Mark Babyatsky, MD (mssm.edu) While most gastrointestinal (digestive health) conditions are associated with weight loss, a notable exception includes severe liver disease and liver cirrhosis. In severe liver disease, patients can look very thin but gain weight because the liver normally makes an important protein known as albumin. As liver disease progresses, it can no longer make much albumin. Since albumin keeps water and other liquids in the bloodstream, its loss results in leaking of fluid from the blood to the belly and legs, causing these parts of the body to increase in size, sometimes by a lot. Even though advanced liver patients appear very ill along with thin faces and arms, they actually gain weight due to the fluid in the legs and abdomen. While weight gain is rare, some patients with duodenal ulcers receive relief by eating more to neutralize the acid made by their stomach, although this appetite rarely leads to weight gain. Kenneth Brown, MD (kennethbrownmd.com) Most digestive problems tend to cause a loss of weight from poor absorption of food, but there are a few situations in which our intestinal health can contribute to weight gain. One problem that I frequently see is when an individual has acid reflux or even an ulcer, they tend to eat frequently to decrease the pain temporarily. The pain briefly is alleviated as both the saliva and food neutralize the acid temporarily, but once the food is digested there is even more pain from rebound acid production. Another very intriguing area of research is the role of small bowel bacterial overgrowth (SIBO) possibly contributing to weight gain, due to the production of methane gasses which may slow the motility down and ultimately lead to more absorption of calories. There are studies underway now looking into the role of bacterial manipulation for potential weight loss. Christine M. Esters (adventureinwellbeing.com) Weight gain is an accumulation of toxins in certain organs. Toxic colon is the first place to cleanse since our colon is our sewage system. The second organ to cleanse is the liver, which is filtering fat soluble toxins, and the third organ is our kidneys that eliminate water soluble toxins. Disease related to colon, like constipation, candida, parasites, heavy metal or related to liver or related to kidney make losing weight difficult to impossible. Lisa Ganjhu, DO (wehealnewyork.org) Losing weight for the most part is really basic math. In order to lose weight you have to burn more calories than you consume. There really aren’t any digestive disorders that make losing weight difficult. Actually since the digestive tract is responsible for getting nutrients from food, disorder in the digestive tract may cause malnutrition and weight loss. There are certain endocrine disorders that make weight loss difficult. The main reason people gain weight is that they eat too much and exercise too little. Lisa Pichney, MD (stopcoloncancernow.com) Digestive conditions such as Crohn’s disease or ulcerative colitis are often treated with steroids; steroid use can cause weight gain. Also, patients with GERD (gastroesophageal reflux disease) or PUD (peptic ulcer disease) often feel better when there is food in their stomach to soak up excess acid. This sometimes results in patients feeding their disease and therefore weight gain can result. The added weight can also contribute to worsening of reflux. Sutha Sachar, MD (susacharmd.com) A lot of people confuse abdominal distension from bloating as fat. The reality is that there are certain causes of bloating, such as lactose intolerance, celiac sprue, food allergies, irritable bowel syndrome, and small intestinal bacterial overgrowth which make an individual feel as if they can’t lose the weight even though they may be. Seeing a gastroenterologist who specializes in bloating can rule out these causes and optimize body image and comfort. Albert Snow, ND (holisticgastroenterology.com) Yes, that can essentially be true about any inflammatory bowel condition — such as IBS or colitis. What all of those conditions have in common is that the sufferer has had antibiotics. This medication destroys the mucosal lining in that gut, which I call the “software” (the “hardware” being the flesh that makes up the GI tract). This software is what identifies which food group you have swallowed and the calories within it. Without the mucosal lining your digestion will not work properly and therefore not process calories properly. This is the most fundamental cause of weight gain: mismanagement of calories. Everything else that we do wrong regarding food and exercise is compounded by the lack of this fundamental principle. That is why so many efforts to manage weight appear to be futile. Conversely, replace the “software,” process calories better, lose weight. This is something that should get everyone’s attention. Having a healthy, well — developed mucosal lining will not only prevent IBD (irritable bowel disease) but will also allow you to eat rich foods and not gain weight. It is nature’s “erasure,” managing our mistakes, including poor diet, by keeping our pH level at a perfect 6.5. My version is the probiotic diet. AA Starpoli, MD (starpoli.com) I would consider depression, iatrogenic causes (those effects of certain medications taken by a patient), and hypothyroidism (low thyroid function) as causes of weight gain. William Chey, MD (med.umich.edu) I am not aware of any common GI problems that cause patients to gain weight. Ironically, successfully treating a number of common GI problems can be associated with unintended weight gain. For example, patients with gastroesophageal reflux disease (acid reflux) or irritable bowel syndrome (IBS) will often gain weight after food — related symptoms like heartburn, abdominal pain, diarrhea, and constipation are improved with appropriate therapy. In addition, the use of certain medications such as antidepressants can stimulate appetite and lead to weight gain. Jacqueline Wolf, MD (drjacquelinewolf.com) Medications used for digestive health conditions can have a major impact on one’s weight. Anyone who is taking corticosteroids (prednisone, prednisolone) will find it hard to lose weight and usually will gain weight. Corticosteroids are given for conditions such as ulcerative colitis, Crohn’s disease, and autoimmune liver disease. The weight gain is both water weight and absolute weight. It causes the face to balloon out and weight gain around the abdomen. Those on this medication usually don’t see the effects reversed until they are on a very low dose of or even off the medication for several months. Other medications used for digestive conditions may make it more difficult to lose weight or cause someone to gain weight. These include the SSRIs and the tricyclic antidepressant medications (amitriptyline, nortriptyline, desipramine) used in irritable bowel syndrome or hormones used for endometriosis. Patients who have a low albumin (malabsorption or problems with the lymphatics) or liver disease may get fluid in their legs or abdomen that may be difficult to lose.
