You may find yourself wondering how you can help. What foods can you make that will tantalize the appetite? How can you stop the weight loss or even reverse it?
Before you whip up every one of your loved one's favorite dishes, wielding your spatula like a mighty sword, it’s important to understand why this battle is even taking place.
Anorexia vs. Cachexia
Anorexia is defined as the “lack or loss of appetite, resulting in the inability to eat.” This anorexia is different than the mental illness anorexia nervosa. It can occur with nearly all forms of life-limiting illnesses but is most common in advanced cancers. Anorexia results in weight loss that is primarily of fat but can include loss of muscle. If caught early on, anorexia may be treated and weight loss reversed with nutritional supplements or increased consumption of food.
Cachexia is defined as a state of “general ill health and malnutrition, marked by weakness and emaciation.” It is also common in advanced cancers and AIDS as well as other advanced life-limiting illnesses such as congestive heart failure. Cachexia occurs in more than 80% of cancer patients before death and is the main cause of death in about 20% of these patients.
In contrast to anorexia, the weight loss with cachexia involves not only loss of fat and muscle, but also of bone mass. Additionally, cachexia doesn’t respond to nutritional supplementation or increased consumption of food.
The term your medical professionals may use for either source of weight loss is “anorexia/cachexia syndrome” (ACS).
Causes of ACS
Metabolic Alterations
In illnesses such as advanced cancers and AIDS, certain chemicals called cytokines are released by the body. The cytokines cause an inflammatory response within the body that can alter how the body metabolizes nutrients.
Physical Symptoms
Symptoms of disease can cause decreased appetite and thus weight loss. Common symptoms that can result in anorexia include:
- Pain
- Dysguesia – a change in taste, usually including aversion to meat
- Aguesia – loss of taste
- Hypersomia – sensitivity to smells, often causing aversion to foods
- Dysphagia – difficulty swallowing foods
- Dyspnea – shortness of breath
- Nausea and/or vomiting
- Constipation or diarrhea
- Many more
Medication Side Effects
Medications used to treat illnesses or increase comfort can have side effects that cause anorexia. Many of the side effects are similar to the physical symptoms listed above.
Psychological or Spiritual Distress
Let’s not diminish or overlook completely the role of emotional, psychological, or spiritual distress can play in anorexia. The effects of the illness and the treatment, coupled with psychological responses such as anxiety or depression and spiritual reactions such as hopelessness, may result in diminished enthusiasm for food and/or a lack in energy to prepare and eat it.
Other Causes
Other causes of anorexia can easily be missed but may be significant. Examples include poorly-fitting dentures and infections of the mouth or esophagus.
Sources:
Ferrell BR, Coyle N. Textbook of Palliative Nursing, 2nd Edition. Oxford Press, 2006.
Kinzbrunner BM, Weinreb NJ, Policzer JS. 20 Common Problems: End of Life Care. McGraw-Hill, 2002.
