Dr. Keith Roach: There are many causes of weight loss
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 a series of 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.
Have you run across this before? Can you give my doctor and me your advice?
Dear W.M.K.: 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-of-control 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. I’d be willing to bet that your doctor looked at your thyroid, but you haven’t mentioned stool studies; fat in the stool is the simplest test for malabsorption.
Dear Dr. Roach: My doctor states that my body could tolerate 3,000 milligrams per day of Tylenol. I am 87 years old and in poor health.
Is he correct?
Dear R.B.: Depending on the exact reason for your poor health, your doctor probably is right.
A daily total limit of 3,000 mg of acetaminophen (Tylenol) is generally considered safe for most adults.
However, in the presence of significant liver disease or in people with heavy alcohol use, a limit of 2,000 mg is safer.
Email questions to ToYourGoodHealth@med.cornell.edu.