Sufferer: The Duchess of Cambridge has endured a well-publicised issue with nausea
A few days ago, my son asked me whether I would rather lose a leg or feel mildly nauseous for the rest of my life. Stupid question. I’d rather lose a leg, obviously.
He was amazed. Nobody gives that answer, he said.
I suspect that the Duchess of Cambridge might right now. She would probably give her right arm as well, to be relieved of her extreme pregnancy sickness.
Anyone who dismisses her as a lightweight for missing her son’s first day of school can’t know what intense nausea feels like. She has to bear the torture day and night for nine months.
But even a more gentle or short-lived nausea — whether from motion sickness, eating too many chocolates, the side-effect of medicine, or even the sight of blood — can be excruciating.
I think feeling sick is underestimated and probably one of the most debilitating feelings there is. In extreme cases, it can lead to isolation, loneliness and depression, according to Dr Adam Farmer, a consultant neurogastroenterologist at the University Hospitals of North Midlands.
He has devoted the past ten years to investigating and treating nausea and says one in eight people suffer from it on a regular basis, with many more doing so intermittently — in fact, after pain, nausea is one of the most frequent complaints seen by GPs.
Yet it remains the poor relation: pain seems more urgent, somehow, possibly as we can often see its cause in the form of a wound. Our understanding of nausea is relatively limited and, in turn, the treatments for it, in Dr Farmer’s view, remain ‘sub-optimal’.
A lot of people brush off nausea as trifling. Typically, they think of teenagers who have had too many cans of cider. Over-indulgence is just one cause. Exercising too hard is another.
Good and bad nerves, oddly, bring on nausea. I think of how we feel on a first date, or when one of our children is unhappy.
This probably relates to the autonomic nervous system, which operates bodily processes such as our heartbeat, breathing and digestion. This has two branches, which work like yin and yang: when we’re broken-hearted, the sympathetic nervous system is very active, while the parasympathetic nervous system, which is associated with dampening nausea, is less active.
Nausea also accompanies almost any disease. Irritable bowel syndrome (IBS) is one example. As Dr Farmer says: ‘The digestive tract only has a limited vocabulary to express disquiet. Its repertoire is feeling sick, being sick, feeling bloated, constipation, diarrhoea. Nausea often occurs if the stomach can’t empty quickly enough.’
One of the most common causes of nausea is side-effects of medicines and surgery.
General anaesthetics, medication and chemotherapy are well-known culprits. They are, in a sense, toxins, which the body is on a mission to reject — this is one of nausea’s chief roles.
No wonder cardboard bowls are a staple of hospitals, ambulances and doctors’ surgeries. Luckily, it is the more common or garden forms of nausea most of us come across — due to a dodgy chicken drumstick, or a 24-hour bug.
Debilitating: The mother-of-two suffered severe morning sickness during her pregnancies
It doesn’t usually last long. But it’s vile. The word ‘nausea’ comes from the Greek for ship. Roman Cicero declared he would rather be killed than suffer seasickness.
Treatments have improved. Antiemetics work by suppressing signals to and from the vomiting centre of the brain, or by increasing the movement through the gastrointestinal tract.
But there is no one-drug-fits-all, and some kinds of nausea — like that consistent with chemotherapy and severe pregnancy sickness — are proving pretty resistant to antiemetic medication. They possibly always will.
Dr Farmer says it is difficult to use the word ‘cure’ in relation to nausea. ‘We’ve made great strides in the past ten years,’ he says. ‘The chemo regimes are less nauseogenic and drugs to treat nausea are better, but we’ve a long way to go. Chemo-induced nausea is still putting people off a life-saving treatment.’
It might seem difficult to understand how chronic nausea could be so debilitating.
But as Qasam Aziz, professor of neurogastroenterology at Barts and The London School of Medicine and Dentistry, explains: ‘One of the most pleasurable things in life is to be able to eat normally and enjoy it. If you can’t do that, it affects your social and personal life. It can ruin your life.’
Professor Aziz has respect for this sensation. As he explains, just as pain is a mechanism designed to prevent us from damaging ourselves, so the unpleasant sensation associated with the urge to vomit is nature’s way of trying to stop us from being sick or becoming ill.
