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Suggest Ways To Gain Weight In An Elderly Person
Question: My father is 81 years old. He had most of his colon removed and some of his small intestine. He is very skinny, has trouble gaining weight and prone to dehydration. I am looking for a diet plan that would give him the best chance of absorbing nutrition and gaining weight. Thank you
Brief Answer:
Short Bowel Syndrome is a challenge
Detailed Answer:
If your father had most of his colon and some of his intestine removed then chances are he might need vitamin D and vitamin B 12 injections. Please talk to the doctor about this. B-12 is absorbed in the terminal ileum and if this was affected in the surgery then vitamin B12 by injection is needed.
Here are short bowel guidelines:
1. Small frequent meals limiting sugar as sugar will encourage dumping syndrome - a fast transit through the remaining intestine leaving little time for absorption.
2. A high calorie, high protein supplement in between meals in small amounts
3. Antidiarrheal meds if needed to prolong transit time for nutrient absorption
4. Have him suck on popsicles throughout the day for more fluid
5.Commercial fiber supplements gradually introduced or find a high calorie, high protein, fiber containing oral enteral feed to supplement between meals.
6. a liquid oral vitamin/mineral supplement is also advised
Also, if you feel you need to personally meet with a dietitian, you can find one locally by looking up eatright.org and putting in your zip code. They can provide a list of dietitians close to your location.
Feel free to write back if you need clarification or additional info, otherwise please rate and close out the query.
Thank you so much. Good luck to you.
I hope this gives you some ideas on increasing nutrient intake. Regards, XXXXXXX Shattler, MS,RDN
Short Bowel Syndrome is a challenge
Detailed Answer:
If your father had most of his colon and some of his intestine removed then chances are he might need vitamin D and vitamin B 12 injections. Please talk to the doctor about this. B-12 is absorbed in the terminal ileum and if this was affected in the surgery then vitamin B12 by injection is needed.
Here are short bowel guidelines:
1. Small frequent meals limiting sugar as sugar will encourage dumping syndrome - a fast transit through the remaining intestine leaving little time for absorption.
2. A high calorie, high protein supplement in between meals in small amounts
3. Antidiarrheal meds if needed to prolong transit time for nutrient absorption
4. Have him suck on popsicles throughout the day for more fluid
5.Commercial fiber supplements gradually introduced or find a high calorie, high protein, fiber containing oral enteral feed to supplement between meals.
6. a liquid oral vitamin/mineral supplement is also advised
Also, if you feel you need to personally meet with a dietitian, you can find one locally by looking up eatright.org and putting in your zip code. They can provide a list of dietitians close to your location.
Feel free to write back if you need clarification or additional info, otherwise please rate and close out the query.
Thank you so much. Good luck to you.
I hope this gives you some ideas on increasing nutrient intake. Regards, XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Can you tell me more about sugar and the dumping syndrome. Should he not eat fruit? Is Peanut butter a good choice for him. I feel like he needs to find foods that will bulk him up - stay in his system the longest. Is that fats or protein, or both? Thank you.
Brief Answer:
Actually, he had a colectomy, but similar concept
Detailed Answer:
Everything I outlined above is designed to keep things in his intestinal track for as long as possible, but let me give additional guidelines, okay?
I need to clarify one recommendation. Excesses of fiber are not recommended and all foods should be chewed well before swallowed. Dumping syndrome is when the food moves quickly through the intestinal track causing diarrhea.
As I advised, special enteral formulas may be necessary. We have found that such high calorie, high protein formulas with glutamine, short-chain fatty acids are beneficial. How does he do on peanut butter? You asked which nutrient stays in the system longer and the answer to that would be fats.
The Mayo Clinic has these guidelines for colectomies:
Many people can have bowel problems after they have had removal of part of the colon or a stoma closure or ostomy reversal. The most common problems are diarrhea, dehydration, and offensive odors. These occur because the normal bacteria and enzyme functions of the colon, such as absorbing fluid, have not yet returned to normal. These problems can be helped with careful attention to diet and to liquid intake.
