How To Eat With Hyperemesis Gravidarum

Help With Food Eating And Hydration

People with hyperemesis gravidarum often find that the list of foods and drinks they can keep down is very small and often does not include the usual healthy choices. Many report that vegetables and some fruits trigger immediate vomiting during peak symptoms. This is common and it is not your fault.

During hyperemesis the goal is not a perfect diet. The goal is to get any calories and fluids in and to prevent complications such as dehydration and serious nutrient deficiency. Expert groups and hospital guidelines consistently recommend small frequent meals, bland food, and foods that are high in carbohydrate and lower in fat such as bread, crackers, rice, pasta and potatoes. RCOG

What Research And Guidelines Say About Eating With Hyperemesis

Clinical guidelines and patient leaflets from major obstetric and nutrition groups repeat similar advice

• Eat small frequent meals and snacks to avoid an empty stomach
• Choose plain foods that are high in carbohydrate and lower in fat such as toast, crackers, crisp bread, rice, potatoes and plain biscuits
• Avoid foods and smells that trigger nausea and vomiting, including spicy or very fatty foods for many people
• Try cold food and drinks which often have less smell and are easier to tolerate

These points appear in patient information from the Royal College of Obstetricians and Gynaecologists and several National Health Service hospitals. RCOG

The Hyperemesis Education And Research Foundation emphasises that the primary goal is to increase nutrient and fluid intake in any form and that whatever a patient can eat and keep down is the best diet in that moment. HER Foundation

A small study of women with hyperemesis found that dry starchy foods such as crackers were commonly recommended and often better tolerated than many other foods which supports the advice to use bland carbohydrate rich snacks. PMC

Specialist reviews note that when oral intake is extremely poor and weight loss and ketones are present, medical teams may need to consider enteral or parenteral nutrition to protect maternal and fetal health. PMC

Why Any Eating Is A Win In Hyperemesis

Hyperemesis gravidarum is a severe medical condition. Vomiting, nausea and food aversions are driven by biology, including hormones and genetic factors such as GDF15, not by choice or motivation. HER Foundation

Because it can be so hard to keep food down, every sip and every bite that stays in matters. Expert resources on hyperemesis tell family members that if the only thing a patient can keep down is ice cream or another single food, that is acceptable in the short term and they should be supported to eat it. The priority is calories and fluids, not variety. HER Foundation

Once symptoms improve there is time to rebuild nutrition. Right now survival eating is real care.

A Simple Way To Think About Food

Protein Fat And Carbohydrate

All foods are made of three main building blocks called macronutrients

• Carbohydrates
  Sugars and starches that provide quick energy. Examples are bread, rice, pasta, potatoes, crackers and fruit juice
• Protein
  Building material for muscles, organs, enzymes and immune function. Examples are meat, eggs, dairy, tofu, beans and lentils
• Fat
  Concentrated energy and important for hormones and brain development. Examples are oils, butter, avocado, nuts and seeds

Most foods contain a mix of these three. For example cheese contains protein and fat. Beans contain protein and carbohydrate. Bread is mostly carbohydrate with a small amount of protein.

Is It Acceptable To Eat Mostly Carbohydrates

In an ideal pregnancy diet you would include all three macronutrients plus plenty of vegetables and fruits. During hyperemesis that is often impossible.

Guidelines for nausea and vomiting in pregnancy and hyperemesis repeatedly suggest increasing intake of carbohydrate rich bland foods and decreasing fatty or very rich foods because this pattern is easier on the stomach for many people.

Because of this, it is acceptable and expected that many patients with hyperemesis will go through periods where they mostly eat carbohydrates such as

• Crackers
• Toast
• Plain pasta
• Plain rice
• Dry cereal
• Bread or bagels

Your body can use carbohydrate for energy and can break down stored fat and protein when needed. This is not perfect nutrition, but it helps prevent severe starvation while you and your medical team work on better symptom control.

If you are only able to eat carbohydrates

• Focus on getting enough total calories
• Sip fluids whenever possible
• Add small amounts of protein or fat only if and when they are tolerated

Any eating in hyperemesis is a win.

