Struggling to put on weight

[Csingicsong]

Hi I wonder if there is anybody struggling to put on weight in spite of having 1800-2000 calorie input a day. On this site I usually find only posts in which people complain of not being able to lose weight. I have persistent AF, heart failure and CKD stage 3a. Whenever I ask my doctor why I cannot put on weight he keeps saying that people struggling from these diseases have the same problem. But I don’t believe this as the posts on this site show just the opposite. If anyone has the same problem and can advise me on what to do, I would appreciate their comments and advice. I am desperate now and nobody seems to care. Thanks a lot for your thoughts. x

[Csingicsong]

Hi Thanks for your comment. Unfortunately, he hasn’t considered any tests. Seemingly he doesn’t want to investigate further. My GP only does what is essential. Sorry to say he is not too useful. 😢. Recently I have asked him to refer me to a dietitian though which he promised to do. But just because I asked him.

[10gingercats]

You can ask your GP for a coeliac blood test.I was diagnosed out of the blue after symtoms similar to yours.Just make sure this is is not weight loss that continues for then you may have to be investigated further. Not all people have symptoms for coeliac but the blood test will give a quicl indicator.

[Csingicsong in reply to 10gingercats]

Thank you very much for your advice. I’ll mention it to my GP when I see him again.

[TopBiscuit in reply to 10gingercats]

Just a heads up - the blood test isn't conclusive; the only 100% test for Coeliac Disease is a biopsy. I was undiagnosed for 20+ years despite classic symptoms (constant diarrhea, ate constantly and was very skinny to name but a few) and despite numerous investigations. I have discovered in recent years that I have something called Immunoglobulin A deficiency which means that I test negative on the blood tests. It wasn't until a Dr carried out the biopsy that my CD was diagnosed.

[10gingercats in reply to TopBiscuit]

You are quite right but the blood test can be a first step to a coeliac diagnosis followed by an endosscopy if the blood reveals relevant antibodies. I quote my own experience (I am not a medic) and have only suggested a possible way forward for Csing ......

[Jalia]

I have the opposite problem and am tempted to say " come and live with me for a few weeks and I'll show you how to put on weight!". I don't mean to belittle your problem as i had a friend with similar problem. Can you not increase your calorie intake by adding more fat to your diet? If you really have no appetite I realise how difficult this can be . Maybe having frequent high calorie snacks ?

[Csingicsong in reply to Jalia]

Thanks a lot for your reply. It’s very difficult for me to increase my calorie intake as I should pay attention to my salt intake as well because of my heart failure. So, it’s not easy that’s why I have asked my GP to refer me to a dietitian. Hope he/she will be able to tell me what diet is appropriate for me considering all my diseases.

[Jalia in reply to Csingicsong]

Here's hoping you don't have to wait too long to see dietician.

Regards

J

[Csingicsong in reply to Jalia]

I hope so too.

[Autumn_Leaves in reply to Csingicsong]

You really do need professional help on this one.

[Territorial]

I lost a large amount of weight for my size around 16 kilograms due to AF i do have a strict diet though but have for some years but the AF though tore the weight off me inside 12 months..

[Csingicsong in reply to Territorial]

Hi Thanks a lot for your reply. Tbh I also think that AF may be the culprit. Perhaps if my imminent ablation is successful which I pray for this problem will be sorted out as well. My husband hopes very much that this will be the case.

[KiwiBlake]

Hi Csingicsong. I can relate to what you are saying. I'm 5'8", and currently weigh 68kg. Male, 52 years old. I have hypothyroidism, which is normally associated with putting on weight, but i struggleto maintain weight. My occupation is farming, so I need to eat well to have the energy to do my physical job. I am Paroxysmal AF, and I get major bloating with certain foods, along with excessive burping and farting. I believe the bloating is a trigger for my AF. In the last couple of weeks I've cut dairy from my diet and am eating a lower FODMAP diet, and so far my bloating has gone. I've been tested for gluten intolerance, which came back as not a problem. I also think genetics plays a role as my parents were similar build to me.

Regards Blake

[Csingicsong in reply to KiwiBlake]

Hi Thanks for your reply. I think I’ll ask my GP to do some test as I have never been tested for gluten and lactose intolerance or anything like that. I don’t think it is genetic in my case.

[TopBiscuit in reply to Csingicsong]

Also, just to clarify, Coeliac Disease is not an intolerance, it's an auto immune disorder. And the best way for you to determine if you have a lactose intolerance is to completely cut out dairy (and any foods that contain traces of it) for a couple of weeks. You'll soon notice the difference if you have an intolerance.

