Nausea when eating: poor appetite? picky eater? or what?

[rideyerbike]

Hello,

I have been through a lot with Crohn's (since '94). Lately I've been on this cycle of losing weight and being unable to gain it back. I was on TPN for 9 months and not eating anything which probably caused some stomach shrinkage, but I've been back on food for about 6 months now and need to gain weight.

I'm 6'2" and 125 lbs.
I was 145 when on TPN.
I've been as low as 120 lbs and as heavy as 155 lbs. in the past.

My current barrier to gaining weight seems to be low appetite. I just can't get enough food in. Complicating this is that food seems less appealing. The only food that seems appealing is junk food (which only makes my disease worse). When I'm eating some healthy food that I used to be able to tolerate in much higher quantities, I start to get nauseous before I've eaten a decent amount. I don't know what is causing this lack of appetite/nausea/increased pickiness. Any thoughts/suggestions?

My other symptoms aren't even that severe right now which confounds me all the more. Just low energy, and achiness. No intense pain.

I'd appreciate your suggestions.

 

[Jennifer]

Hi rideyerbike and welcome to the forum! Sorry to hear that you're having some issues right now but hopefully we'll be able to help.

A few things came to mind while I was reading your post. One being a possible vitamin deficiency. You seem to be craving certain foods and there could be a reason such as being low in salt which will make you crave salty foods. If you haven't had your vitamin levels tested I highly recommend it. People with Crohn's are often low or deficient in vitamins and nutrients mainly due to absorption issues caused by inflammation and scar tissue etc. Check B12, Iron, Potassium, Magnesium, Folic Acid, vit A, B, C, D, E, K and Zinc etc. Being low in any of these can also cause fatigue and many other not so nice symptoms.

Another thing that comes to mind is you say your body prefers junk food yet you want to eat healthy food but tend to become nauseated. Do you not feel nauseous when you eat large amounts of unhealthy foods? Are these healthy foods high in fiber or are they raw? Foods higher in fiber move through your digestive tract faster so if there's a narrowing/stricture caused by inflammation or scar tissue then it will start to back up and bottleneck in that area which can make you nauseous or even vomit.

It sounds like you may be in a mild flare. Have you had any testing done recently (blood work or scopes etc)? Usually when I'm in a flare whether its extreme or mild (every flare is different) I follow the low residue diet. http://www.crohnsforum.com/wiki/Low-Residue-Diet All that is is low salt, low fiber, low fat, little to no soda (only 8 ounces if you have any), low sugar, minimal spices (a little pepper but nothing too spicy), no skins, no seeds, no nuts and nothing raw (no salads, any veggies must be steamed with seeds and skins removed) etc. You can make any meal low residue.

You may also want to try eating smaller yet more frequent meals. Instead of 3 times a day you could try 6 times a day. This way you can be sure that you have nutrients constantly going in (almost ) yet are able to tolerate the amounts you take in with less symptoms.

If this continues and none of the above helps any then this is something you'll really want to talk to your GI about as we don't want you to continue losing weight when there could be something going on. Keep us posted on how you're doing.

Also just to be clear, currently you're not on any medication is that correct? Besides TPN, have you taken anything for Crohn's on the past?

 

[UnXmas]

I have very similar problems. I have delayed gastric emptying for reasons probably unrelated to inflammatory problems like IBD.

Have you tried domperidone? It helped me for a while, though it's stopped working now. I don't know why it doesn't work for me anymore, but it was very useful for several months. It reduces nausea and helps the stomach empty more quickly. I think you can even get it without a doctor's prescription in the UK, though my doctors were always happy to prescribe it. It doesn't have many side effects and the risks are limited to specific groups of patients - most people tolerate it very well.

It really doesn't sound like you're a picky eater! Or only to the extent that symptoms force you to be picky. And that actually works in our favour - eating what we feel like is sometimes the best way to get things down.

Semi liquids go down easier and can pass through the stomach quicker. Pudding and supplements and things. Are you prescribed any supplements? Also I find sugar less filling than fat. Eating calorie-dense foods rather than things full of fibre and water helps. And eating little and often.

Are your doctors helping you out with this at all? Have they checked there's no specfic problem that could be making you feel sick? Do you think it may be just takes a long time to get over the period where you weren't eating?

I know how this can be a really difficult problem, I've started my own threads on it but it seems to be something I'll just have to keep dealing with. Even when a healthy weight is reached, we still have to maintain it! There are things that make it easier though, and definitely check with your doctors in case there's more they can do to help you out.

 

[AckMac]

I don't have any good advice but wanted to say that I hope you feel better soon!

 

[rideyerbike]

Hey folks,
Thanks for the replies.

I have been on every medication in the book including Remicade, Humira, Cimzia. I've been on many courses of steroids in the past; had several operations; permanent ileostomy; no colon; tried every Crohn's diet in the book: raw, 80-10-10, low residue, specific carb diet, etc.

I've failed on basically everything out there and am now looking towards getting an autologous stem cell transplant in the new year. I just want to be a decent weight and stronger than I am now going in so that my recovery is faster.

I have had a not-so-minor flare going on for at least 5 years, but really as long as I can remember to some extent.

I'm currently on 6-MP or purenithol--a basic immune suppressant similar to Imuran.

Things that I used to be able to eat lots of like oatmeal, steamed yams and other steamed veggies, seem to spark this nausea. And I'm still hungry when it happens!

I think the vitamin/mineral deficiency is a good hypothesis. I'll have to look into that more. I get some things tested on a regular basis like iron, but not everything.

I currently take boost/ensure to help supplement/get calories down. I also do fruit/green smoothies, which seem to go down ok as long as there is not too much greens in the mix.

Any further thoughts.