Hyperemesis Gravidarum Diet, Advice from a Dietitian

Hyperemesis gravidarum is defined as the extreme, persistent nausea and vomiting during pregnancy. If you’re experiencing this, my thoughts are with you, sister! While mine wasn’t as severe to be considered hyperemesis, I experienced nausea and vomiting throughout both of my pregnancies and felt like I required Zofran around the clock.

I also tried Diclegis®. The Zofran eventually led to constipation throughout my pregnancy, but at least it gave me some relief.

In this article, I want to share with you a few hyperemesis gravidarum diet tips and provide you with a sample meal plan to help you push through until things settle down.

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What is Hyperemsis Gravidarum?

If you have this condition, I’m sure your doctor has already told you a little bit about what it entails. However, I’d like to quickly just run through hyperemesis gravidarum (HG) and how it differs from morning sickness. (though these diet tips can help with morning sickness, too!)

Morning sickness is something around 70% of women face in their pregnancy. It usually starts at around six weeks and can last anywhere from weeks to months. Mine lasted four months with my first son and all nine months with my second son. Treatment is slightly different with morning sickness. For example, your doctor may prescribe you Unisom and B6 or prescribe Diclegics to help with nausea from morning sickness. However, these two medications may not benefit someone with hyperemesis gravidarum.

Around 3% of women experience hyperemesis gravidarum during pregnancy. It consists of severe nausea and vomiting paired with weight loss. Fortunately, it usually subsides by weeks 14 to 20.

Symptoms of hyperemesis gravidarum include:

• Severe dehydration
• Dark urine
• Weight loss of at least five pounds
• Vomiting more than three times per day
• Constipation

At this time, the exact cause remains uncertain. However, a few theories and studies are in the works to figure out what causes the condition.

How is Hyperemesis Gravidarum Treated?

Your doctor will often prescribe you anti-nausea medications and ask that you drink plenty of fluids to stay hydrated. 

If you cannot keep fluids down for a prolonged period of time, you may require the administration of fluids through an IV. 

When weight loss occurs, and nausea doesn’t subside with medications, you may be admitted to the hospital and started in total parenteral nutrition (TPN).

TPN is the administration of nutrients directly through your blood. It bypasses your digestive tract, so it will not make you nauseous. I’ve personally had several patients require this method of nutrition. However, it’s usually not the treatment of choice because it requires an IV running in you 24/7 and can get in your way and increase the risk of infection.

Usually, your doctor will refer you to a dietitian or discuss dietary changes to help minimize nausea. But—let’s be honest— who wants to go visit with a dietitian when you are hung over the toilet?

However, it’s still beneficial to sit down or speak with a dietitian who can customize a meal plan based on your lifestyle and meal preferences.

With that said, I would like to share some diet changes you can make to help manage hyperemesis gravidarum. 

Hyperemesis Gravidarum Diet

The hyperemesis gravidarum diet isn’t a one-size-fits-all approach. It involves identifying trigger foods, finding foods that you can tolerate, and staying hydrated. 

Identifying Triggers

Do certain foods or smells cause you to vomit as soon as you smell them (or even think about them!)? The first thing you will want to do is identify and avoid triggers around mealtime. This can prevent you from eating if it brings a huge wave of nausea. 

Examples of triggers include:

• Riding in a car
• Smelling perfume
• Tight-fitting clothes
• Toothpaste

Do Probiotics Help With Morning Sickness or Hyperemesis Gravidarum?

A recent study published in the journal Nutrients suggests that pregnant women who took two probiotic capsules per day reduced nausea by up to 16% and vomiting by 33%. It also helped relieve constipation. Researchers believe that progesterone during pregnancy can lead to altered GI motility, which can contribute to nausea and vomiting.

Although probiotics are generally considered safe, it’s important to always speak with your doctor before starting any dietary supplements.

Eating Tips With Hyperemesis

Here are a few eating tips to reduce the feelings of nausea with meals.

1. Eat a small, high-calorie meal or snack every two to three hours.

Aim for something with butter, margarine, or peanut butter to add additional calories. (rice or pasta plain with butter, crackers with peanut butter, etc.)

2. Eat cold or frozen foods like fruit.

Studies show apple and watermelon are the most beneficial fruits and may even be more beneficial than crackers for patients with hyperemesis.

You can also have popsicles or freeze beverages and have them as slushies to get fluids in. Smoothies filled with fruit and 1% milk are also great options to provide you with key nutrients to nourish you and your growing baby. 

3. Have more dry, plain foods

Include rice, pasta, saltine crackers, potatoes with butter.

4. Don’t let yourself get hungry

Graze throughout the day because an empty stomach can actually trigger waves of nausea.

5. Sip on a fizzy beverage

Sip on fizzy beverages. Bonus if it has ginger. Try 7UP, Sprite, Ginger Ale, or another fizzy, cold beverage.

