If you find yourself feeling less hungry or eating less than usual, you may wonder if your multiple sclerosis (MS) is to blame. Over time, a loss of appetite can become challenging. The effects of not eating — such as fatigue, weight loss, weakness, and mood changes — can affect your health and quality of life.

Several members of MyMSTeam have described their experiences with reduced hunger. “All I want to do today is sleep. No interest in anything. No appetite,” one member said.

Another asked, “Does anybody suffer from loss of appetite? I have had no appetite for weeks. I researched it, and it’s a symptom of MS.”

A third member described how severe their condition became. “They threatened me with a feeding tube because I have no appetite, optic neuritis, weakness all over, and a dead right leg.” (Optic neuritis refers to inflammation of the optic nerve, which can cause pain with eye movement and vision loss.)

Read on to learn more about the link between MS and hunger, how a loss of appetite may affect your health, and when to talk to your doctor.

Does MS Affect Appetite?

It’s unclear how many people with MS regularly lose their appetite. The number is hard to track because many factors, including MS itself, can play a role.

Gastrointestinal (GI) problems, issues with the stomach or intestines, are common in people with MS. For example, about 70 percent of people with MS experience bowel symptoms, such as constipation (difficulty or infrequent bowel movements). This and various other types of GI-related symptoms can affect appetite.

Causes of Loss of Appetite in MS

There are many reasons someone with MS might lose their appetite. The most common causes include:

• Fatigue (extreme tiredness that doesn’t improve with rest)
• Swallowing problems
• Digestive issues
• Certain medications
• Nausea (feeling like you might vomit)
• Stress
• Changes in sense of taste
• Mood changes, especially depression
• Relapse (new or worsening symptoms)
• Cognitive impairment (problems with thinking and memory)

We’ll discuss several of these possible reasons below. Understanding the potential cause is the key to addressing the root of the problem.

Fatigue

Fatigue is very common in MS, affecting up to 90 percent of people with the condition. It refers to persistent tiredness that doesn’t improve with rest. Severe fatigue can make you too tired to eat or even forget to eat. When this happens regularly, it can lead to unintentional weight loss.

Swallowing Problems

Some people have MS symptoms that affect their swallowing and chewing muscles, making eating a challenge and sometimes even a risk. The medical term for this condition is dysphagia.

Studies have reported that up to 45 percent of people with MS experience symptoms of dysphagia. Severe cases can lead some people to choke or spit out their food. The lack of nutrition can eventually lead to unintended weight loss.

Indigestion

About 30 percent of people with MS experience indigestion (discomfort or burning pain in the upper abdomen, often accompanied by bloating or nausea). This can lead to feeling full or having abdominal pain and make eating less appealing.

A less common condition called gastroparesis, when the stomach doesn’t empty properly, can also cause early fullness and, in severe cases, weight loss from skipped meals.

Medications

Some medications may cause you to lose your appetite. Examples include certain antidepressants, such as bupropion, and stimulant medications sometimes used to fight chronic fatigue, such as methylphenidate.

Disease-modifying therapies (DMTs) are medications that help slow MS and reduce the number and severity of relapses. Certain DMTs can cause nausea as a side effect, including:

• Dimethyl fumarate
• Ocrelizumab
• Teriflunomide

Medications for mood disorders, including fluoxetine, can also cause nausea.

Nausea

Dizziness and vertigo (a sensation of spinning or moving), which some people with MS experience, can lead to nausea and a lack of desire to eat.

Stress

Living with a chronic (long-term) condition like MS can be very stressful. Stress and mental health disorders, such as depression, can affect appetite. People react to stress differently, and some people who have depression lack the energy to eat or simply don’t feel hungry.

Living with chronic pain can also affect how you feel about food. This doesn’t always lead to a loss of appetite, but pain may change how much you enjoy eating or the types of food you want, especially rich or fatty foods.

Altered Sense of Taste

MS can also affect your sense of taste. Some people have trouble recognizing salty, sweet, sour, or bitter tastes due to MS lesions (nerve damage). Others notice that their medications change how food tastes, either regularly or during flare-ups (periods of worsening symptoms). These effects can make eating less enjoyable and reduce appetite.

“I have had a loss of appetite, because my sense of taste and smell have been affected by the MS,” one MyMSTeam member wrote.

Another said, “On occasion, food can taste bland or gross to me.”

Other Health Conditions

In some cases, MS might not be the cause of your loss of appetite. Other health conditions can lead to unintentional weight loss, including:

• Thyroid disorders
• Hormonal disturbances
• Eating disorders
• Infectious diseases
• Cancer
• Chronic illness

Effects of Appetite Loss

A loss of appetite and the resulting weight changes can negatively affect your health. For example, malnutrition (poor nutrition) can cause low energy, changes in skin and nails, pressure sores (bedsores), and digestive problems. Malnutrition could also weaken your immune system, making you more prone to illness, and it can affect your ability to focus and think clearly.

One MyMSTeam member described their experience: “I’m malnourished because I can’t keep most foods down, and when I can, I’m not hungry.”

When To Check With Your Doctor

If your appetite has decreased and you’re not sure why, talk with your healthcare provider as soon as possible. This is especially important if you also develop fever, night sweats, a cough, bone pain, or other new symptoms. Unexplained weight loss or a lack of appetite can be a sign of another medical condition, ranging from thyroid problems to cancer.

When you visit your doctor, your evaluation may include:

• A review of your medical, surgical, and mental health history
• A review of your medications
• A physical examination
• A conversation about your dietary habits and any changes
• Possible blood testing
• A swallowing test (if there is concern about dysphagia)
• Additional tests or imaging, depending on the possible diagnosis

Once your doctor figures out why you’ve lost your appetite, the main goal is to treat what’s behind it. Depending on what they find, you may need a change in medications, counseling, nutrition supplements, or other treatments.

It may also be a good idea to ask your doctor for a referral to a dietitian, who can offer nutritional rehabilitation and recommend a balanced diet to keep you at a healthy weight. Your meal plan may include eating healthy snacks and small, frequent meals instead of three large meals, or changing recipes to make them easier to eat and more nourishing.

Join the Conversation

On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.

Have you found ways to make eating more appealing? Let others know in the comments below.