Say hello to your little friend. Intestinal parasites, like tapeworms, can cause nausea, fullness, and weight loss. In fact, women throughout history have intentionally swallowed these worms in a misguided attempt to lose weight. The savvy internet sleuth can still find tapeworm eggs sold as pills online. Needless to say, we strongly discourage this practice, as intestinal worms can cause life-threatening obstructions. If you’ve been losing weight and feeling bloated, and you’re an international traveler, you can have your stool screened for evidence of parasites.
Maybe you actually do have cancer. Make sure you are up to date on your cancer screening tests, including a colonoscopy and mammogram or prostate evaluation. Of note, most people with weight loss due to cancer also have other symptoms, like fever, pain, nausea, vomiting, or feeling full quickly when eating (due to liver or spleen enlargement).
Get to the E.R.
You feel lightheaded or have had loss of consciousness. You may be severely dehydrated. A significant drop in your body’s water and salt content can lead to an abrupt reduction in weight over several days. Dehydration often results from the use of medications, like diuretics (which increase urine output) or laxatives (which increase the water content of stool). It can also result from frequent vomiting or diarrhea. Less frequently, it results from excessive exercise and/or inadequate access to water. If untreated, severe dehydration causes low blood pressure, which can result in organ failure and even death. If you don’t quickly bounce back after drinking a rehydration solution, like Pedialyte, get to the E.R. as quickly as possible.
Bloating and Gas
Do you have more gas than ExxonMobil? Do you look on in pity at anyone who joins you in an elevator? Or are you mostly bothered by your bloated belly, which seems to inflate by a size or two after every meal?
Bloating usually results from air in the stomach or intestines. Air gets into the stomach when it is swallowed, usually during normal eating or drinking. In contrast, air is actually produced in the intestines by the trillions of bacteria that live there and help process your food. Stomach air usually causes belching, whereas intestinal air causes flatulence (a.k.a. gas).
Most people, no matter how prim or proper they may seem, pass gas about twenty times per day. If you work in an open floorplan office, that means hundreds of silent but deadlies waft through your airspace between nine and five o’clock. (Another reason to work from home.)
It’s normal to feel bloated every now and then, usually after eating too much or too quickly. In rare cases, however, persistent bloating may be a sign of something more serious, like an intestinal blockage or the accumulation of fluid (rather than air) from liver disease or ovarian cancer.
Take a Chill Pill
Beans, beans, the musical fruit . . . Your intestinal bacteria help process food that your body otherwise can’t handle. They are especially fond of legumes (peas, beans, chickpeas, lentils) and cruciferous vegetables (cauliflower, broccoli, cabbage, brussels sprouts). Unfortunately, the bacteria produce gases like methane and carbon dioxide as they feast on your leftovers. In our experience, these gases seem most eager to escape during work meetings and first dates. Try going a few days without these foods to see if your gas improves. If it does, either continue avoiding them (not ideal, since they’re so healthy) or try a product like Beano, which helps process these foods before your bacteria can grab them.
Your breath always smells incredible. Chewing gum can relieve stress and keep you smelling minty fresh, but it also makes you swallow a lot of air. In addition, gum often contains the sweetener sorbitol. The same intestinal bacteria that feast on legumes and vegetables also make quick work of sorbitol, producing lots of gas. You’ll double your pleasure . . . and your waistline.
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Quick Consult
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Should You Take Probiotics?
You have trillions of bacteria in your intestines—more than the number of human cells in the rest of your body, more even than the number of stars in the galaxy. (Because bacteria cells are so much smaller than our cells, they get packed by the billions into the winding loops of our intestines.)
“But wait!” you say. “Aren’t bacteria bad? Don’t they cause infections? If I have trillions of them down there, am I just a ticking time bomb?” It turns out that most bacteria are not bad actors. Instead, they’re happy to live in our colons like barnacles—enjoying the food as it passes by and providing us some benefits. These bacteria help process our food, regulate our hormones, put the brakes on the immune system (so it doesn’t attack our own cells), and much more. In fact, they can actually prevent infection with bad bacteria, like C. difficile—a.k.a. C. diff—by crowding them out. (That’s why taking antibiotics, which kill all the good bacteria, can lead to C. diff infection.)
