T Nation

Training After Near-Total Colectomy


Hi all,

I hope this might be an appropriate forum. I am posting here instead of under rehab because, frankly, I just feel like I'm more likely to get a response from someone who notices the thread here and I am writing about the general theme of the board. If that is improper, then a mod can feel free to move.

I'll first admit that I've been a reader and poster for many years here. I'll also admit that I made this new ID just because for reasons I'll explain I feel like this is a new phase for me that is going to take time to figure out.

By way of background, I had been training up until July 2014 for ten years with weights total (five consistently prior to July), with a stretch of long distance running in undergrad (marathon running). I had decent but not great lifts: could bench 225x27, squat 405 for a set of 10 and could deadlift just under 5 (...grrr). I'm 27 right now.

In June, I suffered a serious medical event that resulted in a near-total colectomy, along with at the time tube feeding and gastric emptying by tube. That lasted many months. It then turned out that I had developed a massive abscess, which required another tube and some months. I have another surgery tomorrow because after they thought the abscess was resolved and removed the tube, six weeks out I'm still leaking significant fluid.

So for the past couple of months I had somewhat resigned myself to becoming a cardio guy again, as I have significant abdominal scarring running the length of my abdomen and was informed that I'm a high risk hernia candidate. Was up to a point doing almost 2 hours of elliptical a day along with light weights.

The problem--or at least one among several--is that exercise is a big part of my life and I get very into what I'm doing. Specifically, I tend to treat cardio like a race to the bottom as far as leanness and bodyweight goes, which leads to me being miserable. Aside from that, I miss lifting. I know that I'm going to have to navigate my limitations, but this feels like the first step in doing so in a smart way. So I'm trying to start lifting again more seriously.

Here are some limitations and my plan. I wanted to solicit comments.


Restrictions: I am now permanently on what is called a "low residue" diet. Cannot eat vegetables or anything otherwise fibrous (...). Am supposed to avoid fats to the degree that I possibly can because, along with my risk for intestinal blockage, I also now suffer very severe gastroparesis (basically a very slow stomach). Because of the effect eating has on me now, I have to eat late at night, basically once my day is "done." Otherwise, I need to lay down/nap/etc.

Food Choices: the docs have recommended only lean meats and that I basically have to "figure out" other things that work to get calories.

Proteins: So far, I really stick with very low carb Greek yogurt (the Light & Fit 80 calorie packs, frozen), egg substitute and cottage cheese almost exclusively. Even chicken breasts are ok from time to time, but they would probably be hard on my system daily. I'm thinking of introducing more tuna and other very lean fish. Could definitely use ideas here.

Carbs: I've been fairly exclusively on rice cakes and kids cereal so far. Definitely open to recommendations. Nonfat ice cream or frozen yogurt is also good here.

Before all this happened, I'd really been more of a high pro/med fat/low carb sort of trainer, so the carb issue is difficult for me. I frankly don't know much about frequency and loading and such (discussed further below).


I went into the hospital at 200, after cutting from a high of 215. Left the hospital in the 140s. Right now at 155. It's hard to explain how much strength I ultimately lost: I couldn't walk up stairs a month post-op. Part of this is because I am a TRT patient and that wasn't communicated to them during the course of the hospital stay until week three (so much else was going on).

I'm thinking that I am going to opt for a split as follows. I'd up to this point always trained 7 days a week:
Day 1/4 -- Legs/Calves/[maybe abdominals, but probably not]
Day 2/5 -- Back/Biceps/Calves
Day 3/6 -- Chest/Triceps/[Day Three only: Shoulders]
Day 7 -- Shoulders

That's essentially the split I had been running previously. Does that seem reasonable, or should I start back at square one with a SS-type regimen to build basic strength? I much prefer a body part split but don't want to be too aggressive either.

Also, on Diet:

Given the timing considerations, I think nutrient timing is going to work as follows: the food from the previous night fuels the morning workout I do. I think this will work for me because digestion takes me so long that the food isn't really processed until near the time I'm awake anyway.

That said, I have no idea where to really start on a low fat diet like this other than the fact that I obviously am and will be "Intermittent Fasting"
in terms of the structural protocol. But is Carb Backloading something I should look into? The only really structured diet I'd tried before was the Anabolic Diet, which is obviously out. The fiber and fat restrictions just sort of leave me at a loss for where I should start on crafting something that makes sense for late night eating.

Any and all thoughts would be greatly appreciated.


I have a relatively serious case of Ulcerative Colitis, that has caused me set backs multiple times. I feel your pain, in particular the large weight loss from lacking of eating, and the multiple hospital trips.

Every time I return to the gym, I just go back to what I was doing before. I do make sure to be very conservative with my weights to start. I also ultimately surpass where I was prior to stopping, so while progress for me has been slow over the last 4 years or so, it is there.

As far as diet, I was recommended to follow a low residue diet also. Fatty foods are easier on me (not an option for you apparently), vegetables fuck me up. Ask your doctor about whey protein; mine actually recommended I take it. There’s plenty of low residue carbs you can eat – cereals & such. I also find that taking a multivitamin, with additional vitamin D, helps me greatly: ask your doctor about that, in particular the vitamin D.

I think you’ll find you can still be strong.


Hi MinustheColon, I would say I’m sad to hear your story but you seem so positive about getting back into life I dont think it’s necessary.

I’m an exercise physiologist in Australia and have worked extensively in the areas of chronic disease management, post operative rehabilitation and functional rehabilitation.

For many people in your position I would straight up say they should be working with someone like myself to guide them and provide some framework to avoid overdoing things at what is a pretty critical time. You obviously have extensive history in the gym and great numbers so I think that’s somewhat less relevant for you, however you should consider engaging a professional even if only briefly to make sure you’re on the right path.

While your post was quite detailed I wouldnt presume to try and answer most of your questions, but I have a few suggestions:

  • Look up the FODMAP diet. It potentially takes the concept of low residue even further, but has a great deal of information around it and a very supportive community of people with which to discuss meals and recipes.

  • You mentioned Tuna and low fat fish - flaky white fish are going to be low fat. Think fish from the Cod family.
    Tuna, Salmon and other pelagics are high in fat.

  • I’m fairly certain potatos with skin removed are on the low residue list. They’re also quite healthy with a reasonably low GI.

  • I believe the research shows that freezing and toasting white bread lowers the GI considerably. Doing both actually had an even greater effect. Obviously if you have to eat white bread all the time you want to make it as healthy as possible.

  • I suggest while getting back into training you remember to take things very very gently. If I were working with someone like yourself reps would be 15+ per set, intensity, frequency and volume would be very conservative. Keep your timeframes long and just be glad to be moving and doing something again.

-If you’re an intense and goal-driven person you’re more likely to push too hard too soon. Set yourself conservative short and long term goals and work to them without jumping ahead.

-I dont think it matters what split you do really, as long as you’re taking it easy and enjoying yourself.