What supplements can be taken to help improve decreased appetite?

Supplements for Decreased Appetite

For cancer-related appetite loss, long-chain omega-3 fatty acids (fish oil) at 1-2 g/day of EPA+DHA are the primary supplement recommendation, with evidence showing improvements in appetite, food intake, lean body mass, and body weight, particularly in patients undergoing chemotherapy. 1

Primary Supplement Recommendation: Fish Oil/Omega-3 Fatty Acids

Long-chain N-3 fatty acids or fish oil supplementation is recommended to stabilize or improve appetite in patients with advanced cancer undergoing chemotherapy who are at risk of weight loss or malnourished. 1

Dosing and Formulation

• Standard dosing is 1-2 g/day of EPA+DHA combined, or 4-6 g/day of fish oil concentrate 2
• EPA alone can be supplemented up to 1.8 g/day safely 3
• The European Food Safety Authority confirms that combined EPA and DHA up to 5 g/day does not increase bleeding risk 3

Evidence of Efficacy

• Recent systematic reviews demonstrate that omega-3 fatty acids improve appetite, body weight, morbidity, and quality of life in weight-losing cancer patients 1
• Fish oil supplementation increases appetite even in healthy adults, with post-prandial fullness reduced and desire to eat increased, particularly in women 4
• Omega-3 supplementation may provide protective effects against chemotherapy-induced toxicities like peripheral neuropathy 1

Safety Profile and Precautions

• Generally well-tolerated with only mild gastrointestinal effects reported 1
• Fishy aftertaste or belching may impair compliance 1
• Critical exception: Patients receiving ibrutinib must avoid fish oil supplements due to risk of epistaxis 1, 3
• Safe to use with anticoagulants at standard doses (1-2 g/day) with appropriate INR monitoring for warfarin patients 3
• Does not cause clinically significant bleeding in most patients, including those on anticoagulants 3

Context-Specific Considerations

For Cancer-Related Anorexia

The evidence base for supplements in cancer-related appetite loss is stronger than for other causes of decreased appetite. The ESPEN 2021 guidelines specifically recommend omega-3 supplementation in this population with a weak recommendation based on low-level evidence, but note several positive trials published in recent years showing nutritional benefits 1

Non-Cancer Populations

• Evidence for supplements improving appetite in non-cancer populations is limited 2
• Iron supplementation (150 mg sustained-release ferrous sulfate daily) improved appetite and growth in anemic children, suggesting that correcting underlying nutritional deficiencies may help 5
• The American Society of Clinical Oncology states that evidence remains insufficient to support routine use of vitamins, minerals, or dietary supplements for treating cachexia in terms of meaningful improvements in morbidity, mortality, or quality of life 2

Supplements with Insufficient Evidence

The following supplements lack adequate evidence for appetite stimulation and should not be routinely recommended: 1

• Branched-chain amino acids or other amino acid metabolites 1
• Cannabinoids (insufficient data for taste disorders or anorexia) 1
• Non-steroidal anti-inflammatory drugs 1
• Currently approved androgenic steroids 1

Adjunctive Nutritional Strategies

• Oral nutrition supplements combined with dietary counseling improved appetite and nutrition outcomes in cancer patients undergoing treatment 6
• Referral to a registered dietitian for nutritional counseling helps patients meet energy and protein needs 2
• Multimodal approaches combining omega-3 fatty acids with other interventions (such as L-carnitine, celecoxib, and antioxidants) may show better outcomes than single-agent therapy 2

Common Pitfalls to Avoid

• Do not recommend fish oil to patients on ibrutinib - this combination causes epistaxis 1, 3
• Do not expect omega-3 supplementation alone to reverse severe cachexia - it stabilizes rather than dramatically reverses weight loss 1
• Do not use doses exceeding 5 g/day of combined EPA+DHA without physician supervision, though bleeding risk remains low even at these doses 3
• Taste issues (fishy aftertaste) are the primary barrier to compliance - counsel patients about this upfront 1