Problems with queasy and upset stomach are very common in palliative care and there exist numerous interventions that can reduce the occurrence of nausea. The timing, amounts and types of food and drink consumed can have a major effect. In addition, various forms of herbal, pharmacological and psychological treatments are available and often highly effective.

Prevention

Getting a little stabilizing food into the stomach first thing in the morning can be helpful for preventing the onset of nausea. Keep some crisp, dry foods close at hand such as Melba Toast, zwieback, saltine crackers, social tea cookies, pretzels or bread sticks. Have one or two as soon as you get up, and remain at a 45 to 60 degree angle until any queasiness passes. Do not lie back down.

After eating, try to avoid lying down flat for at least one hour, preferably two. If you need to recline, make sure your head is at least four inches higher than your feet.

Large meals are harder for an uneasy stomach to cope with than light meals and snacks. Try to eat six to eight small meals at two to three-hour intervals throughout the day. Don’t allow your stomach to become completely empty as that can cause the queasy, uncomfortable feelings to reappear.

Nauseating Flavors and Odors

If there’s a bad taste in your mouth, try sucking on hard candy, such as peppermint or lemon. Also, rinsing your mouth before and after meals with a mixture of lemon juice and water can be helpful for eliminating unpleasant flavors and thereby reducing nausea.

When cooking, make sure there is plenty of ventilation by opening windows, turning on fans or cooking outdoors as the presence of cooking odors can increase feelings of nausea. Purchase frozen food in boiling bags to minimize the odor of vegetables.

Food and Fluid Issues

Risky foods include fried onions, garlic, sugary desserts, spicy foods, greasy or fried foods, and fish (especially canned, because of the smell). Things like cold meat, fruit, small sandwiches, cereal and milk, yogurt, baked potato, pasta, rice, plain vegetables and other bland foods are easiest to tolerate.

Sometimes it’s safest to avoid hot foods altogether. Avoid spoiling the enjoyment of your absolute favorite foods and comfort foods. Don’t eat them when you’re struggling with nausea. If you do, your body will associate these flavors with being sick and the pleasure will be lost.

Salty and sour foods can aid in reducing nausea. Try eating pretzels or saltine crackers in addition to dill pickles, sour hard candy, lemon sherbet or sucking on lemon wedges.

Instead of drinking with meals, try to take fluids primarily between meals, beginning about 30 minutes after eating. Try to have eight or more cups of liquid each day in the form of milk, water, soymilk, juices, herbal tea or ginger ale. Substitute decaffeinated coffee for regular. Shakes and smoothies as well as commercial supplements are an excellent way to increase protein and calories which can help you meet your nutritional needs.

Vomiting

Large amounts of water, nutrients and electrolytes can be lost through repeated bouts of vomiting. In such cases, rehydration drinks like Pedialyte and sports drinks are helpful for replacing fluids and electrolytes. These reduce the risk of serious dehydration.

The following is a recommended protocol for optimizing hydration and aiding resolution of vomiting.

  • When an hour has gone by without an episode, drink 1 oz of a clear liquid every 20 minutes for the following hour. This includes apple or grape juice mixed half strength with water, rehydration drinks, tea, broth and gelatin. Avoid citrus or tomato juices, lemonade, milk products, alcohol and soft drinks.

  • If vomiting does not recur, gradually increase fluid to 8 oz during the next hour. Continue drinking enough to rehydrate; about ½ to 1 cup extra fluid is needed per episode of vomiting.

  • When your stomach feels stable, begin eating clear soups, crackers, toast, gelatin, cereal and other very light foods for 12-48 hours, until all symptoms have disappeared. Gradually introduce bland foods until a normal diet is resumed.

Possible Alternatives

Ginger has a long history of use in treatment of gastric distress due to multiple causes including motion sickness, hangovers, food poisoning and pregnancy.

Recently it’s been demonstrated in a number of clinical trials to be effective against nausea and vomiting. In addition to carbonated soda, try ginger tea, candy and beer, as well as cooking with the fresh, crystallized or powdered root.

The tuberous roots are located in the produce section of grocery stores and may be kept it in the refrigerator or freezer. It can be sliced or grated, even from the frozen state. Include it in tea, stir-fries, sauces, main dishes, salads and desserts. It gives a pungent bite and has numerous healthful properties including being a potent anti-inflammatory.

Peppermint tea is also reputed to have a calming effect on the stomach and is recommended for nausea. In addition to herbal remedies, a number of psychological techniques have been found effective for diverting attention away from the physical problem with a consequence of nausea reduction. These include:

  • Self-hypnosis

  • Progressive muscle relaxation

  • Biofeedback

  • Guided imagery

  • Systematic desensitization

Lastly, acupressure and acupuncture have been shown to be helpful in some cases.

Legal and Illegal Drugs

A variety of medications are available for controlling nausea. Nevertheless, many cancer patients, primarily young adult males, have turned to daily “pot smoking” in their efforts to find relief. The active ingredient of marijuana, THC, has been synthesized and is available in the prescription drug, Marinol (dronabinol).

Christine Russell, MD, Chairman of the American Cancer Society Advisory Committee states that although smoking the herb is a rapid and efficient drug delivery system, it carries safety risks, especially in those whose immune response is compromised. She notes, “If you wind up inhaling a fungal agent, you won’t have the immunity to fight it off.” Those who need medication for nausea are advised to consult their physician concerning the best options.

Trial and Error

With careful attention to diet and activities, together with the aid of various therapeutic regimens, the majority of nausea can be well controlled. Seek the help of licensed health care professionals to create the best outcome and resolution for this distressing condition.

Don’t give up if one or two things don’t bring relief. Keep trying until you find something that works. In addition to learning new techniques, it may take a number of food, fluid and medication adjustments in order to manage the symptoms. Persistence will pay off in the end.

For more information:

Nausea. (2008). National Comprehensive Cancer Network [On-line]. Available: https://www.nccn.org/patients/resources/life_with_cancer/managing_symptoms/preventing_nausea.aspx