28-Year-Old Female Experiencing Unintentional Weight Loss
Five months prior, my weight was 120 kilograms, but it has since dropped to 98 kilograms. I have noticed a significant decline in my appetite, yet I feel like I might still be consuming a considerable number of calories. This situation began with gastrointestinal issues, including nausea and frequent diarrhea. At that time, I was prescribed several psychiatric medications for bipolar affective disorder (BPAD), specifically clozapine, lithium, and venlafaxine, but had to discontinue them because I couldn't tolerate them anymore. I am currently taking asenapine, which I believe has a more neutral metabolic profile. Upon returning from a trip to Singapore, I suspected that I might have contracted a virus there. I underwent various tests, including blood and stool analyses. My full blood exam and electrolytes returned normal results, as did the C-reactive protein and thyroid-stimulating hormone levels, although I did have a slight iron deficiency. The fecal calprotectin level was marginally elevated, but the fecal PCR and cultures came back normal. Recently, I had the opportunity to trial a continuous glucose monitor (CGM). I experienced several episodes of hypoglycemia, leading me to think that I might be experiencing minor insulin dumping, which could be linked to a gastric sleeve procedure I underwent about five years ago. That surgery initially helped me shed approximately 15 kilograms, but within four years, I regained around 30 kilograms. While my stomach capacity remains reduced, I am able to consume a substantial quantity of food. Approximately three months ago, I underwent both gastroscopy and colonoscopy. These procedures revealed some aphthous ulcers, which are clinically suggestive of mild Crohn’s disease, but not enough inflammation was present for a definitive diagnosis based on histopathology. During my consultation with a gastroenterologist, I had just started Humira for hidradenitis. The doctor mentioned that while Humira would potentially help with Crohn's, my condition was so mild that even without the medication, he would not recommend any specific treatments. He surmised that my diarrhea might be stress-induced, and although I am often under pressure as a junior doctor, I typically gain weight during stressful periods. I've been experiencing early morning awakenings and a degree of heat intolerance. On a positive note, my mental health is currently in a good place. I do not smoke or use recreational drugs. I consume alcohol socially and maintain an active lifestyle, attending the gym three times a week. Existing medical conditions include: - Narcolepsy - Hidradenitis - BPAD Type 1 Current medications are as follows: - Humira - Dexamphetamine (which I've actually reduced after years of use) - Armodafinil - Asenapine I remain pleased with my weight loss, as this feels like the simplest dieting experience I've had. However, I'm uncertain whether this weight reduction signifies any underlying issues. My gastroenterologist plans to reassess me in six months with another calprotectin level check, and he does not appear to be worried at this time. Are there additional blood tests I should be considering?
Answers (1)
8/30/2025, 2:24:24 AM
OpenHealth AI
It’s encouraging to see that you’re taking an active role in managing your health, and you're aware of both your weight loss and its potential implications. Unintentional weight loss, especially coupled with gastrointestinal symptoms, certainly warrants attention. Here’s a structured approach to your situation:
Main Points
You’ve experienced significant weight loss and gastrointestinal issues, and you’re wondering if there are underlying health concerns related to these changes. Your current medical investigations have shown some abnormalities, but nothing definitive has yet been established.
Explanation
Weight loss can be caused by a range of factors, including gastrointestinal disorders (like Crohn's disease), medication side effects, psychiatric conditions, stress, dietary changes, or even malabsorption due to your gastric sleeve surgery. The slight iron deficiency and elevated fecal calprotectin suggest some underlying inflammation, which aligns with your potential Crohn’s diagnosis, reflecting a need for careful management and monitoring.
You’ve also noted early morning awakenings and heat intolerance, which can sometimes be linked to stress or endocrine issues. However, your recent mental health management seems to be stable, which is great.
Next Steps
Here are some prioritized actions for you to consider:
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Monitor Symptoms: Keep a detailed log of your food intake, symptoms, and any changes in bowel habits. This data can help your gastroenterologist identify patterns or triggers during your next appointment.
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Nutritional Assessment: Consider consulting with a nutritionist or dietitian with experience in gastrointestinal health. They can help ensure that your diet is providing adequate nutrition, especially in the context of your weight loss and potential Crohn’s disease.
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Iron Supplementation: Since you have a slight iron deficiency, discuss with your doctor whether you should start an iron supplement or increase dietary iron intake. Symptoms of iron deficiency can include fatigue and further weight loss.
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Routine Blood Work: While your gastroenterologist has a plan for re-evaluation, you may want to request:
- Vitamin D levels: This can often be low in individuals with gastrointestinal issues or limited dietary intake.
- B12 and Folate: These vitamins are essential, especially following gastric surgery, as absorption may be affected.
- Comprehensive Metabolic Panel: To check electrolytes, liver function, and kidney function regularly.
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Potential Causes for Hypoglycemia: Keep monitoring your glucose levels if your episodes of hypoglycemia persist. Discussing these occurrences with your healthcare provider will be crucial in determining the next steps in your management plan.
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Manage Stress: Since stress may impact your gastrointestinal symptoms, consider exploring stress-reduction techniques such as mindfulness, therapy, or yoga.
Let your healthcare providers know about any significant changes in your symptoms or weight in the meantime. Continue to stay engaged in your health, and reach out if you have more questions or need further clarification!
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