Research has shown a link between Hashimoto’s and hypothyroidism to a condition called gastroparesis. Although I have not experienced this condition personally as of yet and hope I never do, I have had many clients who have reported symptoms of what could potentially be related gastroparesis – particularly when TSH is chronically elevated despite thyroid medication.
What is Gastroparesis?
The medical definition for gastroparesis is “the delayed emptying of food from the stomach into the small bowel,” which is basically slow motility or delayed transit time of food that’s entered the stomach and GI tract. The condition commonly occurs in patients receiving enteral nutrition (tube feeding). However, gastroparesis may also be a chronic complication related to conditions such as kidney failure, uncontrolled diabetes, damage to the vagus nerve, Multiple sclerosis, Parkinson’s disease, stomach surgery, chronic use of antidepressant or narcotic medications, autoimmune thyroid disease, and hypothyroidism.
When food stays in the stomach too long, it can ferment and trigger an overgrowth of bacteria. It can also lead to obstructions that can prevent food from passing through the small intestine. The condition can be very scary especially when stomach pain, fullness, and bloating occurs after only a few bites of food.
A 2009 study reviewed gastroparesis as it relates to hypothyroidism and autoimmune thyroid disease. The study included 30 women diagnosed with hypothyroidism. In their discussion, the researchers pointed out that thyroid antibodies found in autoimmune thyroid disease commonly associated with inflammation of the lining of the stomach. Typically, at least from what I have studied and learned, it is often suspected that H. pylori may be the cause of this type of inflammation since H. pylori is believed to be one of the primary stealth infections diagnosed in patients with Hashimoto’s.
Thyroid Meds & Gastroparesis
Absorption issues with levothyroxine is a concern when gastroparesis is an issue. Levothyroxine is a T4-only thyroid replacement medication (it must be converted after absorption to T3 (the active form usable by the cells).
Although it is not uncommon for thyroid patients to require regular raises in the dose to improve hypothyroid symptoms and bring thyroid markers to optimal levels, if this continues to be the case, there may be more than a conversion problem going on.
What this 2016 study found is that gastroparesis could be the underlying/undiagnosed factor which would explain why thyroid medication isn’t being absorbed and properly converted. What the researchers also found in this particular study is that as far as absorption of the medication is concerned the issue can be corrected by changing thyroid medication to a gelatin capsule. While the gelatin form may improve thyroid markers, it does not fix the underlying cause of malabsorption in the first place. Also, one of the researchers’ conclusions was the following:
“…patients with uncontrolled hypothyroidism despite adequate treatment titration, gastroparesis should be considered as a possible mechanism for malabsorption…”
Symptoms related to Gastroparesis
Please note that these are similar to many other common symptoms experienced by people with Hashimoto’s and hypothroidism and not necessarily caused by gastroparesis:
- Feeling full soon after eating or during a meal (could be a red flag for SIBO, inflammation due to food sensitivity, food allergy, or low stomach acid)
- Abdominal bloating (might also be assumed to be related to SIBO, bacteria imbalance, Celiac disease, food sensitivities, or gluten exposure, etc.)
- Blood sugar imbalance (often associated with diet, elevated thyroid hormone, adrenal imbalance, stress, hormone imbalance)
- Heartburn-like symptoms (often thought to be related to LOW stomach acid in Hashimoto’s patients)
- Nausea, vomiting, and constipation (may be due to a variety of factors)
- Chronically elevated TSH despite thyroid hormone replacement
I found this Abstract which underscores what most of the studies have found in that if your TSH is consistently elevated or it spikes and remains elevated even though you’re taking thyroid hormone – and particularly if your practitioner continues to raise the dose and you have other symptoms that are suspect for gastroparesis, it’s probably time for further investigation.
If symptoms like these are lingering and the typical protocols for digestive enzymes and specialized thyroid diets aren’t helping, please don’t assume it’s a food sensitivity, food allergy, or that you’ve accidentally been exposed to gluten, or that it’s SIBO, etc. See a gastroenterologist and get tested to rule out or confirm gastroparesis.
Testing for Gastroparesis
Diagnosing gastroparesis may involve a battery of tests: ultrasound, endoscopy, electrogastrography, scintigraphy, Barium X-ray, or the “smart pill,” an electronic device that you swallow! It reports data back to a computer to indicate the rate at which food is traveling through the digestive system. Pretty cool, right?
Interventions & Diet
Increasing transit time in the stomach is usually accomplished through prescription medications such as Reglan, erythromycin, domperidone, or Cisapride. Other medications routinely prescribed are for nausea and vomiting if needed. But, please don’t think that any of these “fixes” the problem.
