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Loss of appetite

Loss of appetite may also be called anorexia. Many people with cancer have a loss of appetite. It occurs because cancer or its treatments can affect the way food tastes or you don’t feel like eating. If you don’t eat enough, you can lose weight. Weight loss is one of the most common side effects of cancer and its treatment. Weight loss can weaken the immune system, affect how wounds heal and make you tired and uncomfortable. During cancer treatment, you need to stay well nourished to help your body deal with cancer and its treatment. This is also true for children with cancer who need to stay well nourished for normal growth and development.

Causes

Loss of appetite can be caused by the cancer itself, especially advanced cancer. Cancer treatments may cause symptoms that may lead to loss of appetite. These treatments include chemotherapy, radiation therapy and surgery. These symptoms include:

  • nausea and vomiting
  • constipation
  • diarrhea
  • sore mouth, dry mouth, difficulty chewing or swallowing, taste and smell changes
  • fatigue

Loss of appetite may also be caused by:

  • changes in metabolism, possibly due to the cancer
  • pain or pain medicines
  • unpleasant odours or sights
  • a low red blood cell count, or anemia
  • infection
  • being less active
  • difficulty breathing
  • feeling depressed or anxious
  • feeling of fullness due to a buildup of fluid in the abdomen (called ascites)

Symptoms

Symptoms of loss of appetite can vary depending on their cause and other factors. Severe loss of appetite can cause weight loss and malnutrition. It can also lead to loss of muscle mass, which is also called muscle wasting or cachexia.

A loss of appetite can be temporary. Appetite often returns to normal when treatments such as radiation therapy or chemotherapy are completed. It may take several weeks for the appetite to fully recover after treatment is finished.

Symptoms of loss of appetite can include:

  • complaints that food tastes “funny”
  • being put off by food smells
  • not liking food that was once a favourite
  • difficulty chewing and swallowing
  • tiring of eating and giving up after a few mouthfuls
  • eating only 1 or 2 types of foods
  • feeling full sooner than expected, or early satiety

Managing loss of appetite

It is important for a person with cancer to maintain their weight even if their appetite has changed. Proper nutrition helps your body fight disease and cope with the effects of cancer treatment. Your healthcare team can suggest ways to help you manage loss of appetite. You can also try the following.

Keep mealtimes and snacks flexible

Worrying about not eating can further affect the appetite. Try to accept that you may find only a few kinds of food appealing. Do your best to include variety and choice in your diet.

Try not to skip meals. Make an effort to eat regularly even if it is only a few bites. Try eating small meals and snacks throughout the day. Some people may have a better appetite in the morning, so eat a large breakfast. Try eating a bedtime snack.

If you are caring for someone with cancer, try not to blame them for not eating. Do not bribe or threaten them to get them to eat.

Make meals appealing and fun

Appetite is very much affected by how food looks and by the eating environment. Try to help make meals appealing and fun. For example, you can change the form of food. Instead of fresh fruit, mix it in a milkshake. Try a variety of new tastes and textures to find those that are most appealing. Recognize that what is appealing one day may not be appealing the next day.

Explore different ways of presenting food. Put small portions on the plate. Experiment with different combinations on the plate. Change the size of the plate. Use soft lights and quiet music or try a more upbeat music to make mealtimes relaxed and pleasurable. Put a centrepiece on the table or a flower on the tray. Use pretty or funny dishes. Decorate the food. Serve the food in a basket or box.

Have meals with family and friend or invite special guests if the person feels up to it. Make fun rituals around meals, such as pancakes on Sunday.

Cover up tastes and smells

Cancer treatment can sometimes change how foods taste. You can try experimenting with different foods to help cover up tastes and smells that bother you and make food appealing again.

Try new spices, such as basil, nutmeg, cinnamon, parsley, curry, coriander, mint, oregano or rosemary. Spices make the mouth water and change the taste of food. Add new flavours by using lemon, pickles, salad dressings, vinegar, mayonnaise, relish or fruit juices.

Marinate meat in liquids to change the flavour and make it more appealing. Try marinades made with fruit juices, salad dressings, sweet and sour sauce, soy sauce or barbecue sauce.

Serve food cold or at room temperature to reduce strong tastes and smells. Use plastic utensils to help prevent a bitter or metallic taste. Clean the mouth before and after eating to get rid of any tastes and freshen the mouth.

Make every calorie count

You can help prevent weight loss by increasing the nutritional value of the food you eat, especially with calories and protein.

Eat whatever you want, whenever you want it. Eat breakfast food at suppertime if that is most appealing. Eat small snacks and meals every 1–2 hours throughout the day. Eat well during times when the appetite returns.

Keep healthy, high-protein, high-calorie snacks available so they are ready to eat when your appetite returns. These snacks could include cheese and crackers, ice cream, peanut butter, pudding, muffins, instant breakfast preparations and nuts.