It has become clear that shifts in our intestinal bacteria can directly affect our gut and overall health. As a result, there has been intense interest in probiotics, defined as good bacteria and taken in pill form or mixed into food. (For example, you’ve probably seen ads for yogurts and supplements containing bacteria like Bifidobacterium or Lactobacillus.)
So do these supplements actually help? The issue has been studied in diarrhea, constipation, irritable bowel syndrome, and many other conditions, so far with inconclusive results. There’s no evidence that they’re bad, but it’s not certain that they’re helpful either. They may shorten diarrheal illnesses related to infections. In addition, people who have had prior C. diff infection should use probiotics when they need to take antibiotics, to reduce their risk of reinfection.
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You’d love to give the world a Coke. If you drink carbonated soda through a straw, you are essentially begging for bloating and flatulence. First, drinking through the straw usually results in lots of swallowed air. (You might just burp it back out, but if you lie down the air can sometimes slip into the intestines.) Second, the bubbles in your drink continue to escape as the fluid passes through your system. Third, many people cannot fully process the fructose found in sweetened foods and drinks (usually in the form of high fructose corn syrup). Who comes to the rescue? You guessed it, intestinal bacteria, which produce gas as they consume the fructose.
Milk. It does a body . . . not so good. Lactose is the primary sugar in milk, but a lot of people are missing the enzyme (lactase) needed to properly digest it. Lactose intolerance is particularly common among Hispanics (six in ten), blacks (seven in ten), and Asians (nine in ten). The undigested lactose makes its way to the colon, where bacteria ferment it and produce gas. Try cutting back on milk and milk-based products (ice cream, yogurt, cheese) to see if your symptoms improve. If they do, you can try taking lactase supplements or sticking with lactose-free milk (like Lactaid).
Your bloating occurs right before your period. The swings in hormone levels right before your period can cause big-time bloating—and a sudden increase in the appeal of sweatpants—by raising your body’s absorption of fluid and salt. Try to decrease your salt intake and stay as active as possible to keep food moving through your system. If your bloating becomes significantly worse over time, speak to your doctor.
You’re glowing and bloated at the same time. Bloating and constipation affect three out of four pregnant women. (That is, of course, extra bloating on top of the constant bloating resulting from your enlarged uterus.) An increase in the hormone known as progesterone can slow down the movement of food through your intestines. In addition, the iron in prenatal vitamins can worsen constipation. To beat the bloat, you’ll need to stay hydrated, eat more fiber, and try to stay active.
It’s a side effect. Several medications and vitamins are known to cause abdominal bloating. Antibiotics, for example, may eliminate the good bacteria in your intestines and can therefore cause bloating and diarrhea. Aspirin, pain medications (especially opioids like Percocet and Vicodin), iron pills, antacids, and antidepressants can also cause bloating. Please speak to your physician before stopping any medication.
Make an Appointment
You have bloating and abdominal pain that significantly improve after a bowel movement. You may have irritable bowel syndrome, or IBS. In this fairly common condition, the intestines become very sensitive to any kind of distension from food or gas, so you feel bloated and uncomfortable when others would feel fine. Some people also experience diarrhea, constipation, or both; in any case, a bowel movement usually lowers the pressure in the intestines and causes a significant improvement in your overall comfort level. Your doctor may recommend certain dietary changes and medications to better control your symptoms.
You have bloating that doesn’t vary much throughout the day or improve after a bowel movement. You may have fluid around your intestines (known as ascites) rather than air in your intestines. The fluid doesn’t really change with food intake, so you’ll feel bloated throughout the day. If there is a lot of fluid present, your belly may become visibly larger. Potential causes include liver disease, heart disease, and cancers (such as ovarian cancer). An ultrasound of the abdomen can usually detect ascites and the likely cause. Yellowing of the skin and/or eyes points to liver disease, while swelling in the legs points to heart disease.
