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Why we vomit: Throwing up the facts about an experience we've all had

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Theresa Smith 2 / 2

DULUTH — We've all been there.

The bloated feeling in the stomach that doesn't go away, and gets worse instead. The growing pressure. The coppery feel in your mouth, and then something inexorable rushing up your esophagus.

Suddenly, you're rushing to the nearest bathroom.

Your correspondent was undergoing these events a few weeks back when questions occurred:

What's going on here? What causes a person to vomit? What would happen if we couldn't? At what point should one seek medical attention?

For answers, we turned to an expert. Dr. Theresa Smith completed her fellowship in 1991 and has been a gastroenterologist at Essentia Health in Duluth for 22 years. She has seen it all, gastrointestinally speaking, and she and her colleagues are fairly tough-minded on the subject of throwing up.

"It really doesn't bother most of us," Smith said during the conversation in a conference room in the Essentia Health First Street Building. "We can be in the midst of something like that and still be thinking about what we're going to have for lunch."

What follows is an abridged transcript of our questions and Smith's answers.

Q. How common is vomiting?

A. Very common.

Q. What causes it?

A. There are lots of different causes. The most common cause is viral infections or gastroenteritis. And we've all had that, you know, the vomiting, diarrhea that lasts a couple of days and goes away, and usually there's a fever. A lot of people call it the flu. It's technically not the flu, it's viral gastroenteritis. But then bacterial can be (a cause) as well, like food poisoning.

Q. When do you need to seek medical attention?

A. If you have a severe headache with it, because unfortunately vomiting can be a sign of some central nervous system problem like encephalitis, even a ruptured aneurysm in the brain.

If you have a high fever, over 102. If you have other medical problems that put you at risk; if you're not a healthy person to begin with.

But the average healthy person can probably give it 48 hours as long as they're able to keep some liquids down.

Q. What's actually happening when we vomit?

A. Normally when you swallow something there's peristalsis, normal muscle contractions that push the food down into your stomach. Then the stomach relaxes to accommodate food, and then it kind of grinds up the food and churns it up, makes it into smaller pieces and then it gets released into the small intestine so the food can be absorbed. When you're sick, or you're exposed to some poison or toxin that makes you vomit, that normal peristalsis basically reverses itself and you get contractions of your abdominal muscles and the stomach contracts, but backwards, and it forces stuff back up out through your mouth. Things are being propelled the wrong direction.

But it really is a protective mechanism to try and get rid of poisons or toxins, and your muscles know that.

So it's very hard to prevent yourself from vomiting, even though we all try.

Q. What would happen to our bodies if we couldn't vomit?

A. It could allow toxins or poisons to get down into the intestines where they're absorbed and potentially cause worse health problems than if you get rid of it. Your stomach could actually rupture. It's very rare because we do have that mechanism.

Q. When we've been through a bout of throwing up, does it matter what we eat and drink?

A. It probably doesn't matter a whole lot. But in general, because your stomach's not working properly, (choose) things that are low in fat — because high-fat content and high fiber slow down the emptying of the stomach. When your stomach's not working right, you don't want to take things that are going to further slow it down. So clear liquids, the 7Up that our moms all gave us or ginger ale. And ginger does have some antiemetic effect, so the ginger itself can be helpful.

Q. Why do pregnant women vomit?

A. Hormonal changes, and the effect they have on the brain and the functioning of the gastrointestinal tract. There's a lot of big hormonal changes that happen with pregnancy and nausea and sometimes vomiting — usually in the morning — are unfortunately fairly common with pregnancy. There are some women who have very severe vomiting that requires them to be in the hospital, get IV fluids, and it can even have an effect on the development of the baby if the woman becomes dehydrated or malnourished. There are some very severe cases where some people have to actually go on intravenous feeding. That's rare, fortunately.

Usually it gets better after the first trimester. And then as the pregnancy goes on, acid reflux and sometimes nausea from that can be a problem later in the pregnancy.

Q. If you throw up certain foods will you ever eat those foods again?

A. Well, my dogs do. They eat it right away.

I think when you're a child and you throw up, it tends to turn you off on that particular food. I threw up once after eating peanut butter cookies, and I love peanut butter, but it still takes me a while to eat a peanut butter cookie. But I think most people can get over that.

Q. Does the color of the vomit mean anything?

A. The only thing that matters is whether there's blood in it or not. So if it's red and you didn't eat beets, then that's (reason) to seek medical attention. Or black coffee ground-looking stuff can be old blood. So you definitely want to seek medical attention if that's happening.

Q. Do children vomit more than adults do?

A. Yes, they do. And it's partly because they're being exposed to these viruses that they develop immunity to over time. As adults when we get exposed to those we don't get sick like little kids do because we've already been exposed.

In infants, there's a difference between regurgitation and vomiting. Vomiting is contraction of the abdominal muscles and contraction of the diaphragm and everything is forced out. Regurgitation is just effortless, like babies who spit up after they eat. Usually that gets better as they get a little older.

Q. Can excessive drinking lead to vomiting?

A. Oh, yeah. And that is truly your body ridding yourself of toxins. Your body knows you've had too much, and we're going to get rid of it. It can save people's lives. These people who go out and drink huge amounts of hard alcohol, they can develop alcohol poisoning and stop breathing.