We’re doing something a little different with this episode, inviting you to be a fly on the wall as I sit down with Samantha Cook and Stef Maira to talk about what we’re seeing as coaches, educators, and advocates working in the gastroparesis space in 2026.

In this candid conversation, we cover things like:

• Why it’s so important to understand that gastroparesis is not one entity — and what that means for sharing and gathering information

• How misdiagnoses are confusing patients with and without gastroparesis (and the struggles of being “un-diagnosed” with the condition)

• The trend toward more invasive treatments like feeding tubes and surgeries — often rather quickly after diagnosis

• How the natural cycles of gastroparesis can create confusion and self-doubt

These aren’t topics that come up often in the GP community, and that’s exactly why this conversation felt so necessary. We hope it’s a reminder that while dealing with gastroparesis can feel like an emergency, the best approach is often to slow down, breathe, and give yourself time to figure out what works for you.

If you’d prefer to watch this episode, you can find the video here.

Support the Podcast

As always, The Living Well Pod is entirely community-supported. If you find these conversations helpful and want to support the work I do, please consider upgrading to a paid Substack subscription.

Subscribe now

Where to Find Us

Crystal:

• YouTube: @csaltrelli

• Instagram: @csaltrelli

• Website: www.LivingWellWithGastroparesis.com

Samantha:

• Instagram: @thrivingwithgastroparesis

• Website: www.transformative-psych.com

Stef:

• Instagram: @stef.maira
  

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So we dig into what we actually mean by that — and how it can lighten the mental weight that so many of us carry around living with gastroparesis. We talk about the white-knuckled grip we often have on needing gastroparesis to go away before we can feel okay. Why the question "how do I get there?" doesn’t have a step-by-step answer. And how building confidence that you can handle whatever shows up changes the experience, even when the condition itself stays the same.

If you also felt frustrated or confused by our last episode, this one’s for you.

Episode Links:

• What’s in Your “I Can’t Handle” Bucket?

• Register here for Samantha’s free webinar on Monday, May 18th (US) / Tuesday, May 19th (Australia). The topic will be “What is healing?”

• If you’re finding the podcast helpful, please consider supporting it and my other work with a paid Substack subscription. As a thank you, I’ll be hosting a monthly Q&A for paid subscribers starting in June.
  

  Subscribe now

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I know many people struggle with travel after a gastroparesis diagnosis. It’s true that it requires extra planning, preparation, and flexibility, but for me, it’s worth the effort. In the past year, I’ve visited places like Costa Rica, Edinburgh, and the Great Smoky Mountains, and while none of those trips were free of discomfort, I made incredible memories and had wonderful experiences along the way.

Being able to do the things that bring us joy, excitement, and special moments with those we love — whether that’s travel or something else entirely — is a significant reason most of us want to feel better in the first place.

But these things don’t have to wait until you've gotten to a place you call “living well with gastroparesis.” Rather, it seems to me, they’re a vital part of the act of living well with gastroparesis. Of noticing and embracing opportunities to feel fulfilled, regardless of the circumstances you currently find yourself in.

So my suggestion this month is to do something that you enjoy but might’ve set aside since your diagnosis, whether because you’ve been solely focused on fixing your health or because of worries and uncertainties.

It doesn’t have to be as elaborate as a vacation. It might be seeing a movie with your kids, meeting a friend for coffee, going to a concert, or taking a day trip to the beach. Maybe it’s time to get back to your book club or the place where you volunteer. Whatever it is, pick a day, make your plans, and go for it.

Know that it might not be perfect. You might not feel great. You might have to do some preparation that you’d rather not or set some boundaries that feel uncomfortable. Maybe you’ll have to cut the activity short this time. But I’ve found that the more you expand what you allow yourself to do and experience, even when your life doesn’t look the way you want it to, the closer you get to a life that feels the way you want it to.

I’d love it if you’d reply and let me know what you plan to do! And keep reading for some more inspiration and a very important PSA…

Speaking of travel, did you know that Samatha went on an epic seven-week, around-the-world vacation with her family last year — all while navigating gastroparesis, psoriatic arthritis, and her son’s special needs? She told us all about it on the Living Well Pod, and it’s a true testament to finding joy and living well in the midst of symptoms, struggles, and uncertainty. Listen now.

