Gastroparesis and functional dyspepsia. The fallacy of orthodox medicine for diagnosing digestive problems

This article is the first of a series of articles on digestive disorders. This article is somehow an “autobiography” of my Odyssey that made me specialize in nutritional and naturopathic medicine. In this article, through my personal history, you will learn what is gastroparesis, what is functional dyspepsia, what is visceral hypersensitivity/hyperalgesia, how gallstones are formed, and what is the relationship of circadian rhythm cycle and the lack of melatonin with various digestive disorders. Finally, you will understand that most doctors have a little understanding of digestive disorders and the role of nutrition in digestive health, and what they do not know and they cannot diagnose consider as “psychological.” Orthodox medicine uses very basic and rudimentary forms of testing that are not individualized and do not take into account the role of food and the biochemical individuality of patients. But this situation has started to change. As John Keohane and Eamonn Quigley reported in their study entitled «Functional Dyspepsia: The Role of Visceral Hypersensitivity to Its Pathogenesis» published in 2006 in the World Journal Gastroenterology, “For decades, general practitioners and specialists alike dismissed these patients as malingerers or as having some form of somatization disorder. However, it is only in the last decade or so that attempts have been made to elucidate the true pathophysiology of this heterogeneous disease. A number of putative mechanisms have been elucidated, including visceral hypersensitivity, delayed gastric emptying, impaired gastric accommodation, acid sensitivity, Helicobacter pylori (H pylori) infection and disturbed central perception of peripheral visceral events.”

I have serious problem with my digestive system, my stomach needs more than 16 hours in order to empty the solid foods I eat, and consequently I eat especially foods in liquid form (vegetables and fruit juices, goat milk)  and after digesting them I eat a  quantity of solid foods every 48 hours. I digest liquid foods very well, but the problem is with solid foods. After consuming a solid meal I do not eat any other food or water for more than 24 hours, because I have a delay emptying the food. When these fluids (chyme/food residue) accumulate in the stomach (look at the video below https://www.youtube.com/watch?v=m646K7IpW5o ), I feel a terrible chest pain, which can last for another 6-8 hours. In the past, the sensation was burning, with time it was turned into a sensation like a knife to hurt me, and at this period it is just an annoying pain. Improvement of my digestive symptoms is  the result of nutritional changes (fasting than 24 hours between meals without water, no coffee or alcohol, consumption of food supplements, like enzymes, hydrochloric betaine, ox-bile, probiotics, prebiotics, as well as chamomile and linden tea). As a result, I have chronic gastritis and I have lost many kilos/pounds.

My digestive problems started when I was 22 years old along with circadian rhythm disturbances (lack of melatonin). We had sent a saliva specimen to a USA laboratory for a special melatonin test, and the examination showed that my melatonin was secreted from the pineal gland very weak and the excretion was done at 7am instead of 11pm, as is the case in people with normal circadian rhythm. My circadian rhythm disorder is called Free-running sleep. https://en.wikipedia.org/wiki/Free-running_sleep

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                                           The melatonin test that showed that I have a disturbed circadian rhythm

In 2011 my digestive problems disappeared suddenly (complete remission) and slowly my circadian rhythm was normalized. So the question which arises is whether my circadian rhythm disorder is the cause of my digestive problems or my digestive problem contributes to disturbance of my circadian rhythm. Or is it a vicious circle, and the digestive disorder contributes to complete disorganization of my sleep habits, and vice versa, the circadian rhythm disorder contributes to aggravating my digestive problems? During the last five years, small gallstones were formed, which, according to my opinion may be attributed to my chronic melatonin disorder, since there are several studies showing that melatonin levels are a causative factor for gallstone formation. Look at the study Reactive oxygen species and the hypomotility of the gall bladder as targets for the treatment of gallstones with melatonin: a review (Koppisetti S., et al., Dig Dis Sci. 2008 Oct;53(10):2592-603, https://www.ncbi.nlm.nih.gov/pubmed/18338264 ). Another possible cause is that I do not eat meals every few hours, but only a big meal every other day, which causes the bile to settle in the gallbladder. Whenever one consumes a meal with fat, the gallbladder contrasts to drop bile in the intestine to digest fats. So if someone does not eat meals frequently or if he/she does not consume fatty foods, the bile remain for a long period to gallbladder and become solid (stone).  Another reason that contributed to the development of gallstones is that in 2014 (when I was still in recession and my digestion was perfect) due to sadness I started eating a very poor diet based on sweets and carbohydrates for many months. There are many studies that correlate the formation of gallstones with a diet high in carbohydrates. See the following study: Dietary carbohydrates and glycaemic load and the incidence of symptomatic gallstone disease in men http://gut.bmj.com/content/54/6/823  I do not think gallstones have an effect on my digestive problems, because my digestive problems existed many years before the development of the gallstones.

