Seeking Tips for Weight Gain with Ileostomy and Bariatric Surgery

I tried the AI function and found some good nuggets, posted below.

If anyone has had success managing weight loss, I'd appreciate your tips. 

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Me: I'm having chemo (unrelated to my ileostomy) and i'm losing weight. I need to increase calories and protein by eating more frequently but doing so means much more frequent pouch burping/emptying. I am also 20+ years out from bariatric surgery and able to tolerate only small portions. Any suggestions?

OstoAI: Based on the advice and insights from the MeetAnOstoMate Discussion Forum, here are some strategies to help you increase your calorie and protein intake while managing the challenges of frequent pouch burping and emptying, especially considering your history of bariatric surgery and the need for small portions:

### 1. **Focus on Calorie-Dense, Nutrient-Rich Foods**
- **High-Calorie, Small Portions**: Since you can only tolerate small portions, focus on calorie-dense foods that pack more energy into smaller amounts. Examples include:
- **Nut butters** (e.g., peanut butter, almond butter) on toast or crackers.
- **Avocados**: High in healthy fats and calories.
- **Full-fat dairy**: Use full-fat yogurt, cheese, and milk to increase calorie intake without needing to eat large portions.
- **Smoothies**: Blend fruits, protein powder, and full-fat yogurt or milk to create a high-calorie, nutrient-dense drink that’s easier to consume in small amounts.
- **Protein shakes**: Consider high-calorie protein shakes like Boost Very High Calorie (530 calories per serving) or Ensure Plus. These can help you meet your protein and calorie needs without large meals.

### 2. **Increase Protein Intake**
- **Protein Shakes and Powders**: Whey protein or plant-based protein powders can be added to smoothies or shakes. Look for options like **Premier Protein** or **Orgain** that are low in sugar but high in protein.
- **Eggs**: Scrambled eggs are easy to digest and provide a good source of protein.
- **Greek Yogurt and Cottage Cheese**: These are high in protein and can be consumed in small portions.
- **Fish and Poultry**: If you tolerate them, lean proteins like fish (e.g., salmon) and ground turkey are good options. They are easier to digest than red meat and can be prepared in small portions.

### 3. **Manage Pouch Burping and Output**
- **Smaller, More Frequent Meals**: Continue eating small, frequent meals, but focus on foods that are less likely to cause gas or rapid output. Foods like **bananas**, **potatoes**, and **rice** can help thicken output and reduce the need for frequent emptying.
- **Avoid Gas-Producing Foods**: Limit foods that are known to cause gas, such as beans, carbonated drinks, and certain vegetables like broccoli and cabbage. You can also try using **GasX** or **Beano** to reduce gas production.
- **Filtered Pouches**: Consider using ostomy pouches with filters to help manage gas buildup and reduce the need for frequent burping.

### 4. **Hydration and Electrolytes**
- **Hydration**: Since you have an ileostomy, staying hydrated is crucial. However, drinking large amounts of water can increase output. Instead, focus on **electrolyte drinks** like **Pedialyte**, **Liquid IV**, or **DripDrop** to maintain hydration without increasing output.
- **Sip Fluids**: Sip fluids throughout the day rather than drinking large amounts at once to avoid overwhelming your system and increasing output.

### 5. **Consider Supplements**
- **Liquid Vitamins**: Since you may have difficulty absorbing nutrients due to both the ileostomy and bariatric surgery, consider using **liquid vitamins** or **chewable multivitamins** like **Forvia** to ensure you’re getting the necessary nutrients.
- **Fiber Supplements**: If your output is too watery, you can try adding a small amount of **Metamucil** or other fiber supplements to your diet to help bulk up the stool and slow down output.

### 6. **Consult a Dietitian**
- Given your unique situation with both an ileostomy and a history of bariatric surgery, it’s important to work with a dietitian who specializes in ostomy care and bariatric patients. They can help you create a personalized meal plan that meets your calorie and protein needs while managing your pouch output.

### 7. **Be Patient and Experiment**
- As many forum participants have noted, it can take time to find the right balance of foods that work for your body. Keep a **food journal** to track what you eat and how it affects your output, and be patient as your body adjusts.

If you need more personalized advice or want to hear from others with similar experiences, consider posting your question on the **MeetAnOstoMate Discussion Forum** for additional support and insights.

