therapist? Click here.

🧑When to Seek Help Immediately

Seek medical help if you experience:

Vomiting multiple times a day
Unintentional weight loss over 5-10% in a month
Dehydration (dry mouth, dizziness, dark urine)
Blood in vomit or stool

Quick tip: Bring a symptom tracker to appointments so your doctor sees the full picture.

🙋FAQ: Gastroparesis and MS

Q: Is gastroparesis common in people with MS?
A: It’s not common, but it’s not rare either — especially among those with advanced MS or lesions in the vagus nerve area.

Q: Can gastroparesis come and go?
A: Yes. Some people experience flares, particularly during MS relapses, stress, or medication changes.

Q: Will treating my gut help my MS?
A: There’s promising research suggesting that improving gut health can reduce inflammation and even help MS symptoms. It's not a cure, but it's worth exploring.

Q: What should I eat on a bad flare day?
A: Clear broths, diluted smoothies, electrolyte drinks, mashed potatoes, applesauce, and white rice are gentle options.

Q: Can MS-related fatigue worsen gastroparesis?
A: Indirectly, yes — fatigue can reduce physical activity, which slows digestion, and limit your ability to prepare appropriate meals.

✅ Conclusion: You’re Not Alone

Managing gastroparesis and MS together can feel overwhelming, but there is hope. With the right care team, symptom tracking, nutritional support, and emotional tools, you can take back some control. It’s not about perfection — it’s about finding what works for your body, your lifestyle, and your goals.

Don’t hesitate to reach out to others who understand this journey. You're stronger — and more resilient — than you think. 💪🧡

📚 References

National Institute of Diabetes and Digestive and Kidney Diseases. Gastroparesis.
National Multiple Sclerosis Society. Digestive Problems and MS.
Camilleri M. Gastrointestinal motility disorders in neurologic disease.
American College of Gastroenterology. Gastroparesis Clinical Guidelines.
Gastrointestinal Society. Gastroparesis and Prokinetics.
PubMed: MS and Gut Dysbiosis: The Immune-Gastrointestinal Axis.