Hi there. You all seem to have a wealth of information so wonder if you can help me? I’m coeliac with Bile salt malabsorption. So I need to be gluten free with extremely low fat (which controls the bile production). The problem is docs want me to put on weight and this is proving really tricky as large portions also sets off the BSM 
Any suggestions for high calorie but low fat meals?
Thanks in advance
A high-calorie, low-fat regime will make you obese, and may precipitate diabetes T2 if you are predisposed to it, which doesn't seem like a good plan to me.
If you're underweight, I'd suggest a programme of exercise, with a lot of strength work. Your appetite will increase and the weight gain will be mostly muscle. The problem is that it'd be hard to get adequate protein without adding fat.
Have you verified by experimenting on yourself that low-fat meals do actually help? Sometime our bodies do rather counterintuitive things, and reducing bile production might not necessarily be the right solution. Have you attempted, for example, a high-fat, low-carb regime to see what happens? Bowel malfunctions are sometimes caused by chronic inflammation, and a high-carb low-fat diet tends to exacerbate systemic inflammation. Apart from anything else, a very-low-fat diet puts you at risk of micronutrient deficiencies, gallstones, and other obscure metabolic disorders.
I realise the results of such experiments are potentially explosive, but you'd only have to try it for a few days. If you find that the results are horrible, with no improvement over time, then the logical treatment would be cholecystectomy, so that you can eat a (modest) amount of fat without fearing the consequences.
I'm only putting this out there for your consideration because the doctor's suggested course of action seems to have more potential downsides than upsides: it might appear to offer some short-term relief, but it's inherently harmful in the long term.
Weirdly (and I agree rather counter intuitively) gall bladder removal is the primary cause of this condition, tho not in my case. Tho I will admit to being vaguely intrigued by the idea of test running high fat low carb if only for the pleasure of the food. Thanks for taking time to reply
You mean gall bladder removal can precipitate coeliac disease? That's interesting; I never knew that. If true, it would suggest another reason for not reducing gall bladder output.
Bodies are odd - sometimes what's obvious isn't what's right. The classic example would be low-fat diets prescribed for weight loss: fat has more calories, therefore fat is what makes you fat, right? Except that turns out not to be true in practice.
The doctors are prescribing something that sounds superficially plausible, but it's a firefighting measure rather than an attempt at a cure. A low-fat diet might well reduce your symptoms, but it evades the hard-to-answer question: what's on earth is going on with your gut? Your bile-salt malabsorption is almost certainly a consequence of coeliac disease, not a separate issue, so it makes sense to address your gut health in the first instance. Grains, and other starchy foods, are known to exacerbate or cause gut malfunction in susceptible individuals. This is not theory - I imagine your doctors will tell you the same thing. Now, if one's body can't comfortably extract energy from starchy carbs, then the logical position is to eat a fat-based diet. It's got to be one or t'other. The middle position (fat+carbs) just gives you the worst of both worlds, as in fact it does for normal individuals.
You'll find many instances of this working successfully if you search around. This article looks like it would be of interest to you:
thehappycoeliac.com/2015/08...
The basic tradeoff is this:
- Worst-case: a few days of nightmarish trips to the bathroom (you'd need to keep it up for a week or so because your gut inflammation wouldn't disappear instantaneously)
- Best-case: complete freedom from your condition for the rest of your life.
I'm not suggesting a miracle cure - that would be foolish. Just pointing out that some people have found relief in this manner, and it would be worth the risk of experimentation. You might turn out to be one of the lucky ones. I disagree with andyswarbs position - I don't think he understands the aetiology of coeliac disease - but on the other hand, I wouldn't discourage you from testing his suggestion. Dietary experiments might make you uncomfortable, but they're not going to kill you, and you might discover something the doctors haven't thought of.