6. Eat more protein

Though we always revert to the standard “saltines and Sprite,” studies actually show that protein relieves nausea better than carbohydrates. Aim to get lean cuts of meat or plant-based protein from beans and lentils.

7. Avoid eating and drinking at the same time

Sometimes, this can worsen nausea. You may want to space out beverages 1-2 hours before or after meals.

8. Keep trigger foods away from you

If that means your husband is having to go outside and brush his teeth ten times after eating pungent foods like onion or garlic, so be it! This is YOUR pregnancy, momma! And I’m sure everyone in your house is ready to support keeping you and your growing baby healthy!

9. Stay hydrated

Staying hydrated is not only important for your overall health and for your body to function properly, but it can also cause constipation, especially if it is combined with medications that tend to cause constipation.

10. Snack on crunchy foods

Think carrot sticks, pretzels, potato chips, anything bland and crunchy will help you out.

11. Stay sitting up after meals.

Try to sit up in a semi-upright position for at least 30 minutes after meals to help the food stay down and digest.

Foods to Avoid On a Hyperemesis Gravidarum Diet

You’ll want to avoid processed foods, fatty foods, and foods that have a strong smell. Fatty foods are harder to digest and can aggravate a sensitive stomach.

Here are the foods I recommend staying away from with hyperemesis gravidarum:

• Greasy foods
• Spicy foods
• ANY food triggers
• Additives and sugar substitutes
• Fatty foods
• Foods with strong odors
• Caffeine
• Donuts
• Pancakes
• Gravies

Foods to Eat on a Hyperemesis Gravidarum Diet

These foods tend to be a little gentler on the stomach and may ease nausea.

Starches

• Rice
• Pasta
• Crackers
• Bread
• Mashed potatoes
• Bakes potato
• Smoothies
• Bagels
• Rolls
• Rice cakes
• Chips

Dairy

• Low fat pudding
• 1% milk
• Light greek yogurt (for a protein boost!)
• Low-fat cheese

Meat/Protein

• Turkey breast
• Chicken breast
• Low-fat peanut butter
• Eggs
• Cottage cheese
• Beans
• Lentils
• Mixed nuts

Vegetables

• Raw veggies
• Carrots
• Corn
• Peas
• Celery
• Most veggies are ok unless they are fried or smothered in cream sauce

Related: Vegetables for picky eaters! 

Fruits

• Applesauce
• Bananas
• Canned fruit in light syrup
• Watermelon
• Apples
• Fruit juice in small amounts
• Pears
• Jelly
• Most fruits are OK, though some may make symptoms worse

Snacks/Desserts

• Ginger snaps 
• Ginger chews (I personally lived off of these)
• Sour candies
• Plain cake
• Ginger ANYTHING!
• Graham crackers
• Vanilla wafers
• Gelatin
• Italian ice

Sample Day of Eating With The Hyperemesis Gravidarum Diet

Before Getting Out of Bed

• 7 Crackers or 1 Slice of Bread

Breakfast

• 1 ½ cups bland cereal
• 8 oz low-fat milk
• ½ banana

Snack

• 8 oz low-fat Greek yogurt
• 1 cup frozen melon

Lunch

• 1 cup of pasta salad w/ light mayo
• 4 oz chicken breast
• 1 small orange

Snack

• 2 oz low-fat cheese
• 7 crackers
• 1 sliced apple

Dinner

• Medium baked potato w/ margarine
• 4 oz turkey breast
• 1 cup green beans or another vegetable
• Italian ice or dessert of your choice

Before Bed Snack

• 2 Graham crackers
• 1 tablespoon of peanut butter

*This sample hyperemesis gravidarum diet plan provides an estimated 2,100 calories. Nutrients and calories needed by each individual person will vary, especially if you need to gain weight. Consult with a registered dietitian or doctor for an individualized meal plan.

Conclusion

Living with hyperemesis gravidarum can really overshadow your pregnancy joy and glow. Although there isn’t a magic cure to completely prevent or eliminate nausea, a few lifestyle changes can help.

Thankfully, it doesn’t last forever and usually gradually fades after 4 ½ to 5 months of pregnancy. My hope is that you can push through this rough period and can enjoy your pregnancy as you inch closer to meeting your little bundle of joy.

Related Questions

What should I eat if I have hyperemesis gravidarum?

The best foods to eat with hyperemesis gravidarum are bland, cold, or frozen foods. Try to have 4-6 small meals each day and include enough protein in your diet. Hydration is important, too. Be sure to drink at least 8 ounces of any beverage you can tolerate eight times per day.

Does orange juice help with nausea when pregnant?

Orange juice is acidic which can irritate your stomach and make nausea worse. However, if you can tolerate orange juice, it is a great source of Vitamin C. Be sure to choose one pasteurized and fortified with calcium. Avoid fresh-squeezed orange juice unless it is from a highly trusted source because it can be unsafe during pregnancy.