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Gastroparesis
Gastroparesis means the stomach empties too slowly. We look at the vagus nerve, the migrating motor complex, blood sugar, post-viral and autonomic patterns, and medications.
What you may be noticing
A few bites and you feel full. Meals sit like a stone for hours. Nausea, bloating, and upper abdominal discomfort follow eating, and sometimes you vomit food eaten long before. Your appetite shrinks, and weight may drift down. Blood sugar may swing unpredictably if you have diabetes.
Persistent vomiting, inability to keep fluids down, vomiting blood, black stools, or rapid weight loss need urgent medical care.
Why it is rarely one thing
The stomach is a muscular grinder that empties in coordinated waves. Those waves depend on the vagus nerve, on specialized pacemaker cells in the stomach wall, and on the smooth muscle itself. When any part of that circuit falters, food lingers.
Diabetes is a leading known cause, because years of high blood sugar can damage the vagus nerve and the pacemaker cells. Many cases follow a viral illness. Others appear with POTS and dysautonomia, after abdominal surgery, with hypothyroidism, or as a side effect of medications, including opioids and GLP-1 medications. Not a lazy stomach, but a communication problem between the brain, the nerve, and the muscle.
Between meals, a cleansing wave called the migrating motor complex sweeps the stomach and small intestine. In many people with gastroparesis this housekeeping wave is weak or absent, which also invites SIBO. Because eating interrupts it, meal spacing matters. In my 8R gut model, the Restore step is exactly this: re-establishing vagal and enteric nervous system rhythm so peristalsis can return.
Patterns we look for
- Vagal tone and autonomic balance, including heart rate variability.
- Blood sugar control, since high glucose itself slows emptying.
- Post-viral onset and dysautonomia features.
- Thyroid function.
- Medications that slow motility.
- SIBO and migrating motor complex function.
- Low stomach acid, enzyme output, and bile flow.
- Bowel regularity, since drainage downstream shapes comfort upstream.
- Electrolytes and nutrient depletion from limited intake.
How I evaluate it
The comprehensive functional neurological exam assesses brainstem and vagal function through gag reflex, palate elevation, swallowing coordination, and autonomic responses to standing and breathing. These findings guide vagal retraining.
Diagnosis requires a gastric emptying study, coordinated with your gastroenterologist. Functional labs may include fasting glucose, insulin and HbA1c, a thyroid panel, electrolytes, B12, ferritin, vitamin D, and breath testing for SIBO when symptoms suggest it.
How we address it
Regulation first, then motility, then deeper repair.
- Coordinate with your gastroenterologist and prescriber on diagnosis, medication, and any prokinetic prescription.
- Adjust meal structure: smaller meals, lower in fat and fiber, softer textures during flares, and quiet gaps between meals so the cleansing wave can run.
- Stabilize blood sugar, and replete nutrients and electrolytes.
- Calm the system and strengthen vagal tone through slow breathing, gargling and humming, and, where appropriate, ear-based vagus nerve stimulation, which has early research support.
- Support the migrating motor complex with prokinetic categories such as ginger and bitter botanicals, with your care team.
- Keep bowels regular, then treat SIBO if present.
- Retrain brainstem and gut rhythm with paired functional neurology exercises.
Digestion begins in the brainstem. When the nerve speaks clearly, the stomach can move again.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.