The 3 Layers of Gastroparesis (Plus: Free Coaching)
The Living Well Letter: Our Premiere Issue!
Welcome to the first issue of The Living Well Letter! Each month, I’ll be sharing a mix of thoughts, recommendations, tips, and updates to help you navigate life with gastroparesis.
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:
What is the actual physical sensation I’m feeling? (pressure, nausea, fullness, burning - stick to the physical facts)
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.
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