Do you react to diet changes every time you try to eat more? If it's stopping you put on weight, listen to this episode.

Trying to gain weight with IBS can be tricky, but it is possible. In this episode I talk through

• When to see a doctor about unintentional weight loss
• Understanding whether your weight loss is down to restricted diet, or something else.
• Could a fear of the consequences of eating be holding you back from gaining weight.
• How to eat more fat and digest rich meals better
• Why protein is important
• Tips for improving your appetite

Next week's episode will focus on how to increase your appetite. It's for people who never feel hungry. So, stay tuned for that one.

Links

• Download my vegetarian low FODMAP guide - for all the details on beans, and UK fake meat products. https://goodnessmenutrition.vipmembervault.com/products/courses/view/1152028
• Fat absorption - Bile Acid Diarrhoea - https://www.goodnessme-nutrition.com/gut-health/bile-acid-diarrhoea-a-forgotten-reason-for-ibs-d/

Work with me

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

Ready for your gut reset? 🌍 I work with clients worldwide, providing remote consultations and a wealth of educational resources.

Instagram - @goodnessme_nutrition

Why is it so hard to put on

weight if you've got IBS?

2

Especially when you feel like

you're really eating enough already.

3

Unexpected or undesired weight loss can

be more prevalent with people who've

4

got a diarrhoea predominant type of IBS

because often the transit time of food

5

doesn't really allow for proper digestion.

6

But there are also people with

constipation in a low body weight who

7

really struggle to put on any weight.

8

In this episode of the Inside Knowledge

podcast, I'll be sharing my advice

9

on how to increase your energy intake

without worsening your digestive

10

symptoms in either SIBO or IBS.

11

And you'll also learn how to increase your

appetite so you actually want to eat more.

12

Welcome to episode 50 of the

Inside Knowledge podcast.

13

I'm Anna Mapson.

14

This episode I've been meaning

to record for a little while.

15

I did two episodes a few weeks

ago about how to lose weight, and

16

that was Also a popular request.

17

But how to gain weight is something that

I know so many people struggle with when

18

they've got severe digestive conditions.

19

If this is something you struggle with,

maybe you just feel like it's impossible

20

to gain weight because every time you

try to eat more or you try to eat less,

21

different foods you get a flare up.

22

Maybe you've been on a strict elimination

diet for a really long time or you've

23

just been skipping meals because

you're trying to give your digestion

24

a break and feel like if you don't

eat, then you're going to feel better

25

or at least not feel any worse.

26

But over time that can lead to

a real reduced energy intake.

27

So what does it even

mean to be underweight?

28

What am I actually talking about?

29

Well, Often we use the

body mass index, your BMI.

30

That's adjusted for your height

and your gender, but it doesn't

31

take into account any muscle mass.

32

So it's also important to

look at your body composition.

33

So for example, somebody who is in

a very lean body could also be not

34

really nourishing themselves because

their body fat percentage is too low.

35

So you may have a normal BMI, but you

may, if you're completely ripped like a

36

bodybuilder, you may have such a low body

fat that it can impact on your health.

37

And that is really why we're

talking about how a low body weight

38

that's too small for your height.

39

You know, the BMI is not perfect, but it

can give you an indication of your body

40

size, how it compares to other people who

are the same height as you, for example.

41

So, using BMI, which, as I said, is a

kind of crude, way of just adjusting

42

for height and body size and weight.

43

We're looking at a BMI of less than 18.

44

5.

45

That is considered underweight.

46

But as I said, people who are in

a very muscly body, like sometimes

47

bodybuilders will have a very low body

fat percentage and yet have a normal BMI.

48

And that is because it doesn't

take into account muscle mass.

49

the problems with being in a very

small body and not nourishing

50

yourself with sufficient, broad and

balanced diet is it means you can

51

get problems with your immune health.

52

So maybe you're getting more

infections and that can be down to

53

a lack of antioxidant intake, you

know, vitamins, minerals that keep

54

our immune system really healthy.

