There are many causes of weight loss

Cape Breton Post - - IN MEMORIAM/ADVICE - Keith Roach

DEAR DR. ROACH: A year ago, I weighed 175 pounds. My wife was quite con­cerned when I started to lose weight. I am gen­er­ally in good shape.

I vis­ited my lo­cal in­ternist, and he or­dered blood tests, CT and MRI scans, and a brain scan, all of which were fa­vor­able. How­ever, I con­tinue to lose weight, and am now down to 155 and also quite con­cerned. I feel well, and eat three good meals each day, in­clud­ing dessert.

Can you give my doc­tor and me your ad­vice? — W.M.K.

AN­SWER: Un­ex­plained weight loss is not an un­com­mon prob­lem in clin­i­cal medicine. There are many causes, and I am sure your in­ternist has looked for many of them.

There are way too many for me to list, but they come in five gen­eral cat­e­gories. The first is not get­ting or ab­sorb­ing enough calo­ries. Mal­ab­sorp­tion states, such as sprue or chronic pan­cre­ati­tis, can keep your body from get­ting enough nutri­tion de­spite eat­ing plenty. Di­ar­rhea is al­most uni­ver­sal in these cases.

The sec­ond is los­ing the calo­ries you are tak­ing in, and out-of­con­trol di­a­betes mel­li­tus is by far the most com­mon cause. An el­e­vated meta­bolic rate is third, and hy­per­thy­roidism is the clas­sic ex­am­ple. Chronic dis­ease is the fourth, and can­cer in par­tic­u­lar has sev­eral ways it can cause weight loss. Chronic in­fec­tions also some­times show pro­gres­sive weight loss. The fifth ma­jor cat­e­gory is psy­chi­atric dis­ease, es­pe­cially de­pres­sion, but anorexia ner­vosa as well.

Some­times no cause can be found, and some­times peo­ple gain back the weight.

How­ever, it's also the case that a con­di­tion re­veals it­self af­ter months or even years, so you and your doc­tor need to dili­gently look for symp­toms (that you no­tice) and signs (that he dis­cov­ers on exam or by lab­o­ra­tory find­ings) that might in­di­cate why you are los­ing weight. The fact that you are eat­ing well and still los­ing weight sug­gests a hy­per­me­tabolic state, or calo­rie loss. You haven't men­tioned stool stud­ies; fat in the stool is the sim­plest test for mal­ab­sorp­tion.

DEAR DR. ROACH: With sum­mer trav­el­ing upon us, what about food of­fered on the street in for­eign na­tions? Would it be prac­ti­cal to buy bot­tled wa­ter to then wash off ven­dor food? Or, should tourists sim­ply eat only food of­fered when they are back in their ho­tel, ship or such? — N.M.G.

AN­SWER: Trav­el­ing in less-de­vel­oped coun­tries of­fers many worth­while ex­pe­ri­ences, in­clud- ing try­ing new foods. No mat­ter where you eat — ho­tel, ship, res­tau­rant or street — there is al­ways a risk. The Cen­ters for Dis­ease Con­trol and Preven­tion rec­om­mends against street fare, but sev­eral stud­ies have sug­gested that it isn't any riskier than res-tau­rant meals. If you choose to be ad­ven­tur­ous would in­clude:

• Eat food that is cooked in front of you, rather than pre- cooked.

• Never eat any­thing un­cooked that you don't peel your­self, or rinse with your own bot­tled wa­ter. Keep your own hands clean with al­co­hol gels.

• Choose busy ven­dors, es­pe­cially those cater­ing to lo­cals.

• Eat early in the day, not what has been sit­ting around.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­ or re­quest an or­der form of avail­able health news­let­ters at P.O. Box 536475, Or­lando, FL 328536475. Health news­let­ters may be or­dered from www.rb­ma­ (c) 2015 North Amer­ica Syn­di­cate Inc. All Rights Re­served

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