Are you feeling thin and lifeless? Let's learn about Cachexia (Wasting Syndrome)!

Do you sometimes think, 'Oh, why am I so thin? I can't even eat. I'm so tired all day long.' Or have you seen someone close to you suffer from this condition? In fact, there is a very disturbing condition that can occur with some severe, long-term diseases. Doctors call it Cachexia , or Wasting Syndrome . This is actually a condition that affects about 9 million people worldwide. Simply put, it causes the body to gradually waste away. The name comes from two Greek words, "kakos" (bad) and "hexis" (condition). So, "bad body condition" is what it means. This is not an easy thing to do, but let's talk about it in detail, because it is very important to be aware of it.

What are the symptoms of Cachexia?

Doctors may use the word "cachectic" when talking about this condition. See if you or someone you know has these symptoms:

• Unexplained weight loss: This is the main symptom. You keep losing weight, even if you're not trying to lose weight and are eating a healthy diet. Usually, if you lose 5% or more of your total weight within 6 to 12 months, doctors may be suspicious. For example, if you weigh 60 kilos, losing 3 kilos or more could be a sign of this.
• Muscle loss: Doctors also call this muscle wasting or muscle atrophy . Simply put, the muscles in your body gradually lose their strength. They become smaller and weaker. You may find that even tasks that were easy before seem difficult to do.
• Fatigue and weakness: This is not just normal fatigue. You feel so exhausted all day long that you can't do anything. You may not even feel like getting out of bed.
• Anorexia (loss of appetite): Loss of appetite. Food is no longer visible and tastes bad. This is different from the eating disorder called Anorexia Nervosa . This is a condition in which the person loses their appetite due to the illness.

Why does Cachexia occur?

Simply put, cachexia occurs when the relationship between our body's energy demand and the energy supply we get from food is disrupted. The main reason for this is the presence of a serious chronic illness, such as cancer, or heart disease.

Imagine, when you get a serious illness, your immune system starts fighting that illness. Then your body's metabolism speeds up. That means your body needs more energy than usual. But, because of that illness, your appetite may also decrease.

So, when you don't get enough energy from food, what does your body do? It starts to draw energy from your muscles and fat deposits. That's why you lose weight and your muscles melt away.

To put it a little more scientifically, there are several specific reasons that affect this:

• Increased Cytokines: Cytokines are special proteins in our immune system. These help our body fight off invaders like viruses. However, in Cachexia, these cytokines increase too much and cause inflammation throughout the body. This causes fat and muscle loss.
• System-wide inflammation: This inflammation caused by chronic diseases like cancer also causes fat and muscle wasting.
• Insulin resistance: Insulin is a hormone that controls blood sugar in our bodies. Insulin resistance means that our muscle and fat cells do not respond properly to insulin. In cachexia, this condition can lead to further muscle wasting.
• Increased protein turnover: There is a process in our cells where new proteins are made to replace old proteins. This is also called protein degradation . In cachexia, the rate at which these proteins are broken down increases faster than the rate at which new ones are made. This means that the body uses more protein than it makes new ones. This is also a major cause of muscle loss.

What conditions are most commonly associated with Cachexia?

Cachexia is most commonly seen in cancer patients. Studies show that about 40% of cancer patients have cachexia when the disease is first diagnosed, and about 70% of patients with advanced or late-stage cancer have cachexia.

However, this condition can occur not only in people with cancer, but also in people with other serious chronic diseases. Here are a few examples:

• Congestive heart failure: Between 16% and 42% of people with heart failure may develop cardiac cachexia.
• Chronic obstructive pulmonary disease (COPD): Cachexia develops in 27% to 35% of people with COPD.
• Chronic kidney disease (CKD): This condition affects between 30% and 60% of people with CKD.
• Certain infectious diseases: For example, cachexia is common in advanced stages of AIDS (Acquired Immune Deficiency Syndrome) . It can also develop in people with diseases such as tuberculosis and malaria.
• Chronic inflammatory diseases: Between 18% and 67% of people with inflammatory joint conditions, such as rheumatoid arthritis , are likely to develop cachexia.

What are the complications of cachexia?

Cachexia is a condition that can be life-threatening. Consider this, Cachexia is responsible for 20% of cancer deaths. Because when it causes muscle wasting, it can affect the heart and breathing.

Typically, a diagnosis of cachexia means that the end of life is near. This is difficult news to hear, both for the patient and for their loved ones. It can also lead to psychological problems such as anxiety and depression.