55

If you're not getting enough energy,

a really Key sign for women is

56

that you lose your periods and that

is red flag for being underweight

57

and not having enough energy intake.

58

You can have problems with bone

density, so leading to osteoporosis,

59

even at quite a young age.

60

And this is down to, again, not having

enough muscle mass that is stressing

61

the bones and not working your body

effectively, but also not having enough of

62

the key nutrients that help build bones.

63

And also, muscle wastage.

64

So when you're in a very small

body with a very underweight body

65

size, you will get muscle wastage.

66

So your body's drawing nutrients out

from your muscles, particularly protein.

67

So people with IBS tend to lose weight due

to all these kind of restrictive diets.

68

So maybe you're cutting out certain food

groups to get rid of your trigger foods,

69

but the problem is This list of what you

can't eat can get very very long and it

70

just leaves you without a balanced diet So

I've worked with lots of people who feel

71

pretty stuck in this place that they want

to gain weight But they can't work out how

72

to increase the foods without going back

to really terrible Digestive symptoms.

73

One of the main reasons I wanted

to do this podcast as well is

74

to explain that under eating can

actually cause digestive symptoms.

75

So we know that under eating

and malnutrition can affect the

76

function of your digestive tract.

77

It can give you slow motility,

causing problems with constipation

78

just because you're not getting

enough food and slowing down the gut.

79

You can also get malnutrition which

leads to electrolyte disturbances and

80

this can in turn cause motility issues.

81

You can get problems with gastric

emptying, so that's when your stomach

82

is emptying into your small intestine.

83

There are also problems

with Feeling very full.

84

So post prandial fullness, it's called,

which is basically how you feel after

85

you've eaten, bloating, feeling very

full very quickly, and excessive nausea.

86

These are really, really common in

people who under eat, and these are

87

really common in people who have IBS.

88

So, one of the things I really work with

people on a lot is how sometimes you're

89

under eating is contributing to your

symptoms and I know that you feel like

90

you're managing it through not eating but

sometimes what you need to do is to try

91

eating more and obviously we need to work

on how to do that and I'm going to give

92

you a few tips later on in this episode.

93

Before I get into a few tips on how

to gain weight, I want you to think

94

about, is your weight loss unexplained?

95

So, if you recently lost weight without

meaning to, especially if it's been

96

quite quickly, it is really important

for you to get checked over by a doctor.

97

So, think about how much weight you

might have lost and in what time period.

98

If you're not somebody who's weighing your

body recently, that's absolutely fine.

99

Just think about Have you dropped a couple

of clothes sizes over a couple of months?

100

A shorter period of time to lose

a significant amount of weight?

101

Which may indicate there's

something else going on.

102

So the NHS suggests a loss of more

than about 10kg in 3 months would be

103

definitely a red flag for investigation.

104

Or if you're looking at like 5

10 percent of your body weight.

105

So think about how much you're losing.

106

That has happened and

has it happened quickly?

107

And actually, is it down to you

realistically not eating enough food?

108

Maybe you've been fasting, skipping

meals, like I said, reducing down

109

portion sizing, or is it down to

something that you don't know?

110

You feel like you've eaten the same amount

of food, but you've rapidly lost weight.

111

Things that doctors might want to

check out would be inflammatory bowel

112

disease, celiac disease, an overactive

thyroid, or some cancers as well.

113

So, it really is better

important to speak to a GP or

114

gastroenterologist to rule these out.

115

People with digestive issues like SIBO

or IBS, the weight loss is explained

116

by you not eating as much as you were.

117

And sometimes it's easy to see

how what you're eating Could be

118

causing weight loss, but you might

not know how to break out of it.

119

So common restrictions are going on a very

low fat diet, and that could be because

120

you're not breaking down fats very well.

121

You get diarrhea and stomach

cramps, and it could be related

122

to bile acid malabsorption.

123

Maybe you've cut out a lot of other

high fat foods like dairy and you

124

no longer eat any cheese or creams.

