Weight loss question

When the gastrointestinal tract is upset in any part, our body's natural reaction is to turn the GI speed to maximum. Great if we've eaten spoiled food, but not so good for crohnic inflammation. The normal mouth to anus trasit time is about 24 hours + or -. When our UC flares badly, that transit time can be as little as 4 hours. At such a speed, there is much less time for acids and enzymes to break down food into simple molecules that can be readily absorbed by our bodies within the small intestine. I've passed partially digested food, still somewhat recognizable when i was pooping 20+ times a day. We become malnurished as a consequence thereof.

So yes, inflammation of just thd large intestine (the last 4-6 feet) can have a big impact on the 20-some-odd feet of the complete GI tract and cause us to loose weight rapidly during bad flares.

I lost 17 pounds in 3 weeks from continual diarrhea. This was 2+ years before diagnosis. With colon inflammation, the entire digestive tract purges more quickly...so therefore less nutrient intake so sustain weight. And yes...we tend to eat less when we have diarrhea, at least in the beginning when we have NO clue about what's going on.

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Oh absolutely there can be an aversion to eating as a consequence of flaring, i know I experienced it and had to force myself to eat. As it doesn't take much to connect input (eating) with the delayed pain of output (bms). It's a double-cause, we eat less when flaring as it hurts, and what we eat passes right through us leading to poor absorption of nutrients. Make it a triple cause as frequent diarrhea can dehydrate us too, which can cause us to loose several pounds of normally retained water-weight.

No putting lipstick on it, flares are really, really rough on our bodies!

When we have simmering inflammation, it can be near impossible to gain weight. We still have mild UC symptoms, and despite myself eating like a horse I'd gain at most 1/2 a pound every couple weeks. It's the kinda thing were you can eat whatever you desire without the faintest hint of guilt, just to regain a little. Have your friends watch in astonishment as you eat the most awfully sinful desert on the restaurant menu yourself (hey who says you can't have a little fun with it ;-) ). The tricky part is to eat responsibly once you fully heal and have reached your target weight after being so bad about eating too much haha (a number I overshot by more than a couple pounds myself ).

In remission we're essentially normal on weight retention. It's just flares and simmering inflammation that makes things difficult.

Yes, if you cannot regain weight, no matter what you eat then that's a very good sign you still have simmering UC inflammation. Internal healing takes a lot more time than you or I ever want it to take but we have absolutely no choice but to wait through it, so be patient. It is a great sign that you are seeing improvements! Give it another month, and keep the calorie intake high but healthy. I bet you'll be able to regain some of the deficit you've lost while flaring.

Most people with IBD who lose weight during flare-ups lose weight because they eat less, usually because they are trying to reduce symptoms or have lost their appetite. Calories are absorbed from the moment you swallow; only people with Crohn's who have short gut syndrome really suffer from malabsorption and being unable to absorb sufficent calories/nutrients from food alone - hence the need for TPN.

In severe disease, inflammation and fevers will burn up a few extra calories but not that many.

PS: Some people find it naturally hard to gain weight. Body types vary; ectomorphs typically find it hard to gain weight and easy to lose it.

PPS: Not everyone with IBD finds it hard to gain weight. I've got lingering Crohn's inflammation, which isn't mild, and I've got no trouble with putting on weight. The only time I lost weight was when I had pancolitis and I basically restricted my calories to about 1000 calories a day. Now I don't have pancolitis (because I don't have a colon to have pancolitis in) and I can't be bothered with calorie restriction - it's too boring. I also find I'm not only not losing weight, I have to be a bit careful to avoid gaining weight.

PPPS: Sorry, this is a slightly sensitive subject for me. I'd obviously much, much rather not have IBD and be a bit overweight, but to have both active IBD and still have to worry about watching my weight - that's like fate taking the piss out of me :/

Post Edited (NiceCupOfTea) : 8/9/2017 7:09:00 PM (GMT-6)

Bacon Girl said...
You can't absorb any calories if you are pooping out all your food multiple times per day

If that was actually true, everyone with IBD would have to go on TPN or else die of starvation.

