Conditions:
Nausea
Principal Proposed Treatments
•
Ginger, Acupressure/Acupuncture, Vitamin B6
Other Proposed Treatments
•
Peppermint, Vitamin K, Vitamin C, Low-fat Diet
Nausea can be caused by many factors, including stomach flu, viral infections of the inner ear (labyrinthitis), motion sickness, pregnancy, and chemotherapy. If you are continually nauseous, it can be more disabling than chronic pain. Successful treatment can make an enormous difference in your quality of life.
The sensation of nausea can originate in either the nervous system or the digestive tract itself. Most conventional treatments for nausea, such as Dramamine and Compazine, act on the nervous system, but products like Pepto-Bismol soothe the digestive tract directly.
Principal Proposed Treatments for Nausea
The herb ginger has become a widely accepted treatment for nausea of various types. Vitamin B6 may be helpful for the nausea of pregnancy.
Ginger: May Help Several Types of Nausea
Native to southern Asia, ginger is a 2- to 4-foot perennial that produces grass-like leaves up to a foot long and almost an inch wide. Ginger root, as it is named in the grocery store, actually consists of the underground stem of the plant with its bark-like outer covering scraped off.
Ginger has been used as food and medicine for millennia. Ginger's modern use dates back to the early 1980s, when a scientist named D. Mowrey noticed that ginger-filled capsules reduced his nausea during an episode of flu. Subsequent research ultimately led Germany's Commission E to approve ginger as a treatment for indigestion and motion sickness.
Ginger is used for the prevention and treatment of various forms of nausea. These include motion sickness, the nausea and vomiting of pregnancy (morning sickness), and post-surgical nausea.
Note: If you are pregnant or undergoing surgery, do not self-treat with ginger except under physician supervision.
What Is the Scientific Evidence for Ginger?
Scientific evidence suggests that ginger can be helpful for various forms of nausea.
Nausea and Vomiting of Pregnancy
A double-blind placebo-controlled trial of 70 pregnant women evaluated the effectiveness of ginger for morning sickness.1 Participants received either placebo or 250 mg of powdered ginger 3 times daily for a period of 4 days. The results showed that ginger significantly reduced nausea and vomiting. No significant side effects occurred.
Benefits were also seen in a double-blind trial of 27 women.2
Note: Ginger has not been proven safe for pregnant women.
Motion Sickness
A double-blind placebo-controlled study of 79 Swedish naval cadets found that 1 g of ginger could decrease vomiting and cold sweating but without significantly decreasing nausea and vertigo.3 Benefits were also seen in a double-blind study of 36 individuals given ginger, dimenhydrinate, or placebo.4
In addition, a double-blind comparative study that followed 1,489 individuals aboard a ship found ginger to be equally effective as various medications (cinnarizine, cinnarizine with domperidone, cyclizine, dimehydrinate with caffeine, meclozine with caffeine, and scopolamine).5 Another double-blind study found equivalent benefit of ginger at a dose of 500 mg every 4 hours and dimenhydrinate (100 mg every 4 hours) in a group of 60 passengers aboard a ship.6 Similar results were also seen in a small double-blind study involving children.7
However, a 1984 study funded by NASA found that ginger was not any more effective than placebo at reducing the symptoms of nausea caused by a vigorous nausea-provoking method.8 Negative results were also seen in another study that used a strong nausea stimulus.9
Put all together, these studies paint a picture of a treatment that is somewhat effective for motion sickness but cannot overcome severe nausea.
Post-Surgical Nausea
A British double-blind study compared the effects of ginger, placebo, and the drug metoclopramide in the treatment of nausea following gynecological surgery.10 The results in 60 women showed that both treatments produced similar benefits compared to placebo.
A similar British study followed 120 women receiving gynecological surgery.11 Whereas nausea and vomiting developed in 41% of participants given placebo, in the groups treated with ginger or metoclopramide (Reglan), these symptoms developed in only 21% and 27%, respectively.
However, a double-blind study of 108 people undergoing similar surgery showed no benefit with ginger as compared to placebo.12 Negative results were also seen in another study.13
Warning: Do not use ginger either before or immediately after surgery or labor and delivery without a physician's approval. Not only is it important to have an empty stomach before undergoing anesthesia, there are theoretical concerns that ginger may affect bleeding.
For more information, including additional dosage and safety issues, see the full ginger article.
Acupressure/Acupuncture: Very Promising, but Evidence Not Consistent
Numerous studies have evaluated treatment on a single acupuncture point, P6, traditionally thought to be effective for relief of nausea and vomiting. This point is located on the inside of the forearm, about 2 inches above the wrist crease. Most studies have investigated pressure on this point (acupressure) rather than needling. The most common means of applying pressure involves a band placed around the forearm. The band contains a pearl-sized bead that applies stimulation to P6 when pressed by the wearer. Direct massage may also be used.
Although the research record is mixed, on balance, it appears that P6 stimulation offers benefit for nausea. This approach has been studied in anesthesia-induced nausea, the nausea and vomiting of pregnancy, and other forms of nausea as well.
What Is the Scientific Evidence for Acupressure/Acupuncture?