Eat foods high in calories and protein when the appetite is poor. These foods include fish, chicken, turkey, eggs, cheese, milk, ice cream, tofu, nuts, peanut butter, yogurt, beans and lentils. Add butter or margarine to vegetables, soups, pasta, cooked cereal and rice to add fat and calories. Between meals, sip on drinks that are high in calories and protein, such as milkshakes, smoothies and commercial nutrition supplements. Add sugar, syrup, honey or jelly to vegetables, meats, cereals, waffles and rolls to add calories.

Use sour cream or cream cheese on baked potatoes, vegetables or crackers to add additional fat and nutrition and also make the food easier to swallow. Add whipped cream to hot chocolate, ice cream, pie, pudding, gelatin and other desserts. Add powdered coffee creamers or powdered milk to gravy, sauces, soups and hot cereals. Use milk instead of water when making soups, cooked cereals or other recipes. Increase fat and calories by using mayonnaise instead of salad dressing and light cream instead of milk in recipes.

Increase the protein and calorie content of milk products. Double the protein and calorie content of whole milk by adding powdered dry milk. Use half cream and half milk or evaporated milk, which are higher in fat, protein and calories and provide vital minerals and nutrients. Use “instant breakfast” mixes for extra calories.

Use crushed granola, nuts, seeds or wheat germ in shakes or on desserts. Use high-calorie baby formulas for children who still take a bottle.

Check with your healthcare team or registered dietitian for other suggestions on how to improve appetite. People with a weakened immune system or low white blood cell counts may have to take some basic food safety precautions, as suggested by their dietitian.

Stimulate your appetite

Sometimes people with cancer lose their appetite because of treatment or emotional distress. You can try the following to help stimulate your appetite.

Try doing light exercise or walking before meals, in fresh air if possible. Increased activity just before eating and fresh air both stimulate the appetite.

Eat meals in a pleasant, relaxed atmosphere. Eat meals with family members or friends whenever possible. Try not to eat alone. Eating with someone else distracts attention from food and can increase the amount eaten.

If your mouth isn’t sore, drink lemonade or orange juice. Juices that contain acid can stimulate the appetite.

Prevent an early feeling of being full, or early satiety. Drink beverages between meals instead of with meals so they don’t fill up the stomach. Eat smaller meals more often. Avoid certain foods that can produce gas, such as beans, raw vegetables, raw fruit, broccoli, corn, cabbage, cauliflower, carbonated drinks and chewing gum.

Some people find that drinking small amounts of alcohol, such as a glass of wine or beer, helps stimulate their appetite and helps them enjoy their meal. Alcohol is low in nutrition and high in calories. A drink or 2 may make a person feel full and not feel like eating anything else. Alcohol can also interfere with some drugs or cancer treatments and may make them less effective or cause side effects to become worse. Alcohol increases the risk of developing certain types of cancer. Be sure to check with the doctor or healthcare team before drinking any alcoholic beverages.

Use nutritional supplements

Check with your doctor about taking vitamin or mineral supplements to help improve your overall nutrition. Your doctor may recommend commercial nutritional supplements if you can’t meet your nutritional needs from food or drink alone.

Lots of supplements are available. They come in a number of forms and flavours, including:

  • ready-to-use beverages
  • powders
  • puddings
  • bars

These supplements can be used alone or add to small meals to provide more calories or protein. You can buy commercial nutritional supplements, such as Boost or Ensure, from a pharmacy or grocery store. Some supplements are made to address special needs like lactose intolerance or diabetes. Talk to a registered dietitian about commercial nutritional supplements and which one would be best to use.

Use a feeding tube

If loss of appetite becomes severe and there is a risk of malnutrition, the healthcare team may suggest using a feeding tube. This is a thin, flexible tube that is passed through the nose into the stomach or intestine. Once the tube is in place, liquid nutritional supplements are delivered through it. This is called enteral feeding.

Feeding tubes can help you meet your nutritional needs when it is too difficult to eat or drink or you have lost a lot of weight. Feeding tubes may be appropriate if your loss of appetite is temporary and not caused by advanced cancer.

Use appetite stimulants

Your doctor may prescribe drugs to stimulate your appetite. These drugs may include megestrol (Megace) or corticosteroids (steroids).

Some people claim that marijuana helps increase their appetite. To date, studies haven’t shown for certain that marijuana can effectively improve appetite. Find out more about medical marijuana and cannabinoids.

Special considerations for children

Talk to your healthcare team about how you can help manage your child’s loss of appetite and make sure they are getting proper nutrition. Let your child help plan and make meals when they can. Try to serve foods and drinks that the child asks for or that are easy to eat or drink. Remind your child when it’s time to eat and encourage them to eat extra food when they feel well.

For younger children, try to make meals more appealing. Have picnic lunches on a blanket in the yard or on the floor. Have a teddy bears’ picnic with real food. Tell mealtime jokes or play games. You may want to use colourful cups and straws to help your child drink. Serve colourful foods or try making funny faces from vegetables and fruit. You can also use cookie cutters to shape sandwiches, breads, meats and cheeses to make them more appealing.

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