Edit: but, as others have mentioned, this is probably not the time to be cutting out a major food group. In any case, I don't believe that lactose intolerance would cause weight loss, more like digestive problems such as bloating.

[Csingicsong]

Will try. Thanks. x

[Autumn_Leaves]

I was clinically underweight for 7-8 years until quite recently and I know from experience that it’s so hard to gain weight. Most people have no idea how difficult it is. Please accept my apologies in advance if what I suggest is what you’ve already tried. I can only go on my own experience. I’m not dietitian or a healthcare professional.

Firstly, I assume you’ve had all the usual blood tests to rule out more obvious causes. Others have suggested thyroid function tests and coeliac as potential causes of weight loss. Your GP can arrange these along with all the other standard tests though I suspect that you’re already having your liver function checked regularly as well as your kidney function. Always ask for a copy of your blood test results just so you know what tests you’ve actually had.

So, three meals per day plus 2-3 snacks is recommended for people who need to gain weight. The usual healthy eating advice applies, but less so, because if you are underweight this can and will affect your overall health in ways that you don’t want, so bear in mind that you might need to eat more energy dense foods and less of the high fibre bulky foods that fill you up but are low on calories eg large quantities of vegetables.

High energy dense foods can include avocados, nut butters, houmous, cheese, olive oil, butter, full fat milk and yogurt, particularly Greek yogurt and bananas. I appreciate that CKD has dietary restrictions eg salt and sometimes foods that are high in potassium and I’m not knowledgeable at all in that respect, so some suggestions may not be appropriate for your stage of CKD

Fats are energy dense so will add calories without adding much bulk. Again, this is an area that has to be balanced with any other factors, for example I have no idea if you have been advised to eat a low fat diet for health reasons. However, the ‘healthy’ fats such as olive oil should be OK. Nut butters are less bulky than whole nuts. Avocados might have a high potassium content so you’ll have to check if it’s right for you. If you are not lactose intolerant, full fat dairy is considered to be ‘neutral’ when it comes to blood lipids so Greek yogurt would be ideal (as long as it’s compatible with any CKD dietary restrictions).

Your doctor can also prescribe nutrient drinks. You can consume these as a snack between meals. I can’t vouch for the taste but I have a friend who has problems with eating and had these on prescription.

The best person to advise you on this is ideally an NHS dietitian as these people are trained in the dietary needs of people with specific health conditions and are based in hospitals. If your GP is reticent then ask your consultant. They also work in the community but you’ll need your GP to help you out on this, so keep pushing for it. Please remember you are entitled to dietary support especially as you have complex needs.

Asking for dietary advice on the internet isn’t the best way to go about things. There’s too much bad advice, too much misinformation, too many food myths and too many dietary tribes. You don’t need this

All I can say is I’ve been underweight but it was persistence that got me into a safe normal range eventually. When you lose weight, you’ve also lost muscle internally and from the bones. It takes time and energy in the form of calories providing the essential building blocks to repair and recover. You’ll probably need more than 1800 kcal a day to do that, but once you are weight restored, chances are you will revert to your normal amount. Just stick with it, eating by the clock if necessary, and you’ll get there. Above all, please ask for that referral. Good luck.

[Csingicsong in reply to Autumn_Leaves]

Thank you so much for your detailed and very useful advice. I hope I’ll get the chance to see a dietitian soon. My main concern is muscle loss. Thank you again for taking the time to give me advice. I highly appreciate it. 🥰x

[Autumn_Leaves in reply to Csingicsong]

Thanks ❤️

Muscle loss was my biggest concern, and loss of bone density too. It’s very difficult to gain muscle as an older person. Few people get that being underweight can have serious consequences because we don’t just lose skeletal muscle, we also lose muscle internally and that includes the gastrointestinal tract (which is basically a long muscular tube) and the internal organs including cardiac muscle. That’s why it’s so important to regain weight and maintain it. Unfortunately underweight is not taken that seriously but it should be.

[Csingicsong in reply to Autumn_Leaves]

Yes, I absolutely agree. I do my best but I think it is now beyond my control.

[Autumn_Leaves in reply to Csingicsong]

Also want to add, that someone mentioned dietary FODMAPs etc. This is NOT the time for exclusion diets and cutting out food groups etc. Please, please, please don’t eliminate or exclude foods from your diet unless you are under the supervision of a Registered Dietitian. You need to be weight restored before you can even think about going down this route, and it may not even be appropriate. Right now you need to be eating more, not less. Your priority is weight gain, not risking further weight loss. The internet is an absolute quagmire of dietary misinformation and mythology, and following the advice of unqualified people on the internet is never a good idea. You have specific medical needs and a random internet person giving you an uneducated and misinformed opinion is not the one who has to live with the consequences. But you do. So please pursue your referral.