Nausea Due to General Anesthesia
General anesthetics and other medications used for surgery frequently cause nausea. Many studies have evaluated the use of P6 stimulation in women undergoing gynecological surgery, and found benefits. However, the results of acupressure studies in other forms of surgery show about as many negative as positive results.
In a double-blind trial, acupressure at P6 using band and bead stimulation was compared to sham acupressure in 104 patients undergoing laparoscopy (telescopic examination of the abdomen) as part of infertility treatment.20 The results showed significant improvements in nausea and vomiting in the treated group as compared to the placebo group.
A similar double-blind placebo-controlled study of 94 women tested P6 stimulation for prevention of nausea and vomiting during and after cesarean section with spinal anesthesia.21 Again, acupressure treatment helped significantly. Benefits were also seen in other studies: one double-blind study of 60 women receiving minor gynecological surgery,22 a double-blind placebo-controlled trial of 60 women receiving epidural morphine for relief of C-section pain,23 and a single-blind placebo-controlled trial of 125 women undergoing minor gynecological surgery.24 Another double-blind study compared acupuncture to the drug metoclopramide in 75 individuals receiving spinal anesthesia for C-section, and found them equally effective.25 The only negative results discovered during a literature search were from a single-blind trial of 47 women undergoing gynecological surgery, which found no benefit with acupressure.26
However, studies of P6 stimulation in other forms of surgery have produced almost equally balanced mixed results. A double-blind placebo-controlled trial of 200 individuals undergoing various types of surgery reported positive results, but in fact these results fell just shy of the usual cut-off for statistical significance and should properly be considered inconclusive.27 Another large double-blind placebo-controlled trial followed 200 patients undergoing urological surgery and found evidence that P6 stimulation was not effective.28 A double-blind study of 66 children undergoing eye surgery also found no benefit,29 as did a double-blind placebo-controlled trial of 84 children undergoing inguinal surgery.30 On the other hand, three double-blind placebo-controlled trials found benefit against anesthesia-induced nausea for children undergoing eye surgery. One trial used Korean hand acupuncture and enrolled 50 children,31 and another used laser acupuncture and enrolled 40 children.32 A third study was unique in that it tested the effectiveness of acupressure at points other than P6, and also found benefits.46 In addition, band and bead acupressure was found effective in a single-blind placebo-controlled trial of 152 general surgical patients.33
Nausea and Vomiting of Pregnancy
A double-blind placebo-controlled study of 97 women found evidence that real wristband acupressure may help relieve symptoms of morning sickness better than fake wristband acupressure.34 Participants wore either a real wristband or a phony one that appeared identical. Both real and fake acupressure caused noticeable improvement in more than half of the participants. However, women using the real wristband showed better results in terms of the duration of nausea. The intensity of the nausea was not significantly different between groups.
These results are consistent with previous studies, such as a double-blind placebo-controlled crossover trial of 60 women in early pregnancy that used wristband acupressure.35 The results showed a 60% reduction in symptoms in the acupressure group, compared to only a 30% reduction in the placebo group. Interestingly, wearing a band on one wrist was no more effective than wearing a band on both. Comparative benefits were also seen in three other trials enrolling a total of more than 100 women.36-38
A study of acupuncture for morning sickness, however, returned more equivocal results, possibly because even fake acupuncture produces a strong placebo effect. This single-blind, placebo-controlled study of 593 pregnant women with morning sickness compared the effects of traditional acupuncture (many needles, at points chosen by the acupuncturists), P-6 acupuncture, acupuncture at “wrong” points, and no treatment.47
Women in all three treatment groups (including the fake acupuncture group) showed improvements in nausea and dry retching as compared to the no-treatment group; the only notable difference was that benefits began a week earlier in the the traditional acupuncture group. (Unfortunately, the authors do not state whether this difference was statistically significant.) No treatment improved actual vomiting.
Other Forms of Nausea
A single-blind placebo-controlled study looked at the effect of acupressure on motion sickness.39 The researchers divided 64 participants into a real treatment group, each receiving manual acupressure at P6, and three different control groups: no treatment, acupressure at a sham point, and pressure on P6 that was considered too light to do anything. The procedures were conducted while the participants were inside a rotating drum designed to induce motion sickness. The results showed that pressure on P6 was superior to all three control-group outcomes.
Electroacupuncture on P6 may be helpful for chemotherapy-induced nausea. A single-blind placebo-controlled trial of 104 individuals undergoing high-dose chemotherapy for breast cancer found that electrical stimulation on P6 significantly reduced episodes of vomiting.40 Similar improvements were found in a pilot study.41
Vitamin B6
A large double-blind study suggests that 30 mg daily of vitamin B6 can reduce the sensation of nausea in morning sickness.42 For more information, including dosage and safety issues, see the full vitamin B6 article.
Other Proposed Treatments for Nausea
Preliminary studies suggest peppermint oil may be able to reduce post-operative nausea.43
On the basis of studies conducted in the 1950s, a combination of vitamin K (at the enormous dose of 5 mg) and vitamin C (25 mg) is sometimes recommended for morning sickness.44 For more information, including dosage and safety issues, see the full articles on vitamin K and vitamin C.
Diets high in saturated fat (animal fat) can increase morning sickness in some people.45
View References
Last reviewed May 2002 by Medical Review Board
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