According to the European Journal of Gastroenterology & Hepatology, 1,200 mg per day of Ginger (as a supplement) taken in divided doses has been found to improve the transit time of food in the stomach and intestines.
If gastroparesis is diagnosed, it is best to work with a knowledgeable and caring nutritionist, gastroenterologist, and supportive health care team. It is extremely important that you meet your caloric needs every day, keep hydrated, and consume nutrient-dense foods. Depending on the severity of your symptoms this may be a challenge.
Consuming smaller meals throughout the day will help with feeling full and with bloating. Many patients diagnosed with gastroparesis find it more comfortable to make the switch to a liquid-only diet but please do this only under medical supervision and in working with a nutritionist who is knowledgeable in with your complete health history and this condition.
Should gastroparesis be diagnosed you should avoid these foods as they may lead to obstructions in the GI tract due to slower transit time:
- Apples, Berries, Brussels sprouts, Coconuts
- Corn, Figs, Green beans, Legumes
- Oranges, Persimmons, Potato peels
- Sauerkraut, Tomato skins
- High Fiber Bulking Agents: Citrucel, psyllium products (Metamucil, etc), Acacia fiber
- Nuts, seeds, dried fruits
- Vegetables (green peas, broccoli)
- Popcorn
- Cereals
Source: University of Virgina-Digestive Health/images-docs-gastroparesis
The Essential Gastroparesis Cookbook is a great resource to help anyone who is struggling with bloating, stomach pain, feeling full immediately after or during a meal. The recipes can also help with energy levels and mood.
Self-care interventions such as acupuncture may be helpful with stress, discomfort, pain, nausea and inflammation. Biofeedback (I love the RespErate unit) is effective for stress, and acupressure can definitely help with nausea.
As a last resort, surgical intervention is sometimes necessary. If you cannot tolerate food or liquids, surgery is vital to survival.
Nurses Orders!
Gastroparesis is a serious yet manageable condition that’s often overlooked until advanced stages. If you’ve been experiencing bloating after a meal, feeling full almost as soon as you start to eat or immediately after, stomach pain, nausea or vomiting, and your TSH level is chronically elevated despite thyroid hormone replacement, it may be time to have a conversation with your doctor and seek to be tested for gastroparesis. Gastroparesis is not a topic usually discussed in thyroid forums; however, it is real and it is more common in patients with hypothyroidism than you may think.
Hashimoto’s Hypothyroidism Gastroparesis References
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European Journal of Gastroenterology & Hepatology: May 2008 – Volume 20 – Issue 5 – pp 436-440 doi: 10.1097/MEG.0b013e3282f4b224.
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Gastroparesis Overview: Causes & Symptoms. (n.d.). Retrieved December 1, 2016, from http://www.webmd.com/digestive-disorders/digestive-disorders-gastroparesis.
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Reardon, D. P., & Yoo, P. S. (2016). Levothyroxine Tablet Malabsorption Associated with Gastroparesis Corrected with Gelatin Capsule Formulation. Case Reports in Endocrinology, 2016, 1-3. doi:10.1155/2016/1316724.
- J La State Med Soc. 2015 Mar-Apr;167(2):47-9. Epub 2015 Apr 15.
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Yaylali, O., Kirac, S., Yilmaz, M., Akin, F., Yuksel, D., Demirkan, N., & Akdag, B. (2009). Does Hypothyroidism Affect Gastrointestinal Motility? Gastroenterology Research and Practice, 2009, 1-7. doi:10.1155/2009/529802.
I am soooooo very happy to see someone talking about this condition. It is the most terrible, debilitating, suffering malfunction ever! Having said that for some cases you can come back from it (mostly). Working on vagus nerve tone and functionality critical. Correcting nutrient deficiencies is critical. Walking after meals is helpful. Digestive enzymes do help. Acupuncture was super-duper helpful for me; it relieves the nausea and helps with a stressed nervous system. Eating easily digestible foods helps, however a lot of those foods typically are not nutrient dense foods, so make sure you get in a good quality (liquid) multi-vitamin like Calton Nutrition’s Nutreince. Stress management is also so very important because it directly affects the nervous system and the vagus nerve. Ben Greenfield has written/podcasted some on vagus nerve toning. The testing for this condition is terrible and I wouldn’t suggest it or wasting your time and money on it (like I did). It is not easy to diagnose and most doctors don’t know how to treat it even if they can make the diagnosis. If you suspect that you have it, live as though you do (hopefully fix it). Feel free to email me if anyone has any questions about this; I’ll do whatever I can to help.
