Morning sickness

Morning sickness in the common imagination is synonymous with babies on the way. It is true, but it is not the only possible cause: many people of all ages – including children – experience a sense of discomfort in the mouth of the stomach as soon as they wake up, sometimes so strong and persistent that it prevents even having a breakfast worthy of the name.

If the disorder is occasional, there is no need to worry: the reason may be, for example, an overeating the night before, a sudden change in eating habits or very stressful events. Conversely, if it persists or is very intense, it is advisable not to underestimate it and investigate the reasons: it could depend on the lifestyle, but also be the indicator of a pathology. Talking about it with the family doctor is the first step, which could be followed by a visit with the specialist, the gastroenterologist, who can identify or exclude a “malfunction” of the digestive system.

Morning sickness: the most common symptoms and diagnosis

A malaise that even induces waking up due to cramps and abdominal pain or an unpleasant sensation that appears after getting up: nausea is felt in the stomach and throat, can increase salivation, be associated with a sense of dizziness, tiredness, fatigue and increased sweating and, sometimes, but not necessarily, result in vomiting; It causes loss of appetite and can be worsened by the sight or smell of food. In any case, it is the reaction to a vagal stimulus, that is, the activation of the nerves of the digestive tract (pharynx, stomach, intestines) or other areas of the body (vestibular system of the ear, brain stem).

“The feeling of morning sickness is a symptom described above all by adults who suffer from poor digestion,” explains Giulia Martina Cavestro, gastroenterologist at IRCCS San Raffaele Hospital and professor in Gastroenterology at the Vita-Salute San Rafale University. “In medical terms we talk about dyspepsia, which should not be confused with gastritis, which is instead an anatomical-pathological condition, that is, an inflammation of the stomach tissues caused mostly by the bacterium Helicobacter pylori and often, if chronic, is asymptomatic. Acute gastritis, on the other hand, can give symptoms such as nausea, but it is not automatic to correlate that of the morning, indeed, it is quite rare».

The malaise, however, must be investigated: “Nausea can also be due to other important diseases, such as ulcers, and can occur at any time of the day. All the more reason the doctor’s investigation is necessary if nausea is followed by vomiting: if it is food, if it contains traces of blood, if there are retching on an empty stomach and so on. Fortunately, morning sickness alone, outside of pregnancy, often depends on slowed gastrointestinal tract functioning, for various reasons.

The interview with the patient and the anamnesis are essential to diagnose the causes of nausea and the consequent appropriate therapy: “Stomach pain, burning, nausea are distinct symptoms that people can generally describe well”, continues the specialist. “Gastroesophageal reflux without other symptoms, for example, in a young patient does not necessarily need to be investigated with a gastroscopy, which instead may be necessary if nausea is accompanied by pain in the epigastrium, ie under the sternum, because it could be the alarm bell of an ulcerative pathology”. Blood tests can also clarify the picture: “For example, in the case of a young woman in whom nausea and vomiting are accompanied by iron deficiency anemia, i.e. iron deficiency, gastroscopy is another indispensable investigative tool.”

Finally, especially if morning sickness is the manifestation of a state of anxiety, among the symptoms there may also be an increase in heart rate, tremors and sweating.

Causes of morning sickness

A hearty dinner, with many courses, fatty foods and elaborate dishes, perhaps accompanied by wine or beer and spirits, or an evening meal based on cold cuts and cheeses or, even, more simply, a meal not excessive, but consumed late, close to the night’s rest, may require a very laborious digestion, with rising acids in the stomach towards the esophagus, and be the cause of the morning disorder. In addition to changes in diet, adopting a balanced diet, which includes small evening meals with the exclusion of foods that tend to promote gastro-esophageal reflux (fried, animal fats, chocolate, coffee, alcohol, carbonated drinks and foods that, subjectively, are “heavy”), those who suffer from it (but the advice applies to everyone) should wait at least a couple of hours before bedtime. It can also be useful to opt for a pillow that keeps the head slightly elevated.

However, poor digestion is not the only possible cause of nausea in the morning: it can be caused by hypoglycemia and low blood pressure (quite common) and metabolic disorders, as in the case of diabetes.

Even prolonged stress can disturb sleep and night rest and, indirectly, also the digestive system, causing discomfort on the gastric system. Among the disorders of the psyche, anxiety can cause nausea and vomiting, even in children. In these cases, the specialist to refer to can be a neurologist experienced in sleep medicine, a psychologist or a psychiatrist. “It should be emphasized that nausea is sometimes the side effect of some drugs, such as those for older generation depression,” explains Giulia Martina Cavestro. Nausea sometimes affects women who suffer from cycle disorders, such as dysmenorrhea, i.e. painful menstruation, or premenstrual syndrome, due to changes in hormones. Nausea and vomiting are symptoms of flu, but also headache and migraine attacks can be heralded by symptoms such as nausea or bright flashes, and can also happen to those suffering from cervical or dizziness or vestibulitis: the description of the symptoms, first of all to the general practitioner, is important, because the patient may think that the problem is gastric and instead is neurological, gynecological or the competence of the physiatrist or otolaryngology. The correct diagnosis is essential to identify targeted therapies.

