Remember that you are worthy of your own love, no matter how you look or feel.
While most symptoms of inflammatory bowel disease (IBD) are invisible, weight loss is an extremely visible one that takes a physical and mental toll on those who experience it.
Maintaining adequate weight is often an ongoing challenge because weight can fluctuate easily in people with IBD. In a culture that praises smaller bodies, we are sometimes even complimented for weight loss, which is perceived as a sign of health, rather than a sign of a chronic invisible illness flaring.
Losing weight and struggling to maintain a healthy weight with IBD is something I worked to balance for many years. During that time, I lacked self-confidence and self-love.
Even at times when I felt really well, I could not get past a certain number on the scale. I often felt like I was disappearing into thin air. I felt bones that people are not supposed to feel because they are normally protected by fat, which was scary and unnerving.
However, I did manage to gain weight and keep it on long-term using the strategies outlined below.
The small intestine is where most of our nutrients from food are absorbed. Since the small intestine is involved with Crohn’s disease, this can be a significant hurdle to gaining and maintaining weight.
Even though ulcerative colitis (UC) is only in the large intestine, it does not mean that those with UC shouldn’t focus on healing inflammation. That’s because inflammation can occur from gut permeability, bacterial and fungal overgrowths, food sensitivities, and more — not just from inflammation directly from having IBD. Additionally, inflammation in the large intestine presents its own concerns.
The more inflammation you have, the more your body will struggle to absorb nutrients. That hurts your chances of achieving an adequate weight.
I saw improvements in my weight when I made my diet simple but nutrient-dense. I left out some of the “fun” gluten-free snacks I enjoyed and zeroed in on proteins, grass-fed butter and extra virgin olive oil, bone broth, teas, and herbs.
I even swapped out some of the products I used on my skin and in my home to eliminate them as a potential source of stress for my body.
To start healing inflammation, focus on eating an anti-inflammatory diet and incorporating the best foods for gut health.
In general, an anti-inflammatory diet is low in sugar and free of refined grains. The focus should be on whole foods like quality proteins, fats, fruits, vegetables, nuts and seeds as tolerated, and water as the main source of hydration.
It’s important to evaluate what you are eating on a typical day and see how you can optimize the types and quantities of your food. Not eating enough macronutrients, including protein, carbohydrates, or fat, can be detrimental, especially if you are already underweight.
When you’re looking to gain weight, it’s not the right time to cut any macronutrients (I’m looking at you, keto.)
Try to prioritize whole-food macronutrients. What I mean is, pick sweet potatoes over bread. Choose chicken, beef, and fish over protein powders. Opt for extra virgin olive oil, grass-fed butter (if tolerated), and coconut oil over vegetable oils. This provides nutrients that are much more easily usable and have health benefits.
Give yourself a mental checklist and make sure there is always protein, fat, and carbohydrates on your plate. You may want to work with a dietitian or nutritionist to make sure your portions are adequate for your goals.
Some foods have more calories than others, which can be a great thing when you are trying to gain weight.
Fats have the most calories per gram compared to protein and carbohydrates. Foods with higher fat content like coconut, avocado, nuts — and the products made from them — are foods to consider daily.
Start to think about how you can add more of these high-calorie foods to your diet.
When I needed to gain and maintain weight, I was adding sliced avocado onto dishes, having smoothies in between meals, and snacking on rice cakes with nut butter.
An extra drizzle of extra virgin olive oil or slices of avocado will add up when you make these choices consistently.
These are just a handful of ways you can start including high-calorie (but still nutrient-dense) foods to your plate.
It’s common for larger meals to cause gastrointestinal distress in IBD. Larger meals during the day could trigger diarrhea in some, which is not helpful for weight gain.
If you are experiencing gastrointestinal symptoms while trying to gain weight, eating smaller meals and snacks throughout the day will likely feel better for you and not cause additional symptoms in the long run.
To ensure you have access to plenty of food options that you can reach for daily, buy and prepare some easy-to-grab foods. Some extra snacks I have stocked up on are:
- soft-boiled eggs
- meat sticks or jerky
- dried mango
- hot buckwheat cereal or oatmeal
- grilled chicken strips
- smoked salmon
- gluten-free toast or waffles with jam and nut butter
Be sure to leave extra snacks where you work or wherever you spend time outside your home.
It can be hard to get in enough calories without feeling like you’re eating all day long.
Not only that, but not everyone’s job or lifestyle can accommodate eating so frequently.
That’s where liquid nutrition can be a helpful supplement to support a nutrient-dense diet or to temporarily replace solid food when needed.
An important note: Do some research on liquid nutrition supplements before you buy or start incorporating them. Some popular liquid nutrition supplements on the market use poor ingredients. Remember, you want to heal inflammation at the same time as gain weight, so avoid things like corn fillers, vegetable oils, and artificial ingredients.
Use these as a supplement to your diet. They can be consumed in between meals, when you don’t have the time to eat a full meal, or as a replacement for solid food to give your digestive system a break.
For so long, I did not move my body in a productive way. Aside from occasional short walks, exercise was not part of my lifestyle.
I was either too tired or afraid that the exercise would burn calories that I could not afford to lose. At that time, it did not occur to me that I should try exercising with intention.
Strength training helps build muscle, which will benefit your body composition goals. Additionally, it is important to maintain muscle mass, which being sedentary and having nutrient deficiencies puts you at risk for losing.
I did not start strength training with weights, and I don’t recommend you do either if you are in or recovering from a flare or generally feel weak. Bodyweight exercises are great to start with and include in your routine down the line.
Try anything from lunges, squats, pushups, planks, and more. Start slow and gradually increase your reps as tolerated.
You don’t need a lot of time to do these exercises. Start your day with some of these exercises or taking breaks during your workday and pumping out a few reps.
This is a more drastic option and considers your health and vitality in the big picture. You should consider the pros, cons, and state of your health.
I list this as an option because having a bowel resection surgery is what allowed me to make leaps and bounds with my weight and overall health.
How does this work? A surgeon will remove the parts of your intestine that have been scarred from inflammation and maybe other very inflamed areas. Without these compromised areas, you are able to absorb nutrients much easier and experience less pain.
For me, this was like being given a clean slate. I was able to gain weight and have maintained that weight more than 2 years into remission so far.
The surgery gave me other added benefits, like abundant energy and a reduction in symptoms.
Is bowel resection surgery right for you? This is a question you need to bring up with your doctor and discuss with a gastrointestinal surgeon. If you have a hard time getting out of flares, maintaining weight, or managing pain that interrupts your life daily, your doctors may feel this is a good option for you.
Keep in mind that every body and every case of IBD works differently. People gain and maintain weight in different capacities.
Weight gain also takes time, especially when you’re working with inflammation and pain. Be gentle with yourself and your journey and reach out to your doctor and other health professionals that can guide and support you through this.
The most important thing I want you to take away is that you are worthy of your own love, no matter how you look or feel.
Looking back, I can see how I did not love myself in the times I really needed it. Have an appreciation for the challenges your body is pushing through and don’t lose sight of what you can accomplish.
Alexa Federico is an author, nutritional therapy practitioner, and autoimmune paleo coach who lives in Boston. Her experience with Crohn’s disease inspired her to work with the IBD community. Alexa is an aspiring yogi who would live in a cozy coffee shop if she could! She’s the Guide in the IBD Healthline app and would love to meet you there. You can also connect with her on her website or Instagram.