As the result of these health problems (gastroparesis and circadian rhythm disturbances), the last two years I have chronic fatigue syndrome/adrenal fatigue. https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/symptoms-causes/syc-20360490 https://draxe.com/3-steps-to-heal-adrenal-fatigue/

No one medical doctor could understand what was my health problem, believing that it was “psychological”. This year studying the gastroparesis issue, I discovered that I have gastroparesis. It is so frustrating medical doctors, even gastroenterologists, could not understand that I had gastroparesis. If I were not a health practitioner, I would not discover the cause of the problem and what exactly is my illness.

This year I made a gastroscopy. My gastroenterologist asked me to eat my meal at night and after 14 hours the next morning to go to hospital for gastroscopy. Gastroscopy showed that 14 hours after taking my meal, many food debris had remained, so gastroscopy could not be done normally. So my gastroenterologist realized that indeed I had gastroparesis. https://www.webmd.com/digestive-disorders/digestive-disorders-gastroparesis  Unfortunately, he is not an expert in gastroparesis. He was thinking to do a surgery to my stomach in pylorus (pyloroplasty) https://en.wikipedia.org/wiki/Pyloroplasty , but he was not sure if this procedure could help me.

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          Photos of my gastroscopy that showed food particles in my stomach 14 hours after my dinner

I could not find a gastroenterologist specialized in gastroparesis here in Greece. My opinion was that my digestive problems were related with my vagus nerve. Searching on books about vagus nerve stimulation and epilepsy, https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns  I thought that maybe vagus nerve stimulation could be a therapy for my digestive problems https://www.ucsfhealth.org/conditions/gastroparesis/treatment.html . So searching on internet I discovered that there are open clinical studies for vagus nerve stimulation for the therapy of gastroparesis. Contacting with a clinic in California (USA), they told me that they could accept me to participate in the study, but they need a scintigraphy test in order to accept me https://digestive.templehealth.org/content/GastricEmptyingScintigraphy.htm .

Fortunately I found here in Greece a gastroenterologist who is specialist in gastroparesis. From my medical story (clinical symptoms and gastroscopy) she was 100% sure that I have severe gastroparesis. I told her about the scintigraphy test that τthe USA hospital had suggested me, and she told me “ok, it is not necessary, because we do not do a clinical study, from your symptoms it is obvious that you have gastroparesis, but if you like do it in order to be according with the protocols”. She suggested me to do Botox therapy for gastroparesis initially https://www.g-pact.org/gastroparesis/treatment-options/surgical-intervention https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501969/ .

I did the test, and the emptying of my stomach was normal!

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                                                                                         My scintigraphy test

So I sent a message to this clinic writing:

Dear Ms …,

I am the person from Greece that I had expressed the interest to participate in your study.

Fortunately I found here in Greece a gastroenterologist who is specialist in gastroparesis. From my medical story (clinical symptoms and gastroscopy) she was 100% sure that I have severe gastroparesis. I told her about the scintigraphy test that you have suggested me, and she told me “ok, it is not necessary, because we do not do a clinical study, from your symptoms it is obvious that you have gastroparesis, but if you like do it in order to be according with the protocols”. She suggested me to do botox therapy for gastroparesis initially.

I did the test, and the emptying of my stomach was normal!

I would like to tell you my opinions and if you like your gastroenterologist to answer to me.

