Dr. Hillary Roland, ND
19 Tips to Manage Nausea, Heartburn & Constipation in Pregnancy
Pregnancy can definitely be hard on a women’s digestive tract. Here are some tips to help you address and overcome common digestive complaints of expectant mothers...
First, let me just say that, at 8 months pregnant, I FEEL YOUR PAIN.
I could barely get off the couch my first trimester with either my first or my current pregnancy. It felt like the only way to keep from throwing up was to lie down with my eyes closed and breathe through the nausea.
Now in my third trimester, every meal is a negotiation: do I want to eat and suffer the consequences of heartburn, or skip the meal even though I'm starving? Both unpleasant choices!
So what’s going on?
The high levels of progesterone that help keep the uterus relaxed also relax the smooth muscles that line the digestive tract. This slows down motility, which is the motion of the intestines that moves food and waste forward. It also relaxes the sphincters that keep food from rising in the esophagus and the sphincters that control the release of digestive juices.
Bile leaks into our small intestine contributing to nausea. Food and acid move back up the esophagus causing burning and discomfort. Elevated estrogen levels also can decrease stomach acid production. This can cause slower protein breakdown and further relax the lower esophageal sphincter, making reflux even worse.
This slowed motility is actually important in pregnancy because it allows women more time to absorb nutrients from their food so they can feed themselves and grow a baby.
However, if you are prone to constipation, it will certainly make it worse. As if that wasn’t bad enough, the slow passage of food allows for the bacteria in the gut to spend more time fermenting food fibers, which means your body creates more gas.
Here are some tips to help you cope:
1. Eat some protein every 2 hours – even if you don’t want to! I used to stare at 12 almonds on the table and convince myself I would feel better if I ate them. Nausea gets worse when your blood sugar drops, which is why you may feel worse in the morning. You haven’t eaten all night and your blood sugar is low! Regular protein consumption is a must.
2. Eat in the middle of the night – do this if the nausea hits you hard in the morning. Try keeping some almonds by the bed and having a small midnight snack when you inevitably get up to pee. ;-)
3. Check your prenatal vitamins – not all prenatal vitamins are created equal. Some brands contain high levels of B-vitamins, which can make you nauseous and exacerbate the issue. Choose a food-based prenatal vitamin since they tend to be easier on tender tummies. Also avoid one-a-day formulas; look for a prenatal vitamin where you can take one dose in the morning and one in the evening so you’re not getting all the nutrients at once. You’ll absorb more from the vitamins this way, too!
4. Take ginger – there have been plenty of studies showing ginger’s efficacy for nausea and vomiting in pregnancy. It works in any form (tea, capsules, candy, tincture, fresh root) so be sure to take the form that seems the most appetizing for you. Can’t swallow capsules? Try sipping the tea. Can’t stand the smell of the tea? Try the suckers.
5. Take Vitamin B6 – also known as pyridoxine, B6 similarly has a number of studies that support its effectiveness for relieving nausea and vomiting in pregnancy. This nutrient helps your liver breakdown all of those pregnancy hormones that are contributing to your nausea. You can take between 10mg and 100mg up to 3x per day, but check with your OB/GYN on the right dose for you.
6. Eat salty or acidic foods – enter classic pregnancy pickle cravings! One cause for nausea is that the progesterone discussed earlier allows bile to pool in your intestines. Salty and acidic foods like pickles, or my personal favorite nausea buster grapefruit, can help break-up the bile. If that doesn’t sit right try bland foods like toast and oatmeal to soak up the bile instead. Just watch your carbohydrate intake, especially if you’re at risk for gestational diabetes.
7. Eat small meals more frequently - having less food in your stomach allows it to move through more quickly. This is especially important in the third trimester when your enlarged uterus is pushing against the stomach and taking up the room where food would go.
8. Chew carefully and eat slowly - this way your stomach has less work to do to get the food ready to send down into the small intestine.
9. Take a digestive enzyme with meals - this helps the food move from the stomach into the small intestine with greater speed. I always carried some papaya enzymes in my purse. They are chewable and sweet so it was like a little treat with each meal.
10. Drink a little water with some lemon juice or apple cider vinegar before meals - this can increase the production of stomach acid and digestive enzymes, which helps increase tone in the lower esophageal sphincter thereby helping move the food.
11. Take DGL - deglycyrrhizinated licorice (DGL) is a root extract that is anti-inflammatory. This special version of licorice has the compound glycyrrhizin removed. This is important because glycyrrhizin can raise blood pressure, which is not good for a pregnant woman. DGL however is very safe and will help calm and soothe inflammation in an irritated esophagus.
12. Elevate the head of your bed 6 inches - put a couple of bricks or books under the legs at the top of the bed. This is especially helpful if your heartburn picks up at night. Raising the head of the bed will help to keep your food at the bottom of your stomach while you slowly digest. A slight tilt to the bed can make a big difference to you and your partner won’t even notice.
13. If you’re experiencing a burning sensation, take some calcium chews or drink liquid calcium. Calcium can neutralize the stomach acid and provide instant relief. Don’t over do it with this one, though. Excessive calcium intake can cause milk alkali syndrome and lead to kidney damage.
14. Drink more water – your body needs a lot of fluid during pregnancy. Blood volume is increasing and you’re producing amniotic fluid. If you don’t provide enough liquids, your body will suck up every last drop and your stools can get hard and difficult to pass.
15. Eat lots of fiber – strive to eat a minimum of 28g per day. The best way to do this is to incorporate 6-7 cups of veggies into your daily diet. Yet if just the thought of kale makes your stomach turn, try adding ground flax seed to a smoothie, yogurt, or applesauce. If you’re still not getting enough, consider a fiber supplement.
16. Move your body – the benefits of exercise in pregnancy are endless! I know it’s hard to do anything if you’re not feeling well or if your belly is huge and your feet are swollen. However, physical activity helps encourage the motility of the digestive tract and keep things moving. Not to mention all those lovely endorphins will boost your mood, energy levels, and overall sense of well being.
17. Try beets – add 1 tbsp of lemon juice and 1 tbsp of olive oil to a serving of beets. This magic formula will stimulate your liver and help get your digestive tract on the move.
18. Consider changing iron supplements – many women end up taking iron supplements during their pregnancy to help make all of the extra red blood cells their pregnant body needs. Unfortunately, iron supplements can make constipation worse. Use an herbal iron supplement or try a supplement that contains iron bisglycinate; they tend to be the easiest on a pregnant tummy. I also have seen women significantly improve their iron counts with a tablespoon of black strap molasses each day.
19. Take magnesium – magnesium is an osmotic laxative. This means if you have a lot of it in your digestive tract, it will help hold water in your colon. This will keep stools softer and help move them through. I recommend starting with 200mg and increasing the dose by 100mg every day until you have comfortable bowel movements. If you get loose stools, you’re taking too much and you need to lower the dose. It’s a good idea to take it at night because magnesium will also help calm your nervous system so you can sleep.
It’s important to keep your digestive tract functioning optimally during pregnancy so you can get nutrients you need, as well as support the nutritional needs of your baby.
Note: if your symptoms do not improve be sure to let your OB/GYN or midwife know you are struggling. You also can work with an alternative care provider such as a naturopathic doctor who has experience helping pregnant patients.
Work With Dr. Hillary Roland, ND
Need help overcoming your pregnancy discomforts? Schedule an office visit in Evergreen or Boulder to discuss what's going on. Together we'll create a plan to help both you and baby thrive!
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