When breakfast is impossible

A symptom related to morning sickness is difficulty eating breakfast: a problem that often also affects children. “In this case, however, it is important above all the food education given by parents, also through example”, explains Giulia Martina Cavestro. “Snacks, biscuits or other industrial products high in sugar and fat to increase their palatability, perhaps rushed to the car while accompanying children to kindergarten, or swallowed a moment before getting on the school bus can “remain on the stomach” – more if the child suffers from motion sickness, that is, car sickness which in turn causes nausea – can establish a vicious circle that causes the child, And then the teenager, “expect” nausea and refuse breakfast, which is instead a fundamental meal. The ideal is not to be in a hurry, to provide enough time to make it sitting at the table, in serenity, with fruit, rusks or bread and jam ».

If a baby is on the way

The specialist continues: “In a young woman of childbearing age who suffers from morning nausea and vomiting, the first of the triggers to be excluded – or to think about – is pregnancy”. The suspicion can be confirmed with a test that can be purchased at the pharmacy: again, if the pregnancy test is negative, menstruation is absent and the disorder persists it is necessary to contact the doctor, gynecologist and / or gastroenterologist, depending on the patient’s situation.

But why is morning sickness the first “bell” of a pregnancy, immediately after conception? “It is one of the many ‘side effects’ of the hormonal changes necessary to allow the body to accept the fetus and provide for its development. Pregnancy nausea (also with stomach acid and reflux after meals) is often caused by a slowing of gastric motility, so much so that it is often accompanied by constipation, because intestinal activity also slows down. The culprit is the rapid increase in progesterone, the main hormone of pregnancy, which has a muscle relaxant effect, or relaxation of the muscles, and the surge of chorionic gonadotropin and estrogen. To this physiological cause is gradually added a “mechanical” factor: the increase in the weight of the uterus, which compresses the gastrointestinal tract and with pressure hinders its activity. The disorder, which can occur in the pregnant woman also seeing or smelling some foods and substances, generally develops in the first trimester around the fifth week, can remain in the first months of gestation and disappear around the sixteenth-eighteenth week, but can also last for the duration of pregnancy.

Remedies for morning sickness

“The advice to snack and chew something solid – a cookie, a piece of bread, a cracker – to “dry the gastric juices” and mitigate the discomfort has no scientific validity. And the same is true when it is recommended because it is thought that nausea may be due to “an empty stomach”, adds the gastroenterologist. “This remedy can give a subjective well-being in case of peptic ulcer by raising the pH of the stomach a little, but not so much. In addition to antacids or drugs that increase gastric motility – always to be taken under medical supervision – physical movement and sport, moderate and appropriate to pregnancy (walking, gymnastics, swimming, etc.) is more useful because it can relieve nausea and many other symptoms, and ginger which, also in the form of herbal teas, promotes gastric motility giving relief. The same effect could have spicy foods, such as a pinch of chili.”

Next to ginger, among the natural remedies for nausea there are relaxing herbal teas, such as passionflower, chamomile, lemon balm, linden, valerian that can also be taken during the day, to alleviate anxiety and improve the quality of sleep, so that even morning ailments can cease.

It also seems that vitamin B6 supplements also have an anti-nausea effect, modulating serotonin and norepinephrine, two neurotransmitters that act on the control of nausea in the brain.

Even if you are pregnant, attention to the symptom should be high if nausea and vomiting are frequent throughout the day. In this case they are to be reported to the doctor because, in addition to representing a disabling disorder, they could report a hyperemesis gravidarum, with the risk of weight loss, dehydration, lack of energy and other consequences, even serious.

Triggering smells

Smells can be a trigger of morning sickness even outside pregnancy: there are those who try it, for example, if neighbors cook meat sauce or if someone smokes a cigarette at the bus stop. “Smell plays a very important role in digestive function,” she says. “There is a phase of digestion that is based on the smell, thought and sight of food, and it is precisely the first phase of the digestive process (a vagal stimulus, that is, of the vagus nerve, the longest of the nervous system which, among many functions, also carries the gustatory sensory information to the central system) that allows us to start gastric acid secretion and start the breakdown of food: The famous “mouth watering” that can come at the sight of a nice plate of pasta or smelling the scent of freshly baked bread passing in front of a bakery. However, if a person is dyspeptic, that is, he has digestive difficulties, on certain occasions he could, for a sort of short circuit of this phase, have discomfort only by smelling the smell of food as well as substances that he does not like (smoke, gasoline, etc.)» concludes the expert.

How to prevent morning sickness

Since the main cause of morning sickness is dyspepsia, the most effective prevention is to pay attention to dinner. The following table shows the habits to follow or avoid during the evening meal.

It is also important to eat early enough, calmly, chewing well and for a long time, or in any case in such a way as to have a few hours of time before bedtime to promote digestion. The ideal would be to be able to afford a short walk after dinner.

Finally, if you have a tendency to low blood pressure or hypoglycemia, or during the sweet expectation, it may be worth trying to alleviate nausea immediately by keeping a packet of dry biscuits or crackers on the bedside table to be able to consume a couple before getting up.