If I knew that the protocols of scintigraphy for  gastric emptying suggest so little and simple food ( boil white egg and a small piece of bread with a little jam), I would not go through this whole process. This food is not food for an adult, but for infants. I know that I will digest this kind of food, especially when I had 36 hours of fasting in order my stomach was resting and I slept 12 hours before this test (my digestion problems are tied with a circadian rhythm disturbance problem I have. But what if I eat a full lunch as all adults of my age and weight eat?

I talked to my gastroenterologist and while she was convinced that I have serious gastroparesis, based on this finding,  she mentioned that I belong to the spectrum of gastroparesis (like autism spectrum) and I have something like functional dyspepsia with pain.

However, I would like tell you that my first gastroenterologist made gastroscopy to me a few months ago and I had eaten  my meal at night 16 hours before gastroscopy. Nevertheless he found food debris in my stomach and he was unable to do the gastroscopy properly. And he thought that pyloric surgery maybe was a solution for my problem.

And now to answer your possible question, what am I eating and 20 hours after my meal food debris remain in my stomach and I suffer from pain as well. I use to eat what all normal people eat! For example, when I did gastroscopy, I had eaten a breast chicken with a few roasted potatoes, a plate of boiled spinach with olive oil, 1 slice of bread and 1 piece of a homemade sweet. Do you think it’s normal that this meal has not been digested after 16 hours (look at the gastroscopy in the attachments)? Surely I will not eat 1 boiled egg and a small piece of bread with a liitle jam because I do not have anorexia nervosa and I do not go for a photo model, I want to gain weight, not lose any weight !!!

Basically this is the amount of meals I eat. For example,  look at the video that I uploaded in youtube and listen to the sound »glou glou » that makes my stomach  with the title “Gastropaperis: 16 hours after my meal.” Gastroparesis: 16 hours after my meal No, it’s not water, it’s the chyme of digested food stuck in my stomach 16 hours after my meal and I suffered from chest pain. What did I eat? 1 yoghurt, 1 omelet with cheese and ham, a small plate of lettuce with olive oil and 1 piece of bread. Do you think that this amount of food is so huge to justify after 16 hours my stomach to make this sound and to feel pain?

I cannot understand this test (scintigraphy). It does not take into account the diversity of people. What would be the result of this test if the food  was bigger and if it contained vegetable fibers and fat (for example, olive oil and butter). Since dietary advice for gastroparesis is to eat very small meals without fiber and without fat (because fiber and fat delay gastric emptying), I wonder how one can diagnose gastroparesis with foods that do not cause slow gastric emptying and are recommended for the symptomatic treatment of gastroparesis! Yes, perhaps this test proves that I do not have the classic form of gastroparesis (and maybe this is the reason I have never had vomit as a symptom after eating, as many patients with gastroparesis have), but all clinical symptoms show that the food I eat remain 16-20 hours after eating and I feel chest pain, especially 12 hours after my meal pain, and this chest pain lasts about 8 hours, and as a result I have chronic gastritis.

What is the opinion of the doctor of your study?”

And they gave me the following answer:

Hello Marios,

The question you raise are good research questions. There is still a lot we do not know about gastroparesis and how it presents

In different people.  Consequently, it is a frustrating disease for patients to have and providers to treat.  I am truly sorry that you are living with this disease.”

And they told me that they do not set up to see patients remotely. Therefore, they cannot provide me  with medical opinions or advice without seeing me in person and doing a physical exam

or more testing. At ***** Hospital,  they are not allowed to provide medical opinions to patient’s they do not see directly.

And they wrote to me some websites which do collect a lot of gastroparesis/functional dyspepsia information.

What I would like to stress is that scintigraphy is dynamic and not static test, as the gastroenterologist told me, meaning that if I had done the test another day, the results could be different, ie it could show that my gastric emptying is not normal. If I were in a clinical study, they could repeat the test several hours and days to come to conclusions, but as a private individual I cannot pay 200 euros each time for something that is self-evident.

