This topic is about someone who has had an ileostomy due to severe ulcerative colitis and is struggling to regain weight. After initially losing a significant amount of weight, they managed to gain some back with high-protein meals and nutritional drinks. However, since returning to work, their weight has plateaued or even decreased slightly. They are seeking advice on whether this is normal and how to effectively gain weight.

Here are some helpful insights and advice:

- Understand the physiology:
- After an ileostomy, food moves through the small intestine more quickly, which can limit calorie and nutrient absorption. The shorter the remaining small intestine, the more pronounced this effect can be.
- Foods that are liquid, high in fiber, or hard to digest, like raw carrots and popcorn, can speed up transit and reduce nutrient uptake.

- Work with professionals:
- Consider consulting a dietitian or nutritionist to create a personalized plan and explore possible supplements.
- Regularly check blood work, including CBC and metabolic panels, to adjust iron and vitamin intake as needed.

- Increase calorie density and meal frequency:
- Aim to eat 5-6 small meals a day or whenever you feel hungry.
- Pair high-protein foods with calorie-rich, quality carbohydrates like oats, rice, potatoes, peanut butter, bananas, chocolate, ice cream, and even fast food if there are no cardiovascular concerns.
- Keep protein snacks like cold chicken strips or deli meats handy for between meals.

- Use specialized nutrition products:
- Continue with nutritional drinks like Fresubin Energy and consider adding an extra bottle each day.
- Whey protein powders can provide additional protein without adding bulk.
- Some people find success with high-nutrient, low-glycemic snack bars and commercial meal-replacement shakes.

- Medications that can help:
- To slow down very liquid output and improve absorption, medications like Lomotil or Imodium can be used, and Octreotide injections may be considered in more stubborn cases.
- To stimulate appetite, short courses of oral steroids might be prescribed under medical supervision.

- Hydration and electrolyte management:
- Stay well-hydrated with water and electrolyte drinks like Gatorade G2 or diluted fruit juice, as dehydration can worsen malabsorption.

- Exercise strategically:
- Engage in resistance or weight training to build lean muscle mass, which can contribute to healthy weight gain. Be mindful that activities like golf may burn more calories than expected, so adjust your intake accordingly.

- Monitor for opposite trends:
- Some people with an ileostomy may experience weight gain due to metabolic changes or medications like certain antidepressants. If this becomes an issue, limit foods with empty calories and focus on balanced nutrition.

- Practical reminders:
- Avoid dehydration by drinking water frequently, especially in hot weather or during exercise.
- Be cautious with time-release medications, as rapid transit can affect their effectiveness, possibly requiring dosage adjustments.