Most bulimics are normal weight, so they are certainly absorbing calories from somewhere despite vomiting most of what they eat up. I'm not suggesting you were bulimic by the way; I'm saying genuine malabsorption is quite hard to achieve. Just diarrhoea or vomiting alone won't lead to malabsorption in otherwise healthy people. I had diarrhoea from the day I was diagnosed in 2000, but I didn't lose any weight for the first few years - I only lost weight when my disease got worse and I started eating less to try and reduce my symptoms (aided possibly by the metabolism-boosting effects of having fevers).

Also, what about people with IBS who have diarrhoea? They aren't malabsorbed either.

Post Edited (NiceCupOfTea) : 8/9/2017 8:12:40 PM (GMT-6)

Ihatepooping said...
So I have been on entyvio about 9 weeks .... I will usually have one or two bms both in the AM but the first one of the day is huge... Like indescribably huge as it feels like all the food o had eaten he previous day all comes out at once.

I had the same experience. It very gradually improved over a year.

I don't believe UC ever comes to the point of malnutrition needing a feeding tube for most flares. The only time we contend with them, is if we need to fatten up before a surgery, and that is getting rarer and rarer these days as we're usually in a much, much better state when undergoing a colectomy then was the case several decades ago due to medication improvement and early interventions.

We are still getting some nutrients from foods during flares but not as much as we would during a remission. We're just inefficient digesters during flares. The more complex to digest things are only partially digested when we have very fast transit times during flares. As an example, I saw raw fruits and veggies would pass in a semi-digested state for me quite regularly. That's why I'm consistent in suggesting folks eat well cooked foods and avoiding raw when flaring. Soups, broths, potatoes, rice, and well cooked meats have nutrients that are readily available for speedy digestion. So depending on what you eat, you do get a good percentage of the nutrients needed. What that percentage is, depends on what you eat and how fast your GI tract is moving. But there are most certainly consequences thereof.

Rapid weight loss only occurs during the very worst of our flares, which is hopefully a month or less when we start on Pred to stabilize ourselves. Afterwards, the weight loss slows to a more manageable and sustainable rate while our meds begin to work. The average weight loss is about 20 pounds during a severe UC flareup. I've hit 17 pounds of weight loss within 3 weeks during my 20+ bms a day flare. Much milder flares were a loss of 5 pounds during the worst of it. Given, there is still a gradual weight loss as we continue to recover and it might account for another 3-4 pounds as we simmer and recover. It, like everything UC, can be highly variable but 20-ish pounds seems to be a safe number, a few overachievers and underachievers noted.

Does a aversion/distaste for food have an affect, oh yes undeniably. However, it is not the entire equation by itself. It can definitely accelerate weight loss. I hear fasting mentioned a lot during flares, and that also accelerates weight loss.

And our abysmal blood test numbers (low iron, vitamins B, b12, D, and others) and hairloss as consequences of flares kind of speaks volumes to malnutrition, poor nutrient absorption, or whatever you want to phrase it is. Generally all semantics at that point. It's not just something that our Crohn's disease friends experience, even without us having small intestinal inflammation.

Well, I used "whole pieces"kind of liberally. I meant more identifiable (like shredded carrots) and they'd pass through undigested. Also pieces of potato skins. And peas that looked deflated. Stuff that I have never seen in it's "identifiable" stages, you know?

I am definitely chewing more thoroughly and will keep being mindful about that, especially as I am tapering off the digestive enzymes.

As far as being depleted in things, I really wasn't;t either (except for vitamin D). As you know, my b12 and folate are sky high. All others were normal.

Just gone through c-diff plus my UC I have dropped from my normal 175lbs down to my weight presently of 149 lb
I am 76 year old male