In order to realize how much slowly I digest solid foods, it is enough to tell you that when I take my regular meals with multivitamins, my urine when urinating becomes yellow after 12 hours of my meal instead of 2-3 hours, as is the case with everyone normal people. On the contrary, when I take multivitamins with my liquid meals (juices or milk), my urine becomes yellow normally after 2 hours, which clearly shows that I have difficulty in digesting solid foods. (Urine after taking multivitamins becomes yellow, because some of the B complex vitamins are yellow). This alone for me was enough to realize that I was slow to digest. I do not need specialized tests. The clinical picture speaks by itself!

I have always said that my case is very reminiscent of fibromyalgia, mainly because of my circadian rhythm disorder and the lack of melatonin (and lack of serotonin?). Talking to the gastroenterologist, who is specialist in gastroparesis, she told me that people with gastroparesis/functional dyspepsia have a different perceptiveness of the sense of pain in the stomach, ie hypersensitivity to the pain. This reminded me of the algesthesia/allodynia that fibromyalgia people have. To put it simply, nerves in the stomach (like other nerves in other parts of the body) carry messages to the brain, and vice versa. Of course, the nerves are filtering the messages they will send to the brain, in order not to carry insignificant messages to the brain and cause discomfort to it. Obviously, in individuals with gastroparesis/functional dyspepsia, there is a hyperactivity of the nerves in the area, so many people with gastroparesis have constant nausea and vomiting. (I am deliberately speaking very popular, for more details see the studies I have presented below). This is why many gastroenterologists specializing in gastroparesis are giving to their patients serotonin reuptake inhibitors SSRI at lower doses than they are used to treat depression. But medical doctors use anti-depressant medications to treat fibromyalgia and algesthetic pain. Antidepressant drugs provide analgesia through various mechanisms, including increasing levels of serotonin, which helps the brain to control pain. Therefore, since the amino acids L-tryptophan and the bioactive compounds in saffron can regulate serotonergic activities in the brain, some scientists have suggested these as potential central analgesics. 5-hydroxytryptophan (5-HTP) has shown very good results in the treatment of fibromyalgia. I remember that a few months ago I had taken a dietary supplement containing 5-HTP and saffron, and this supplement had increased my appetite, and I was nervous because I had to wait for a few hours to completely empty my stomach and to extinguish the irritation and the sense of pain in order to I eat a next meal. It is worth stressing that 5-HTP and saffron usually reduce appetite and emotional hunger. 5-HTP and saffron worked in me differently for at least some time, but they could not act completely and to help me more because of the seriousness of my problem. Note that due to chronic fatigue/adrenal fatigue I suffer, most of the antidepressants I have taken, especially Remeron (mirtazapine) and Cymbalta (duloxetine), caused complete suppression (24-hour sleep, something like Klein-Levin Syndrome) and I did not have the courage to get up from my bed or even drink water! Unfortunately, similar action, although to a lesser extent, medicinal cannabis (THC oil) had. It caused me terrible drowsiness and reduced my appetite. Let’s consider that most people who take THC have an increased appetite and hunger and they have a desire for sweets. Cannabis with THC is also used to treat anorexia nervosa. So cannabis reduces my appetite! Unfortunately, CBD oil (cannabidiol) disturbs my stomach for 1.5 hours after taking it, so I cannot consume it fast, as it is recommended.

Let’s return to the health issue of the hypersensitivity to pain experienced by people with gastroparesis/functional indigestion. The above mentioned gastroenterologist, who is specialist in gastroparesis, would mean a condition called “visceral hypersensitivity” or “visceral hyperalgesia” Visceral hypersensitivity/visceral hyperalgesia https://www.verywell.com/visceral-hypersensitivity-1945074 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590155/ See also here: Functional dyspepsia: The role of visceral hypersensitivity in its pathogenesis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130973/ See also here: Dyspeptic patients with visceral hypersensitivity: sensitisation of pain specific or multimodal pathways? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774593/ See also here: Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis https://www.ncbi.nlm.nih.gov/pubmed/18282170

Conclusion: Orthodox medicine uses very rudimentary forms of testing in a way, and there is minimal understanding of foods and their complexity by MDs, as is proved with my case with my scintigraphy test.