You also have diabetes and can’t keep food down. The stomach normally churns food into small pieces and pushes them into your intestines. Diabetes can damage the nerves around the stomach and impair its ability to perform these tasks. In this condition, known as gastroparesis, food just sits in the stomach rather than moving through your system. As a result, you feel bloated and nauseated all the time, unable to eat a full meal because there is literally no room left down there. Your doctor can confirm the diagnosis with a scan that monitors stomach emptying speeds. The treatment for gastroparesis centers on eating frequent small meals, consisting primarily of soft foods. Some medications can also relieve nausea and nudge the stomach to work a bit harder.
Get to the E.R.
You also have nausea and severe abdominal pain. You may have a blockage in your intestines preventing the normal passage of food and air. If untreated, an obstruction can lead to severe, life-threatening damage to the intestines. Get to an E.R. or urgent care center right away for an X-ray of your abdomen, which can usually detect any significant blockage.
You have had significant weight gain in the last one to two weeks and also feel short of breath. Diseases of the kidney, heart, or liver may cause progressive accumulation of fluid around your lungs and intestines. Even if you have no known problems with any of these organs, you should get to an urgent care center or E.R. for an evaluation.
Nausea and Vomiting
There’s nothing quite like the dread of realizing you have to vomit. You rush to the toilet, hurl open the seat, fall to your knees, and spend a few seconds firing out the contents of your stomach. Then, as you catch your breath and feel the sting rise in your nose and mouth, you discover a sensation that actually is worse—realizing you have to vomit again, and that the suffering isn’t over yet.
Though horrifically unpleasant, vomiting is actually a protective reflex, designed to purge our bodies of incoming toxins. When the stomach senses it may contain something dangerous—like poison or your mother-in-law’s lasagna—it vigorously wrings itself, ejecting its contents right back out of your mouth.
Thankfully, most people vomit only a few times per year—perhaps after a night of questionable sushi or a few too many cocktails. You boot. You rally. Life goes on.
Sometimes, however, nausea and vomiting can cause days or even weeks of agony, making it hard to keep down your food or even be in public. Likewise, you may notice some blood or bile (green liquid) in your vomit—is that ever okay? Should you just sleep with a bowl next to your bed? Pop a few Pepto-Bismol? At what point do you need to get checked out?
Take a Chill Pill
You have mild belly pain and have been vomiting for a day or two. You may also have some diarrhea. You likely have gastroenteritis (commonly called stomach flu), which typically occurs when an infection irritates your stomach and intestines. The most common symptoms are nausea, vomiting, diarrhea, and mild belly pain. Some people also get a fever. The key is to stay hydrated by sipping broths and products like Pedialyte. (Sports drinks, like Gatorade, are fine too but not quite as well-balanced to maximize absorption from your gut and match the fluids lost in diarrhea.) Stick with small, bland meals that won’t antagonize your stomach. You can also take Pepto-Bismol, which calms down irritation in your stomach. You should feel better within a few days. If you don’t, call your doctor. If you have severe abdominal pain or bloody diarrhea, or you feel lightheaded and can’t keep anything down, get to the E.R.
You enjoyed a delicious meal with friends—all of whom are now puking. You were so proud of your potato salad. Alas, now your friends think they’re all victims of a near-miss assassination attempt. (Side tip: get the next dinner party catered.)
Food poisoning is a form of gastroenteritis that occurs when your meal has been contaminated with bacteria or their toxins. Most people experience nausea, vomiting, and belly pain starting six to twenty-four hours later. The most common bugs include Salmonella (found in eggs, undercooked chicken, and unpasteurized milk), Vibrio (found in raw shellfish), and Staph (found in foods prepared by hand and not cooked afterward, like deli meats, pastries, and salads). The diagnosis is likely if multiple people share a meal and then all become ill. The key is to stay hydrated, using broths and products like Pedialyte, and be patient. Pepto-Bismol can also reduce symptoms. See your doctor if you haven’t recovered after a few days.
