Appetite problems may not have to be part of your new normal

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How’s your appetite been? My guess is that it’s been better. Since your injury, maybe you’ve had some ups and downs with wanting to eat.

Maybe you just don’t feel hungry throughout the day. You find it hard to stomach food and what you used to eat just don’t seem as appetizing. You might even get to the end of the day, and only then realize how little you have eaten. You then feel you should eat something, so you unpleasantly force yourself to grab some bites.

And this sucks. Because you used to love food. Now when you do eat, you might only go for what’s fast, easy, and convenient. But these foods just don’t make you feel good. You might even find that once you start eating them, you just can’t stop! Your appetite swings again and all of this is making your recovery harder.

When I talk with other survivors, almost everyone says they have problems with appetite. Either they feel they have lost it completely, or they have periods when they feel they are overeating. Yet, when you search online for brain injury and nutrition, you mostly come across articles on supplements plus foods to eat and avoid — you get info on WHAT to eat.

Focusing only on what to eat would be like saying exercise is good for recovery, so get on a mountain bike and do a bumpy trail through the woods…

Just as that level of exercise is inappropriate for a person struggling with a brain injury, so is a list of foods to include or avoid that don’t take into consideration a person’s ABILITY to eat.

I know you want to enjoy your food. I know it’s hard to feed yourself when you don’t have any desire to eat. I know you feel like you don’t have any control over this.

But there’s a chance you do.

Appetite is something we can look at and work on. There are many reasons why you may have problems with appetite post injury. So for you today, this article looks at some of the reasons and what you can start doing to help overcome your challenges with appetite.

Why has my appetite changed post injury?

Your appetite is complex! It’s run and influenced by all sorts of hormones, neurons, genetics and environmental factors. And your brain injury adds yet another layer. There aren’t many, but a couple of studies have showed changes in appetite post injury (Suskaver et al. 2017). And it seems women are more likely to experience these changes than men (Brickell et al. 2016).

But what’s the cause? Here are some things that may contribute as culprits in brain injury:

#1 Damage to nerves involved in appetite. The most obvious cause may be the actual trauma to nerves related to how you perceive food. For example, damage to the olfactory nerves as well as to the fontal & temporal lobes of the brain may impair the sense of taste and smell. A person with this kind of trauma may not be able to recognize different odors or taste various flavours the same way they used to (Devere. 2017).

#2 Speech and swallowing problems. These issues are known as dysphasia and dysphagia. These can be common in certain brain injuries (Kjaersgaard, & Kristensen. 2017). Problems with appetite are often noted in tandem (Modirrousta et al. 2013).

#3 Problems related to digestion. Another common complaint I hear (and the topic of a future article) is gastrointestinal problems. This may be things like IBS or acid reflux. Reflux can for sure irritate the mouth, tongue and the upper parts of your digestive tract. Plus the acid itself can leave behind a bitter taste. And having to run to the bathroom (or not being able to go at all!) can really lower your drive to eat (Devere. 2017).

#4 Other symptoms. Do you have any nausea? Vomiting? Dizziness? This sort of goes with the above, but these common TBI symptoms are no fun as guests at the dinner table.

#5 Changes to the gut microbiome? This is a very popular area of science right now, but one we don’t know enough about. Still, it seems the microbes in your digestive system could be affected by your brain injury (Rice et al. 2019) and that some of the bacteria in there help spark appetite (Fetissov. 2017). So stay-science-tuned as we unfold this part of the mystery!

#6 Mood and mental health. It is well-known that changes in appetite happen in depression and anxiety, and that these mental health problems can come bundled with TBI. Changes in appetite can look like impulsive eating to help cope with distressful emotions (Tatsi et al. 2019). It can also be experiencing less pleasure with food, and therefore not wanting it as much (Coccurello. 2019).

#7 Loneliness and isolation. This is tied to the above, but I thought it warranted its own focus. The nature of your brain injury can force you into isolation. Isolation and loneliness may also trigger eating habits you might not otherwise choose for your health (Tatsi et al. 2019).

#8 Medications. Taking medications can be very important for your recovery. They have many pros, and they also have cons. For certain people some medications may cause appetite changes. Typically these are medications that can cause a dry mouth or have gastrointestinal side effects (Devere. 2017).

#9 Sleep troubles. Disturbed sleep is another common symptom in TBI. Misaligned sleep schedules, like those in shift work, can confuse your body’s natural rhythm (Qian. 2019). This as well as sleep deprivation can affect your hunger, satiety, and cravings (Knutson. 2007).

#10 Skipping meals. Whether this is due to not having enough energy to cook, or not even having enough energy to eat, I often see that people who routinely skip meals have lost connection with their sensations of hunger & satiety — their perception of their appetite changes (Leidy & Campbell. 2010).

What can I do about my appetite problems with brain injury?

“Oh, I thought I’d just have to live with no appetite forever!”

This was something one client said to me after I told them we could take a look at solving their appetite problem 🙂

When I work with clients, appetite is one of the first places I start. If you have appetite problems, here are 4 things you can do to get started.