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Me in 2014 with normal weight, when I had a remission of my digestive disorder/circadian rhythm disturbance

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Me in 2016 when I had again the same digestive problem and I had started to lose weight.

Some thoughts

Let’s see what is gastroparesis (source: Canadian Society of Intestinal Research): https://www.badgut.org/

The word ‘gastro’ refers to the stomach, and the word ‘paresis’ means partial paralysis, so gastroparesis means partial paralysis of the stomach. To understand what goes wrong in gastroparesis, it is important to know how a healthy digestive tract functions. When we eat, we start by chewing and swallowing (ingesting), which requires conscious effort. Once the food reaches the esophagus, an automatic, rhythmic motion (peristalsis) takes over, propelling the contents all the way through the digestive tract. Typically, the passage of food from one area of the digestive tract to the next is precisely coordinated, so that food stays in each area just the right amount of time. For the stomach, this is approximately two hours.

However, in those with gastroparesis, the food does not move from the stomach into the intestine as quickly as it should (delayed gastric emptying). Gastroparesis is a motility disorder, which means there is no physical obstruction preventing timely digestion, but rather difficulty regulating muscular activity. It occurs when the pair of nerves that connects the brainstem to the gastrointestinal tract (vagus nerve) is damaged or not functioning properly. Since the vagus nerve is unable to send the necessary messages to ensure that the muscles in the stomach continue to work normally, food remains in the stomach for too long, leading to symptoms.

Let’s see what the article writes about the symptoms of gastroparesis:

  1. Feel full after small amounts of food

Answer: I did feel this when my digestive problems started, 22 years old, but over time my stomach was trained to receive large amounts of food after fasting (over 24 hours fast between meals).

  1. Nausea

Answer: I never feel sick

  1. Vomiting

Answer: I have never had vomiting from food consumption (very rare when I was 22 years old if I was eating a bigger meal, and when I was 27 years sometimes food particles throw up from my mouth after eating without a burning sensation.

  1. Reduced appetite

Answer: I had a reduced appetite when I was 22 years old. During this period, I used to eat 3 meals a day, and consequently I could not eat the next meal. So I did not  have appetite due to indigestion, a condition that is called “literally anorexia”, and not due to anorexia nervosa, as many ignorant doctors believed. So slowly the 3 meals became 2, and progressively the 2 meals became 1 meal per day and so on. In my current phase, I have a huge appetite when after 24-36 hours fast I feed on liquid foods (even in huge quantities) and I could not satisfy my appetite, feeling hungry, but if I eat solid food (a normal meal for my age and body, not a small amount of food), then I feel full and drowsy and I do not have the appetite for over 24 hours.

  1. Abdominal pain

Answer: No, I do not feel abdominal pain, but after 12 hours of solid food I feel chest pain that can last for 8 hours.

  1. Heartburn and gastroesophageal reflux

Answer: No, I do not feel heartburn or gastroesophageal reflux. In fact, I think I have a low secretion of hydrochloric acid, so antacids do nothing or even worsen me, while betaine hydrochloride supplements re somewhat helpful. So I had not realized until now that my problem was gastroparesis, but I had the impression that it was hypochlorhydria. And I had this impression because the longer I fast and my stomach is empty, the better I feel, unlike people who have hyperchlorhydia (hypersecretion of gastric juices) and they do not feel good when their stomach is empty for many hours. But doctors use to give antacids to all dyspeptic! I remember once in a hospital doctors put an antacid medicine in my serum without asking me, because they have read in my medical history that I had chronic gastritis, and then when I ate a small meal (boiled zucchini), I felt like I had eaten stones!

  1. These symptoms can lead to weight loss and nutrient deficiencies.

Answer: I have a weight loss but not a lack of micronutrients (because I am taking dietary supplements), but I have protein malnutrition  because I cannot eat the necessary amount of protein that my body needs every day.

  1. Since the digestive system doesn’t work smoothly, sufferers also experience periods of low blood sugar while the food remains in the stomach, and high blood sugar when it eventually reaches the intestines.

