Several readers recently inquired about why patients with Idiopathic Pulmonary Fibrosis often lose weight.
Early in the course of IPF, patients have no problem maintaining their normal weight. However with advancing severity of IPF, many patients gradually lose weight. There are several contributing factors.
Decreased appetite
There are a few potential contributing factors to decreased appetite in IPF. First, medications may cause nausea that is a potent appetite suppressant. Second, patients with dramatic cough often require medications that cause dry mouth, nausea or sedation, all of which may in turn reduce your appetite. Third, depression is common in patients with chronic lung disease. Low appetite is a common symptom of depression. Lastly, in patients with IPF who develop right heart failure, fluid retention and hepatic (liver) congestion with fluid backing up into the liver often causes early satiety (premature sense of fullness after eating just a few bites of food).
Decreased stamina for eating and food preparation
When our lungs work properly, we do not think about our breathing during everyday tasks such as eating. However, with progressive fibrosis, even eating may become a form of exercise. When we eat, we direct more blood flow to the muscles of chewing and swallowing. As IPF progresses patients are forced to breath quickly and shallowly due to progressive scar replacement in their lungs. Oxygen through nasal cannulas is used to help support blood oxygen levels. The process of chewing interferes with the rapid shallow breathing pattern. Thus when patients with any advanced lung disease eat (chew in particular) they are doing a form of exercise and at the same time they are breathing less effectively.
In patients that live alone and are responsible for their own shopping and food preparation the problem is amplified. These tasks may become barriers to just getting a meal on the table.
Increased energy consumption from increased work of breathing
When we are healthy, breathing is very energy efficient. However, with advancing lung disease, breathing becomes less efficient and consumes more energy.
Strategies to combat weight loss in Idiopathic Pulmonary Fibrosis
First, a careful inventory of medications is important. Review each medication and consider the possible contribution to decreased appetite. Unnecessary medications should be stopped and doses reduced whenever possible. The new medications that treat IPF can cause nausea. Working with your doctor, try reducing the dose or even stop taking the medications for a week or two and see if your appetite and intake improve.
Second, consider the role of depression. Acknowledging depression is not a sign of weakness. Rather it is the first step in treating it. Work with your medical team. Often talk therapy can be very helpful. Antidepressants are very effective and some directly improve appetite quite quickly.
Third, modify your diet. Avoid foods that require more work to eat. For example, a piece of steak takes more energy to eat than does pasta. Choose foods that are easy to chew and swallow and are more calorie dense. For example, full fat yogurt is easy to eat and relatively calorie dense. Ice cream is another good choice. Fish is easier to swallow than beef. Avoid large meals. Rather than eating three large meals, think about 5 smaller meals. Smoothies or shakes are a great source of delicious easy to consume calories.
Fourth, increase your oxygen flow during meals. This may help reduce your shortness of breath.
Fifth, if you need help with shopping and meal preparation don’t be afraid to ask. In many areas delivered meals is another option.
Medications that Help with Weight Loss for Pulmonary Fibrosis Patients
Lastly, there are a couple of medications that can directly increase appetite for Pulmonary Fibrosis patients. Megesterol acetate (Megace) has been used to increase appetite. It is generally well tolerated but does have side effects. It can causes suppression of your adrenal glands and therefore should not be stopped abruptly after taking the medication for many months. It can also increase the risk of blood clots.
A second medication is Dronabinol (Marinol). This medication contains the active ingredient in marijuana. It helps with medication and disease related nausea and stimulates appetite. Although generally well tolerated, some patients have an unpleasant mental sensation ranging from just feeling weird to feeling paranoid. Always start at the lowest dose and increase gradually until the desired effect is achieved.