[Csingicsong in reply to Autumn_Leaves]

Thank you so much again for your advice. However, recently I have had to cut out some kinds of food from my diet as after my cardiac ablation my gerd has flared up aggressively. Now I am feeling a bit better but this can be repeated as I am going to have a catheter ablation just in 2 days. I am dreading that I’ll have to fight the very unpleasant symptoms of gerd again. Btw can I ask you what was your BMI index when you were underweight and what is it now? Hope you don’t mind my asking.

[Autumn_Leaves in reply to Csingicsong]

Some people have terrible problems with GERD. I have acid reflux at night from time to time so I’m not too bad so far. The worst things for me is eating too much and eating too late, but people find they have triggers like tomatoes and spicy foods, and for others it’s fried foods. You probably have a good idea already about what helps and what doesn’t.

When my weight was at my lowest I avoided the scales, it was too depressing, but around the time of my first DEXA scan for osteoporosis my BMI was around 17.0. At present I’m stable at about 19.7. Although the NHS normal weight range is BMI 18.5–25, I don’t consider a BMI of 18.5 as being a healthy normal for me. Normal for me is around what I am now which is my pre-menopausal weight. I didn’t gain weight at menopause, I lost weight, so I can only compare myself to what I was before menopause. I did lose bone mass and I did lose muscle mass, and I can’t stress enough how important it is to hang on to your muscles and your bone density. I have had some increase in bone density and I have regained muscle (not much though) but it’s far better not to lose it in the first place, and not easy to gain it back when you’re older. I hope you can get some good support with this because it should be taken seriously every bit as much as obesity.

[Csingicsong in reply to Autumn_Leaves]

Thank you so much for your detailed comment. Can I ask how you can regain muscle? Exercise, walk (I regularly do these but they don’t seem to help) or what else? I’d highly appreciate your reply to this question as I am really worried about muscle loss. And not just and primarily because I look awful. Thanks for your reply. 💕x

[Autumn_Leaves in reply to Csingicsong]

Weights and resistance bands. There’s a lot of online materials you could look at for “over 60s” or “seniors”. The NHS website is quite good, as is the BHF. Go gently at first. You can use baked bean tins (doesn’t have to be baked beans, though!) or 500ml filled plastic water bottles as makeshift weights. There are exercises using your own body weight too. There’s the good old sit-to-stand, wall presses etc. So quite a lot to choose from, just go at your own pace and start with what you can do and slowly build up.

Agree, it doesn’t look nice to see your arms and legs looking like twigs. I found it quite distressing.

[Csingicsong in reply to Autumn_Leaves]

Thank you so much for your advice. Tbh I have already tried all these, so far not too much success. But I won’t give up and will continue to do these exercises. Take care! X

[KiwiBlake in reply to Autumn_Leaves]

I totally agree with Autumn leaves. Don't try low FODMAP. (I was just referring to my situation and bloating). Get as much protein and carbs as you can into you. Good sources of protein are eggs, lean red meat, chicken, fish. Good sources of carbs are pasta, rice and potatoes. Regards Blake

[Csingicsong in reply to KiwiBlake]

Thanks a lot for your useful advice, Blake. I wish you all the best. x

[Autumn_Leaves in reply to KiwiBlake]

The FODMAP protocol can be enormously helpful for some people. I’ve been through it myself under the supervision of a specialist Registered Dietitian, and in another context I’d recommend it. The elimination and reintroduction phases require a lot of motivation, self discipline, planning and fluency about FODMAPs and arguably cooking skills and a willingness to be innovative and experimental. It’s a lot of work, no doubt about it. It’s not a diet for life, the elimination and reintroduction phases should only be regarded as a diagnostic tool as not all people will have the same sensitivities, and it’s often just one or two foods that cause problems, not all FODMAPs. It wouldn’t have been appropriate for me until I was adequately weight restored as weight loss can in itself have a significant and detrimental impact on the health of the digestive tract, particularly where there is loss of its musculature. I’m not knocking it. It’s good in some situations.

[Popepaul in reply to Autumn_Leaves]

A well considered response.

[10gingercats]

Don't hold your breathe re. seeing a dietician. They are in very short supply.After the coeliac episode I was refered by the consultant the same afternoon to the dietician which was a fluke. My husband has been trying to get help re. a complex diabetic problem and has been refered to a group session......not what he wanted.No dietician avail. for around a year. My follow ups have been cancelled twice.

