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It almost seems like adding insult to injury to have to deal with weight gain after a colectomy. After all, by the time you have a colectomy, you have dealt with (usually) years of debilitating but misdiagnosed gastrointestinal problems. You have had major surgery and had to stay in the hospital for several days to even several weeks. You have had to change your diet drastically, and you probably have lost your taste for the foods you once loved. Weight gain is in itself distressing, but obesity can interfere with any future plans to reverse an ileostomy or a pouch.How on earth can you now have to deal with weight gain after a colectomy?

As one mother of three who had a colectomy puts it:

"The only reason I have gained weight is because I have enjoyed the sheer joy of being able to eat without doubling over in pain and running to the bathroom. "

Simply being able to eat without pain makes a huge difference in calorie consumption for some people.

You can finally eat without racing to the bathroom, so you indulge in some of your favorite foods. On the other hand, you can't eat high-fiber, low-calorie foods. Your system will do well with, say, a hot dog, no mustard, but you can have real problems with a bowl of spinach salad. It's dense, sugary, salty, fatty foods that give you fewer symptoms. Combined with inactivity after the surgery, weight gain is inevitable, and to a certain extent, a good thing, but eating more and doing less are not the only factors. Another cause of weight gain after colectomy is disruption of gastrointestinal flora.

When you lose part or all of your colon, you also lose the bacteria that were present in it. Some of these colon bacteria, particularly certain kinds of Bacteroidetes, convert starchy carbohydrates into fatty acids rather than into sugar. They are especially important in the digestion of foods like rice and potatoes. Converting starch into fat may sound like it would make you fatter, but fats made this way bypass your fat cells and are directly burned by your muscles. When you lose these friendly bacteria, more of your food gets turned into sugar, which your body efficiently turns into fat.

What can you do to keep from gaining weight after a total colectomy?

  • Enjoy eating, but savor each bite. You don't have to eat all your favor foods just because you can. You can enjoy a single treat a day, and not worry about never being able to eat them again.
  • Your doctor will probably tell you to stick to bland, high-carb foods immediately after your surgery, for up to about two weeks. You really want to follow your doctor's advice on this point. You can get really sick from fiber the first couple of weeks after surgery. After you have begun to recover, however, it's time to introduce or reintroduce "normal" foods. Just take them on one at a time. Don't go from a restricted diet one day to an all-you-can-eat buffet the next. It's particularly important to eat just one vegetable or fruit per meal until you are sure your system can tolerate them.
  • If you have an ongoing problem with pouchitis, don't skip out on any part of the antibiotics your doctor has prescribed for you, but as soon as you finish them, start taking a broad-spectrum probiotic supplement like those made by Alive! (the brand name includes an exclamation point), Gaia Source, or Health Labs Rx. (There are many other good brands but these are a good place to start if you are unfamiliar with these kinds of products.) The probiotic bacteria will help you avoid weight gain. Probiotic supplements are better than probiotic foods like cold-packed sauerkraut, kimchi, and yogurt because they don't have fiber. However, you need to eat either a small amount of fiber-rich plant food or boiled potatoes or rice (which are sources of "resistant starch," which acts like fiber) to provide food for the bacteria.

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