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Hi. Docs think I have chronic refractory SIBO. Seeing a new doc next week. Lots of bloating and explosive gas when I go to the bathroom. And I have gained at least 25 pounds since my ileostomy takedown 7 months ago. Instead of feeling well and being thinner, I am tired and fat. (Total proctocolectomy was for colorectal cancer, so I am happy with that outcome but my quality of life is not at all what I had hoped it would be by this point post-op). Why am I gaining so much weight? I have cut back on calories. Pre-diagnosis I was insulin resistant and took Ozempic with good weight loss, but that drug may not be safe in colorectal cancer so perhaps my insulin resistance is part of the problem.

Last edited by Stephen J. Thompson, MD
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Hi Stephen,

I cannot give too much advice on insulin-resistant problems but I can say that generally, after a proctocolectomy, we tend to lose weight at first and then start to put it on again because we can finally eat without difficulty or pain. (most often due to either UC or Crohns which seriously compromised our eating habits)

Firstly, is it fat or water gain? Are you holding water? Are you swollen? Do you have a salt-rich diet? Do you eat store-bought industrial foods?

Next, what are you eating? Whenever I want to lose weight, I do not go on a diet...I  change the balance of my diet. I go heavier on proteins and lighter on carbs. I reduce sugar and fats. I do not radically change my eating habits or it is not sustainable for me.

That said, I generally eat healthy foods with after-dinner-snacking being my big calorie problem.

I cook to avoid pre-cooked and industrial foods that are full of salt, sugars, fats, and chemicals that my body doesn't need. They can cause water retention too. Some are chocked full of hormones to boot, so you end up with a double whammy.

I use fresh or frozen fruits and vegetables and never canned foods because they are very high in sodium and sulfites (I'm allergic)

Lots of grilled fish, chicken and light meats, soups full of good veggies and beef or chicken bones (soups are your friend, they are very satisfying, fill you up and are comfort-food especially with a whole-grain sandwich or side dish), homemade stews without fats (or I skim them off of the top). If you have SIBO, your body will like this too because there are fewer carbs for the bacteria to enjoy and proliferate...thus less gas. The higher the protein in your diet the less gas in your output.

But all protein is not good for diabetes as far as I know...your body needs healthy carbs to sustain its blood sugar choose whole grains instead of white flour breads and pastas...they stick around longer so they maintain the 'fullness' level too...they also hold more water so they can help to bulk up your output. I have a gluten sensitivity so I avoid too much pasta (or use lentil or chickpea pasta but whole grains are great for you)

My general rule was: switch whites to raw or whole grains, up the protein and lower the carbs. Avoid all sugary drinks. No pizzas or fast foods other than sushi. Use butter or olive oil as fats (healthier and yes, you still need some fats in your butter contains vitamin A...). Make your own foods (pre-cook and freeze if your life is time-sensitive. Avoid reserving yourself. Use reasonable portion control. I said Reasonable. Not extreme. If you are hungry after your meal, you will snack...which is anti-intuitive. So, you are better off eating a little bit more and not snacking later on (my big problem, I don't eat enough at meals, my blood sugar plummets and then I finish off the ice cream).

Do it slowly and incrementally, not suddenly or it is just not sustainable. Increase your output too...walk a little more, do small exercises and movements regularly. Do not stay sedentary. That is both the enemy of weight and blood sugar.

If you need help, PM me.


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