Managing Nausea, Vomiting & Poor Appetite

Article Summary

Nausea, vomiting and poor appetite are common complaints among individuals with vestibular disorders. These symptoms can significantly affect one’s ability to work, participate in social activities, drive, and perform household tasks. Often, they can become interrelated, creating a vicious cycle. There are many strategies that have been shown to help reduce or alleviate nausea, vomiting and anorexia.

By Danielle Beatty, DPT and Theresa Galvin, MS, RDN, CD-N

DIETARY RECOMMENDATIONS FOR NAUSEA AND VOMITING

It is important to rest the stomach and yet still avoid dehydration during acute periods of nausea and vomiting. Initially steer clear of any foods and beverages and try ice chips only. As you gain confidence progress to clear fluids, advancing to solid food.

Clear fluids are easy for the stomach to absorb, and include:

  • Water
  • Sports Drinks
  • Clear Broths
  • Popsicles
  • Jell-O
  • Flat ginger ale
  • Coconut water
  • Non-caffeinated peppermint tea

Don’t take too much fluid at once. One to two ounces at a time, taken every 10-15 minutes, may be all the stomach can handle at first. Avoid milk products for the first 24-48 hours during nausea and/or vomiting episodes.

When you reintroduce solid foods:

  • Eat small, frequent meals
  • Eat bland foods, like crackers/soup and broth
  • Eat and drink slowly
  • Drink clear fluids
  • Try well tolerated foods such as toast, crackers, yogurt, cream of wheat, oatmeal, boiled potatoes, rice, noodles, and carbonated drinks
  • Avoid fried/greasy foods and sweets
  • Avoid physical activity soon after eating
  • Do not lie flat for at least 2 hours after eating
  • Eat foods cold or at room temperature
  • Avoid eating in a warm or stuffy room
  • Avoid liquids with your meals, drink 1/2 hour before or after eating
  • Rinse your mouth before and after eating to eliminate any bad tastes that may make you nauseated

Ginger

Ginger can help control nausea. Studies show that ginger is effective in relieving nausea/vomiting in patients undergoing chemotherapy and with pregnant women.1 Ginger can be found in supplements, gummies, hard candy, juice, tea, and gum. There is no clear consensus on the recommended amount of ginger to be used, but most studies use 0.5-1.5 grams of dried ginger root per day. If you are on a blood thinner or prone to low blood pressure/blood sugar, be sure to talk to your doctor, as ginger can affect these.

Poor Appetite

Poor appetite makes it hard to eat enough, resulting in weight and nutrient loss. Here are some ideas to consider:

  • Eat small amounts of food at least 6 times a day. Try to eat every 2-3 hours
  • When you go out, carry snacks that won’t spoil, such as crackers, bananas and nuts
  • Light exercise may make you want to eat more
  • Ask your doctor about medicine that can make your appetite stronger
  • Nutritional supplements (powders, liquids, puddings and bars) help meet caloric needs, but should not be used to replace meals

Rubbing Alcohol

Another method to reduce nausea involves inhalation of isopropyl alcohol. One study on patients in the emergency department showed that those who inhaled the scent had a significant reduction in nausea compared to those who did not.2 Rubbing alcohol is a common staple in many households, which makes this technique convenient
and easy. It can also be used on the go by carrying alcohol wipes in your purse or wallet.

Essential Oils

Essential oils have gained much popularity over the years. Scents such as peppermint and spearmint have been shown to reduce nausea and vomiting in people undergoing chemotherapy.3 Additionally, putting a few drops of peppermint or lavender on a tissue or on the hand, can be inhaled to provide relief. Lemon scent can help reduce nausea and vomiting in pregnant women.4

OTC Bands

Motion sickness bands work based on the premise of acupressure. Acupressure is “an alternative medicine technique similar in principle to acupuncture. It is based on the concept of life energy which flows through ‘meridians’ in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in these meridians. Pressure may be applied by hand, by elbow, or with various devices.”5