The following foods, which are easily digestible, may decrease the amount or frequency of diarrhea:
a) applesauce k) peanut butter(use almond, cashew butter, natural and stir well)
b) bananas l) potatoes
c) boiled rice (white) m) pretzels
d) bread or toast n) sugar-free cereals (e.g., Cheerios,
e) cheese Total, Shredded Wheat, Corn Flakes)
f) cream of rice o) tapioca
g) cream of wheat p) weak teas
h) fiber supplements q) yogurt
i) marshmallows
j) pasta
If you have very frequent diarrhea or profuse loose stools, this can cause your body to lose a lot of fluids and eventually result in dehydration. The first sign of dehydration is feeling thirsty, weak or faint. If you continue to be dehydrated, you may experience the following symptoms:
o urinating less than usual.
o tiredness
o shortness of breath with exertion
o stomach cramps
o dry skin
Frequent loose stools or diarrhea can also cause your body to lose important fluids and
electrolytes, such as potassium and sodium, which are important for your body’s natural functioning. A blood test is needed to determine if this is happening. *
You can re-hydrate yourself by drinking a non alcoholic, caffeine-free beverage like water
frequently in small amounts. You can also use other fluids, such as a bouillon cube in hot water;
orange juice diluted with water or club soda; weak decaffeinated tea; Gatorade is also strongly
encouraged. Gatorade replenishes the body’s natural electrolytes.
The following information is taken from the Academy of Dietetics Manual on Colectomies:Tips
Take small bites of foods and chew thoroughly.
Eat meals and snacks at the same times each day.
Instead of large meals, try eating smaller meals more often.
Eating the largest meal in the middle of the day may decrease stool output at night, making it easier for you to get a full night’s rest.
Avoid spicy or fried foods, as well as foods that are high in sugar (candy, cake, pies, cookies). All of these foods can cause diarrhea. This is the "dumping syndrome" I was talking about earlier.
Foods that can thicken stools include bananas, applesauce, rice and pasta.
Some foods may cause odors. Limit onions, eggs, fish, broccoli, and cabbage.
Some foods may increase gas production. These foods are; beans, broccoli, cabbage, cauliflower.
Do not drink from straws, smoke, or chew gum or tobacco. These practices can cause you to swallow air and have gas.
Have at least 8 to 10 cups of fluids per day. You may need to drink more during hot weather or other times when you lose extra fluid, such as when you exercise.
Foods Recommended
Some people are sensitive to some of the foods listed on the Recommended Foods chart.
You may find that some of these foods cause you to have gas, unpleasant odors, or diarrhea.
If this is the case, you should stop eating the foods that bother you. After 2 to 3 weeks, you can try small amounts to see whether they still cause symptoms.
Most of the recommended foods are low in fiber because fiber can be hard for your body to digest while you are recovering.
When you first start eating solid foods - this is right after surgery, it is especially important that you stick to low-fiber choices.
Recommended Foods
Milk and milk products Buttermilk and kefir
Evaporated milk
Nonfat (skim) or low-fat milk
Yogurt
Powdered milk
Cheese
Soy milk
Low-fat ice cream
Sherbet
If you have diarrhea, try lactose-free milk and other lactose-free products. Lactose is a kind of sugar in milk that causes diarrhea in some people.
Buttermilk, yogurt, and kefir can help keep your body from producing bad odors.
Cheese can help thicken stools. It may be a good choice if you have diarrhea.
Meats and other protein foods Any meat or poultry prepared without added fat
Smooth nut butters
Fish
Eggs
Dried beans and peas can cause gas or bad odors. They should be avoided.
For some people, fish and eggs can cause bad odors. Try them in small amounts and see how your body reacts.
Peanut butter can help thicken stools. Smooth peanut butter may be a good choice if you have diarrhea. Do not eat chunky spreads.
Grains Bread, bagels, rolls, crackers, pasta, and cereals made from white or refined flour
White rice
At first, you should only choose grain foods that are made with refined grains (white flour and white rice). These are low in fiber.
White rice and pasta can help thicken stools. They may be good choices if you have diarrhea.
As you recover, you can try foods made with whole grains (like whole wheat, brown rice, or oats). Start with small amounts and see how you feel after eating them.
Vegetables Most well-cooked vegetables without seeds
Iceberg lettuce
Strained vegetable juice
Potatoes without skins
Some vegetables are more likely than others to cause gas, odors, or diarrhea.
Many people have trouble with gas or odors when they eat onions, garlic, or leeks.
Vegetables in the cabbage family are also likely to cause problems. Avoid cabbages, broccoli, brussels sprouts, and cauliflower.
Asparagus may cause bad odors.
Potatoes can help thicken stools. They may be a good choice if you have diarrhea.
Fruits Most fruit juices (without pulp)
Peeled fruit
Canned fruit
Fresh fruit without edible seeds
Prune juice and grape juice can cause diarrhea. Avoid them.
Fruit peels should be avoided because they are high in fiber.
Bananas and applesauce can help thicken stools. They may be good choices if you have diarrhea.
Fats and oils;Butter, cream, cream cheese, margarine, mayonnaise, and oils
When possible, choose healthy oils and fats, such as canola and olive oils.
