Medically Reviewed by Kareem Sassi, MD
One of the most debilitating problems that came along with my ulcerative colitis (UC) diagnosis in 2012 was nausea. Seven years later, my worst (and most irritating) symptom is still nausea. For people with UC, nausea is tough because it can be hard to pinpoint the reason — it could be stress, fatigue, an oncoming flare, a side effect of one of the many medications we take, or something we ate.
According to the Crohn’s and Colitis Foundation, malnutrition and weight loss are common symptoms of ulcerative colitis. For me, nausea was definitely the big reason I lost over 30 pounds over the course of about eight weeks. Add in abdominal pain and a depleted appetite and it was difficult for me to consume the calories I needed.
In my first two years with ulcerative colitis, malnourishment led to low energy, vitamin and mineral deficiencies, weakness, and the obvious loss of muscle mass and weight. On top of running to the bathroom with diarrhea between 30 and 60 times per day, I was frequently vomiting.
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When Nausea and Malnourishment Land You in the Hospital
Ulcerative colitis emergencies had me in and out of the hospital on numerous occasions. Since I was too nauseated to eat, I twice had a PICC line (peripherally inserted central catheter) placed on the inside of my left arm so that I could receive TPN (total parenteral nutrition, a specialized form of food) intravenously.
At home, my nausea was so crippling that I would take the food my dad would make for me and try to hide it in the trash. Even so, my father, a physician, was consistent and stern with his monitoring of my food intake. He knew I was always on the cusp of malnourishment, which meant another hospital stay and another PICC line.
Eventually, my condition became so severe that in 2013 I had an IPAA (ileal pouch-anal anastomosis) surgery series. During these procedures, a surgeon removes the colon and rectum and uses the end of the small intestine, known as the ileum, to form an internal pouch that’s commonly shaped like a J. I have lived with a J-pouch for about five years.
Strategies for Handling Nausea After Eating
Even though I have a J-pouch, my nausea is often extremely debilitating, making it hard for me to function at work or when I’m out with friends. I’ve consulted with a dietitian who specializes in ulcerative colitis, and she’s helped me really understand what foods to avoid and why.
I’ve also figured out a few other coping strategies:
- Whether you have a colon or not, it’s crucial to eat as much lean protein as possible. I am a big fan of white fish and chicken, and I also love turkey bacon. Egg whites are another very tolerable option. I avoid protein powder, protein bars, or other artificial protein sources, as they are really hard for your body to digest. My baked chicken breasts are so delicious and easy on the stomach: Preheat the oven to 400 degrees, put chicken breasts on a baking sheet, spread plain Greek yogurt on top, sprinkle on a little salt and pepper (try not to overseason!), then bake for 25 to 35 minutes.
- Many people turn to carbohydrates when they’re nauseated, but large amounts of carbs are not the best option for people with ulcerative colitis. I didn’t know this until my gastroenterologist at the Cleveland Clinic told me that when the bowel is not working properly, sugars from undigested carbohydrates can come back up into the stomach, causing irritation. That’s why I try not to eat a lot of carbs when I’m nauseated; instead of two pieces of toast, I might have just one. Bagel thins are a good choice, and I also really like English muffins.
- When I’m nauseated after eating, my first strategy is to lie down, usually on my left side in the fetal position. It’s important to rest your body properly when it’s in overdrive trying to digest something. I also take deep breaths and try to focus on my breathing.
- There is always medication, both prescription and over-the-counter — I’ve tried them all. Zofran (ondansetron) is a prescription medication that you can take as a tablet that dissolves on the tongue; it helps me with mild nausea and does not make me drowsy. Phenergan (promethazine) has been my go-to since my UC diagnosis. When my nausea is extremely severe, I take 25 milligrams orally, even though it makes me very sleepy; I have also received it via intramuscular injection and IV. I often pair either Zofran or Phenergan with over-the-counter options like Tums (calcium carbonate) or Pepto-Bismol (bismuth subsalicylate). (I like the chewable Pepto because I think my body absorbs the medication better that way.) Dramamine (dimenhydrinate) is an option as well, but it often isn’t strong enough for me, plus it can make me drowsy.
- If you live in a state where medicinal marijuana is legal, it’s a great option. When I turn to medical marijuana for my nausea, I do not use edibles; instead I rely on a vape pen, with the dosage and strains prescribed by my doctor. Dispensary employees are very knowledgeable about what method and strains can help specific kinds of nausea.
- Drink fluids to stay hydrated — but not a bunch of water, which can flush electrolytes, nutrients, and vitamins out your system. Extreme nausea can be a sign that your electrolytes are out of balance, so try sugar-free electrolyte drinks like G2 or Powerade Zero (avoid regular Gatorade or Powerade since both are high in sugar); I also really like Propel.
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