Question: WM from the USA asks, “I have had several GI surgeries and have an ileostomy. My meals “empty” quickly and I am having trouble gaining weight. Even though I drink three cans of high calorie Ensure daily, between my regular meals, I am cannot gain weight. Should I adjust my diet?”

GG responds: Patients who have had much of their digestive system removed and have an ileostomy,  often cannot tolerate sweeteners, including the corn syrup found in commercially prepared canned liquid supplements like Boost or Ensure (or any other sweetener) nor can we tolerate milk products (also in Ensure) including lactose or milk "sugars", and ice cream, yogurt, etc.

Therefore, you may need to follow a Malabsorption  Diet per our NUTRITION page on www.pmppals.org for more info. It’s important for you to consult with a licensed, clinical dietician who understands your specific needs . Often dieticians and physician may recommend canned nutritional liquid supplements without fully understanding your particular needs.

Provide your dietician with a copy of her operative report(s) so that (s)he can read which portions of your digestive system have been removed.

It is possible that if you avoid the prepared canned liquid supplements and begin to add solid food like white rice to your meals (to help slow the gut) and eat a bit of lean protein with your meals, like turkey, chicken, etc, you may start to gain some weight again.

You may also consider drinking diet sodas  for variety to your fluid intake, but avoid the high sugar/corn syrup sodas.  Additionally  avoid caffeine, high sugar juices like apple and orange, etc, as these  tend to "empty" our gut quickly and end up in our ostomy bag just as quickly as we drink them and can lead to rapid dehydration and electrolyte loss.

Some “short gut syndrome” patients drink Gatorade or other sports drinks to replace electrolyte loss, but these can "backfire" on you if the sugars/sweeteners in those drinks affect your digestive system; remember, with "short gut syndrome" which is what you may have, we need to avoid sweeteners, milk products and caffeine, including those found in sports’ drinks and canned liquid supplements.

That is not to say that you can never have a cup of coffee...just be aware, that things like coffee, Ensure, etc, will likely move through your gut very quickly and will take any nutritional food/meal right along with it.

Once again, consult with a licensed, registered healthcare professional to determine the best course of action for your specific needs.