People who experience a loss of appetite due to cancer may eat less than usual (or not at all) or feel full after eating only a small amount, according to the American Cancer Society (ACS). This makes it hard to get the nutrients needed to stay strong and feel better overall. The risks of not eating enough include weight loss, increased fatigue, muscle loss, and nutrient deficiencies. Here’s what you need to know about appetite loss and ways to get the calories and nutrients you need.
What Causes Loss of Appetite with NSCLC?
Loss of appetite can sometimes be caused by changes in metabolism — the body’s process of breaking down food — that may happen with advanced cancer. What’s more, side effects of treatment, such as nausea, dry mouth, mouth sores, or difficulty swallowing or chewing, can make eating difficult or painful. Fatigue, depression, shortness of breath, and changes in the perception of the way food tastes or smells can also contribute to a lack of appetite. And cancer medications and treatments themselves, including chemotherapy and radiation, can also impact your appetite. In some cases, NSCLC cancer cells may create the antidiuretic hormone, which can cause the kidneys to hold onto water and lower salt levels in the body. A potential side effect of this condition, known as syndrome of inappropriate antidiuretic hormone secretion (SIADH), is appetite loss, which can be accompanied by muscle weakness, cramps, nausea, vomiting, restlessness, and confusion. Untreated, severe cases can lead to seizures or coma. If you’re diagnosed with SIADH, your doctor may recommend limiting fluids or prescribe medications to treat the condition and its symptoms. “It’s less likely that any treatment will help you if you can’t keep nutrition up and get up and move about,” says David Graham, MD, an oncologist at the Levine Cancer Institute in Charlotte, North Carolina. “I tell people, ‘You’re on the see-food diet: If you see food, eat it!’” Sometimes conventional wisdom about eating and nutrition has to be discarded entirely, Dr. Graham says. “One of the biggest problems I have to get through with patients,” he says, “is that so many of us are raised on three meals a day. With cancer, that often becomes frustrating if you can’t eat a big meal.” His advice? Always have something around to munch on with calories and protein. “I don’t care as much about cholesterol or any of that,” he says. “I want good calories and protein.”
What You Can Do About Appetite Loss
Remember that good nutrition is important, even when you don’t feel like eating. Try to think of food as part of your treatment, since it can help you keep up your strength and energy, maintain a healthy weight, and reduce your risk of infection. According to organizations such as the ACS and GO2 Foundation for Lung Cancer, there are many things you can do to get the calories and nutrients you need when you’re coping with a lack of appetite. Among their suggestions:
Talk to your doctor about ways to address underlying problems or other conditions that may be contributing to your poor appetite. Your doctor may also prescribe medications that can help directly address appetite and weight loss.Instead of three large meals a day, try having six to eight small meals.Eat foods you enjoy, whenever you feel hungry. (But try to eat healthy whole foods that are dense in calories and protein when you can). Try pudding, ice cream, yogurt, hard-boiled eggs, peanut butter, and cream-based soups.Don’t be afraid to try new foods, because you might find you enjoy different things during treatment.Add sauces and gravies to meats cut into small pieces to make it easier to chew and swallow.Avoid dry or coarse snacks if you have dry mouth or difficulty swallowing. Chewing gum or sucking on ice cubes or hard candy can help with dry mouth.Try light exercise an hour before meals to stimulate your appetite, and remain as active as you can throughout the day.Use flavored supplements designed to boost nutrition.Drink between meals rather than with meals to avoid feeling too full.Try eating foods cold or at room temperature rather than hot if you’re sensitive to taste or smell.Add spices or flavorings to make the taste of food more appealing.Ask friends and family to help you shop for or prepare meals if you’re fatigued.Make meals more enjoyable by playing your favorite music or watching TV while you eat, or eat with a friend.
Caregivers can help with nutrition by offering snacks and starchy foods (bread, pasta, potatoes), keeping cool drinks handy, and making shakes and smoothies when the person they’re caring for doesn’t want to eat. Encourage eating without nagging or arguing. And the ACS stresses that it’s important for caregivers not to blame themselves if their loved one refuses to or can’t eat. Taofeek Owonikoko, MD, chief of the division of hematology/oncology at UPMC Hillman Cancer Center in Pittsburgh, says he tells his patients to “eat as much of a balanced diet as they can.” He adds that marijuana might also help, because it may stimulate appetite but remains cautious. “I cannot be an advocate for it,” Dr. Owonikoko says, “but my patients who have used marijuana have reported improvement in appetite and less nausea. People report good outcomes with the use of medicinal marijuana products.” Purchasing it can be tricky. Laws on medical marijuana use vary by state, which can make it difficult to purchase, depending on where you live. Visit the National Conference of State Legislatures to learn more about your state’s medical marijuana laws. The ACS notes, though, that medical marijuana wasn’t better than a placebo or a drug (megestrol acetate) used to increase appetite in studies of people with cancer. They support the need for more research on medical marijuana for people with cancer and say decisions to use it should be made between a cancer patient and their doctor. Owonikoko also encourages exercise to help stimulate appetite, but “You shouldn’t overdo it,” he says. “You should do as much as you feel you can tolerate.” He also says that you might want to seek professional help. “Depending on where you have been treated, you might have dietitians who can give you advice on what kind of food to eat. That’s something that can help,” says Owonikoko. If you’ve lost your appetite, talk to your doctor or a registered dietitian about ways to get the essential nutrients you need to help you power through treatments. Additional reporting by Colleen de Bellefonds