Some medical studies have suggested that acupressure may be effective at managing nausea and vomiting. However, these studies may have bias and a placebo effect. Motion sickness bands use pressure applied at P6, which is the 6th point on the Pericardium pathway in Chinese medicine. This point is found about 2 inches above your
wrist crease on the palm side, right in the middle between the tendons. The Pericardium pathway passes through your chest, down through your diaphragm and into your mid and lower abdomen. The motion sickness bands are elastic and typically have a plastic stud placed at the P6, where manual pressure can be applied. Pressure can also be applied by your thumb or elbow without the use of the band or with the use of acupressure balls or other instruments. Compared to applying pressure at a placebo point or no pressure at all, applying pressure at P6 has been shown to significantly reduce nausea, vomiting, and the need for nausea medication in pregnant women.6

Breathing

Diaphragmatic breathing is a technique commonly used for people with breathing disorders such as COPD (chronic obstructive pulmonary disease), but it can also be used for relaxation and to decrease nausea. This involves breathing in through your nose while trying to expand your abdomen (as opposed to letting your chest rise), and breathing out through pursed lips. Diaphragmatic breathing has been shown beneficial to reduce motion sickness symptoms on healthy subjects while putting them through a virtual reality experience.7

Drugs

Over the counter medications include Bonine (Meclizine) and Dramamine. Physicians usually recommend taking these medications sparingly and only when nausea and dizziness is quite elevated. Side effects can include drowsiness. A physician can also prescribe medications, such as Phernergan, Antivert (Meclizine), and Valium. Talk to your doctor to get more information.

CBD Oil

CBD oil is gaining popularity as a potential treatment for various ailments. Cannabidiol is extracted from the flowers and buds of marijuana or hemp plants. It does not produce a “high” as with marijuana, as it has little to no THC (tetrahydrocannabinol). Studies have shown effectiveness in treatment for epilepsy. However, all other proposed uses show limited effectiveness as of yet, according to the Food & Drug Administration (FDA). One study did show that combined with antiemetic (anti-vomiting) therapy, CBD oil is beneficial in reducing nausea/vomiting in patients undergoing chemotherapy.8 CBD oil is not regulated by the FDA, so this poses some concern over the quality and quantity of its ingredients. It is important to discuss benefits, concerns, and potential adverse effects with your physician before attempting this regimen.

Other Nausea Management Strategies

  • Apply a cold compress to the back of your neck
  • Get fresh air or use a fan
  • Find a focal point in front of you and maintaining focus on that point
  • Use distraction (read a book, watch television, listen to music)
  • Altoids Extra Strong Mints can be carried around in your pocket and can offer relief

What works for one person may not work the same for another, so be open to trying various techniques to find which options work best for you.

View References
1

Lete I, Allué J. The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Integr Med Insights. 2016;11:11–17. Published 2016 Mar 31.

2

Beadle, Kenneth Lee et al. Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine, Vol 68, Issue 1, 1 – 9.e1

3

Tayarani-Najaran Z, Talasaz-Firoozi E, Nasiri R, Jalali N, Hassanzadeh M. Antiemetic activity of volatile oil from Mentha spicata and Mentha piperita in chemotherapy-induced nausea and vomiting. Ecancermedicalscience . 2013;7:290.

4

Yavari Kia P, Safajou F, Shahnazi M, Nazemiyeh H. The effect of lemon inhalation aromatherapy on nausea and vomiting of pregnancy: a doubleblinded, randomized, controlled clinical trial. Iran Red Crescent Med J 2014;16(3):e14360.

5

Wikipedia. Acupressure. https://en.wikipedia.org/wiki/Acupressure

6

Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med. 2001 Sep;46(9):835-9

7

Russell ME et al. Use of controlled diaphragmatic breathing for the management of motion sickness in a virtual reality environment. Appl Psychophysiol Biofeedback, 2014 Dec;39(3-4):269- 77.

8

Duran M, Pérez E, Abanades S, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol. 2010;70(5):656–663.