A couple of weeks ago, I discovered something that absolutely infuriated me: about 80% of the “gastroparesis books” on Amazon appear to be written by people who have absolutely no expertise in gastroparesis — and worse, several of them are claiming to be written by doctors or dietitians who don’t even exist.

Watch my 90-second summary of this dangerous trend or the full video where I tell you how to make sure you’re selecting legitimate resources that can provide helpful advice. And be sure to keep reporting these listings when you see them. Sadly, all of the books I discussed in these videos are still being sold on Amazon...

Living Well with Gastroparesis Program

After 15 years of helping people live well with gastroparesis, I’ve recently put all of my best advice, tips, answers, and insights into a single online, on-demand resource called the Living Well with Gastroparesis Program.

Get the details here.

*Subscriber discount: use code LETTER to save 20% until May 31.

One-on-One Coaching

If you’re looking for more hands-on support, I recommend reaching out to LWWGP-Certified coaches Samantha Cook and Stefanie Maira. Both have gastroparesis themselves and have been trained by me in the Living Well with Gastroparesis approach. Whether you’re looking to navigate the emotional strain with Samantha or find a more sustainable, practical rhythm with Stef, they’re both wonderful resources for helping you move gastroparesis out of the center of your world so you can spend more time focusing on what you actually enjoy. Learn more here.

Connect with Crystal...

• YouTube: @csaltrelli

• Instagram: @csaltrelli

• Website: www.LivingWellWithGastroparesis.com

Connect with Samantha…

• Instagram: @thrivingwithgastroparesis

• Website: www.transformative-psych.com

Connect with Stef…

• Instagram: @stef.maira

This was on my mind because it was just a week ago that I was telling my coach, Living Well Pod guest Missy Maiorano, that “medical emergencies” were something I could not handle.

Missy was sharing what she calls the “I Can’t Handle” Bucket, explaining how our brains make up stories about the kinds of things we are and are not capable of enduring, and then categorize imagined scenarios and outcomes — “yes, this is okay,” “oh no, I must never experience that.” We tend to spend a lot of time and attention worrying about or trying to prevent the things that get tossed into the “I Can’t Handle” Bucket. It can be a heavy load to carry.

I used to have a lot of gastroparesis-related things in my bucket. I couldn’t handle… if I needed a feeding tube. If my symptoms got worse. If I lost ten more pounds. If the condition never went away. But what I’ve seen in the last 22 years, both personally and from watching thousands of other people navigate this condition, is that… we do. If or when those things come up in real time, we handle them.

During our session, Missy went on to say that if we dig just a tiny bit deeper, we find that it’s not really the circumstances themselves that feel unbearable — it’s the feelings we expect to experience as a result. Uncertainty, loss of control, terror, helplessness, panic, grief, despair.

That feels true to me. Because in reality, I’ve handled a lot of medical emergencies, serious life-threatening ones — both my own and my daughter’s. And yet, my brain has continued to insist that I have to monitor and watch and predict to ensure that nothing like that ever happens again because it was terrifying and I cannot handle terror.

Guess what? I was terrified last night (see: trembling, sweating, palpitations). But unlike in the past, that felt… okay? Not good. Not comfortable. But also not like a problem. I don’t know how to describe it any better than that, but it made a significant difference to just let the terror be there as I put one foot in front of the other and did what needed to be done. It felt like a little weight had left my bucket.

And when I look back at the last two decades of my life with gastroparesis, the same is true. At some point, I became less afraid of the despair when it showed up. Less resistant to the inherent uncertainty of an “idiopathic” diagnosis. As I stopped being so certain about what was okay and what wasn’t, my whole experience of gastroparesis got a heck of a lot lighter. I no longer felt like the characters in Star Wars, trying to keep the walls of the trash compactor from closing in.

One thing I know for sure is that we are all so much more capable and resilient than we think. That’s evidenced by my daughter, who is thankfully doing well and resting comfortably next to me today, and it’s evidenced by the fact that you and I have both made it through every difficult, scary, uncertain experience we’ve had — regardless of what we thought we could handle.