When cachexia causes weight loss and changes in appearance, some people may feel embarrassed and anxious. It is also very sad to be unable to do your own work because of the weakness in your body.

Research has shown that there can be some unpleasant interactions between the person with cachexia and their caregivers. Imagine how difficult it is to watch your loved one become thin, weak, and lose their independence. Sometimes, caregivers think, "If I just give them a little more food, I'll be able to control this." However, when the patient refuses to eat, they feel sad and angry. This pressure to eat can make even family gatherings unpleasant. Some patients pretend to be asleep when guests come over, hoping that they will force them to eat.

How is Cachexia diagnosed?

The first thing a doctor will do is give you a physical examination. They will ask about your general health, any other medical conditions you have, especially whether you are taking any chronic medications that may be causing your cachexia. They may also do tests to check your physical fitness and muscle strength. They may also do blood tests, such as a Comprehensive Metabolic Panel (CMP) , and a CT (Computed Tomography) scan .

How is Cachexia treated?

In fact, there is no specific treatment for cachexia yet. Doctors mainly focus on treating the underlying condition that caused cachexia. That means treating the cancer, heart disease, or other chronic disease is the most important thing.

Additionally, when you have an appetite, you can be recommended ways to increase the amount of food you eat.

For example, doctors may recommend eating small, frequent meals that are high in protein, fat, and calories . Even if you can't eat a large meal at once, eating smaller meals more often can help you get more calories. It's a good idea to talk to your nutritionist about what foods are appropriate for you at this time of year and how you can get the most out of every bite you eat.

Is there a cure for cachexia?

Currently, there is no specific medication approved for cachexia. Although some research suggests that the drug megestrol acetate may increase appetite and cause some weight gain, it is not yet approved by the US Food and Drug Administration (FDA) as a treatment for cachexia caused by cancer. In some cases, doctors may prescribe medications such as corticosteroids for a short period of time.

What can caregivers do?

If you are caring for someone with cachexia, it is important to remember this: When cachexia develops due to a serious illness, the body's metabolism speeds up, so patients do not feel hungry. That is why, even if you give them more calories , the cachexia condition does not always improve. Force -feeding only increases symptoms such as nausea and vomiting. This makes the patient even more uncomfortable.

So, instead of forcing your loved one to eat, think of other ways to comfort them. For example, small things like giving them a massage every now and then, applying some lotion to their body, or applying moisturizer to their lips if they are dry can be very comforting. It is also very important for you to talk to them and listen to them.

If I have Cachexia, what should I expect?

If you have this condition, you may already be suffering from a serious, possibly terminal illness. Depending on your condition, a diagnosis of cachexia may mean that you are nearing the end of your life. However, because there are so many conditions that can cause cachexia, your condition may be completely different from someone else's. Therefore, the best way to know what to expect is to talk to your healthcare team. Be open with them.

How do I take care of myself?

Although there is no definitive guide to living with cachexia, these suggestions may help you:

• Eat well (but not forcefully): Eat when you feel like eating. But don't force yourself to eat because you absolutely have to.
• Try smaller meals: When you're feeling stressed, you may not feel like eating a big meal. So, try eating smaller portions of higher-calorie foods several times a day. Talk to your nutritionist about meal ideas.
• Do light exercise: If possible, doing very light exercise can help strengthen your muscles. Even just walking or shaking your arms and legs a little will do.
• Get mental health support: It's common for people with serious illnesses like this to experience stress and depression. So, never hesitate to ask your medical team for help with this.
• Consider palliative care: Palliative care is a specialized form of treatment that helps manage your symptoms and the side effects of treatment.
• Ask about hospice support: Ask your medical team about hospice support. This may include support from people like spiritual counselors and social workers.

Is tube feeding a treatment for cachexia?

Doctors generally do not recommend enteral feeding and parenteral nutrition for cachexia, as these treatments have not been proven to improve cachexia or extend life.

Tube feeding is the administration of liquid nutrition through a flexible tube inserted through the nose, directly into the stomach, or into the small intestine. Parenteral nutrition is the administration of nutrition directly into a vein through an IV line.

Finally, what to remember (Take-Home Message)

Cachexia, or Wasting Syndrome, is a condition that affects people with serious chronic illnesses, especially advanced cancer and heart disease. Often, it is considered one of the final stages of life. This is truly heartbreaking news to hear, whether you have cachexia or are caring for someone who does. Your doctors know how much cachexia can disrupt your daily life and affect your mental health. If you are in this situation, do not hold anything back and seek mental health support from your medical team. Remember, you are not alone. The most important thing is to be aware of this, understand it, and get the help you need.

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