Practical Eating Strategies Backed By Expert Advice

Small Frequent Bites

Many hospital and charity guides advise eating little and often and nibbling or sipping every hour during times of relative relief. hyperemesis.ie

Ideas

• Keep dry snacks by your bed and eat a few bites before sitting up
• Aim for about one small snack that is roughly one hundred to two hundred calories every hour you are awake if you can
• Take tiny sips of fluid every few minutes instead of large drinks

Foods Many People With Hyperemesis Tolerate Better

These are common examples from research, maternity hospital leaflets and patient surveys Manchester NHS Foundation Trust

• Plain crackers, pretzels, rice cakes
• Dry toast, bagels, plain bread
• Plain rice, plain pasta, noodles, potatoes
• Plain biscuits or cookies, graham style crackers
• Simple breakfast cereals without strong flavors

Cold foods can be easier because they smell less. Some people do better with salty foods, others with slightly sweet foods. Expect this to change from day to day.

Drinks

Hydration is as important as food. Many patients report better tolerance for

• Ice cold water or water with lemon or mint
• Sparkling water or soda water
• Lemonade
• Ginger ale or similar soft drinks
• Electrolyte drinks such as oral rehydration solutions or sports drinks
• Ice chips, ice lollies, or popsicles

Try not to drink large amounts at the same time that you eat. Some dietetic guides suggest having drinks in between snacks instead of with food to reduce fullness and vomiting. hyperemesis.ie

Fortifying Food To Get More Calories

If you can manage small meals you can add calories and nutrients without increasing volume very much. Dietitians often suggest

For people who eat dairy

• Add cheese, butter, cream, sour cream or yogurt to potatoes, pasta or bread
• Use whole milk in drinks or cereal
• Add protein powder to milkshakes if tolerated

For people who avoid dairy or are vegan

• Add avocado or hummus to bread, crackers or potatoes
• Use nut butters or seed butters on crackers or toast
• Choose fortified plant milks and cereals for extra vitamins and minerals
• Cook with olive oil, avocado oil or coconut oil for extra calories

These ideas mirror the strategies in dietetic leaflets and nutrition guidance for hyperemesis which focus on calorie dense additions and fortified foods. HER Foundation

When To Ask For More Help

Because prolonged poor intake can lead to dehydration, weight loss, ketones and vitamin deficiency, it is important to seek medical care early. National reviews and regulatory agencies advise contacting a clinician urgently if you

• Cannot keep fluids down for more than about eight hours
• Cannot keep any food down for more than about twenty four hours
• Have dark urine, very little urine, or feel dizzy on standing
• Have abdominal pain, fever, confusion or vision changes

uhsussex.nhs.uk

Your clinician can

• Check for dehydration and ketones
• Give intravenous fluids and vitamins such as thiamine
• Prescribe pregnancy safe anti nausea medicines
• Refer you to a dietitian
• Consider tube feeding or other nutrition support if needed in severe cases Norfolk and Norwich University Hospitals+1

Please Do Not Feel Guilty

Hyperemesis gravidarum is not caused by failure, weakness or poor self care. It is a serious medical condition with real biological causes.

If the only things you can manage are beige carbohydrates or one single food, you are still doing something important for yourself and your baby. Expert organisations that specialise in hyperemesis repeatedly affirm that whatever you can eat and keep down is the right food for you at that moment. HER Foundation

When symptoms ease you and your care team can rebuild a more varied and nutrient rich diet. For now, survival eating is enough.

Trusted Resources For More Detailed Guides

You and your team may find these helpful

• Hyperemesis Education And Research Foundation food strategies and nutrition resources for pregnancy and hyperemesis HER Foundation
• Royal College of Obstetricians and Gynaecologists patient information on pregnancy sickness and hyperemesis gravidarum RCOG
• National Health Service dietetic leaflets on hyperemesis gravid arum and nausea and vomiting in pregnancy which include practical eating ideas and sample menus Manchester NHS Foundation Trust

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