Answer: The opposite! I never feel hypoglycemia, although I eat huge amounts of simple sugars at every meal (for example, I can drink 8 glasses of fresh watermelon juice in one meal, into which I will drop black sugar, and yet after 2 hours I do not I feel hypoglycemia). My sugar is so normal. And I wonder why the article writes this about sugar. Instead, I thought I did not get hypoglycemia, because the food pass from my stomach very slowly, and the food delays to pass into the small intestine. As a result, my body perceives a high glycemic index food (such as fruit juice) like a low glycemic index food (as if it contained fiber and not too many sugars) because I have a sluggish digestive system and food sugars pass into the bloodstream slowly, so there is no hypersecretion of insulin and a sharp drop in blood sugar.

In lifestyle and dietary changes it writes:

In individuals with mild gastroparesis, a few changes to dietary habits can largely reduce symptoms. Most of these changes focus on reducing the amount of food you eat at once, because overeating makes it even more difficult for your stomach to empty. Consuming smaller meals more frequently, rather than two or three large meals, can help. You may also find relief by eating mostly soft or liquid foods, such as soups and smoothies. Chewing each bite very well and consuming non-fizzy liquids with meals can also make digestion easier. Avoiding or limiting high fibre and high fat foods can reduce discomfort, since these foods typically take longer to digest.

Answer: I cannot eat 6 small meals a day, not even 2 or 3. But a big solid meal day by day or a big liquid meal every day. Perhaps someone is wondering why I digest better larger amounts of food rather than small frequent meals. One possible cause is that with fasting I give to my digestive system the opportunity to rest and fill the pancreatic enzyme stores. Furthermore,  after a long fast, I get very hungry and eating with hunger the digestive fluids are secreted better to digest food. I feel perfect when I eat liquid meals, but not with soups or smoothies, but only with fruit and vegetable juices and milk. I could eat smoothies (or ice cream)  after liquid foods to stop my hunger and in order not to have so sluggish digestion with dyspeptic problems as I would have if I ate solid meals. I chew each bite very well. The fat in the food does not bother me. I eat enough fat (olive oil with food or gull fatty dairy products) to get more calories and keep my weight. I am not sure if I am disturbed or my dyspeptic problems are aggravated by fibers, but I have noticed that sometimes if my solid meal has too many vegetables, the problems of chest pain after 12 hours are more elevated, although not always.

In the symptoms of functional dyspepsia the article writes:

  1. The disturbed motility present in functional dyspepsia leads to amplified sensation in the upper gut (visceral hyperalgesia). This is due to uncoordinated and even ineffectual emptying of the upper digestive tract.

Answer: Maybe it happens.

  1. Pain

Answer: Only after 12-16 hours after consuming solid food, but never after consuming liquid food. Two years ago after 12 hours of my solid meal I felt chest burning (in addition to chest pain), and the burning slowly turned like someone to stab me on the chest with a knife, and now that feeling has been reduced, I just feel a chest pain for hours.

  1. Fullness

Answer: Yes, but I eat large quantities, it is natural if I drink 2 glasses of carrot juice with coconut oil, 5 glasses of fresh apple juice and chew 8 oranges to drink their juice at once (orange juice irritates the stomach, but not if I chew it and I drink their juice without swallowing the orange skin), it is natural to feel fullness. Even if I eat my food that contains enough food.

  1. Bloating

Answer: If bloating means swollen belly, no.

  1. Inability to finish meals.

Answer: No, I eat until I get full.

  1. Heartburn

Answer: No.

  1. Sour taste in the mouth

Answer: No.

  1. Excessive burping

Answer: No.

  1. Nausea

Answer: No.

  1. Vomiting

Answer: No.

  1. Functional dyspepsia may come and go and symptoms could present with increased severity for several weeks or months and then decrease or disappear entirely for some time.

Answer: My symptoms are never diminishing! If my digestive problem starts, it lasts for many years (maybe a few symptoms change, but the problem remains). It occurred around 2003 and lasted until 2011, from 2011 to 2015 I had a complete remission, and from 2015 until today I have the same digestive disorder again.