Hi there. Sorry I was unclear - BSM is mainly (or very often) caused by gall bladder removal. And I do agree that bodies (mine in particular 😂) can behave in a contradictory way. I will give it some thought. My coeliac has responded really well to Gf (my gut villi were extremely damaged on diagnosis 3 years ago and a recent biopsy shows almost total recovery). I am vaguely hoping (optimist that I am) that the BSM will resolve. Tho it appears to be a permanent condition for 50% of people - tho admittedly based on the tiny amount of info I have managed to unearth. It seems a little understood - and certainly hugely underdiagnosed - condition. In studies 30% of people diagnosed with diarrhoea predominant IBS were positive for BSM when tested with sehcat scan. Scary.
I have read a few people saying gall bladder removal kicked off their coeliac disease. However it's worth noting that most autoimmune diseases are triggered when the body goes through a stressful event, and gallbladder removal would tick that box...
That’s interesting it hadn’t occurred to me it might be that way around. The diarrhoea symptoms have gone on for so many decades i have no way of knowing which was causing it initially. Food for thought 
Just to be clear here: i wasn't actually suggesting that gall bladder removal would be a good idea, merely that it's the logical endpoint of the doctor's train of thought.
Since the basic problem is gut-related (her gall bladder is doing exactly what it's supposed to do) I was just pondering on that issue. I'm not a big fan of the "let's cut this bit out and see what happens" approach to disease.
Very intriguing about the stress connection. However the thought occurs that someone with no gall bladder would most likely be prescribed a low-fat grain-based diet ... which absolutely does trigger an autoimmune response (to a greater or lesser degree) in most people.
It's ok, I didn't think you were suggesting hacking bits off! But I'm just passing on feedback I've seen elsewhere.
Hi Tillyxx, I am also a coeliac and we have a Gluten free topic section on here and I describe my diet as a whole food gluten free one, which works for me.
Here's an interesting and informative article on foods to avoid:
healthline.com/health/bile-...
I would have thought that many plant based dairy alternatives could well suit your dietary needs as many plant based foods and free from gluten as well. Also eating whole foods with plenty of roughage which also pack a nutritional punch rather than processed food.
I wish you well with this and please do let us know how you get on.
Jerry 😊
Thanks Jerry. High roughage also seems to aggravate but I do love it so try to keep as much in as my poor knackered body can tolerate 😂. You’re a great source of info btw always appreciated.
Is this a long term thing, or just a short term diet to see if things improve? I don't think it's a great way to live long-term, because we need a certain amount of fat in our diets for day to day functioning.
In terms of calorific low fat foods, remember that sugar is a fat free substance, and is pretty high in calories.
Might be worth looking at pea protein to help you meet your protein needs. If you have a food processor, consider blending dates with pea protein, cocoa powder and maybe a little maple syrup, and making protein balls? You could look at these for some flavour ideas, although a lot of the recipes use nuts, so you'd need to find a substitute: fitfluential.com/healthy-bi...
You can also buy red lentil and green pea pastas from Morrisons in the free from section, which are good substitutes that will help you meet protein needs while keeping fat low.
I think TheAwfulToad is fundamentally wrong in asserting that carbs are bad for you and is giving bad advice. He misses the hugely beneficial proven benefits of whole plant foods which are shown time and time again to reverse T2D rather than encourage it. Yes if you consume a lot of refined carbs then I would say they are not good for you. And yes you need some fats in your diet, but sufficient of these can be gained easily from nuts & seeds.
Though I should say when I argue for a low fat diet, what I am not suggesting is buying fat reduced foods. I am instead arguing for buying foods that are naturally low in fat.
His suggestion that cardio work outs are good for you is good advice. If you are not used to exercise then starting with walking and then building pace is a good approach. Not only do you get good exercise that is good for the mind but also you get lots of Vitamin D from the sunshine! This will help with mood and your immune system. On its own the latter will help your body function better.
