Q: I have a long history with appetite issues. I used to have a very fast and healthy metabolism, no issue eating a ton of food. I exercised a lot, always very skinny but healthy. Lately my appetite has been nonexistent and I really don’t know why. I am at a loss. I still have a decent amount of energy, and I try and exercise, but that doesn’t do too much to help. I have no idea what to do. Any advice would be very appreciated.

As an internal medicine specialist, I have a voracious appetite for complex medical enigmas, to try and solve medical mysteries. I feel so satisfied when I can provide a solution to a lifetime of medical concerns and truly help a patient on the road to recovery.

Your issue with loss of appetite is an intriguing and challenging problem that will be difficult to tackle in this column without a lot more information. But that’s not to say that I won’t try!

On one hand, you state that you have had a long history of appetite issues, which implies to me that this is a more chronic problem, but you also state that you have had more recent issues with poor appetite, which tells me that something new may be going on.

Before we get to advice, it is vital to try to figure out the underlying source of your anorexia (the medical term for loss of appetite, not to be confused with anorexia nervosa, which is another column for another day).

A loss of appetite can be physical or psychological, and is often temporary due to factors such as infection or digestive issues. Once the cause is determined and treated, the appetite will often come back.

Common short-term causes of poor appetite include colds, flu, other respiratory infections, acid reflux and food poisoning, to name a few. Other frequent causes include food allergies, pregnancy, stress, side effects from numerous medications, and alcohol and drug use.

More chronic underlying medical problems can also present with poor appetite. Examples include digestive conditions such as Crohn’s disease or irritable bowel syndrome, asthma, diabetes, chronic liver or kidney disease, and many cancers, to name just a few. Using drugs recreationally, especially cocaine and amphetamines, or going through drug withdrawals, especially from cannabis, will also lead to poor appetite.

Finally for today’s discussion, there are many psychological causes of poor appetite, including depression, anxiety, panic disorder, stress and grief, to name just a few.

So you can see why I need a lot more information to truly answer your question! You need a full medical work-up to find out what is causing your concerning symptoms.

There are treatments for poor appetite, including medications that can stimulate your hunger, but it is most urgent to find out the reason behind the symptoms. Smaller but more frequent meals may help somewhat, and staying well hydrated is important to your health.

The fact that your energy is still good is a positive sign. You did not mention, however, if your weight has been affected. I also want to know if you are having other symptoms such as stomach pain or diarrhea.

So, my best medical advice is for you to see your health care practitioner as soon as possible. It sounds like you are truly hungry to get some answers.