Common vitamin/mineral deficiencies with gastroparesis

Gastroparesis is a condition in which an individual experiences delayed gastrointestinal (GI) motility without a specific blockage or barrier.  Symptoms from this condition can include nausea, vomiting, abdominal bloating, or pain, amongst others. Given the complexity of the symptoms associated with this disease, it is not uncommon for individuals to experience inadequate oral intake.  Prolonged, this may also result in more specific vitamin and mineral deficiencies. To better understand which nutrients may be most at risk for a deficiency, let’s take a closer look.   

Nutrition impact

Compared to a healthy adult, vitamin and mineral deficiencies have increased incidence in patients with gastroparesis. In fact, one statistic suggests that over 50% of these individuals are deficient in one or more vitamins or minerals. Age, other comorbidities, poor dietary intake, and lack of nutritional counseling can all worsen this risk.  Nutrients most commonly deficient in this patient population are iron, vitamin D, and vitamin B12.    

Iron 

Iron deficiency in patients with gastroparesis can result from several different factors. One major factor is inconsistent intake of iron-rich foods.  Whether it be from an individual preference or avoidance of foods that might aggravate symptoms of gastroparesis, overall intake of iron is often lower in comparison to a healthy adult. Absorption of iron also requires support from stomach acidity. Treatment for gastroparesis often includes medication or surgery that reduces this acidity, therefore decreasing the ability of iron to be modified into ferrous iron, a more absorbable form. Additionally, the site of enteral nutrition provision makes a difference. With jejunal nutrition support, primary absorption in the small intestine is bypassed, increasing the risk for iron deficiency.    

Recommended daily allowance:  

• Men (19-50 years): 8 mg  
• Women (19-50 years): 18 mg  
• Men and Women (51+ years): 8 mg  

Supplementation: Different forms of iron are available, with an oral choice being the first line of intervention. Monitoring the patient for tolerance with iron supplementation is encouraged. Constipation is a common problem, which is a concern in individuals already dealing with slow gut motility.   

Vitamin D

A common cause of gastroparesis is related to complications after surgery that result in delayed gastric motility. Post-surgical gastroparesis can increase the risk of low bone mineral density.  Evidence suggests it may be triggered by changes in the absorption and metabolism of vitamin D in the body.  In addition, deficits are often seen in this group of individuals because of dietary limitations with calcium and vitamin D-rich food sources.  Monitoring bone mineral density and 25-hydroxyvitamin D levels is recommended to better identify individuals with this type of deficiency.    

Recommended daily allowance:  

• Men and Women (19 – 70 years): 600 IU  
• Men and Women (71 + years): 800 IU  

Supplementation: Combined supplementation of vitamin D and calcium, beyond that found in a standard multivitamin, is encouraged in patients at risk for compromised bone health or with a vitamin D deficiency. Specific supplementation should be individualized based on the level of deficiency. 

Vitamin B12 (Cobalamin)

Vitamin B12 deficiency is a concern in individuals with gastroparesis, especially those who have received gastric resection.  With the change in GI structure, there is a decrease in intrinsic factor (IF) and stomach acid, both of which are needed to promote B12 absorption.  A relationship between vitamin B12 deficiency and diabetic gastroparesis has also been suggested due to its influence on the autonomic nervous system.  Other factors influencing the deficiency of vitamin B12 in this group of patients include poor diet intake and individuals with bacterial overgrowth.  

Recommended daily allowance:  

• Men and Women (19+ years): 2.4 mcg  

Supplementation:  

Replacement of vitamin B12 should be individualized based on the level of deficiency. This can be observed with baseline and quarterly monitoring of lab values.  Depending on the need, supplementation can be given orally, nasally, or by intramuscular injection.  

Patient application  

Beyond the more common deficiencies, nutrition assessment should include a more specific evaluation of dietary intake. Each patient’s diet tolerance, lack of intake from certain food groups, and natural vitamins and minerals may vary. Treating these differences, considering GI symptoms, and providing the patient with a balanced nutrition plan is necessary to improve the patient’s overall health. 

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References

National Institute of Diabetes and Digestive and Kidney Diseases. Gastroparesis. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/definition-facts. Accessed June 24, 2024.   

Amjad W, Qureshi W, Singh R, Richter S. Nutritional deficiencies and predictors of mortality in diabetic and nondiabetic gastroparesis. Ann Gastroenterol. 2021;34(6):788-795. doi: 10.20524/aog.2021.0660.  

Palmer L, Janas R, Spring M. Gastrointestinal Disease. In: The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 3rd edition. United States: American Society for Parenteral and Enteral Nutrition; 2017:505-509.  

Parrish C and McCray S. Gastroparesis and nutrition: the art. Practical Gastroenterology. 2011:29-41.  

National Institutes of Health. Fact Sheet for Health Professionals. Iron. https://ods.od.nih.gov/factsheets/iron-HealthProfessional/. Accessed June 25, 2024.  

National Institutes of Health. Fact Sheet for Health Professionals. Vitamin D. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed June 25, 2024.  

Ahmed S, Abd El-Hafez A, Mohsen M, et al. Is vitamin B12 deficiency a risk factor for gastroparesis in patients with type 2 diabetes? Diabetol Metab Syndr. 2023;15:33. doi: 10.1186/s13098-023-01005-0.  

National Institutes of Health. Fact Sheet for Health Professionals. Vitamin B12. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/. Accessed June 27, 2024.