Hi Candice, I am also very happy to see someone talking about hashimoto and GP. I was diagnosed last year and quickly found out that doctors do not know a lot about GP. The diet the doctor suggest is very poor in nutrition and medication are not effective. I started my search on how to get myself nutritionally healthy. This has been a very hard and scary journey. My weight drop down to a little over 100 lbs. l would love to hear what has helped you. I jucice, mostly vegtalbles and sip on that, I only eat small meals, I take digestive enzymes, multi vitamin, magnesium, inbergest and walk a lot . I have heard that the vagus nerve and the nervous system is affected in GP, not sure how to work on that. Stress makes my symptoms much worse. I also have very painful burping immediately after I eat, so painfully it hurts my heart, have insomnia every night. I tried acupuncture once, I did not find it made much of a difference.
Please contact me regarding this topic. I would love to talk to you.
Hi Melinda, please email me your contact info [email protected].
Great article, Shannon!
I have all above for yrs. But I swear drs. Don’t know what they are doing. I suffer with my stomach and live in the bathroom. Over a yr ago my heart rate was low they can’t figure noting out or why, all this must be related. So, I choosevti have a pacemaker. Not that I wanted it. Now I have to live with that on top of all this. What do I do to feel better? And ti make my stomach stop hurting. Pleace help.
Me Too! 4 years with GP now mine is very painful ALL THE TIME not just when eating.We have spent almost 100,000 total trying to fix me….Mayo Clinic gave me the diagonise, but were not very helpful, we flew form Florida, to MN.thinking they don’t know anything down here they HAVE to know up there, nope! Anyway my hope is I am health as an ox on paper WITH THE EXCEPTION of Hoshimotos so I hope if I can get my numbers right and now I am FINNALLY getting on Naturethyroid I hope it works, Snithroid as we know was getting my number up a little but gosh are they stuberd about free t3 and uptake and the whole bit, my Doctor/Endo even said ‘well if you want that kinda of treament you should go to a Natropath dahhh have and still would if I could afford it.My life saving were spent on just finding out what was wrong with me, and two sugeries that I did not need, that was my worst mistake, but I was desparate.Major problem out there with GP no answers young girls just dropping out of life like flies, so sad.Sorry about my spelling and typing I am not dumb, just a little learning deprived. Please feel free to comment. Healthy Dreams, Ava
Sorry I forgot to ask and I hope I am bugging anyone, but please GP’ERS out there could you tell me this? Do you have a constant tight squezzing band around your diaphram and in the center of your stomach just gets tight tight tight, and worst the band under both bottom ribs burns like hot greese, not to be confused with acid relux this is neuropathic burn and if you have it you know, I hear MS people call it the MS hug, sound nice NOT!I don’t have MS. That is how must of my pain is felt I need meds for it is on a level 8-9 with out yes that bad.Its not just the charlie horse cramp under the left rib and mild burning in the tum.I wish…..PLEASE IF YOU HAVE THIS LET ME KNOW.It is the reason I am on here today if it was just the GP general I guess I would be at a moive or somthing.Luv and hugs to all who suffer I am soory.Ava
I had the same problem for two years. Seen two doctors. One said it was ulcers. The other doctor said it was my gallbladder he saw no ulcers.Medications made me go through change your life. Which I didn’t even go through. So I went off of them. Didn’t help anyway. Decided to research and changed my diet! I didn’t want to get operated on for the gallbladder so my dr. agreed that he wouldn’t operate unless I got sicker.which I was already pretty sick! I really don’t think the doctors understand what’s causing the problem!
I try to think what I did differently. Eventually I got better again with diet and watching everything I eat. I don’t know why but I also think it had to do with a vaccine I got. Haven’t gotten any more vaccines and I’m healing. I personally think my body could not handle the vaccine. But again that’s just what I think. upon researching I’ve learned so much about what’s in our food. So it could’ve also been something that was in my normal diet! I have never had another vaccine. Not saying vaccine are bad, just saying I think they’re bad for me!
I’m finding this article a bit late but I thought I would comment in case this helped anyone else…I need more thyroid testing to figure out what is going on (a few non-normal results) but I’ve been dealing with unable-to-diagnose stomach issues for years. I too had almost all these symptoms, inclusing the feeling as if a band was around my ribcage, squeezing, or, alternatively, some days I felt as if my ribs were expanding. Painful spots that I could literally point to, sometimes all-over pain and some scary days where I wondered if I was dying but the doctors couldn’t figure it out. Last year was really rough, I was very sick, so I started eating soup. I hated soup, but now I make my own every day—no store bought stuff because I can’t control the ingredients…except five months later, I can literally put any veggie or even meat (the worst to digest for me) into soup form and my body accepts it. Soup is easy to digest. My stomach issues have virtually gone away, I feel so much better, my nutrition is much improved and the heart palpitations and anxiety attacks I used to battle every week are rare now.