So, I wonder what’s in your “I Can’t Handle” bucket that you maybe don’t even know you’re carrying around. What has your brain said you have to brace against and prevent at all costs, and what is it that you’re really trying to avoid? Because it seems to me that lightening the load starts with just looking at what feels heavy and seeing what it’s really made of.

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Recently, I’ve been spending some time thinking through my own health history and concluding that my gastroparesis is likely linked to having hypermobile Ehlers-Danlos syndrome. It occurred to me that maybe, to some extent, this is just how my body is made. Maybe it’s not something I can fully “fix” in the way I wanted to and tried to for so many years.

And that thought felt like a relief.

In this episode, Samantha and I talk about what that relief reveals—not about gastroparesis itself, but about the stories we carry around responsibility, control, and what we think it means if we get well or we don't.

We also dig into the three layers of gastroparesis that I introduced in the last Living Well Letter, and I share something I haven’t talked about much publicly: the years I spent wondering if doing this work was somehow keeping me stuck in having gastroparesis. Turns out, it wasn’t. But seeing that belief for what it was—just a story—was revealing in its own right.

If you've ever felt like you were on the hamster wheel of healing, or wondered if accepting your condition and still wanting it to go away could somehow coexist, this episode is for you.

Episode Links:

• The Three Layers of Gastroparesis

• Crystal’s Living Well with Gastroparesis Program

• Samantha’s Thriving With Gastroparesis Community

Subscribe now

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In case you missed it, my podcast co-host Samantha Cook and I were on The Living Well Pod earlier this month, talking about a Zoom call we participated in with some important and influential people in the gastroparesis space: doctors, researchers, non-profit organizations.

During that call, I shared something that’s become clear to me over the past fifteen years: that how we think about and understand this condition— the fear that we carry, the uncertainty, the worry that we will never feel “normal” again— often has just as much impact on our quality of life as the condition itself.

Yet, there seems to be a common belief that addressing the mental and emotional side, the lived experience, somehow invalidates that gastroparesis is a real disorder with an organic cause.

So in this month’s Food for Thought section, I’m sharing something new that I’ve come up with to illustrate how these things actually go hand-in-hand, and together can help us feel better all the way around.

I hope you’ll give it a read and let me know if it resonates with you!

Warmly,
Crystal

We can think about our experience of gastroparesis as being made up of three “layers:”

Layer 1: This is the physical disease itself. The dysfunction of the muscles, nerves, or cells in and around the stomach. The documented delay in gastric emptying. The abnormal physiology that produces vomiting, nausea, and fullness.

This is the layer we address with dietary modification, medication, and/or surgery. When people say “gastroparesis is an organic disease,” this is the layer they’re talking about. And this layer desperately needs more research funding, clearer diagnostic criteria, better physician education, and improved treatment options.

But this layer alone doesn’t create your experience of gastroparesis.

Layer 2: This is the gut-brain connection. The gut and the brain are in constant communication through the nervous system, specifically the vagus nerve. Your gut sends signals up to your brain. Your brain sends signals back down. And the state of that entire system—how sensitized it is, how activated it is—affects the sensations that you experience. Your stomach typically works less efficiently and produces more discomfort when you’re in a stressed state than in a calm one. That’s true for everybody, but it’s especially impactful for those of us with existing gut dysfunction.

This layer can have a significant impact by amplifying (or not) what’s going on in Layer 1. But it’s still not the whole picture.

Layer 3: This is your moment-to-moment experience. Layer 3 is where meaning is made. This is your thoughts, feelings, beliefs, and stories — and how seriously you take them.

This is where a sensation of nausea gets turned into, “This is how I’m going to feel forever, and I can’t bear it.” Layer 3 is where hypervigilance and constant monitoring lives — do I feel better, do I feel worse, what does this mean, what should I do?

Why This Matters

The key here is that these layers don’t just stack on top of each other - they actively influence each other in a feedback loop.

