Nausea & Vomiting and Appetite
Feeling sick (nausea) and vomiting
Many illnesses can sometimes make you feel sick (nausea) or vomit (be sick). Treatment will be based on the most likely cause of your nausea. If it is caused by something like pain, a raised calcium level or another chemical imbalance, it’s important that this is treated. Your doctors may prescribe an anti-sickness (anti-emetic) drug. These often work better when they’re taken regularly so that the sickness doesn’t have a chance to come back. They’re usually given as tablets, but if you can’t keep tablets down there are other ways to have them. Some anti-sickness drugs can be dissolved in your mouth; others can be given by injection or as a suppository into your back passage. Sometimes anti-sickness medicines are given by constant infusion under the skin (subcutaneously), using a small portable pump called a syringe driver. Wellbeing therapies such as relaxation and acupuncture can also be used to help reduce nausea and vomiting.
Tips for coping with nausea
- Try to avoid eating or preparing food when you feel sick. If possible, let someone else do the cooking.
- Try to avoid fried foods and foods with a strong smell.
- Smaller meals on a small plate are easier to manage.
- Eat cold or warm food if the smell of hot food makes you feel sick.
- Eat several small snacks and meals each day, and chew the food well.
- Peppermints or peppermint tea help some people.
- Ginger can also be helpful – try ginger biscuits or ginger beer.
- Sip drinks slowly.
- Try not to have too much to drink just before you eat.
Lack of appetite
You may have a lack of appetite for many reasons. It may be caused by your illness, medicine or treatment, or it may be due to other symptoms such as pain, fatigue, constipation, sore mouth and/or feelings of anxiety, sadness, emptiness or frustration. If you are not eating, it is important that you speak to your doctor or nurse. Some causes of lack of appetite can be treated and there are medications available that can stimulate appetite. Weight loss often accompanies living with a terminal illness. However, you should not assume that a lack of appetite cannot be treated. If your appetite is poor, try having smaller, more frequent meals, rather than larger plates of food three times a day.
You can add high-protein powders to your normal food, or you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. You can also ask to be referred to a dietician at the hospital. They can advise which foods are best for you and whether any food supplements would be helpful. If you’re not in hospital your GP can arrange this for you. If you need help with cooking or shopping, a district nurse or social worker can give you information about Meals on Wheels or a home help. You could also see if someone else could prepare your meals, so that you’re not too tired to eat by the time they’re ready. If you’ve lost weight and are finding it difficult to put it back on, your doctor may prescribe a short course of steroids or a drug called megestrol acetate (Megace®)| to boost your appetite. Your GP or palliative care team will discuss this with you to decide the most appropriate drug for you.
Tips for a poor appetite
- If possible, sit upright when eating or drinking
- Ensure meals are taken in a relaxed environment
- Alcohol can act as an appetite stimulant e.g. a small sherry 15 minutes before a meal
- Use a small plate
- Offer small snacks/ meals frequently
People who are very unwell may find that they become weak and their body is not able to absorb food very well. In this case, it’s best to eat what you want when you feel able to. In some cases steroids or other medication may help.
You may find that your sense of taste changes, or that the texture of food seems different. This may be due to your illness, or it can be a temporary change due to medications. You may no longer enjoy certain foods, or feel that all foods taste the same. Some people taking medications notice a metallic taste in their mouth. Others find that food has no taste at all.
Coping with taste changes
- Eat foods that you enjoy and ignore those that don’t appeal to you. But try them again after a few weeks as your sense of taste may change again.
- Use seasonings, spices and herbs like rosemary, basil and mint to flavour your food.
- Try marinating meat in fruit juices or wine to improve its flavour, or eat it with strong sauces like sweet and sour or curry.
- Serve fish, chicken and egg dishes with sauces.
- Cold meats may taste better served with pickle or chutney.
- Sharp-tasting foods like fresh fruit, fruit juices and bitter boiled sweets can be refreshing and leave a pleasant taste in your mouth.
- If you go off the taste of tea or coffee, try lemon tea or green tea instead, or perhaps an ice-cold fizzy drink like lemonade or fresh orange juice with soda water.
- Some people find that cold foods taste more palatable than hot foods.
When to call for help
- Whenever your condition demands it.
- Persistent vomiting may mean that drugs need to be given by an alternative route (e.g. suppositories or injections). These need to be organised by a nurse or a doctor.