Season 4 Episode 3: Why Am I Nauseous?

Nausea is not necessarily an IBS symptom but it is something that many with IBS deal with, and by extension attribute to their gut issues. During this episode, I explain why nausea is not necessarily a symptom of IBS but can instead be attributed to other factors in our life. I explain the relationship between anxiety, chronic pain, poor nutrition and other issues that can show up as nausea in our day to day life.

In this episode, we cover:

• What is nausea?

• The relationship between pain and nausea

• Why does anxiety make me feel sick?

• Skipping meals is not good for your digestion

• Hydration and other stomach issues when it comes to nausea

• How can you combat nausea?

Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.

Today's episode is one that I have been so excited to create because this is a question that I get asked all the time: Why am I nauseous?

Nausea is not necessarily an IBS symptom but this is something that many with IBS do deal with, and people attribute to their IBS. So, short answer that we're going to dive deeper into is that nausea can be caused by anxiety, pain, whether that is acute or chronic, skipping meals, and not adequately nourishing, slow digestion, upper GI issues like Gerd and reflux, dehydration, hormonal changes, inner ear issues, and something very wrong that needs to be addressed. So let's dive deeper and see what might be contributing to your nausea and what's really going on!

To start, let's define nausea, because this is something that is difficult to define, and I think this is why there is so little information, and probably even less feedback from providers on what's really going on. The true definition of nausea is a feeling of sickness with an inclination to vomit. So whether you vomit or not, nausea is that feeling that you will, and that general feeling of sickness.

Nausea is very difficult to truly define and so what can help is that if you are struggling with what you call nausea, write out the characteristics and explain how you feel, because there's not going to be one single definition or translation of the word nausea to a specific symptom category, but if you can explain that you do feel like you're going to vomit, or maybe you actually feel dizzy, maybe you feel pressure in your chest, maybe you feel like you just have an upset stomach, like you just feel kind of sick and icky, you know, if you will, or like that stomach, sickness, whatever it is that you're feeling, kind of really describe that to your providers, versus just saying nausea, because there's not a great definition and translation.

So when we think about nausea, there are acute forms and chronic forms, and the causes can be different. So when we're talking about acute nausea, this is short term. So this is you know, you're not daily nauseous, but maybe one day you're experiencing severe nausea, or for a smaller period of time, or maybe a rotating period of time that you have this nausea. Chronic nausea is going to be more long term. So this might be daily or just consistently occurring over a longer period of time.

Your causes of more acute or short term nausea include sea or motion sickness, that one is fairly obvious, where if you're on a boat, or you're in a car, and you're dealing with that motion sickness, that will contribute to nausea. Reactions to certain smells, or odors, this can be linked to past experiences, if something's made you sick in the past, then that might spark this feeling of nausea that you're experiencing. Food poisoning, this is going to also maybe overlap with other symptoms like actual vomiting, diarrhea, stomach pain, and things like that. Acute Pain, so whenever you experience high levels of pain, this can cause more nausea and this can even be true from an IBS and gut health standpoint. If you are having very short term pain that's coming up every now and then as part of like a major flare, then that can contribute to more nausea. If you fall, if you hurt yourself, cut off a finger, you know, those intense pain moments, then you are going to have more nausea.

Acute inner ear imbalance, or what we call vertigo, that can be fairly common as a cause of nausea. Usually, that's going to be the dizziness nausea, where it's like you can't even stand you have to lay down immediately. That can be due to inner ear imbalance. And then heat exhaustion or stroke, so if you've been outside, if you've been in the heat summertime, and you're experiencing nausea, only in those moments, and that might be linked to heat exhaustion or heat stroke.

Now the more chronic forms of nausea, which is what I get asked about the most, the acute form, sometimes you can put those pieces together, but the more chronic forms are the ones that can be more difficult to undo and untie.

Some of those different causes can be, anxiety as a big one and we'll go over a little bit more about why that happens. Chronic pain, so not just that short term pain, but chronic pain over time, which again can be part of even IBS. Slow digestion, and we're going to go over that a bit more as well. Ongoing inner ear issue, so again, if you have that daily vertigo feeling, that could be kind of an ongoing inner ear problem. Dehydration, chronic dehydration, and then certain medications or supplements.

