Introduction
Appetite is a feeling, that makes us eat and enjoy a meal to fill our tummy. Being partially physical and partially emotional, appetite stands as an important key to our satiety & nourishment. A disturbance or loss of appetite can affect the quantity and quality of food intake hence nourishment & health. People of any age/gender/race can experience a loss of appetite and for many different reasons. People may have less desire to eat, lose interest in food, or feel nausea at the idea of eating. Also, there can be fatigue and weight loss if there is no food intake to sustain the body. The reasons for loss of appetite can be short-term, including the common cold, food poisoning, other infections, or the side effects of medication. It can develop due to long-term medical conditions, such as diabetes, cancer, or any other chronic illness.
Signs & symptoms
- Feeling not hungry
- Aversion to food
- Nausea, rarely vomiting
- Feeling full after taking only a little amount of food
- Tiredness
Causes
A loss of appetite can be physical or psychological. The causes can be short-term or long-term.
Short term causes include:
- colds
- flu
- respiratory infections
- bacteria or viral infections
- constipation
- an upset stomach
- digestive issues
- acid reflux
- food poisoning
- allergies
- food intolerances
- a stomach bug or gastroenteritis
- pregnancy
- hormonal imbalances
- stress
- medication side effects
- alcohol or drug use
- sore mouth/mouth ulcer
Long-term medical conditions:
- Irritable bowel syndrome
- Crohn’s disease
- Addison’s disease
- Asthma
- Diabetes
- chronic liver or kidney disease
- AIDS
- Hypothyroidism
- COPD
- Heart failure
- Carcinoma of gastro-intestinal tract
Medications and treatments that often cause a loss of appetite include:
- sedatives
- some antibiotics
- immunotherapy
- chemotherapy
- radiation therapy
- Anaesthesia drugs and major surgeries
Psychological factors and mental health conditions can have a significant impact on a person’s appetite. These can include:
- depression
- anxiety
- panic attacks
- stress
- grief
- eating disorders, such as anorexia nervosa
- Pancreatic, ovarian, or stomach cancer.
Hunger is initiated by a complex system of physical and hormonal signals. The brain, nervous system, pancreas, stomach, and the rest of the intestinal tract are involved in the process. There are two primary hormones involved in hunger signals: ghrelin and leptin. After the digestion of the food eaten before, the stomach (and other parts of the digestive tract, to a lesser degree) produces ghrelin, which increases appetite, gastric motility, and gastric acid secretion. Ghrelin levels are the highest right before meals when the blood sugar is low and the stomach is empty. When the tummy is full of food, fat cells secrete leptin, which interacts with the brain to say that the body has enough calories in storage, and it is, therefore, time to inhibit hunger signals. A wide variety of other hormones are involved in hunger and appetite signals, including insulin and cortisol.
Though we use the terms hunger and appetite as synonyms, there is a difference. One is more physical and the other is more psychological. True hunger occurs when the body demands nutrients to function. It is physiological. It occurs because of biological changes throughout the body, which signal that the body needs to eat to maintain energy levels. Appetite is simply the desire to eat. It can be a result of hunger, but often has other causes, such as emotional or environmental conditions.
A craving is an uncontrollable desire to eat a specific food. Cravings increase the appetite and can occur regardless of hunger. Some nutritional deficiencies play a role in a condition called pica, a condition that causes cravings for non-nutritive foods, such as soil and dirt. Not for all, but many individuals with pica are deficient in minerals such as iron or zinc. Food intake is regulated by the central nervous system depending on macronutrients and environmental changes. The hypothalamus is the target of hunger and satiety signals arising from the peripheral organs and the brain. Noradrenaline-neuropeptide Y and opioid-galanine are involved in carbohydrate and fat intake, respectively, while serotonin-CCK-insulin and dopamine-cyclic dipeptides systems inhibit them. Histamine and proinflammatory cytokines are involved in stress- and sickness-induced anorexia. Leptin accelerated intrahypothalamic anorexic mechanisms executed by POMC/CART and CRH but suppresses orexigenic mechanisms promoted by NPY and orexin. Although these mechanisms elegantly regulate appetite and feeding behavior, disruption of weight control has been accelerated and the incidence of obesity and eating disorder are dramatically increasing recent years in our modern society. A new approach may be necessary to solve the problems of weight control.