For lifestyle and dietary changes it writes:

Although no evidence directly links specific foods to functional dyspepsia, it does make sense to limit or avoid foods where a symptom effect is obvious on an individual basis. Some patients have reported increased symptoms when consuming excessive amounts of milk, alcohol, caffeine, fatty or fried foods, mint, tomatoes, citrus fruits, and some spices. However, there is no hard and fast rule, as irritating foods vary among individuals. Avoiding large portions at mealtime and eating smaller, more frequent meals is important to normalize upper gut motility. Following meals, it may help to avoid lying down for at least two hours.

Although no items directly link specific foods to functional dyspepsia, it makes sense to limit or avoid food where a symptom of symptoms is obvious on an individual basis. Some patients have reported increased symptoms when they consume too much milk, alcohol, caffeine, oily or fried foods, mint, tomatoes, citrus and some spices. However, there is no hard and fast rule, as irritating foods differ among individuals. Avoiding large portions of the meal and eating smaller, more frequent meals is important for the normalization of the upper bowel movement. After meals, it can help you avoid lying down for at least two hours.

Answer: I am only feel annoyed with solid foods, not with liquid meals. There are also some foods, even in small quantities, which disturb me more because of chronic gastritis, such as alcohol, caffeine, fried foods, mint, citrus fruit (especially their juice) and hot spices. Avoiding large portions of the meal and eating smaller, more frequent meals increases my digestive problems. It does not bother me to lie down after a meal, though I avoid it.

Important clarification:

As I mentioned at the beginning of the article, my digestive problem is related to the circadian rhythm disorder I have. For example there are times during the day when I may be «awake,» but my body is actually «asleep». At that moment even consuming a glass of water or a capsule of a supplement may upset my stomach, and when my biological clock is at the top of the «awake» feeling, I can drink pounds of water or many capsules at once and I do not feel any digestive irritation. Just at that time, which holds a few hours a day (around 4 hours,) I can drink and eat. This is an additional reason why I cannot make small and frequent meals. I only have 3 hours per day that my body is in a situation like the biological clock of most people during 12-3 at noon, when they are at the peak of their energy. This “12-3 pm” can be at 12-3 am in the evening (usually evening I digest better), but this is also not stable. For example, this period I write and publish this article, the peak of my energy comes out at 2-5 pm, something unusual for me. As you can see, I am in a long jet lung, which does not help digestive activity at all. Although I think that when my digestive condition will be solved, my biological clock will be able to normalize, as it happens in the past (2011-2015). For an ignorant, all these look like “psychological”, “psychosomatic”.  But my condition is not psychological! A very good neurologist and a good gastroenterologist can understand it. If it was psychological, why did my digestive problems and the disturbance of the circadian rhythm disappear during the period 2011-2015? My psychological situation had not changed for the better. So it is a real condition that needs medical attention and cure.

Marios Dimopoulos

Nutritionist-Author

Fellow of the American Council of Applied Clinical Nutrition

Member of the American Association of Drugless Practitioners

Member of the American Association of Nutritional Consultants

Member of the Canadian Association of Natural Nutritional Practitioners

Member of the Association for Natural Medicine in Europe

Member of the Panhellenic (Greek) Association of Naturopaths

The sound you hear is not water I have drunk, it is a food residue that has trapped in my stomach 12 to 16 hours after my meal (for example my classic meal is: 1 sheep yogurt, 1 omelet with cheese and ham,1 beetroot grated with olive oil and 1 piece of homemade sweet, another other meal is: chicken in the oven with potatoes, a plate of spinach or broccoli with olive oil, 1 slice of bread and 1 piece of homemade sweet). I should mention that after taking this kind of meal I do not eat any other food or water for more than 24 hours. When these fluids accumulate in the stomach, I feel a terrible chest pain, which can last for another 6 hours. In the past, the sensation was burning, with time it was turned into a sensation like a knife to hurt me, and at this period it is just an annoying pain. Gastroscopy showed that 14 hours after taking such a meal, many food debris had remained, so gastroscopy could not be done normally.

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