Beverages Any, except alcoholic beverages, prune juice,
and grape juice
Carbonated drinks (such as soda) can cause gas. If you try them, start with a small amount.
Alcoholic drinks (especially beer) can cause bad odors.
Cranberry juice can help keep your body from producing bad odors.
Colostomy Sample 1-Day Menu View Nutrient Info
Breakfast
Omelet made with 2 egg whites
2 tablespoons grated cheese, for omelet
8 ounces orange juice (no pulp) (0.4 g fiber)
Morning Snack
1 English muffin (1.4 g fiber)
1 teaspoon margarine, for English muffin
Lunch
Lasagna (4-inch square) (2.15 g fiber)
1 slice french bread (0.8 g fiber)
1 teaspoon margarine, for french bread
1 cup fresh melon (4.8 g fiber)
1 cup soy milk (3.2 g fiber)
1 cup water
Afternoon Snack
1 cup yogurt
1 small banana (2.6 g fiber)
1 cup water
Evening Meal
1 ounce (small handful) pretzels (1.8 g fiber)
2 cups iced tea
Turkey Sandwich (1.5 g fiber):
2 ounces turkey
1 ounce swiss cheese
2 slices white bread
Evening Snack
2 whole XXXXXXX crackers (0.8 g fiber)
1 tablespoon smooth peanut butter (1.0 g fiber)
1 cup soy milk (3.2 g fiber)
1 cup water
Using Ensure Plus, 4 oz., between meals, again, might be a good idea.
I have provided two different sets of recommendations from two reliable sources. I hope this helps. If specific questions still exist, I am here. Regards, XXXXXXX
Actually, he had a colectomy, but similar concept
Detailed Answer:
Everything I outlined above is designed to keep things in his intestinal track for as long as possible, but let me give additional guidelines, okay?
I need to clarify one recommendation. Excesses of fiber are not recommended and all foods should be chewed well before swallowed. Dumping syndrome is when the food moves quickly through the intestinal track causing diarrhea.
As I advised, special enteral formulas may be necessary. We have found that such high calorie, high protein formulas with glutamine, short-chain fatty acids are beneficial. How does he do on peanut butter? You asked which nutrient stays in the system longer and the answer to that would be fats.
The Mayo Clinic has these guidelines for colectomies:
Many people can have bowel problems after they have had removal of part of the colon or a stoma closure or ostomy reversal. The most common problems are diarrhea, dehydration, and offensive odors. These occur because the normal bacteria and enzyme functions of the colon, such as absorbing fluid, have not yet returned to normal. These problems can be helped with careful attention to diet and to liquid intake.
The following foods, which are easily digestible, may decrease the amount or frequency of diarrhea:
a) applesauce k) peanut butter(use almond, cashew butter, natural and stir well)
b) bananas l) potatoes
c) boiled rice (white) m) pretzels
d) bread or toast n) sugar-free cereals (e.g., Cheerios,
e) cheese Total, Shredded Wheat, Corn Flakes)
f) cream of rice o) tapioca
g) cream of wheat p) weak teas
h) fiber supplements q) yogurt
i) marshmallows
j) pasta
If you have very frequent diarrhea or profuse loose stools, this can cause your body to lose a lot of fluids and eventually result in dehydration. The first sign of dehydration is feeling thirsty, weak or faint. If you continue to be dehydrated, you may experience the following symptoms:
o urinating less than usual.
o tiredness
o shortness of breath with exertion
o stomach cramps
o dry skin
Frequent loose stools or diarrhea can also cause your body to lose important fluids and
electrolytes, such as potassium and sodium, which are important for your body’s natural functioning. A blood test is needed to determine if this is happening. *
You can re-hydrate yourself by drinking a non alcoholic, caffeine-free beverage like water
frequently in small amounts. You can also use other fluids, such as a bouillon cube in hot water;
orange juice diluted with water or club soda; weak decaffeinated tea; Gatorade is also strongly
encouraged. Gatorade replenishes the body’s natural electrolytes.
The following information is taken from the Academy of Dietetics Manual on Colectomies:Tips
Take small bites of foods and chew thoroughly.
Eat meals and snacks at the same times each day.
Instead of large meals, try eating smaller meals more often.
Eating the largest meal in the middle of the day may decrease stool output at night, making it easier for you to get a full night’s rest.
Avoid spicy or fried foods, as well as foods that are high in sugar (candy, cake, pies, cookies). All of these foods can cause diarrhea. This is the "dumping syndrome" I was talking about earlier.