[Csingicsong in reply to 10gingercats]

Oh, no. This sounds quite disappointing.😢

[Autumn_Leaves in reply to Csingicsong]

It may be difficult, but people can and do get referrals.

[Csingicsong in reply to Autumn_Leaves]

Let’s hope.

[pusillanimous in reply to 10gingercats]

I have to wonder if dietetics is an occupation that is either not entered or frequently quit ! My daughter-in-law has an honours degree in dietetics, but after completing her year in a government hospital (it is mandatory for all health professionals to work for a year in a government hospital on graduation here in South Africa, even though they have paid their own university fees) - she was completely demoralised and has never ever practised her profession,

[Csingicsong in reply to pusillanimous]

So sorry to hear this.

[Deejay62]

I have most of what you have but severe pulmonary hypertension added. When my fluid retention is bad I struggle to eat so I lose weight. But I’m not eating much, in fact hardly anything, so that’s why the weight loss. When the fluid reduces I have to really watch what I eat. Since being on some new tablets, dapagliflozin, I’ve found I have been losing a lot of weight. I’ve also been losing a lot of fluid. I hope you can find out why you’re eating so much but still losing weight. Ask your cardiologist or heart failure nurse. They might be able to help. I ask my cardiologist a lot of things now instead of the Gp, I still use Gp for emergencies, but not often. Cardiologists usually will run blood tests for me. Maybe it’s because I’ve built up a long relationship with them. All the best.

[Csingicsong in reply to Deejay62]

Thank you very much. I completely agree that it’s better to ask the cardiologist in my case (unfortunately, I have no heart failure nurse any more) but it’s very difficult for me to get hold of my cardiologist and the tel appointments they arrange are very rare. Anyway, one is due for me now at end/August, so I’ll mention my problem to the doctor. Although I have already mentioned it to my doctors and the heart failure nurses (at that time I still have one) several times but nobody seemed to care.

[Deejay62 in reply to Csingicsong]

Mention it again and tell them it’s worrying you. Hopefully they will give you a proper explanation. All the best

[Csingicsong in reply to Deejay62]

Thanks. Will do that.

[Autumn_Leaves in reply to Deejay62]

I’m sorry to read about your conditions. It can’t be easy.

[Deejay62 in reply to Autumn_Leaves]

I’ve had heart failure for 20 years because I have dilated cardiomyopathy and arrhythmias. I’ve come to terms with it now and I am well looked after by my cardiology team. I think it’s because I’ve been with them so long. Many newly diagnosed on here aren’t getting the same support and it’s very sad how things have changed.

[Autumn_Leaves in reply to Deejay62]

It’s good that you can get the help you need. My friend’s mum seems to be well looked after too. Cardiology departments seem stretched to the limits now. I really do wish we could have a properly funded health service. It’s heartbreaking (figuratively and literally) to see things as they are now.

[irene75359]

You have my sympathy. My daughter's mother-in-law is Italian, lives in the UK and at a health check at her GP practice was told she was very underweight. I have watched her eat (in amazement). A really big bowel of pasta with liberal olive oil and that is only for starters. She does all her own cooking, lots of the food is fried, liberal olive oil in everything, cheese, various meats and all absolutely delicious. The practice gave her a leaflet to help her gain weight. She was disgusted at the suggestions and said to them she wouldn't eat that rubbish - cream cakes, food with high sugar and fat content. She doesn't know why she doesn't put on weight and has come to terms with the fact that she will always be extremely slim. I would hope that a qualified dietitian will give you better advice than she received. I am really sorry that your GP is declining to do further tests, it sounds like further investigation is needed, if only to rule things out.

[Autumn_Leaves in reply to irene75359]

It’s more significant if your mum is losing weight or has lost a significant amount of weight relatively recently. If her weight is stable it’s less of a concern. Many geriatric patients with frailty and perhaps with multiple diagnoses have poor appetites, often have problems chewing and swallowing and in that context the high fat/high calorie suggestions give a lot of calories without much chewing or preparation. By that stage, they may well have lived a very long life so the dietary guidelines for healthy eating are less of a priority. They need foods that are easy to physically eat and are palatable to someone with a very poor appetite. My own mother developed dysphagia ie the inability to swallow at the end of her life because of Parkinson’s disease so I’m well aware of the difficulties that frail elderly people experience. The accompanying weight loss can be significant and also puts them at risk of infection, bed sores etc. I’m glad your mother can live independently and I hope she remains in relatively good health well into her old age.