Weight Loss Concerns: Gastrointestinal Issues and Stress

Weight loss over the past year?

Hello, doctor.
I am a 32-year-old male, 172 cm tall and weighing 56 kg.
Since November 2021, I have been experiencing belching and bloating after meals.
I have consulted both Western and Traditional Chinese medicine, and they suggested possible gastritis or gastroesophageal reflux disease (GERD).
I have not undergone an endoscopy, but basic health checks and blood tests have shown normal results, except for slightly elevated cholesterol levels.
However, my weight has decreased over the past year, which concerns me.
I maintained a weight of 63-64 kg in 2021, and due to the pandemic, I did not exercise, reaching a maximum of 66 kg.
By January 2022, my weight was still around 63-64 kg, but I did not weigh myself daily.
On April 24, my weight was 60 kg, and on June 5, it was between 58.7-59.3 kg.
In July, I underwent an endoscopy that confirmed GERD with a slightly loose lower esophageal sphincter and gastritis, but no gastric ulcers were found.
In the same month, a dermatologist diagnosed me with shingles.
On August 1, my weight was 56.8 kg, and on August 4, it was 57.5 kg.
From September to November, my average weight was around 56 to 57.5 kg.
On November 21, my weight was between 55.9 and 56 kg.
Since November, I have been having a dinner of a box of vegetables with about 40 g of cereal.
I have not exercised this year, but my food intake has significantly decreased.
I have been taking Chinese medicine to adjust my constitution, skipping breakfast, and having half or less of a lunch box.
For dinner, I sometimes only eat vegetables without rice.
I drink half a cup of milk tea with a little sugar daily and almost do not eat late-night snacks.
Previously, I could finish a lunch box and still eat fried food or snacks.
My stomach has been uncomfortable for nearly a year, and after two months of PPI treatment in July, I saw significant improvement, but I still cannot eat too much.
Currently, I experience bloating after dinner, which can last until one or two in the morning when I go to sleep.
Sometimes, I feel a bloated sensation above my navel, which can be somewhat painful, leading to discomfort that requires me to lie down for a long time before feeling better.
I tend to be a nervous person and worry about pancreatic cancer, but I have not experienced tea-colored urine, pale stools, or jaundice.
Doctor, could my weight loss over the past year be due to my stomach issues, shingles, and stress-related insomnia, or should I consider undergoing some advanced health screenings at my own expense? Thank you, doctor.

Niming, 30~39 year old female. Ask Date: 2022/11/21

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please discuss with the attending physician about increasing caloric intake and whether to consult or refer to other specialties for assistance in diagnosis and treatment.

Reply Date: 2022/11/21

More Info

Weight loss, gastrointestinal issues, and stress are interconnected concerns that can significantly impact an individual's overall health. In your case, the combination of symptoms you've described—such as persistent belching, bloating, and weight loss—suggests that there may be underlying gastrointestinal disorders exacerbated by stress and anxiety.

Firstly, it is essential to recognize that gastrointestinal symptoms can often be influenced by psychological factors. Stress and anxiety can lead to increased gastric acid production and altered gut motility, which may manifest as bloating, belching, and discomfort after eating. This phenomenon is sometimes referred to as "functional gastrointestinal disorder," where the symptoms are real but do not necessarily correlate with identifiable structural or biochemical abnormalities.

Your history of weight loss is concerning, especially given that you have experienced a significant drop from your usual weight of around 63-64 kg to 56 kg over the past year. While some weight loss can be attributed to dietary changes and decreased appetite, it is crucial to rule out any serious underlying conditions. The fact that you have been diagnosed with gastroesophageal reflux disease (GERD) and gastritis indicates that your gastrointestinal tract is already compromised, which could contribute to your symptoms and weight loss.

The presence of shingles (herpes zoster) may also play a role in your overall health. While shingles primarily affects the skin and nerves, the stress associated with a viral infection can exacerbate gastrointestinal symptoms and lead to further weight loss. Additionally, the pain and discomfort from shingles may reduce your appetite, further contributing to weight loss.

Given your symptoms and the significant weight loss, it is advisable to consult with a gastroenterologist for a comprehensive evaluation. This may include further diagnostic testing, such as an upper endoscopy, to assess the state of your gastrointestinal lining and rule out any serious conditions, including malignancies. Although your previous tests have returned normal results, persistent symptoms warrant a thorough investigation.

In terms of managing your symptoms, consider the following strategies:
1. Dietary Adjustments: Focus on a balanced diet that includes small, frequent meals rather than large portions. This can help reduce bloating and discomfort. Avoid trigger foods that may exacerbate your GERD, such as spicy foods, caffeine, and fatty meals.

2. Stress Management: Since you mentioned being a naturally anxious person, incorporating stress-reduction techniques such as mindfulness, meditation, or yoga may help alleviate some of your gastrointestinal symptoms. Cognitive-behavioral therapy (CBT) can also be beneficial in managing anxiety and stress.

3. Regular Follow-ups: Keep regular appointments with your healthcare provider to monitor your weight and gastrointestinal symptoms. If your symptoms persist or worsen, further investigations may be necessary.

4. Medication Review: If you are currently taking any medications, discuss with your doctor whether they could be contributing to your gastrointestinal issues or weight loss.

5. Nutritional Support: If you continue to struggle with weight gain, consider consulting a registered dietitian who can help create a tailored meal plan that meets your nutritional needs and supports healthy weight gain.

In conclusion, while your gastrointestinal issues and weight loss may be related to stress and anxiety, it is crucial to rule out any serious underlying conditions. A comprehensive evaluation by a gastroenterologist, along with lifestyle modifications and stress management techniques, can help address your concerns and improve your overall well-being.

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