When you’re in Layer 3 panic (”I can’t live like this, I need to find the answer NOW”), that impacts Layer 2 - your nervous system goes into threat mode. This makes your gut work even less efficiently and amplifies the discomfort you feel. This then confirms the Layer 3 story that something is terribly wrong, which keeps Layer 2 activated, which makes Layer 1 symptoms feel worse. Round and round.

This is why our usual approaches get stuck.

We spend most of our time trying to fix Layer 1. That’s reasonable - it’s the actual disease. But our treatment options are limited and often ineffective. So we keep searching: new doctors, stricter dietary rules, more medications. But the desperation so many of feel around that search, that’s Layer 3 thinking (”I have to find an answer, or I’ll never get relief”), which keeps the feedback loop spinning.

Some of us shift our focus to Layer 2 - vagal tone exercises, nervous system regulation, stress reduction. And that can help. But when that becomes the new thing we desperately need to “fix” to finally feel okay, we’re right back in the same pattern. Still in Layer 3 urgency, just with a different target.

It seems to me that Layer 3 is the most accessible and changeable part of the feedback loop, but also the part we look at the least.

Let’s be super clear: you can’t think your way to better gastric emptying. Layer 1 is still there; the physical dysfunction doesn’t disappear. But when Layer 3 shifts, we stop catastrophizing every sensation, the urgency to fix it right now eases, and we’re no longer treating every symptom as a puzzle we have to solve. And that means we feel safer in our body. In turn, Layer 2 calms down. It stops amplifying Layer 1 as much. The stomach still empties slowly, but it’s not compounded by Layers 2 and 3.

We’re not curing gastroparesis. (I wish we could!) We’re not healing the stomach. But we are genuinely changing how it feels to live with this condition by addressing the most accessible, changeable piece of the system.

So what does this mean for you, right now?

It means you don’t have to wait on better treatments or perfect nervous system regulation to experience some relief. There’s relief available right now at Layer 3.

Here’s a simple practice to start: the next time you feel symptomatic, pause and ask yourself two questions:

1. What is the actual physical sensation I’m feeling? (pressure, nausea, fullness, burning - stick to the physical facts)

2. What story is my brain telling me about it? (”This will never end,” “I can’t handle this,” “Something must be wrong”)

Notice when your brain goes from “I feel nauseous” to “I can’t live like this.” Notice the difference between the physical sensation and the story about what it means.

That’s it. You’re not trying to change either one. Right now, you’re just learning to tell them apart. That awareness alone starts to interrupt the feedback loop.

The more you practice this distinction, the more space opens up between the sensation and the story. And in that space, real relief becomes possible - not because the symptom disappeared, but because it’s no longer being amplified by layers of meaning.

Seeing this totally changed my own experience of gastroparesis, and it’s been transformative for my clients, as well. That’s why it’s so important to me to share this with patients and practitioners alike. I hope there’s something in this that helps you, too, or at the very least, offers a little “food for thought.”

If you’d like some support or guidance working through any or all of the “layers” of gastroparesis, here are two ways to do that this month…

Living Well with Gastroparesis Program

I've spent the past 15 years helping people live well with gastroparesis, and I've finally put everything I wish I could share with every person who reaches out into a single online, on-demand resource.

The Living Well with Gastroparesis program is designed to help you work through all of the layers we discussed above — not just the practical symptom management, but also the fears and expectations around food and symptoms that make our lives smaller, and the nervous system patterns that amplify symptoms.

Get all the details here.

Free Live Coaching: TONIGHT

Living Well with Gastroparesis coach and psychologist, Samantha Cook, is offering free 1:1 coaching sessions tonight. This is a chance to talk through something that feels stuck, get personalized guidance on a challenge you're facing, test out whether coaching might be right for you, or simply ask a question that's been on your mind.

• North America: Monday, March 30 from 7pm - 9pm ET / 4pm - 6pm PT

• Australia: Tuesday, March 31 from 10am - 12noon

Register here to receive the Zoom link. Join anytime during the 2-hour window - you'll enter a waiting room and Samantha will work with participants one-on-one for about 15 minutes each. No need to stay the whole time.

