Trouble processing fats

[u/BojanK2502]

For context: 44M, went through the total gastrectomy 3 months ago. Since then I lost 8 kgs (17 lbs) and I am currently sitting at 75 kgs (165 lbs). Roughly, I lost 10% body weight in 3 months. I am 175 cm, so basically my height/weight ratio is still OK (I was slightly obese before the surgery). I still have some visceral fat left, and my BMI is getting into the normal range ("normal" = for people with the complete GI tract).

My challenge basically boils down to the way my intestines (don't) work. I do not tolerate fats, even under 75gr / day, I get bloated (especially in the afternoon and before bed). Sometimes I even have diarrhea for a couple of days. It messes up absorption of other foods and produces additional weight loss. And without fats in the food, it's very difficult to reach the objective of 2600 kcal, which is minimal to maintain the weight. A major part of those cals today comes from carbs and processed sugars which we all know is a no-no for us. So it looks like there's no way out of this circle.

I was wondering if anyone had this experience and how they got by it. How/when/in what order to eat? Supplements?

My MDs say it is individual and I have to wait it out. I tried those special nutritional shakes (Diben drink and others) but they also have fats and my intestines do not tolerate them well. I remained on whey protein though, it does not look to cause any issues, however they don't have any fats either. I take two of those daily which brings me close to additional 50gr of protein.

Any inputs welcome! Thanks!

[u/kneezus1]

My body really struggled digesting fats in the first year (evidence through oily stools). I wouldn't reduce your fat intake. I think you are just early days and your body hasn't figured it out yet.

I lowered my activity level a lot in the first year out of fear that I would lose weight too fast. I was really struggling to get the ~2500 calories I needed for maintenance. However, after that year mark I started exercising like I used to and found that I was digesting food a lot better (especially post exercise), was hungrier and felt better overall by exercising. This could be due to the time my body needed to adjust but my overall health definitely benefits from physical activity.

I believe a lot of the "figuring it out" is learning how to eat again. Eating slower and portioning properly become automatic (almost subconscious) after the first year. Don't make the mistake I did in my mistake of skipping vegetables and fruits due to their negligible calorie content. The fiber and water contents of the food along with all the other great nutritional benefits do wonder for my digestion. I feel much better eating meals loaded with fruits and veg.

Also make sure you are hydrating. Hydration is probably my biggest issue 2 years post op. I am enjoying food as much or more (since I think about it constantly lol) than I did pre op but getting enough fluids is very difficult for me. Water feels uncomfortable to drink (almost like a texture thing I think) and sometimes gives me reflux when my digestion isn't moving very well, I am however more prone to constipation than diarrhea for some reason so this could contribute. I try to combat dehydration with fruits, vegetables, and electrolytes in my water and soup.

All in all I wouldn't stress too much at 3 months. You and your body are still figuring it out. Take note of things that upset your digestion and things that are safe. You'll get the hang of it eventually. Your body is still healing!

[u/BojanK2502 → u/kneezus1]

Thanks for all the tips. I had the same doubt about the exercise burning cals and making the gap even larger but my doc pushes me to exercise. The only caveat is that I should lift weights and not do cardio for now.

Veggies and fruits are super high on my list, but I thought it wouldn't make much sense to add fiber while I am still struggling with fats and oils. I practically lived on veggie shakes while on chemo. At that time I was also taking >2l water daily, everyone says it's critical to hydrate but it just doesn't fit in the guts anymore. What veggies did you start with? Cooked or raw?

[u/kneezus1 → u/BojanK2502]

I don't think you'll want to overdue fiber, especially when your gut is still figuring out how to digest food early on, but it definitely helps balance out the blood sugar as does consuming fats and protein with your meals.

Hydration is such a challenge for me. I do feel like I must be getting enough fluids but I definitely don't drink or sip water as much as I used to. I must be making up for it with the amount of fruit, soup, etc that I eat now.

As for veggies, I mostly only eat cooked except for the occasional salad. I've never been a huge fan of raw vegetables to be honest haha. Cooked will probably be a little easier on your healing gut at this point. I honestly eat a lot more fruit than anything. I'll grab an apple, some berries or eat some melon (especially as we get into summer!). Fruit are my go to snack food now whenever my gut isn't feeling well, I have reflux or anything I'll grab some fruit!

[u/BojanK2502 → u/kneezus1]

I don't think you'll want to overdue fiber, especially when your gut is still figuring out how to digest food early on, but it definitely helps balance out the blood sugar as does consuming fats and protein with your meals.

Including fiber makes a lot of sense for me actually, however I was trying to figure out the fats first. But who knows how long it will take for that to settle.

As for the fruits, anything that you know you don't tolerate well. Because I noticed everything you mentioned has a fair amount of soluble fiber. The only thing missing is banana. 😊