Foods that can thicken stools include bananas, applesauce, rice and pasta.
Some foods may cause odors. Limit onions, eggs, fish, broccoli, and cabbage.
Some foods may increase gas production. These foods are; beans, broccoli, cabbage, cauliflower.
Do not drink from straws, smoke, or chew gum or tobacco. These practices can cause you to swallow air and have gas.
Have at least 8 to 10 cups of fluids per day. You may need to drink more during hot weather or other times when you lose extra fluid, such as when you exercise.
Foods Recommended
Some people are sensitive to some of the foods listed on the Recommended Foods chart.
You may find that some of these foods cause you to have gas, unpleasant odors, or diarrhea.
If this is the case, you should stop eating the foods that bother you. After 2 to 3 weeks, you can try small amounts to see whether they still cause symptoms.
Most of the recommended foods are low in fiber because fiber can be hard for your body to digest while you are recovering.
When you first start eating solid foods - this is right after surgery, it is especially important that you stick to low-fiber choices.
Recommended Foods
Milk and milk products Buttermilk and kefir
Evaporated milk
Nonfat (skim) or low-fat milk
Yogurt
Powdered milk
Cheese
Soy milk
Low-fat ice cream
Sherbet
If you have diarrhea, try lactose-free milk and other lactose-free products. Lactose is a kind of sugar in milk that causes diarrhea in some people.
Buttermilk, yogurt, and kefir can help keep your body from producing bad odors.
Cheese can help thicken stools. It may be a good choice if you have diarrhea.
Meats and other protein foods Any meat or poultry prepared without added fat
Smooth nut butters
Fish
Eggs
Dried beans and peas can cause gas or bad odors. They should be avoided.
For some people, fish and eggs can cause bad odors. Try them in small amounts and see how your body reacts.
Peanut butter can help thicken stools. Smooth peanut butter may be a good choice if you have diarrhea. Do not eat chunky spreads.
Grains Bread, bagels, rolls, crackers, pasta, and cereals made from white or refined flour
White rice
At first, you should only choose grain foods that are made with refined grains (white flour and white rice). These are low in fiber.
White rice and pasta can help thicken stools. They may be good choices if you have diarrhea.
As you recover, you can try foods made with whole grains (like whole wheat, brown rice, or oats). Start with small amounts and see how you feel after eating them.
Vegetables Most well-cooked vegetables without seeds
Iceberg lettuce
Strained vegetable juice
Potatoes without skins
Some vegetables are more likely than others to cause gas, odors, or diarrhea.
Many people have trouble with gas or odors when they eat onions, garlic, or leeks.
Vegetables in the cabbage family are also likely to cause problems. Avoid cabbages, broccoli, brussels sprouts, and cauliflower.
Asparagus may cause bad odors.
Potatoes can help thicken stools. They may be a good choice if you have diarrhea.
Fruits Most fruit juices (without pulp)
Peeled fruit
Canned fruit
Fresh fruit without edible seeds
Prune juice and grape juice can cause diarrhea. Avoid them.
Fruit peels should be avoided because they are high in fiber.
Bananas and applesauce can help thicken stools. They may be good choices if you have diarrhea.
Fats and oils;Butter, cream, cream cheese, margarine, mayonnaise, and oils
When possible, choose healthy oils and fats, such as canola and olive oils.
Beverages Any, except alcoholic beverages, prune juice,
and grape juice
Carbonated drinks (such as soda) can cause gas. If you try them, start with a small amount.
Alcoholic drinks (especially beer) can cause bad odors.
Cranberry juice can help keep your body from producing bad odors.
Colostomy Sample 1-Day Menu View Nutrient Info
Breakfast
Omelet made with 2 egg whites
2 tablespoons grated cheese, for omelet
8 ounces orange juice (no pulp) (0.4 g fiber)
Morning Snack
1 English muffin (1.4 g fiber)
1 teaspoon margarine, for English muffin
Lunch
Lasagna (4-inch square) (2.15 g fiber)
1 slice french bread (0.8 g fiber)
1 teaspoon margarine, for french bread
1 cup fresh melon (4.8 g fiber)
1 cup soy milk (3.2 g fiber)
1 cup water
Afternoon Snack
1 cup yogurt
1 small banana (2.6 g fiber)
1 cup water
Evening Meal
1 ounce (small handful) pretzels (1.8 g fiber)
2 cups iced tea
Turkey Sandwich (1.5 g fiber):
2 ounces turkey
1 ounce swiss cheese
2 slices white bread
Evening Snack
2 whole XXXXXXX crackers (0.8 g fiber)
1 tablespoon smooth peanut butter (1.0 g fiber)
1 cup soy milk (3.2 g fiber)
1 cup water
Using Ensure Plus, 4 oz., between meals, again, might be a good idea.
