Dear Doctor

I always have nausea in the mornings. But unlike some of my colleagues with the same problem, I don’t drink alcohol. What could be the cause and how do I treat this condition? Kamanzi

Dear Kamanzi,

One can have nausea in the mornings due to multiple reasons, drinking alcohol being one of them. Soft drinks and sodas also cause dyspepsia like alcohol. If consumed in the evening before, they can cause nausea with or without vomiting in the mornings. Hot spicy and or heavy food consumed in the evening before can cause nausea the next morning. It can also be due to a heavy dinner or taking dinner very late in the evening, which causes indigestion. Chronic constipation also leads to nausea in the mornings. A woman in the reproductive age group can have morning nausea with or without vomiting due to pregnancy.

Drugs like pain killers of the NSAID (non-steroidal anti-inflammatory drugs) group, corticoids, and etcetera, cause nausea as a side effect. One can have morning nausea due to medical disorders like peptic ulcer, chronic gastritis, chronic esophagitis, cancer of the food pipe or stomach, and liver disorders. Nausea can be due to food poisoning or worm infestation. Here, nausea may be accompanied by abdominal pain and or diarrhea.

The underlying cause for nausea in the mornings, can be detected by a good history including diet, consumption of alcohol, sodas, and bowel habits. Clinical examination may or may not be helpful. Investigations like stool examination, liver function tests, upper G.I. endoscopy (where food pipe and stomach are visualised by passing a thin tube through the mouth), abdominal ultrasound.

Treatment consists of using drugs which reduce stomach acid production and anti-vomiting drugs. Treatment of any underlying cause if detected helps in curing the problem.

Preventive measures when adopted aid in preventing the condition. Take frequent small meals, avoid taking heavy meals or very spicy meals in evening, avoid eating late in the evening, and avoid alcohol and excess of sodas. Regular intake of diet containing fresh green vegetables, fresh fruits, helps in regular cleaning of bowels and thus prevents constipation with resultant nausea. Drinking adequate amount of water is also useful in this regard.