As for foods to help you maintain weight what about rice, quinoa, buckwheat and perhaps amaranth. For people with sensitivity issues white basmati rice may cause fewer reactions but for full nutritional profile wholegrain rice has to be better. Quinoa and buckwheat could be great staples for you providing extremely high in protein. As for vegetables I would try to go for broccoli or pak choi. I would probably reduce intake of things like spinach.
Finally, although I have no personal experience checking our FODMAP would seem worthwhile.
Hi Hidden
Welcome to the Healthy eating forum. There are some 'Low-fat recipes' here in the Goodfood website - hope they are helpful, and you find some recipes that you enjoy.
bbcgoodfood.com/recipes/col...
Zest
Hello Tilly
Are you able to eat foods like salmon or sardines, nuts and avocado, or are they too much fat?
Making sure you are getting enough protein may help with weight gain. If you need to eat small meals, something nutrient dense like steak would be a good idea. You could grill it and have it with boiled potatoes and some greens. If you are ok with dairy, perhaps try some low fat yoghurt with granola added.
Sadly I think the chances of any diet making me obese are pretty low 😂. I absolutely wouldn’t chose a low fat diet but it has a huge impact on my condition (yes medically proven and life changingly effective in my case - I’ve gone from being effectively housebound with chronic violent diarrhoea to a month long road trip with the family). So while far from normally wise it’s definitely what I have to do. “Good” fats are as damaging as “bad” but I do make sure I get some of them - apart from anything totally fat free is just misery inducing.
I have a hyperactive lurcher and 9 year old and take more exercise than is frankly natural 😂
High protein is a good call I need to think more about that. And thanks all for your suggestions. I needed some inspiration, really helpful x
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Supplemental ideas 🤔💡 (just in case not already thought 🤔 💭 of, Tillyxx):
As a Coeliac with Bile Acid Malabsorption (BAM), is it safe for you to ingest (or increase ingestion of) any of these types (potatoes & starches) of low fat — not necessarily high calorie food — but weight-gaining foods — if you’re comfortable ingesting more of them?
. . . • Quinoa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • Oats
. . . • Corn 🌽 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • Squash
. . . • Buckwheat (not ‘wheat’ but a pseudo-grain) . . . • Potatoes 🥔 & Sweet Potatoes 🍠
. . . • Winter Root Vegetables 🥕 ( mindovermunch.com/blog/wint... )
. . . • Beans & Legumes 🍛 ( healthline.com/nutrition/he... )
. . . . [list from: healthline.com/nutrition/18... ]
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If you’re ‘up for it’, you can even blenderize sweet potatoes 🍠 into drinkable smoothies 🍹! 😃 [Brings new meaning to expression "liquid lunch". 😁 ]
Yes, 🍠 blenderized with water 💦 (& even a fruit you can tolerate), can be a tasty 😋 drinkable ‘weight enhancer’. 👍👍
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Best wishes, Tillyxx. ☺️ 🙏 🍀 🌺 🌞
If you’d like, let us know how you make out.
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Have you received medication for the bile malabsorption?
I was prescribed Colesevelam after having a temporary Ileostomy reversed.
I was tested and less than 1% was reabsorbed so for a while it was like I was passing battery acid!
The Colesevelam worked a treat. I only took 3 doses as it a really powerful reaction and bunged me up but I understand that many people use it regularly.
I a man fortunate that my body has managed to sort itself out and I don't need to take medication anymore for this.
It's mainly prescribed to lower cholesterol and, from what my gastroenterologist told me, very expensive. It's therefore not something offered immediately as budgets are considered sometimes more important than offering the best treatment.
May be worth asking to try it if you haven't already...?
Yes I’m on colosevelam. 6 tabs a day. Sometimes I can eat normally but the most foolproof approach is the meds and diet combined. Happy your body recovered fingers crossed mine does the same
Ps laughed out loud at passing battery acid - great if scarily accurate description 😂
Low protien low carb and low fat diet
High calorie but healthy?
Low Fat / Low Sugar Chocolate Cake