125

Maybe you find protein really

difficult to digest and you

126

have cut right back on meats.

127

And then obviously the FODMAP diet, so

you might have really reduced the amounts

128

of vegetables and fruits that you eat

and also you've cut out maybe dairy.

129

Gluten, soya, like sugary foods.

130

Just trying to find the

thing that is your trigger.

131

So I'm not at all trying to

say that the blame is on you.

132

I really understand that

it is a tough place to be.

133

Ultimately, if you want to gain

weight, you need to eat more

134

calories than you burn off every day.

135

And it's important to do this slowly

and ideally using healthy foods

136

that are going to support your

body, like give you what you need.

137

But essentially it boils

down to eating more calories.

138

So an ideal way to increase it would

be around 500 calories a day over

139

time, like maybe do an extra 500

calories a day for a week, and then

140

another extra 500 calories, and then

you're slowly increasing it that way.

141

Or possibly and or, you also need to

eat more often to eat bigger portions

142

of the foods that you're already eating.

143

So you need to eat more volume and you

also need to eat more energy dense foods.

144

So I'll have some tips on

that for you in just a moment.

145

The other thing I wanted to mention is

whether your fear of the consequences

146

of eating could potentially be

holding you back from taking

147

these steps to increase your diet.

148

If you haven't already, listen to episode

43 where I talk about ARFID, that is

149

Avoidant Restrictive Food Intake Disorder.

150

This is a disorder where people really

struggle to increase their food variety

151

and volume because They have a lot of

fear about the consequences of what

152

they're going to eat This is really

understandable in people who've got

153

really bad digestive distress The problem

is when it becomes this eating disorder

154

more than just a slight fear of food or

worried about eating It becomes an eating

155

disorder when it leads to Unintentional

weight loss or nutrient deficiency.

156

And that's when it's more of a problem.

157

It's not just feeling a

bit nervous about eating.

158

It's actually affecting your life and

affecting your socializing, affecting

159

everything to do with the way that you

eat and the way that you live your life.

160

If you're worried that that affects you, I

would say start with your doctor but also

161

there are particular therapists trained

in eating disorders and things that can be

162

really helpful if it resonates with you.

163

Um, have a little think about it.

164

Listen to the episode about

ARFID that I recorded previously

165

and see if that might help.

166

Okay, so I've got seven things that

I think will help you to increase

167

your body weight when you're

struggling with SIBO or with IBS.

168

Firstly, regular meal times.

169

So, eat regularly throughout the

day and don't skip any meals.

170

If you're aiming to add calories

to your diet one of the best things

171

you can do is to add in a snack.

172

Now, particularly in the SIBO world,

people often want to try and regulate

173

their migrating motor complex.

174

That's the small impulse that moves

through our small intestine and And it

175

helps to keep the small intestine clean.

176

Now, I also really promote to

most people to have a little

177

overnight fast that is 12 hours.

178

So you're giving your digestion

a rest overnight, you're not

179

basically having a late night snack.

180

But, when your body is empty, underweight

and undernourished, I would say this is

181

less important and the most important

thing for you to do is to restore a

182

healthy weight and restore healthy

nutrient intake and you cannot do that if

183

you're fasting and you're skipping meals.

184

So, I know it's a real challenge to

think, well, what's most important?

185

Do I want to help get rid of my SIBO

and help my small intestine cleaning?

186

Or do I need to have another snack?

187

When you're used to fasting,

sometimes it feels very easy.

188

And a lot of people I work with say

that they just don't even feel hungry.

189

They don't even want to eat.

190

And so it's easy for them to fast

and it makes them feel better.

191

So why should they stop?

192

Well, um, Like I said, being in an

underweight and undernourished body has

193

got consequences, and what we want to try

and do, if you want to get your digestion

194

sorted, is to get your entire body

healthy, not just focusing on the gut.

