Cachexia: Causes, Symptoms, Treatment

What Is Cachexia?

Cachexia (aka “wasting syndrome”) is a condition that causes your muscles to waste away. It comes with extreme weight loss and can include loss of body fat along with muscle. It’s one of the symptoms you may have with chronic conditions, including:

• Chronic renal failure
• HIV
• Cancer
• Multiple sclerosis
• Kidney disease
• Congestive heart failure

Many conditions can cause you to lose weight, but cachexia affects you regardless of how much you eat. Normally, if you don’t eat enough food, you’ll only lose fat. Your body usually will hold onto your skeletal muscle mass, which you need for basic life function. But in cachexia, you’ll lose both fat and muscle early on.

A big difference between cachexia and regular weight loss is that it happens without trying. In this case, you don’t lose weight because you want to, but because of factors beyond your control. At the same time, your metabolism changes, causing the body to break down too much muscle. Inflammation affects your appetite and makes your body burn more calories than it should.

The condition is one of the body’s responses to fighting disease. When your nutritional stores get low, the body breaks down muscle and fat to get more energy to fuel your brain. You can get very weak, which makes you more likely to get infections, too. Taking in more nutrients or calories usually doesn’t make cachexia go away.

Cachexia vs. anorexia

Cachexia and anorexia both make you not eat enough and lose a lot of weight. However, cachexia is a metabolic disorder that comes with other health conditions, including cancer. Anorexia is an eating disorder that happens when you have a fear of gaining weight or you see your body in a distorted way.

When you have cachexia, you’ll lose muscle and sometimes fat. With anorexia, you’ll lose mostly fat at first. But if you’re really not getting enough to eat and lose 25% of your body weight, you can lose a lot of muscle from anorexia, too. Another difference is that when you have anorexia, eating or getting nutritional supplements will help you gain the weight back. When you have cachexia, getting more nutrition and calories won’t make it go away.

Stages of Cachexia

Cachexia happens in three main stages:

• Precachexia. This is where you lose up to 5% of your body weight due to a known disease. In this stage, you’ll lose your appetite. You’ll also have changes in your metabolism and inflammation.
• Cachexia. You lose more than 5% of your body weight in 12 months or less without trying to lose weight. Other symptoms include decreased appetite, inflammation, fatigue, and loss of muscle strength.
• Refractory cachexia. This happens when you have cancer and lose weight, muscle, and function. You’ll show a lack of response to cancer treatment. About 80% of people with cancer in its late stages have cachexia and a third will die from the condition.

Causes of Cachexia

Cachexia is caused by a variety of factors. When you have the condition, your body contains abnormal levels of certain substances. Your body won’t use the food you eat the way it should as your metabolism gets out of balance. These imbalances are part of what leads to weight loss and wasting of your muscles.

Several factors interact together and worsen the condition by:

• Causing inflammation
• Increasing your metabolism
• Preventing muscle growth
• Increasing muscle breakdown‌

The condition also makes your liver unable to respond well to insulin, leading to insulin resistance. This means that your body loses its ability to use blood sugar (glucose) for energy.

‌Cachexia has also been linked to:

• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis
• HIV
• Chronic renal failure, with about one in every four people with the condition showing signs of malnourishment
• Rheumatoid arthritis
• Crohn’s disease
• Congestive heart failure
• Organ failure

Cancer cachexia

Cancer cachexia is sometimes called “cancer anorexia-cachexia.” Research is still underway to find out why this happens and the other potential causes of cachexia.

One reason cancer leads to cachexia is that the disease causes your immune system to release certain chemicals called cytokines into your bloodstream. These chemical messengers cause inflammation that leads to muscle and fat loss. Cytokines also speed up your metabolism, making you burn calories faster.

