Nausea is a sick, queasy feeling that may occur during cancer treatment, either due to the disease itself or a side effect of treatment.  Nausea may be accompanied by vomiting.  Although many people experience bouts of nausea through treatment that can be adequately managed, ongoing, uncontrolled nausea (especially if you’re vomiting) can lead to loss of appetite, dehydration, electrolyte imbalances, weakness, and weight loss.    

Dietary strategies to reduce nausea 

When you’re feeling nauseous even the thought of eating can be very unsettling.  All of our senses (sight, smell, taste, sounds, satiety) are very involved in our relationship with food, so managing meals in the most sensory-neutral way possible may be helpful.

• Mini meals: Over-extending the stomach can aggravate nausea, so try breaking down eating into six or eight mini meals instead of three larger ones.  These closer to snack-size meals could include homemade or store-bought protein shakes taken in smaller portions.   

• Cold, odorless foods: Hot foods give off stronger odors which can trigger nausea or stimulate food aversions.  Cold foods tend to be odorless so ½ of a cold cut or cheese sandwich, Greek yogurt, pudding, ice cream, toast with nut butter, fruit and nuts, cereal with milk, a mini protein shake, tortilla chips and hummus, or cheese and crackers may be easier to consider. 

• Opt for what is appealing: Avoid foods that are off-putting, even if you think they’re “healthy” or something you should be eating (like red meat for iron, for example).  It’s more important to eat calories and protein regularly than to worry about the quality of your diet when you’re feeling nauseous.   

• An empty stomach can make nausea worse: While food can be a turn-off, having an empty stomach can further aggravate nausea.   Eat a few dry crackers or a slice of toast before moving around much in the morning.  Continue to eat something small every two to three hours over the day.  Be sure to eat something in the morning on the day of your treatment. 

• Save your favorites: Don’t try to tease your appetite with your favorite foods as you may end up developing an aversion to them.  Save them for when you’re feeling better and can really enjoy them.  

• Avoid extreme tastes: Fatty, fried, spicy or very sweets foods may feel heavy in your stomach.   Bland foods tend to be more neutral and may be less emotionally triggering.  

• Stay upright and sit quietly after eating to help your stomach settle. Calm your environment with soft music, a favorite TV show or light conversation with company.  

• Stick to a very limited diet if you must, but only for a short time: Choosing to eat broth, toast and other easily digested foods may help ease symptoms but are nutritionally inadequate and should only be followed for a very short period of time. Seek help from your oncologist and registered dietitian for help managing persistent nausea and vomiting.  

Manage your environment 

• Avoid cooking odors prior to attempting to eat. Try preparing foods ahead that can be reheated quickly in a microwave, or allow others to prepare your food without you present.   

• Eat in a well-ventilated space. 

• Grill meat, poultry and seafood outside to keep your home odor free. 

• Suck on hard candies, like lemon or peppermint, to keep your mouth free of bad tastes. 

 Tips for staying hydrated 

• Sip fluids throughout the day, limiting them at mealtimes if you find they contribute to feeling too full. 

• Add lemon, lime, cranberry or other juices or flavorings to water to make it more appealing. 

• All fluids count, and we often drink more when our fluids are flavored.  Diluted juices (often easier on the stomach), electrolyte beverages, broths, herbal or fruit teas, and fruit smoothies are all options. Frozen or thickened fluids like juice pops, sherbet, sorbet, or gelatin also count as fluids. 

If you’re vomiting, it’s important to include electrolyte-containing beverages, like Pedialyte, Gatorade, Powerade, Ultima, salty broth (for sodium) and coconut water (for potassium), to prevent electrolyte imbalances. 

Note: If vomiting persists despite efforts to treat it, it’s important to call your doctor. 

Medications for managing nausea 

There are many medications, or combinations of medications, available to treat nausea. It’s important to take anti-nausea medications as prescribed. It is often necessary to take them continuously to keep nausea in check. Regularly communicating with your clinical team about what is and isn’t working is critical for determining the best medications for you. Taking these medications at the first sign of nausea helps them to be more effective.   

Some anti-nausea medications cause constipation. Eating a high fiber diet and staying hydrated can help, but it’s often recommended to take stool softeners and other bowel medications proactively while taking certain anti-nausea medications. Following your clinician’s recommendations can help avoid severe episodes of constipation, which may further worsen nausea. 

Natural remedies that may be helpful 

Although anti-nausea medications are the main treatment for nausea and vomiting, mind-body strategies can also be helpful additions to a nausea management plan: 

• Ginger–ginger has been used for centuries as a natural nausea remedy.  It can be taken as candied ginger, ginger tea, ginger honey crystals mixed in hot or cold water, or used in cooking.  To make ginger root tea, cover a few thin slices of cleaned ginger root with boiling water, cover and steep for at least 5 minutes.  Ginger has a very strong flavor and may not be tolerated by some.  Adding honey and lemon can smooth out the taste.   Most bottled ginger ales do not contain natural ginger, though some people still find it helpful.   

• Acupuncture and Acupressure – these traditional Chinese techniques using very fine needles or pressure points may be helpful at managing nausea.  

• Emotional Support  - various therapies provided by trained experts may be helpful for managing nausea.  Relaxation techniques, guided imagery, and music therapy are a few approaches that may provide some relief.   

• Medical Cannabis –research suggests active components in cannabis may be helpful in managing nausea and vomiting in patients undergoing chemotherapy. There are also two medications based on marijuana compounds approved in the US for management of nausea and vomiting. If you’re interested in medical cannabis or medications derived from it speak to your oncologist. 

What to eat when you feel nauseous 

The following is a list of foods that may be better tolerated or potentially problematic. Everyone’s experience is unique so if something on the limit list is appealing, eat it. 

Sample mini meal eating plan