The one thing I didn't really hit on with nausea is hormones, and so those who deal with a menstrual cycle where hormones are shifting throughout the month, nausea could be a part of that as well. Typically, it's going to be linked to the digestion side of things and some of these other pieces, but sometimes that can also be separate. If you are dealing with really severe nausea at like the lows and highs of different hormone shifts through your menstrual cycle, that can be a sign that maybe the hormones aren't regulating appropriately or like you're more sensitive to those shifts and that would be something to log and keep up with.

Alright, so I can't go deep into every single cause of nausea or we'll be here for a while, but I do want to go a little bit deeper into those that I see the most often with digestive disorders, and really how we deal with that and how we identify those things in practice, so that you can really get a handle on why the nausea might be connected to your digestion.

Okay, starting with anxiety. So when we're thinking about anxiety, this can also be used to describe stress, but nausea is one of the top symptoms of anxiety and something that we often overlook when we're thinking about nausea, because we can tribute it more to what did I eat, what did I drink, what's going on with my gut, versus what's going on with mental health and emotional health.

So what is happening is there's likely changes in the vagus nerve, which is that longest cranial nerve, that's also part of the gut brain communication pathway. Now, when there are changes to the vagus nerve, in times up anxiety and high stress, this might lead to nausea directly from those nerve changes. And so this can be a direct impact.

This can also be a misnaming symptom if you will, where the feeling of anxiety feels like nausea or you kind of feel unwell because it's like sensory overload and heightening and you feel that stress, you feel that tension, your body's in that state. Sometimes that can be named as nausea, even though it may not be true nausea, if you will, so that can be kind of a misdiagnosis/misname of the symptom.

One thing that I usually ask is, what are stress levels like and I look for other signs of anxiety that might be the root of the nausea. Now, usually, I'm going to do this after I rule out some of the other causes that we're going to talk about, but some of the signs that you can look for are heightened irritability and vulnerability to shifts in your mood throughout the day, so someone cuts you off in traffic, and it just sends you into a spiral or you kind of feel that heightened stress and that tension on yourself. Poor sleep, where you are kind of wired at the end of the day and you feel like you can't fully rest and sleep, you're constantly distracted with like scrolling and like shifting your brain and trying to refocus, because you want to escape from that moment. If there are signs of that, then anxiety might be a bigger problem, and contributing to the nausea that you feel and may be somewhere to start.

Now another one is pain and the chronic pain issue. So what happens when you're in pain, whether acute or chronic, this can cause the body to release hormones like adrenaline, which is like our fight and flight hormone, right? This will activate certain receptors in your brain and in your gut that will result in nausea. So this is a hormone messenger piece. So you're going to feel this with acute and short term pain because you go into that stress response where those hormones are released, but this can also happen low levels chronically, if you're in a chronic state of pain, you might be dealing with this activation, which is contributing to more nausea. And in these states, the nausea is not likely to improve until we get the pain under control. And so again, this is something that we assess for, something that you want to look for and then you want to make sure you're addressing the contributors to the pain to then address the nausea, versus just addressing the nausea first, because it's likely a downstream effect and problem.

Another thing that we see with nausea is skipping meals and poor intake. So whenever you skip meals, your stomach does still produce stomach acid as part of the digestion process. So we produce stomach acid whenever we eat, but your stomach is also producing it occasionally, even if you're not eating. So when you're skipping meals, this acid isn't doing what it needs to with digestion, so it can build up and actually lead to reflux and upper GI issues, which can also be nausea. So many times reflux is that feeling of nausea, where you feel you're going to vomit because there's actually pressure and acid coming up and that can contribute to the symptom you're feeling. One thing that we want to look at, are we skipping meals, and could there be that increase in stomach acid reflux and GERD type symptoms like heartburn can also be a piece of this, so instead of adding medications that may also have a side effect of nausea, what we can do is establish more consistent meal patterns and avoid skipping meals or going really long periods without eating.

What also happens whenever you have an empty stomach and you're dealing with hunger is that this can also be miscommunicated and misdirected as nausea. So hunger can sometimes feel like nausea for a lot of people and so that's something that you want to kind of navigate in yourself, where if you feel that symptom, and you do eat and goes away, then you might start to rename that sensation as hunger versus nausea. This will especially be true if you also deal with constipation, which is the next part that we want to talk about, and that slowed digestion.

