Symptoms

Decreased interest in, enjoyment of, or ability to eat food. A persistent lack of appetite can have a severe effect on your enjoyment of life and over time may lead to weight loss so it is important to try to maintain a healthy appetite.

Causes

Appetite problems may be a secondary effect of nausea and vomiting and the liver side effects of some non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors. They may also be caused by malabsorption (inability to properly absorb nutrients), problems with maintaining a healthy balance of bacteria in the gut, and fungal, bacterial or viral infections which irritate or inflame the gastrointestinal (gut) lining. Some people find that taking medications affects their sensation of taste and can make eating much less enjoyable. Stress, depression and fatigue are also associated with loss of appetite.

Complementary & Supportive Therapy

Appetite stimulants: Ginger tea ( Zingiber officinale ) promotes gastric acid secretion, which stimulates appetite and helps food absorption. Wine or pickles before meals can stimulate appetite, but avoid these if you have digestive upsets, candidiasis, thrush or other fungal conditions. ‘Bitter tonics' help to activate the secretion of digestive (gastric) juices. Taking approximately 2–3mls of Swedish Bitters, before meals may help stimulate the appetite.

Swedish Bitters contains a number of herbs including aloe ( Aloe vera ), myrrh ( Commiphora molmol ), saffron ( Crocus sativus ), senna leaves ( Cassia senna ), camphor ( Cinnamonum camphora ), angelica root ( Angelica archangelica ), zedvoary root ( Curcuma zedoraria ), manna ash ( Fraxinus ornus ), carline thistle root ( Carlina vulgaris ), gentian root ( Gentiana lutea ) and Chinese rhubarb root ( Rheum palmatum ).

Eating and drinking: Raw foods are often more palatable than cooked foods, and they stimulate the gut to produce digestive juices which may improve the appetite (try carrots, celery, pineapples, paw paws or papaya for example). Eat when you are hungry, pay attention to your cravings and enjoy your favourite foods.

If you rarely feel hungry then structure your meal times by eating at regular intervals e.g. every three to four hours. Eat frequent small meals, rather than two to three large meals daily. Try to shop for food and prepare your own meals as anticipation of food can stimulate your appetite, but if the smell of cooking makes you nauseous, accept offers from friends and carers to help prepare meals or eat foods which require little or no cooking.

Zinc helps the body to make saliva and low levels of zinc are linked to reduced appetite. However, supplements can only help if you are zinc-deficient. Lean meats, milks, cheese, nuts and seeds are all good sources of zinc. Limit low energy fluids (tea, coffee, diet drinks) and choose more nutritious drinks (milk, juice, energy supplements such as Sustagen and Ensure Plus, and soups).

Choose high-energy snack foods such as nuts, yoghurts, cheese and dairy desserts.

Exercise: Regular exercise and physical activity can help to stimulate the appetite. Even small amounts of exercise can help.

There is some evidence that the active ingredient in cannabis (THC) helps some people to control nausea and improve appetite.

Possession and use of cannabis and its derivatives is illegal in Australia. The laws in South Australia, the Australian Capital Territory and the Northern Territory require police to impose minor on the spot penalties or cautions rather than prosecutions for possession or use of small quantities of cannabis. Trials of cannabis, to assess its medicinal use, have been proposed in NSW but had not commenced at the time of going to print.

Medical & Drug Treatment

Appetite loss due to nausea or drug induced hepatitis (liver inflammation) requires treatment which addresses these underlying causes. Salivary replacement and stimulant medications are sometimes prescribed if there is a lack of saliva leading to a dry mouth.

Special Precautions and Considerations

• Successful treatment depends on first identifying the cause of the problem. Your doctor can offer appropriate management suitable to your individual situation. + Zinc supplements can cause nausea in those who are not deficient and may cause vomiting.
• Try to avoid refined sugar, fatty foods, excessive alcohol and smoking as they can reduce appetite.
• Raw and pickled foods should be avoided if you have ongoing digestive upsets, such as nausea, vomiting and diarrhoea. In this case, it may be better to have steamed or stir-fried vegetables.