Dear Dr. Roach >> I am a 71-year-old healthy, active woman. I normally work out six days a week and used to be in very good shape. I am having stomach issues, which caused me to lose 20 pounds since the end of December 2023. I was thin to begin with and have lost a significant amount of muscle and most of my body fat. I was diagnosed with gastric intestinal metaplasia in 2019 and was having trouble eating, but I didn’t lose any significant weight at that time. No treatment was recommended beyond a suggested follow-up in a year or two.

I have difficulty eating anything but a small amount of food, and if I do “overeat,” I vomit. Eating is beyond a chore, and I continue to lose weight. I have been worked up with no conclusions in sight. I had a colonoscopy two years ago that was normal. I had an abdominal CT scan with and without contrast, an endoscopy, an MR enterography, and a brain scan this year, with no results that explain my problem.

I am seeing another GI doctor soon, but I’m not particularly hopeful. I am 5 feet, 11 inches tall, and now weigh 129 pounds. I am feeling desperate. Do you have any ideas?

— L.W.

dear reader >> Weight loss can have many different causes, and it seems like your doctors have carefully looked for many of the concerning ones. Key features of your story are that you are vomiting and losing weight.

Intestinal metaplasia is when the lining of the stomach develops a microscopic appearance, similar to the intestines. This can predispose people to stomach cancer, but intestinal metaplasia can also be associated with low acid in the stomach.

Vomiting after eating normal amounts of food is a concern for a stomach mass, but between the endoscopy and the CT scan, it should have shown up. I would be concerned about gastroparesis, where the stomach doesn’t squeeze properly. Vomiting after eating is a hallmark symptom, as is feeling very full after a little food. A gastric emptying study can confirm the diagnosis.

Dear Dr. Roach >> Why would I want to drink an electrolyte sports drink? The electrolytes seem minimal. Are my electrolytes lowered during an hour of exercise? I am a 90-year-old female in good health who goes to the gym with a trainer for strengthening muscles and improving balance. I don’t have any health issues.

— R.P.

dear reader >> It’s great that you are exercising at 90. This will help you avoid falls, live longer and feel better. Having a trainer is also a great way of making sure that you are performing the exercises safely and correctly.

As far as electrolyte sports drinks are concerned, there is no reason that you need them. You are not likely to lose significant amounts of electrolytes during an hour at the gym. Endurance athletes who exercise multiple hours outside need to be mindful of electrolyte and fluid replacement, but plain old water is just fine for almost everyone else.

For older adults taking medications (especially diuretics) that might affect the body’s electrolyte balance, it’s probably worth a discussion with their doctor about what fluid to use while exercising.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.