Whenever your digestion is slowed, we see this with gastro precess, which is slow stomach emptying, so it slowed down through the first part of the digestive process or with constipation, where there's maybe a slowdown in the lower part of the digestive process, and even being constipated, that's going to create some tension on all of those gut muscles and slow things down more. So if you're backed up, that's increased slow down.

Whenever you have slow digestion, that pressure is likely to build up up top and you're also going to feel this like over fullness, and that can be nausea and come off as nausea. So you may feel that feeling like you're gonna vomit because it's like, I feel very full, I feel like things just aren't moving, they're kind of stuck, but also just that fullness and discomfort that can be kind of that upset stomach kind of feeling of sickness that we talked about earlier, which is going to be nausea.

So if you're skipping meals, and you're constipated, that's a perfect storm to be dealing with nausea. And so one thing that we assess for is are you pooping regularly, if you go back to the start of the season, where we talked about what poop should look like, how it gets formed, that whole process, that's going to help you really evaluate am I pooping enough and is it coming out like it should be, and that's something that usually we can improve, and nausea will improve alongside that.

In addition to food and not eating enough, we also can see nausea with chronic dehydration and not drinking enough. And this one might be more obvious to some, especially in acute forms where like you didn't drink any water because of some reason, and you're really nauseous, that is a very hallmark symptom of dehydration. What I see more often is that just continued low intakes with water can cause more nausea.

Now the cells that you have in your body, all the cells that are made up in the body that are there to help the body function, tissues and all those good things, they don't have what they need to function whenever you do not have enough fluid that you're taking in. What this does is this leads to weakness, dizziness, and nausea. And so you're going to feel that overall like kind of halfway functioning, chronic nausea, because you don't have enough fluid for yourself and for your body to function, so it's reduced capacity and function overall.

If you are dealing with this, usually more water can worsen nausea. So something that a lot of people fall into is that they're chronically dehydrated, and then they try to increase water and they feel more nauseous or maybe they even vomit, they throw up the water. If that is you, the goal is to go slow with your increase. The result of that doesn't mean that you do not need water, it means that your body has adapted and you are chronically dehydrated, and you have to get used to drinking that water again. So you want to go very slow and steady with your water increase to not worsen the nausea and be able to adjust and build that water intake up to then now prevent the nausea. So it's a bit of a step by step approach that you have to take which can be really beneficial and successful.

Another big cause of nausea is upper GI issues. So I talked about this a little bit with the slow digestion piece and even that stomach acid piece with skipping meals, but whenever you have reflux where you're dealing with the reflux of, meaning the contents of the stomach come up back through the esophagus, that does feel like nausea because you feel like you're going to vomit.

Now this can be due to skipping meals, this can be due to constipation, slow digestion, this can also be due to issues with the lower esophageal sphincter which is like a little flap between the esophagus and the stomach, it doesn't usually mean that you have too much stomach acid, what it means is that the stomach acid, all those contents of the stomach are making their way back up, which is not ideal. And so there's a lot of different reasons and causes of that, if that's something that's present, you're also dealing with that feeling that acid in the back of your throat, dealing with heartburn, kind of that burning stomach, if you know that you struggle with those symptoms, then that's something that we want to try to get a hold of, and then that will improve the nausea. So that would be our main focus, is to focus on the upper GI, focus on treating the GERD or finding solutions for the GERD in the reflux, and then the nausea will improve.

And then I mentioned you know that there is sometimes something that's very wrong that's causing nausea, I don't go to something very wrong unless there are other major red flags, or we've exhausted the list of potential causes, we've gotten all these other pieces under control, and the nausea is still hanging around, then I may want to dig deeper and say, okay, what else is going on here that might be contributing?

So some of the things that can be going on aren't food poisoning, usually other red flags are going to show up with this, but even like ongoing viruses and infections, maybe from that, or in a different way, that can cause some nausea so that's something we may want to be testing for looking for. SIBO of SIFO, which is bacterial overgrowth or fungal overgrowth, nausea can be a symptom of those, typically, we're going to again, see red flags for that with other digestive symptoms but that is something we may dig into, or if we find that that's present, then we may be able to attribute that to the nausea that you've been experiencing.

An ulcer, so not just that the stomach acids coming up or anything there, but there might be an ulcer in the stomach of the small intestine, that can sometimes lead to nausea. That's something that we might look for, maybe an upper endoscopy or kind of, if especially if there's like burning in the stomach or things like that, any other signs that an ulcer could be present.