I have provided two different sets of recommendations from two reliable sources. I hope this helps. If specific questions still exist, I am here. Regards, XXXXXXX
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you. This is very helpful. So, sugar in fruit is okay bc it is recommended to eat bananas, etc. he is I the hospital now and they give him 3 meals per day and no snacks. He has TPN, but maybe could get off it if he had a disciplined diet . Nurse just came in and said wanted to give him hit medicines in ice cream. Nuts. Anyway, applesauce has fiber , but is recommended. I guess will need a nutritionist to balance everything. Dehydration is a big issue for him- have you ever heard of doing preventive dehydration. Maybe he goes 1 per week to get hydrated? You have been very heloful
Brief Answer:
You did not provide me with complete information
Detailed Answer:
If he is on TPN now, that generally progresses after the TPN is pulled to clear to NO FIBER, LOW RESIDUE. Please ask for a post-surgical diet sheet which is different than everything I told you above.
And he can't have NUTS right now! He will be lactose intolerant.
Request a RD consult, not a tech.
He is to be gradually reintroduced to food with no dairy at first according to the clinical manuals. Progress from a low residue diet (similar to a low fiber diet) to the diet recommended above.
Contact eatright.org for a list of Registered Dietitians close to your zip code for personalized assistance.
You may need someone to help troubleshoot with you after you go home and work with you on a reasonable meal plan to prevent malnutrition and keep his fluids up. It will be a challenge and a change.
I wish you good luck. Remember to demand that RDN hospital instruction before discharge and seek help if you need it (on a timely basis).
Remember it is easier to keep someone healthy than to try to get them back there once they have declined.
My best to both of you.
Please close and rate the query if you are satisfied.
XXXXXXX Shattler, MS,RDN
You did not provide me with complete information
Detailed Answer:
If he is on TPN now, that generally progresses after the TPN is pulled to clear to NO FIBER, LOW RESIDUE. Please ask for a post-surgical diet sheet which is different than everything I told you above.
And he can't have NUTS right now! He will be lactose intolerant.
Request a RD consult, not a tech.
He is to be gradually reintroduced to food with no dairy at first according to the clinical manuals. Progress from a low residue diet (similar to a low fiber diet) to the diet recommended above.
Contact eatright.org for a list of Registered Dietitians close to your zip code for personalized assistance.
You may need someone to help troubleshoot with you after you go home and work with you on a reasonable meal plan to prevent malnutrition and keep his fluids up. It will be a challenge and a change.
I wish you good luck. Remember to demand that RDN hospital instruction before discharge and seek help if you need it (on a timely basis).
Remember it is easier to keep someone healthy than to try to get them back there once they have declined.
My best to both of you.
Please close and rate the query if you are satisfied.
XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you. He didn't have surgery this time, but a GI bleed . The TPN was primarily because he is not getting enough nutrition, super skinny, so I wanted to understand the diet bc he keeps running into trouble. He has not been following a good diet plan before the hospital and has been without much colon for 2.5 yrs. we have had many dehydration crises. Thank you for your help .
Brief Answer:
Don't be afraid to ask for a Discharge Diet Instruction!
Detailed Answer:
He is technically a high risk nutrition patient and thus should have had an assessment, care plan, intervention and education with monitoring. I just wanted you to understand his transition diet as he should not go home and try to begin eating as normally as he is being pushed.
Since he is hospitalized, I cannot get involved, it is the hospital's responsibility to provide adequate education for him.
Clearly you are right, he needs to keep his fluids up. Some of my earlier suggestions should help. Please monitor weight as that is a risk as well and seek early help if you run into trouble. Regards and best wishes, XXXXXXX Shattler, MS,RDN
Don't be afraid to ask for a Discharge Diet Instruction!
Detailed Answer:
He is technically a high risk nutrition patient and thus should have had an assessment, care plan, intervention and education with monitoring. I just wanted you to understand his transition diet as he should not go home and try to begin eating as normally as he is being pushed.
Since he is hospitalized, I cannot get involved, it is the hospital's responsibility to provide adequate education for him.
Clearly you are right, he needs to keep his fluids up. Some of my earlier suggestions should help. Please monitor weight as that is a risk as well and seek early help if you run into trouble. Regards and best wishes, XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by :
Dr. Prasad
Thank you so much for sharing your knowledge. He will be going to rehab soon, maybe tomorrow. thank you again!
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