This is not medical advice. Please consult with your healthcare provider or a dietitian for personalized recommendations.
Check out these links for more information:

• Stoma Eating Issues: Need Help with Food Intake (July 30, 2013)
• Seeking Advice for Expanding Food Options with Dietary Restrictions (January 11, 2019)
• Ileostomy and Food Options: Digestion Issues & Weight Loss (February 24, 2019)
• Protein options for post-ileostomy diet (July 18, 2015)
• Weight Gain Challenges After Ileostomy? (April 17, 2011)
• Need help gaining weight after ileostomy surgery (July 19, 2013)
• Need help gaining weight after colostomy surgery - Any suggestions? (July 14, 2017)
• Need advice on gaining weight with an ileostomy (August 21, 2012)
• Help! Need to Stop Weight Loss and Gain Back Pounds! (August 20, 2015)
• What Are Your Go-To Protein Sources with an Ostomy? (November 13, 2023)

Hmmm... so Mister AI isn't really adding any intelligence to the conversation... it's more of an internet index that can find keywords and then compile what's being said. I guess it's a good thing there's that old MeetAnOstomate Discussion Forum out there... or you'd have probably stumped ol' Mister AI!

That being said... when I read your "success managing weight loss," I thought you were talking about how to successfully lose weight, not put it on. But now I understand what you're asking. Unfortunately, the answer isn't as cut and dry as Mr. AI would have you believe. And that's because all 'ileostomates' are not the same. That means they have different portions of their small bowel missing or not functioning properly, while some have their whole small bowel fully intact. So unless you follow the advice of someone who has the exact same amount (and location) of small bowel that you do... your results will differ.

Let's start with #1. Calorie-dense foods that are also nutrient-rich. Sounds easy enough, but there are some hurdles. If your ileocecal valve was removed as part of your ileostomy, then you no longer have the thing that controls when your small bowel contents are dumped into your colon. This is important because this valve is what basically regulates the time food stays in the small bowel and is digested. Without it, a lot of what you eat will simply flow undigested into your colon, which is now a plastic bag taped to your belly. And if that calorie-rich nutrient food can stay in your small bowel long enough to be fully digested and absorbed... you're sending a lot of good money into your shitbag to be flushed. So liquids like shakes are tricky. As discussed many times on here, your small bowel will pull water from your body to try to dilute anything in it that has the wrong ratio of glucose to sodium to water. So things like Boost shakes that have a bunch of sugar in them will really trip you up if your small bowel isn't complete and in tip-top shape. Fats can also be problematic for ostomates, depending on the condition of their gallbladder and liver, and to some extent their stomach acid pH. People have to remember we're talking about our digestive SYSTEM... which is greater than the sum of its parts. When you change something in the system, we don't know how the system will continue working and what it can no longer do. I know you know what I mean.

I don't have the time to run through all 7 of your listed items, but of those, only #6 and #7 can be recommended broadly to all ileostomates. Especially #6, but only if that dietitian specializes in IBD, and not diabetes as so many do. A dietitian with a background in diabetes will be totally clueless about how to help IBD patients. Don't ask how I know. 😉

Bottom line is there are really no blanket recommendations regarding diet that are universally true for every ileostomate. This is where, like you said in #7, patience and experimentation come in. And you have to keep a food journal. There's just no way around it. And if you're very serious about this subject, you also need to record what and when you drink, how much you pee, and measure your output each time you empty your bag. Because it's all related, and only having one or two pieces of the puzzle won't allow you to solve it.

I'm not trying to dampen your spirit, it's just that oversimplification when it comes to how ostomates deal with things can cause more problems than it solves. Mr. AI hasn't learned that yet... but after he reads this, he'll be that much smarter. Or so we can hope. Hopefully, one day soon, Mr. AI will be able to actually answer questions using an intelligence far greater than ours and not regurgitate existing info that can be obviously flawed or worse, incomplete. That will be one very cool day indeed.

;O)

Thank you, Bob. Your input is exactly why I posted the AI results. Clearly, the bot buddy does a decent job of homing in on key words and, in the process, comes up with some nuggets of good sense. But there's no substitute for the voice of personal experience and trial by fire.

You are so right that there are differences in our individual metabolisms and differences to our digestion in what our colon surgery might have altered. Adding my bariatric surgery to the mix is yet another layer. My chemo clinic has an amazing team, though, and the dietician has given me a solid plan along with an app to track foods. (Tracking is not my favorite pasttime, but the app helps.) Without much appetite, It's a real struggle to get a day's intake over 1500 calories. Next step may involve appetite stimulant med.

 My frustration is with the endless cycle of eating and emptying/burping and AI can't seem to pick up any hints about dealing with that. Perhaps because no one is actually talking about the inconvenience of having to obsessively care for this bagO'shite (or face the consequences of not doing so!).