Hunger and appetite are rather complex systems. They work well in normal healthy people but sometimes the rhythm is lost. Many factors including physical, mental, and environmental can be blamed for the same. But in most people, obesity or a chronic disease makes such a loss of appetite. Genetic conditions, environmental influences, hormones, mental health conditions, and many other aspects can disturb the normal hunger cues.
Diagnosis
- History taking
- Physical examination – palpation of abdomen by feeling with their hand for any unusual bloating, lumps, or tenderness.
- blood tests
- an abdominal X-ray
- an endoscopy
Treatments for appetite loss will depend on the cause.
Eating small, regular meals instead of three large meals can be helpful.
Liquid meals are often easier to take and with high absorption rate.
Carminative medications to reduce other symptoms, for example, nausea help increase appetite.
If depression or anxiety are causing people to experience a loss of appetite, counseling, meditation, cognitive therapies, and sometimes antidepressants can help.
Prognosis
Loss of appetite usually has a good prognosis. In short-term conditions, it resolves without any treatment. But in chronic medical conditions, proper treatment is essential. It can worsen and lead to complications otherwise.
Complications
In the chronic loss of appetite, malnutrition or vitamin and electrolyte deficiencies, and life-threatening complications can happen. If left untreated, your decreased appetite can also be accompanied by more severe symptoms, such as:
- extreme fatigue.
- weight loss.
- a rapid heart rate.
- fever.
- irritability.
- a general ill feeling, or malaise.
Disease & Ayurveda
Agnimandya
Nidana
Intake of excess food
Intake of food that is not familiar or with different potency
Intake of food before the previously had meals get digested
Untimely food intake
Dry, cold, and heavy foods
Untimely food intake
Day sleep and keeping awake at night
Suppression of natural urges
Incompatibility of panchakarma procedures
Excessive worry, fear, anger, jealousy
Excessive intake of tea, coffee, tobacco, alcohol etc.
Food and habits causing vitiation of Kapha
Purvaaroopa
Not mentioned
Samprapti
When the causative factors vitiate kapha, it gets smeared on the walls of the intestines and all channels into and out of it get obstructed. This causes a loss in the digestive fire. Proper digestion and absorption will not happen in this case. Due to this weakened Agni, undigested and partially digested food is retained in the stomach and is called Ama. It contains many toxic products to the body and enters into the channels & circulatory system, Ama causes many diseases. This is why Loss of appetite (Agnimaandya) is considered as the root cause of all the diseases in Ayurveda.
Lakshana
Indigestion
Decreased appetite
Loss of taste & salivation
Sour belching/heartburn
Heaviness and distension of abdomen
Divisions
Not mentioned
Prognosis
Sukhasadhya
Chikithsa
The Ayurveda treatment of Agnimandya is basically two steps. One is to remove any Aama (mixture of digested and undigested food particles in the stomach which turns toxic to the body) or obstruction in the channels. The next step is to enhance the Agni (digestive fire) and bring it into normal.
Samana
Upavasam
Langhanam
Aamapachana oushadhas
Agnideepana oushadhas
Sodhana
Sodhana therapies other than Sadyovamana (Therapeutic vomiting) are not indicated in a person with Loss of appetite/indigestion in the initial stage. Once the undigested food is cleared and the person is devoid of Ama, medicines and procedures to improve the Agni can be administered. The panachakarma therapies include:
Vamanam
Virechanam
Asthapanavasti
Anuvasanavasti
Sneha-sweada
Commonly used medicines
Dhanwantaram gulika
Abhayarishtam
Dasamoolarishtam
Shaddharanam choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
People may find it easier to eat several smaller meals a day instead of three bigger ones.
Aim to make these meals high in calories and protein to make sure the body is getting plenty of nutrients and energy. People may also find having liquid meals, such as smoothies and protein drinks, easier to take.
Adding herbs, spices, or other flavourings to meals may also encourage people to eat more easily. Eating meals in relaxing or social settings may make eating more enjoyable.
People can also keep drinking plenty of fluids to prevent dehydration. Gentle exercise, such as a short walk, may sometimes increase appetite as well.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduce the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturb digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Avoid day sleeping
Avoid a sedentary lifestyle. Be active.
Avoid stress and emotional hurricanes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid sitting continuously for a long time and avoid squatting.
Yoga
Regular stretching exercises, cardio work out, and following a specific Yogacharya with yoga asanas like pavanamuktasana, vajrasana, etc are recommended for improving digestion.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
In fever conditions, no exercises are recommended.
Pavanamuktasana
Vajrasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
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