Autoimmune disease, so this can happen and so if we have other immune type symptoms that are going on, like really extreme fatigue, that feeling you just can't get out of bed and you're dizzy and nauseous all the time. other signs of that, that like maybe the immune system is reacting to something or something's going on that we might look at any potential autoimmune diseases or disorders that could be present.

Thyroid disorder, so that would link that to hormones and so especially if we're dealing with other again, other symptoms, hair loss, really intense weight fluctuations, chronic constipation that's just not really responding, missing periods or altered menstrual cycles, then we might evaluate for any thyroid issues that could be causing nausea as well.

And then intense pain, that might be a sign that other organs are in distress. So if we've done what we need to for the gut, and there is still really intense pain present that's leading to nausea, we might look for issues with the pancreas, the kidneys, gallbladder, other organs and see if there's something wrong somewhere else in the body that might be contributing.

Those are, again, always where I want to start first, we don't want to just jump to those conclusions right away but if you're thinking about maybe your own story, your own history, then you might be able to put those pieces together and determine what might be contributing to nausea for you specifically.

Now, aside from the cause, what do we actually do about it? So that is another question that I get asked and there's no one size fits all solution for nausea, because it really does depend on what's causing it. There are very few really good band aids, if you will, for nausea. We do want to address the cause we really want to dig deeper to figure out what's going on with assessment, but there are some tips that you can at least start with and start exploring and see if they work for you.

One is eating small meals more often. So this can help with kind of reducing the load on your digestive system and your stomach if things are moving slower so that you don't feel like things are just going to come back up. So you would just eat small meals, spread them out a little bit but kind of spread them throughout the day, so that you're eating enough throughout the entire day.

Improve your gut motility. So doing other things to improve digestive capacity, moving the body, eating enough, maybe adding some support stuff with constipation, adding more water, more fiber all those different things, increase your water and then add minerals if needed for the extra electrolyte hydration boost. Again, this is going to be more individualized but if you aren't drinking enough water finding ways to increase that and keep it consistent day by day. And sometimes minerals can be beneficial and even help with the nausea a bit if hydration has been the problem over time.

Move your body but be cautious with high intensity exercise. So we really want the focus to be movement…walking, you know maybe lifting weights, adding some strength doing pilates or yoga or lower intensity exercise. High intensity extra size can put the body into a stress state and if that stress component is there that might contribute to more nausea, high intensity exercise is likely going to make nausea worse, but increasing movement in other ways may actually help bring it down and support some of those other causes of the nausea in the first place. So that's where I’d begin.

Implement boundaries with stressors in mind and add in mindfulness activities. So this is attacking the anxiety piece of like, can we incorporate more mindfulness throughout the day, modify stressors or address stressors in a unique way, maybe add therapy or different solutions and strategies to help with that side of it.

Eating ginger and incorporating ginger tea, ginger chews, those can be really beneficial, even as a band aid for kind of calming the digestive system a bit, and that can sometimes help nausea even the smell of that can help. Peppermint is also like that, for some where chewing on like a peppermint candy, drinking a peppermint tea, smelling peppermint may help ease the nausea, that's very helpful with motion sickness.

Eat more slowly and chew thoroughly. So again, reducing some of that load on the gut that helping really allow the digestive system to work as well as it needs to, slowing down and chewing really well, that can sometimes really help and be beneficial for nausea, and then getting fresh air. There's a lot of power in that and that's something that I've learned from experience with like motion sickness and things like that, some of my clients have experienced, breathing fresh air can sometimes be really beneficial.

So those are some tips where you can begin. But the big takeaway is that nausea may not be a hallmark symptom of IBS or digestive disorder and it's not a one size fits all symptom, it's also not a one size fits all solution. The goal is to really identify what is your nausea presenting as? How often is it happening? And then start putting pieces together to see what are correlations that might be present attached to some of these causes and where can you start to address the different potential causes and then monitor the benefit that might be there to see what works best for you.

If that still ends up nowhere, if you're hitting a roadblock, then to dig a little bit deeper, like what else could be going on that might be contributing here. So I hope that's helpful. I would love to hear any questions that you have or thoughts that you have or anything you want to add even for tips, so please make sure to come hang out with me on Instagram at erinjudge.rd or over on Facebook at The Gut Community and share what you think with our community so that they can benefit from your expertise and knowledge as well!