You’ve been shopping for strollers. First of all, congratulations (we hope!). Unfortunately, many women spend a good portion of the first trimester kneeling over a toilet. Though it’s called morning sickness, the nausea of pregnancy can strike at any time of day. Many scientists believe the nausea actually has an evolutionary purpose, forcing you to stick with bland, safe foods while your developing fetus is the most sensitive to toxins. You should feel better by about twenty weeks—at which point you’ll instead be worrying about the mechanics of getting around with your bump.
Keep your obstetrician updated, but you probably don’t need to worry unless the nausea really interferes with your life or is associated with fever, belly pain, or diarrhea. Calm your stomach by eating small, frequent meals and snacking on ginger candies or teas. You can also try vitamin B6 (also known as pyridoxine), starting at 10 milligrams three times per day. Some women swear by acupuncture or pressure wristbands, though it’s not clear they work. If all else fails, your doctor will prescribe medication to suppress nausea.
You don't think you’re pregnant, but it's also not impossible. If you’re female, and you could be pregnant (meaning, you have a functioning uterus and have had sex with a man—yes, even that guy—in the last nine months), you should always consider that your nausea is actually morning sickness. Pee on a stick just to be sure.
Make an Appointment
You recently started a new medication. Many medications cause nausea as a side effect. The most common culprits include pain medications (particularly opioids, like hydrocodone or oxycodone), antibiotics, and chemotherapies. If you think one of your medications could be causing nausea, speak to your doctor. If the offending medication can’t be changed (as is often the case with chemotherapies), your doctor may prescribe a strong antinausea medication to help you power through.
You feel like the world is spinning around your head. Your inner ears are responsible for sensing the position and movement of your head. When these sensors go haywire, you experience vertigo: the extremely uncomfortable sensation of constant motion. Because many poisons and toxins (including alcohol) can cause vertigo, your body’s instinctual response is to vomit out any toxin that may still be in your stomach. Unfortunately, even if your vertigo is completely unrelated to toxins, the vomiting instinct remains. Your doctor should perform a thorough evaluation to determine the cause of your vertigo and an appropriate treatment. (See the section on dizziness.)
> You feel full soon after starting each meal, then vomit within an hour. Are most of your meals coming back up for a second taste? Early filling and vomiting suggest your stomach is not properly transferring food to your intestines. As a result, you feel full earlier than normal, and your stomach sometimes overfills and triggers vomiting.
One explanation is that the connection between the stomach and intestines is literally blocked. This condition, known as gastric outlet obstruction, usually occurs when a stomach ulcer causes swelling around the stomach’s exit. Another, less likely cause is a tumor in the wall of the stomach.
It’s also possible that the stomach is not pushing food through your system because its muscles aren’t contracting. Instead, the stomach is just filling up like a limp bag of flesh, not processing or advancing your food. This condition, known as gastroparesis, most often occurs in people with longstanding diabetes, which damages the nerves that control the stomach’s muscles.
To figure out the exact cause of your symptoms, your doctor will need to perform a few tests, including an endoscopy (which is like a colonoscopy, except the camera goes down your throat rather than up your you-know-what).
You have a beautiful bong collection. If you’ve been smoking, eating, or otherwise imbibing marijuana on a regular basis for years, you may have cannabinoid hyperemesis syndrome. This condition requires daily or more-than-daily use of marijuana—we’re talking Half Baked, not the occasional joint from your neighbor. The condition is associated with frequent nausea and vomiting that mysteriously improve in hot baths or showers. If life consists primarily of getting high, vomiting, and showering, try abstaining from the weed for a few days to see if the vomiting improves. Unfortunately, there’s no effective long-term solution other than dropping the habit.
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