Note: if demand exceeds the time available, other arrangements may be made.

Connect with Crystal...

• YouTube: @csaltrelli

• Instagram: @csaltrelli

• Website: www.LivingWellWithGastroparesis.com

Connect with Samantha…

• Instagram: @thrivingwithgastroparesis

• Website: www.transformative-psych.com

In this episode, I share an uncomfortable experience I had on a call with gastroparesis doctors and advocates, where I spoke about how we might better support people living with gastroparesis, given the resources that are available to us right now.

It didn’t land the way I hoped. But that moment ultimately strengthened my resolve to keep talking about something I believe is often overlooked — and really important — within this community: how things like fear, uncertainty, and the way we understand our diagnosis can shape our day-to-day experience of living with gastroparesis.

This matters because even while many of us are waiting for better treatment options, there are still ways for our experience to shift. There can still be real relief from suffering.

Toward the end of the episode, Samantha shares examples of exactly this from her Thriving with Gastroparesis community, where people are learning to navigate symptoms differently, feel less afraid, and find joy and flexibility in their lives, even when their medical situation remains challenging.

So if you’ve been feeling stuck because it seems like there’s nothing to help you right now, we hope this conversation offers a fresh perspective and a reminder that you’re not alone.

Episode Links:

• Samantha’s Thriving With Gastroparesis Community

• Crystal’s Living Well with Gastroparesis Program

Subscribe now

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And then something shifted.

In this video, Stef shares how she gradually rebuilt trust in her body, expanded her diet, and regained a sense of freedom and flexibility… even while she’s still managing gastroparesis.

We discuss:

• How stress, fear, and online support groups intensified her symptoms

• The turning point that helped her rebuild her life

• What it actually looks like to experiment with foods again

• How labeling foods as “safe” or “unsafe” can keep you stuck

• The role of intuition, flexibility, and grace in managing symptoms

• Navigating fertility and IVF with gastroparesis

• How her experience now shapes her work as a Living Well with Gastroparesis coach

Stef’s story is powerful, relatable, and incredibly hopeful, especially if you’re newly diagnosed or feeling overwhelmed by your current circumstances. I hope this conversation reminds you that your experience is not static, and that meaningful change is absolutely possible—often in ways you can’t yet imagine.

Links Mentioned:

• Crystal on the I’ve Got Guts podcast

• Stef’s Coaching Services

• Stef’s Instagram

• For more info about one-on-one coaching, email Stefanie.A.Maira@gmail.com.

You’ll hear about Samantha’s work with her Thriving with Gastroparesis group, Crystal’s rewrite of Living Well with Gastroparesis, and the discoveries that have re-energized our passion for this work. We explore what the latest studies are saying about the gut-brain connection, perception, and symptom experience, and why it’s such an encouraging time for our community.

Episode Links:

• Samantha’s Thriving With Gastroparesis Community

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We reflect on the experiences and insights that kept bringing us back to this theme all season long, from hearing the many different paths our guests have taken to live well, to noticing how much lighter this podcast felt once we stopped trying to get it “right.”

We explore:

• Why chasing the “right way” often leads to more struggle, not less

• Trusting your own wisdom instead of searching for the perfect blueprint

• How curiosity opens the door to new possibilities

• What’s next for the show

As always, thank you so much for being here. Make sure you’re subscribed, so you’ll know when new episodes drop—including a special between-seasons surprise coming this summer!

Episode Links:

• Samantha’s Thriving With Gastroparesis Community

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Sarie speaks candidly about navigating cancer treatment without falling into hypervigilance, handling the ups and downs of her emotional experience, what she does when loved ones don’t understand, why she no longer sees her body as the enemy, and lots more.

This is one of our favorite conversations so far, and we’re excited to share Sarie’s incredible insights with you.

Episode Links:

• Sari’s Website & Instagram

• Samantha’s Thriving With Gastroparesis Community

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This discussion truly captures the essence of what we explore each week on the show. It left us feeling calm and grounded, and we hope it does the same for you.