#1 Get a medical review. There are many health issues that could be contributing to your appetite problems. You’ll want to rule them out! Talk to your doctor about blood tests you can do related to appetite. Some common ones might be looking at blood sugar and thyroid hormone levels.

#2 Work towards a meal and snack routine. I know this one is easier said than done! Routine is definitely a friend to your brain, but also to your stomach. A routine of when and where you eat may or may not fully solve your appetite problems. But it will definitely give you the foundation you need to get good nutrition in the face of poor appetite. It will also help you reconnect with your lost hunger and satiety cues, if this is possible for you.

#3 Eat with others! I know this one has it’s pros and cons. The idea of a family dinner or friend potluck may be overwhelming. Social eating can be overstimulating. But as isolation and loneliness really impact your health and appetite, this is worth you working on. Think of one or two good people you can invite over to quietly dine with. It could be neighbour. It could be a family member. It could be a friend who needs an excuse to get out of the house! The benefits will be huge for you and your pal. Plus the good ones will even help you get the groceries and cook! And the REALLY good ones will wash your dishes 😉

#4 Don’t beat yourself up over eating to cope with tough emotions. Brain injuries are rough. There is no one perfect coping mechanism for all the distress this is causing you. If you find you are eating in response to your emotions instead of to your appetite, allow yourself to recognize this for what it is, without judgement. Yes, everyone would benefit from working on a selection of healthy ways to cope. But beating yourself up over eating for emotions can only make this aspect of managing your appetite more difficult. You’re a champion just for coping 🙂

Your appetite is quite the intricate system. My hope for you is to work with your appetite in a way that allows you to get good nutrition and enjoy food 🙂

If your appetite is low and you want help getting to the root of the issue

OR

If you find you’re craving food all the time

OR

If you have a physical or neurological issue that has killed your appetite, and you want to get nutrition without it feeling like a chore…

I can help.

Book a free call with me. And we’ll appropriately get you back up on that bike 🙂

Best in brain health for all,

Krystal Merrells, Registered Dietitian

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References:

Brickell, T. A., Lippa, S. M., French, L. M., Kennedy, J. E., Bailie, J. M., & Lange, R. T. (2017). Female Service Members and Symptom Reporting after Combat and Non-Combat-Related Mild Traumatic Brain Injury. Journal of Neurotrauma, 34(2), 300–312.

Coccurello, R. (2019). Anhedonia in depression symptomatology: appetite dysregulation and defective brain reward processing. Behavioural Brain Research, 112041.

DeVere, R. (2017). Disorders of Taste and Smell. CONTINUUM: Lifelong Learning in Neurology, 23(2), 421–446.

Eirini Tatsi, Atiya Kamal, Alistar Turvill, Regina Holler4 (2019) Emotion dysregulation and loneliness as predictors of food addiction, Journal of Health and Social Sciences 2019; 4,1:43-58.

Fetissov SO. Role of the gut microbiota in host appetite control: bacterial growth to animal feeding behaviour. Nat Rev Endocrinol 2017;13:11–25.

Kathryn R. Kinasz, David A. Ross, and Joseph J. Cooper, Eat to Live or Live to Eat? The Neurobiology of Appetite Regulation, Biol Psychiatry. 2017 May 01; 81(9): e73–e75.

Kjaersgaard, A., & Kristensen, H. K. (2017). Brain Injury and Severe Eating Difficulties at Admission—Patient Perspective Nine to Fifteen Months after Discharge: A Pilot Study. Brain Sciences, 7(12), 96.

Knutson, K. L., Spiegel, K., Penev, P., & Van Cauter, E. (2007). The metabolic consequences of sleep deprivation. Sleep Medicine Reviews, 11(3), 163–178.

Leidy, H. J., & Campbell, W. W. (2010). The Effect of Eating Frequency on Appetite Control and Food Intake: Brief Synopsis of Controlled Feeding Studies. The Journal of Nutrition, 141(1), 154–157.

Modirrousta, M., Price, B. H., & Dickerson, B. C. (2013). Neuropsychiatric symptoms in primary progressive aphasia: phenomenology, pathophysiology, and approach to assessment and treatment. Neurodegenerative Disease Management, 3(2), 133–146.

Rice, M. W., Pandya, J. D., & Shear, D. A. (2019). Gut Microbiota as a Therapeutic Target to Ameliorate the Biochemical, Neuroanatomical, and Behavioral Effects of Traumatic Brain Injuries. Frontiers in Neurology, 10.

Suskauer, S. J., Rane, S., Reesman, J., & Slomine, B. S. (2018). Caregiver-report of symptoms following traumatic brain injury in a small clinical sample of preschool-aged children. Journal of Pediatric Rehabilitation Medicine, 11(1), 7–14.

Qian, J., Morris, C. J., Caputo, R., Wang, W., Garaulet, M., & Scheer, F. A. J. L. (2019). Sex differences in the circadian misalignment effects on energy regulation. Proceedings of the National Academy of Sciences, 201914003.