He says: ‘If you drink vodka after vodka, nausea is the warning for you to behave yourself, and if you ignore that warning, it will lead to vomiting. If you didn’t have nausea, you might not have two vodkas, but ten — and that would eventually lead to liver failure.
Helping hand: Some patients sometimes look to alternative therapies, such as acupuncture, to reduce the symptoms of feeling sick
‘Nausea is a protective sensation you couldn’t live without.’ A more mundane example, he adds, might be when you’re feeling hungry and thirsty — and nauseous. Nausea is the body’s way of saying you’re dehydrated and need to eat.
Yet something so intangible is hard to describe, let alone measure. Professor Aziz asks his patients to rate it on a scale of zero to ten, but says brain imaging promises a more objective measure.
In a paper published in the Journal of Physiology in 2015, he and his co-authors found there are various areas of the brain that are responsive to nausea. Different areas are sensitive to its different causes, with some overlap.
I asked him if, in some cases, it is possible to exercise mind-over-matter with nausea, just as some people achieve mastery over pain. ‘There is individual variation,’ he says, ‘and that is partly down to genetics, environment, his or her upbringing and social situation.’
It seems that, perhaps as I hate feeling sick so much, I have developed a bespoke mind-over-matter and have managed not to throw up since I was nine. When I was in my 20s, anorexia turned into bulimia, but even so, I never vomited: I have the dubious distinction of being one of the first people officially diagnosed with an alternative form of bulimia — the kind in which ‘atonement’ for a binge is to starve for several days.
It seems that, perhaps as I hate feeling sick so much, I have developed a bespoke mind-over-matter and have managed not to throw up since I was nine.
Whether it is luck or some psychological obstinacy born out of a sick phobia, provenance unknown, and the fact that I don’t drink alcohol, I almost never feel queasy. I’ve managed to dodge food poisoning and the norovirus.
Some feelings of nausea, whatever their cause, cannot be overcome by the mind alone, and can cause misery, sometimes lasting.
But really severe nausea is the preserve of the unlucky few. One of my friends who, like the Duchess of Cambridge, experienced the solemnly named hyperemesis gravidarum, stopped at one child because she couldn’t face a second nine-month bout of hell.
Another, pregnant for the third time, contemplated an abortion despite yearning for a big family ever since she was a child.
For some people with chronic nausea, doctors try everything, yet little works — but psychotherapy or hypnotherapy can help.
Dr Farmer says patients sometimes look to alternative therapies, such as acupuncture, and there is no doubt some derive great benefits from them.
‘They’re not mainstream because doctors don’t really understand how or why they work,’ he explains. ‘We are a conservative bunch on the whole. But my view is that if they do no harm, and are possibly beneficial, then go ahead.’
One idea is that yoga, with its deep breathing, might help; he suggests it appears to increase the activity of the vagus nerve.
This nerve runs from the brain to the abdomen and carries messages from the gut and other organs to the brain and back. ‘When this nerve is less active, it seems to equate to higher nausea,’ says Dr Farmer. ‘The old wives’ tale of deep, slow breaths to help nausea may have some basis to it.’
‘Apparently, the Duchess of Cambridge has tried ice lollies,’ he adds. ‘Why might that work? We know putting one’s face in cold water is a way to activate the vagus nerve so maybe ice lollies do, too.’
He also recommends over-the-counter medicines for queasiness — such as Benadryl. Although it is really an antihistamine, it also effectively blocks messages from the inner ear (our balance mechanism) to the part of the brain that controls nausea and vomiting.
But if nausea persists and there is blood in the vomit, or it is causing weight loss and real concern, he recommends you visit your GP.
Years ago, I read a piece in The New Yorker about a woman with hyperemesis gravidarum. When her twins were born, the sickness lifted within hours. She ate a giant hamburger with blue cheese and chips and declared it delicious.
Thankfully, for nausea suffers everywhere, it seems there is light at the end of the tunnel, even if progress along that tunnel is sickeningly slow.