In this episode, we’re talking about Ikigai, the Japanese concept that loosely translates to “reason for being.” We explore how reconnecting with what you love—even in small ways—can shift your experience and allow for more freedom, peace, and ease no matter what you’re dealing with.

What We Talk About in This Episode:

• What Ikigai means and how it relates to chronic illness

• The inward focus of managing chronic illness and how it can shift your energy away from what truly lights you up

• The shift from “my possibilities are limited” to “my possibilities are different.”

• Why healing isn’t just about protocols—it’s also about curiosity, passion, and doing the things that matter to you

Episode Links:

• Ikigai: The Japanese Secret to a Long and Healthy Life

• Samantha’s Thriving With Gastroparesis Community

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We talk about creating boundaries around illness, finding joy in everyday moments, and embracing rest without guilt. Vanessa also shares the story behind Girl With Guts — her platform for authentic advocacy and community — and reminds us that thriving doesn’t mean having it all figured out.

Whether you live with chronic illness, disability, or both, this conversation will leave you feeling seen, uplifted, and encouraged.

Episode Links:

• Girl with Guts

• Join Samantha’s Thriving With Gastroparesis Community

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We talk about how frantic thinking can narrow our perspective and make solutions feel out of reach, while a quieter mind often opens the door to clarity, creative problem-solving, and even unexpected sources of support.

If you’re feeling stressed about making ends meet, we hope this short discussion offers a bit of breathing room and maybe a fresh perspective. We’ll see you on Thursday for another full-length episode!

We explore:

• How it feels when the answer isn’t as complex or dramatic as we expected

• The difference between anxious problem-solving and true insight

• What it looks like to trust your gut even when experts disagree — and how we can innocently get in the way of our own intuition

• How letting go of assumptions and “over-doing” can open the door to relief

This conversation is for anyone who’s been told one thing but sensed something different. It’s a reminder that our inner knowing is worth listening to—and that clarity often comes when we’re willing to see things in a new light.

Episode Links:

• Ep. 7: When There Are No Answers

• Join Samantha’s Thriving With Gastroparesis Community

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Together, we explore:

• Why recovery from illness doesn’t always bring the relief we expect

• The impact of pregnancy, postpartum, and motherhood on the healing journey

• The overlap of chronic illness, mental health, and disordered eating—especially in digestive disorders

• The daily practice of self-compassion, rest, and letting go of “shoulds”

• How discomfort can be a doorway to growth

This conversation invites us to rethink what healing really looks like and to make space for the messy but meaningful middle between “sick” and “not sick.”

Episode Links:

• Join Samantha’s Thriving With Gastroparesis Community

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There’s nothing you have to do in those moments; your thinking will settle on its own. But sometimes, certain things do feel helpful or supportive. Whether it’s music, movement, or just taking a breath, these small acts can create space and help us stay grounded while the mental snow settles.

There’s no right or wrong way to move through overwhelm, but we hope this conversation reminds you that you’re not alone—and that it’s okay to simply do what occurs to you (even if it’s singing poorly at the top of your lungs 🙈).

We’ll see you on Thursday with a full-length episode!

In this honest and deeply relatable conversation, we talk about how quickly fearful thinking can take hold after a new diagnosis, and how noticing the feelings of uncertainty and unease can gently bring us back to the present.

We also explore the difference between practical next steps and mental spiraling, the role of self-care (especially for those who tend to do it all), and the clarity that comes from simply letting our thoughts settle.

If you’re feeling overwhelmed or unsettled by a new diagnosis, this episode is a reminder that peace is never as far away as it seems.

Episode Links:

• Samantha’s Thriving With Gastroparesis Community

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We talk about the initial disappointment and disbelief Megan felt, the relief of letting go of trying to figure out why her symptoms came back, and the quiet strength she’s discovered in meeting each day as it comes, with less resistance, more presence, and fewer rules than before.

Megan’s story is a reminder that our physical health will ebb and flow but we can always meet those ups and downs with a fresh perspective. If you’ve ever struggled with the thought that things shouldn’t be this way, this conversation is for you.

Episode Links:

• Megan’s Gastroparesis Story (YouTube video)

• Samantha’s Thriving With Gastroparesis Community

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