195

One of the best ways of getting rid of

SIBO, this overgrowth of bacteria in

196

the small intestine, is to drink water.

197

to be in a really healthy body with

a strong immune system and you can't

198

do that if you are under nourished.

199

Your body will struggle to fight

off this bacterial infection

200

in the small intestine.

201

So we want to try and get your

whole body strong and part of

202

that is about eating regularly.

203

So don't worry about an overnight fast and

don't worry if you need to have a snack.

204

I do recommend still having a discrete

snack rather than And I don't mean

205

like a secret one, I mean discreet

as in one episode of a snack, rather

206

than nibbling on food all day.

207

I still think having regular meals with

a regular snack time, so you might have

208

three meals and two snacks, or three

meals and three snacks if you need it.

209

If you've been, uh, Eating a reduced

amount of food for a long period of time

210

you may feel quick fullness that sometimes

they call it postprandial Fullness you

211

will feel that very quickly as soon as

you start to eat and feel like you just

212

can't eat anymore this is where having

small regular meals can help in terms of

213

getting the nutrients in and sometimes You

might hear me say, eat snacks, and think,

214

oh well I don't want to eat junk food.

215

But a snack doesn't necessarily have to

mean a packet of crisps or some biscuits.

216

It could just mean a very small meal.

217

So again, thinking about those

balanced macros, protein,

218

fats and carbs in each little.

219

Right, the third area is around

increasing your fat content.

220

Fats contain 9 calories per

gram compared to 4 calories

221

for protein and carbohydrates.

222

So this means when you're having More

fat in your diet, it will give you more

223

energy density and will overall help

you to increase your calorie intake.

224

But some people really struggle with

fat digestion, so build up slowly

225

and see where your tolerance lies for

increased oils and fats in your diet.

226

If you can manage lactose containing

foods, then things like full fat

227

milk, hard cheeses can be really

helpful and even playing around

228

with adding cream to your diet,

adding cream to different meals.

229

Some healthy plant based fats would

be things like avocados, nuts,

230

seeds, coconut oil and olives.

231

Now, a lot of people will say, yeah,

but they're high FODMAP, I can't

232

eat those, I'm on a SIBO diet, or

IBS people shouldn't eat FODMAPs.

233

Well, not everyone with IBS

or SIBO reacts this way.

234

to all of these kind of

fermentable starches.

235

So while tolerance to foods definitely

changes over time, it's important to

236

test out how you get on with small

amounts of these things like nuts

237

or avocado and build up from there.

238

The other thing is oily fish, if

you eat fish, are a great source

239

of calories and the omega 3 also

might help with anxiety and mood

240

issues as well as skin conditions,

so oily fish are a great choice.

241

The other thing you could consider

would be taking a digestive enzyme which

242

contains lipase and that will help you

break your fats down as it hits the small

243

intestine so may help you with absorbing

and digesting the fats if you find

244

that fatty foods are an issue for you.

245

Now, fish, as I mentioned just now,

is a good source of protein as well,

246

and that is my fourth tip, is about

increasing your protein intake.

247

Protein is a building block for our

muscles, and when we eat protein,

248

it helps stimulate muscle growth.

249

So, in order to gain weight, you

probably need to increase your

250

protein, and most people with IBS do.

251

Do you find that they can

digest protein quite well?

252

So I'm talking about things like

meats, fish, eggs, and these are

253

really great sources of protein.

254

However, if you're on a vegetarian

diet, you can also include things

255

like tofu, meat substitutes.

256

And if you want my guide on low FODMAP

versions of meat substitutes, you can go

257

to the link in the show notes and I've

got a download that you can access that.

258

Just trying to think about

every meal and snack, does it

259

contain some sort of protein.

260

Nuts and nut butter.

261

So you might be okay with peanut

butter, for example, that is

262

also a good source of fat.

263

So very good to add to a piece

of sourdough toast, maybe like a

264

cracker that you feel okay with.

265

These are really good ways to

bulk up your calorie intake and

266

a little bit of protein as well.

