Appetite Loss

WHEN TO SEE YOUR DOCTOR

* You lose your appetite for more than two weeks.

* You are also experiencing frequent fatigue, a change in taste sensitivity or pain anywhere in your body.

What Your Symptom Is Telling You

If you're like most people, a temporarily misplaced appetite is a welcome opportunity to reduce calories. (Visions of fitting back into last year's jeans dance in your head.) But when the days stretch into weeks and treats that normally tempt you continue to turn you off, there could be cause for concern.

Undereating or a loss of appetite is a common symptom that could signal any number of conditions, many of which are no big deal.

Almost any infection could cause a loss of appetite, according to Donald S. Robertson, M.D., medical director of Southwest Bariatric Nutrition Center in Scottsdale, Arizona, and coauthor of The Snowbird Diet. A passing cold or flu virus could be responsible, for example. So could more serious things like tuberculosis, low thyroid function, diseases of the heart or lungs or liver problems.

"Unfortunately, one of the most common early warning signs for cancer is appetite loss, which is usually accompanied by changes in taste sensitivity," says Robin Kanarek, Ph.D., professor of psychology and physiological psychologist at Tufts University in Medford, Massachusetts.

"Appetite loss is the body's defense against ingesting anything that could slow the healing process," explains David Levitsky, Ph.D., professor of nutrition and psychology at Cornell University in Ithaca, New York.

Disease is not the only thing that can dampen the appetite, however. Sometimes things you take into your body on purpose—prescription drugs, for example—can cause problems, according to G. Michael Steelman, M.D., vice president of the American Society of Bariatric Physicians, who is in private practice in Oklahoma City. Antibiotics like erythromycin inhibit the taste buds and slow the transport of food through the intestines, prolonging the feeling of fullness after you eat, he explains. And amphetamines—which were once commonly prescribed for weight loss—dull hunger pangs, says Dr. Robertson.

Pain relievers and anti-arthritis medications can irritate the stomach, producing nausea and an aversion to food. Digitalis (a heart medication) and diuretics (taken to combat fluid retention and lower high blood pressure) can also dampen the desire to eat.

Sometimes what you don't put in your mouth can cause problems. Overall nutritional deficiencies can sap the vitality right out of an otherwise healthy appetite, Dr. Steelman says. Older people, in particular, may suffer from an inadequate intake of zinc, a deficiency that can deaden taste buds.

Aging itself exacts a toll on the appetite. In older people the metabolism slows down, muscle mass decreases and physical ailments impede activity, Dr. Steelman explains. On top of all this, taste sensations diminish and stomach secretions don't flow like they used to. All of these things contribute to appetite loss.

And sometimes things that are happening in your life affect your appetite. "If you've recently begun a new exercise program, you could experience appetite loss while your body adjusts to its new demands," says Dr. Levitsky.

Psychological health, in general, plays a big role in your appetite. Over the long haul, stress can send you to the fridge for the consoling comfort of food, Dr. Steelman says. But short-term pressures usually depress the appetite. Depression robs some people of their desire to eat.

And anorexia nervosa is a disorder that forces people—usually young women—to almost completely deny the need to eat. "They're obsessed with food, but they're afraid of eating for fear of getting fat," Dr. Steelman says. "For them, it's easier not to eat anything than eat rationally."

Symptom Relief

A brief loss of appetite is no reason to worry. But if you can't remember the last time you felt like eating, you might want to try restoring your normal eating habits. Here are a few things to be aware of.

Know what's normal. What exactly is a healthy appetite? "It's a level of eating that maintains normal body weight," says Dr. Kanarek.

"If you have a healthy appetite, you consume a variety of foods. A hearty appetite for nothing but steak is not a healthy appetite," adds Adam Drewnowski, Ph.D., professor and director of the Human Nutrition Program at the University of Michigan School of Public Health in Ann Arbor.

"If you must constantly force yourself to eat, that's not a good sign," adds Dr. Levitsky.

Vitamins may revitalize. A daily multivitamin and mineral supplement seems to help stimulate a stubborn appetite, Dr. Steelman says. And the extra nutrients certainly can't hurt if your undereating has caused undernourishment. Older people can sometimes rev up their desire to eat by taking zinc supplements, says Dr. Steelman. Ask your doctor whether a zinc supplement is appropriate for you.

Review your medications. Ask your doctor about all the medications you are currently taking—both prescription and over-the-counter. He may be able to substitute drugs that don't interfere with your appetite, Dr. Steelman says.

Eat anything you want. If food has lost its appeal, try changing your diet. Determine which foods are appetizing, and concentrate on eating them. If you only want ice cream, go ahead and indulge in your favorite flavor. "I'm not advocating an unhealthy diet, but if ice cream is the only way to get necessary calories into your body then, by all means, go ahead," says Dr. Drewnowski. "The trick is to increase the pleasantness quotient."

Downsize your eating habits. Eat smaller, more frequent meals, suggests Dr. Kanarek. Your stomach will accept smaller amounts of food more readily, she explains.

Drink plenty of water. If you've started a new exercise program, your most important nutrient is water. Dehydration can cause appetite loss, advises Dr. Levitsky. Drink a glass of water before your workout and another immediately afterward. In addition, make sure you drink six to eight eight-ounce glasses of water every day.

Doctor your appetite. If you don't find your misplaced appetite after two weeks, see your doctor for a checkup. Physical problems must first be diagnosed before any treatment begins. You might find that all you need is a course of antibiotics to knock out a low-grade infection.

Take stock of mental health. If you are depressed, antidepressant medications might be prescribed to stimulate your appetite. By bringing your mental health back to normal, you'll find yourself wanting to eat again, says Dr. Kanarek. (For other tips on dealing with depression, see page 144.)

Let the pros help. Anorexia nervosa usually doesn't lend itself to self-help remedies, and most people with the disorder need to be hospitalized. "It's tough to treat," Dr. Steelman says. "It requires intense therapy from a psychological and nutritional standpoint." Forced feeding through intravenous injections or a gastric tube may be necessary.