Symptoms of Cachexia

When you have cachexia, the first symptom is muscle and fat loss, making you look like you’re not eating enough and are malnourished. In the early stages, you could have cachexia and still look like you have a normal weight. You also may show signs of:

• Fatigue, which makes it hard for you to enjoy the things you love
• Less muscle strength and muscle wasting
• Appetite loss
• Low levels of the albumin protein
• Anemia
• High levels of inflammation
• Loss of muscle mass and a low fat-free mass index
• Swelling or edema as low protein levels in the blood cause fluid to stay in body tissues

Treatment of Cachexia

Research has not established a single treatment plan or medicine that can cure cachexia. This is partly because of the many factors that cause it. The best approach would be to try several types of therapy, as changing your diet alone won’t work. You might also want to try the following:

• Make eating a social event. There is pleasure in sitting together with friends and family to share a meal. Thinking about the social aspect of eating instead of the amount of food you eat can help change your emotional, social, and psychological relationship to eating. It will also make you look forward to family mealtimes and feel less isolated for the sake of your mental health.
• Supplement your nutrition. Supplements alone aren’t enough to stop cachexia, but they may help when taken with other treatments.
• Use appetite stimulants. Medications such as megestrol and dronabinol can boost your appetite, but remember, eating more may not stop muscle wasting or stop the symptoms from getting worse. While products with cannabis (marijuana) in them may help, there isn’t enough good evidence for this yet.
• Anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or other drugs that fight inflammation may help prevent cachexia from getting worse.
• Branched-chain amino acids. These may help keep you from breaking down proteins or alter your metabolism, but more study is needed.
• Omega-3 fatty acids. One study showed an omega-3 fatty acid supplement helped with energy, appetite, and cachexia.
• Eat small, frequent meals. If your body can tolerate it, eat high-calorie foods in small portions throughout the day. Choose drinks with nutritional supplements between meals to get more calories and nutrients.
• Seek emotional support. Let your family or caregivers know how you feel and why you may not want to eat sometimes. When your family understands what you’re going through, it can help them give you the support you need.

Other tools that may help with cachexia include:

• Exercise
• Physical therapy
• Yoga
• Meditation
• Counseling, either alone or with a spouse or family members
• Support groups

If you have fatigue, mouth sores, or other symptoms related to your trouble eating and cachexia, ask your doctor if there are treatments that may help with those.

Complications of Cachexia

Cachexia itself is a complication of many other chronic conditions, including cancer. It can make you feel very weak and tired. When you have cachexia, you may have more trouble enjoying life due to a lack of energy.

Sometimes, pain in advanced cancer or other conditions goes along with cachexia. It’s not clear how cachexia and pain are related. But when you have cachexia and pain, it may make your loss of appetite, eating, and fatigue even worse.

Cachexia complications also include:

• Trouble functioning physically
• Worse response to chemotherapy
• More side effects from chemo or other treatments
• More risk of complications after surgery
• High medical costs

What is the life expectancy of someone with cachexia?

Cachexia is often a sign that another condition you have is advanced, and you are nearing the end of your life. But your life expectancy will depend on how severe your cachexia is and what stage of cachexia you’re at.

When you have advanced cancer, by the time you’ve reached the final (refractory) stage of cachexia, treatments won’t manage your cancer anymore. Generally, doctors don’t expect people with advanced-stage cachexia to live for more than 3 months.

Takeaways

Cachexia is a wasting syndrome that comes with advanced cancers and other serious health conditions. When you have it, you will lose weight and muscle mass without trying. There’s no treatment to make cachexia go away, but your doctor may be able to help you manage the symptoms and enjoy your life more.

Cachexia FAQs

• What are the symptoms of cachexia?

The main symptom of cachexia is the loss of fat and muscle. You’ll also lose your appetite and may have weakness and fatigue.

• What does it mean when someone is cachectic?

A person has cachexia or is “cachectic” when they’ve lost more than 5% of their body weight in 6 to 12 months without trying due to muscle wasting related to cancer or another serious disease. Before this stage, a person will have precachexia.

• Is cachexia a sign of dying?

Cachexia is a metabolic disorder that comes with many advanced cancers including:

• Pancreatic cancer
• Colon cancer
• Lung cancer

When you have cachexia and cancer, it’s a sign that your disease is affecting your immune system in ways that keep you from building muscle while the muscle you have breaks down. When cachexia reaches its final stages, you may be nearing the end of your life.

• How long can you live with cachexia?

How long you can live with cachexia depends on how severe it is and how advanced your cancer or another condition that’s causing the cachexia is. In the most advanced stages of cachexia, you will stop responding to treatment. At this stage, you’re not likely to live for more than 3 months.