Struggling to gain weight?

I’m writing this post as I have noticed a fair few individuals on IBS support groups that have experienced significant weight loss and this can be very detrimental leading to malnutrition and secondary consequences of malnutrition, such as muscle wasting, impaired immune system and increased morbidity and mortality. Weight loss is uncommon in IBS and it is usually the sign of another underlying disease. Other diseases with similar symptoms to IBS which affect the absorption of nutrients and are usually associated with weight loss include coeliac disease, crohn’s disease and ulcerative colitis. It is very important that your GP or gastroenterologist conducts the necessary tests before diagnosing you with IBS to rule out other possible conditions. A full blood count,  erythrocyte sedimentation rate and CRP (these will be elevated if there is inflammation) and antibody testing for coeliac disease is recommended by the National Institute for Health and Care Excellence (NICE).  If you’re still expecting results or still struggling with gaining weight despite the tests being negative I’ve put together a few tips on maximizing your intake and increasing the calorific value of your meals. I’ve worked with a lot of patients in hospital who were malnourished and losing weight and the first step to enhance dietary intake is through the use of food fortification. This however is more challenging in IBS due to the dietary restrictions. These are a few tips of how to optimise your current intake. The advice given is generalized therefore it is important to be aware of your own tolerances in order to prevent IBS symptoms.

  1. Have six small meals a day, 3 meals and 3 snacks.
  2. Avoid drinks just before meal time as this can make you feel full.
  3. Add sugar, golden syrup or maple syrup to cereal or porridge to increase the calories of the meal without increasing the portion size.
  4. Aim to drink a pint of lactose free milk a day. If choosing a plant based-alternative check the packaging to ensure that it is calcium enriched.
  5. Include protein sources with your meals such as meat, poultry, fish, eggs, and low FODMAP dairy products.
  6. Aim for calorie rich drinks such as; smoothies, milk and hot chocolate. Make your own smoothies from lactose free milk, low FODMAP fruit and lactose free yoghurt.
    Here’s a few recipes:
    Banana Peanut Butter Smoothie: 1 cup milk, 1 banana, 2 tbsp peanut butter and sugar to taste
    Yoghurt Smoothie: 150ml lactose free milk with 1/2 pot of lactose free yoghurt
    Fruit Smoothie: 200ml lactose free milk, and 80g pureed low FODMAP fruit
  7. Have 3 small snacks a day. Snack ideas include:
    • lactose free yoghurt
    • banana with peanut butter
    • fruit with lactose free yoghurt and cream
    • a handful of low FODMAP nuts such as peanuts
    • Crisps
    • low fodmap biscuits
    • low fodmap slice of cake
    • rice pudding made with lactose free milk
    • A slice of toast with jam or butter
    • custard made from Birds Custard Powder (300g pack) with lactose free milk

You can get FODMAP friendly recipes on this blog or check out FODMAP friendly products you can purchase here.

For those who tolerate fat well:

  1. Add lactose free cream to cereal, porridge, soups and mashed potatoes.
  2. Add hard cheeses like cheddar or lactose free cheese to mashed potatoes, soup, eggs and pasta.
  3. Add butter, margarine or oil to meals.

If suffering from nausea:

  1. Try plain foods.
  2. Avoid greasy, fatty and spicy foods.
  3. Try cold meals such as a sandwich as strong odours can worsen nausea.
  4. Eat little and often and chew your food slowly.
  5. Discuss the possible use of anti-emetics with your GP.

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