267

Now, sometimes people ask,

what about a protein shake?

268

So I would say, um, You could

consider adding a protein shake if

269

you're struggling to eat enough food.

270

The goal is really to try and get

your energy intake through food

271

but where that's not possible a

protein shake could be helpful.

272

And whey or soy based isolate protein

shakes are normally good for people

273

with IBS, however not everybody.

274

You can get low FODMAP vegan protein

shakes if you need to navigate those.

275

Now the fifth tip is about

how to improve your appetite.

276

I think I'm going to do another

whole episode about this next week

277

because there's lots to say about

it and I'm running out of time.

278

But just quickly, things that

you could consider is whether

279

you might have a zinc deficiency.

280

So zinc deficiency may

cause a loss of appetite.

281

So if you never feel hungry, This

could be a factor for you, but

282

also want you to think about how to

connect again with your appetite.

283

Most people I work with have in some

way suppressed their connection

284

to their digestive system because

they've had a lot of, you know,

285

Terrible stuff coming back from that.

286

All the messages have been about pain,

uncomfortable gas and feeling sick.

287

And so of course you're trying to

minimize that, but actually it can

288

also stop you from feeling hunger.

289

So what I work on with my clients

is how to feel hunger again.

290

What does it actually feel like for you?

291

And when do you feel hunger?

292

Also, although it's a bit

counterintuitive, sometimes

293

doing more exercise can really

stimulate your appetite.

294

So don't be afraid to do a little bit

of weight training, try and build some

295

muscle and then try and eat more in order

to fuel your body for that exercise.

296

So certainly thinking about your

appetite before and after every

297

meal, are you eating to the point of

just taking the edge of your hunger?

298

Or are you eating to the

point of being actually full?

299

And when you want to increase your weight,

you are going to need to feel full.

300

And like I said, I know people with

IBS can feel full very quickly.

301

So we need to work on it

and to track that over time.

302

It's not going to be something

that you can get over quickly, but

303

it is important to think about.

304

And how to try to connect

with your appetite.

305

The last two tips, um, number

six is don't drink at meal times.

306

So I don't mean you can't have any liquid.

307

It's okay to sip on water to help

your meal go down, but try not to

308

drink a really big glass of water

right before your meal, or don't

309

drink something as your meal.

310

eating loads because you're just taking

up space in your stomach and that

311

may make you feel fuller more quickly

which you don't want because the liquid

312

will go through you very quickly.

313

The final tip Is about getting better

quality sleep and you may think what

314

on earth has that got to do with

gaining weight Well, partly being sleep

315

deprived can interfere with our body's

repair processes So you're building

316

muscle overnight when you're resting.

317

You're not always just building

muscle when you are doing the exercise

318

Helping your body feel more rested can

help reduce anxiety, which is really

319

important when you're starting to change

your diet because of IBS symptoms.

320

The gut brain connection

is super, super important.

321

So when we're making dietary changes, You

really want to actively try to focus on

322

how to reduce down your anxiety levels.

323

That can be through getting better sleep.

324

And if you're someone who struggles

with insomnia, yeah, that's still going

325

to be difficult, but maybe there's

some things you can do to prioritize

326

getting better sleep, like nice wind

down, stopping looking at your emails

327

at 10 o'clock at night, having the

room nice and cool, but also quiet.

328

And if that's not possible, using

an eye mask, using earphones.

329

Yeah.

330

trying to block out the world for

eight hours so you can try and feel

331

better and your gut symptoms are less

of a problem when you are less tired.

332

They don't obviously go away, but

people feel more resilient when

333

you are feeling more rested.

334

So, I know that is a lot that

I've been through in this episode.

335

I'm going to, I think, focus on

appetite next week because that's That

336

is really key to making this work.

337

So stay tuned for that next week.

338

Okay.

339

I'm going to leave it there.

340

Thank you very much for listening to the

inside knowledge for people with IBS.

341

Better digestion for everyone.