Sunday, September 15, 2013

IBD, Ginger Ale, and Coke

Soda and Nausea in Inflammatory Bowel Disease

Many of us remember getting sick as a child and being given soda for an upset stomach.  The soda was generally either ginger ale (the ginger was the theoretical active ingredient) or Coke (the syrup had alleged anti-emetic value).  Preparation varied based on tradition – sometimes it was allowed to go flat, sometimes it was room temperature, sometimes it was only the alleged active ingredient that was given (raw ginger or cola syrup).  Sometimes alternatives were used – 7-Up instead of Ginger Ale.  Despite the anecdotal reports and tradition (which can certainly have a pronounced placebo effect on nausea), what does the evidence tell us?
Those with IBD tend to suffer from nausea for lots of reasons – post-surgical nausea, flare-based nausea, or nausea from certain medications.  Most of the anti-nausea studies don’t specifically address IBD, but they do look at nausea related to chemotherapy, post-surgical status, or other drug-induced nausea.  These studies are not all robust, but they may provide some insight for IBD patients looking to treat nausea with a traditional remedy.

There have been no significant clinical studies done evaluating Coke, cola syrup, or similar products to evaluate their efficacy in nausea treatment.  Additionally, there is no cause-of-action that would give a high prior probability to these treatments working.  Evaluations of the upper-GI following consumption of a carbonated cola beverage showed no significant physiological response.(1)  Interestingly, one of the few treatments to use Coke is to combat phytobezoars, a blockage due to intestinal accumulation of plant fiber (2).

What about ginger ale?  There are no specific studies looking at ginger ale, however there are multiple studies looking at ginger itself.  With regards to pregnancy, a double blind study looking at 1 gram of ginger v. placebo in treating nausea and vomiting in pregnancy showed a decline in both with the ginger group.(3)  A contemporaneous meta review showed that ginger had positive effects on nausea and vomiting in pregnancy, seasickness, and chemotherapy-induced nausea, but concluded that the studies to-date were small and not conclusive. (4)  A much larger study of 576 patients undergoing chemotherapy showed that ginger at .5 and 1g doses had a moderate positive effect, but surprisingly the effect reversed at 1.5g.  The lack of a dose-response is interesting and needs more explanation through further research.  Ginger itself is not known to have significant side effects at the doses tested. 

The current research leans toward ginger having a small but positive effect on mild-to-moderate nausea when taken in moderation.  That said, many commercial ginger ales have “ginger flavoring” that has no real ginger, and the ones that have real ginger are fairly quiet about the amount included.  Additionally, chewing ginger root may exceed the .5 to 1g doses that appear to have a positive effect unless carefully doled out.  If you are experiencing mild to moderate nausea with your Crohn’s or Ulcerative Colitis, a small dose of ginger may help and isn’t likely to cause any harm, but don’t expect your ginger ale to provide it (unless you make it yourself) -- there is no evidence that commercial ginger ale provides any benefit.

Nausea that leads to vomiting is another story.  Repeated vomiting, especially when combined with diarrhea and fever, can lead to fluid loss.  For those with fluid loss, soda products are not a great choice – they don’t address potential electrolyte imbalances.  Especially in younger children, fluid loss can be a life threatening condition and replacing the water and the electrolytes through products like Pedialyte (or home-made variants containing the right sugar-salt-water balance, supplemented with potassium) is a better choice. 

Bottom Line

·         There is no evidence that Coke or cola syrup help with nausea. 
·         Small amounts of ginger (1g) have shown a preliminary, positive effect on mild to moderate nausea and vomiting.
·         Many commercial ginger ales have little or no ginger in them, and no evidence that ginger ale itself helps with nausea and vomiting beyond the comfort factor.
·         As long as you don’t have significant fluid loss, drink whatever provides you comfort.  If you do have fluid loss, stick with liquids that help electrolyte balance and get help if it becomes extreme.

1.       Cuomo, Rosario, Maria Flavia Savarese, Giovanni Sarnelli, Giovanna Vollono, Alba Rocco, Pietro Coccoli, Carla Cirillo, Lorenzo Asciore, Gerardo Nardone, and Maxime Buyckx. "Sweetened carbonated drinks do not alter upper digestive tract physiology in healthy subjects." Neurogastroenterology & Motility20, no. 7 (2008): 780-789.
2.       Ladas, Spiros D., Konstantinos Triantafyllou, Charalabos Tzathas, Pericles Tassios, Theodore Rokkas, and Sotirios A. Raptis. "Gastric phytobezoars may be treated by nasogastric Coca-Cola lavage." European journal of gastroenterology & hepatology 14, no. 7 (2002): 801-803.
3.       Vutyavanich, Teraporn, Theerajana Kraisarin, and Rung-aroon Ruangsri. "Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial." Obstetrics & Gynecology 97, no. 4 (2001): 577-582.
4.       Ernst, E., and M. H. Pittler. "Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials." British journal of anaesthesia84, no. 3 (2000): 367-371.

5.       Ryan, Julie L., Charles E. Heckler, Joseph A. Roscoe, Shaker R. Dakhil, Jeffrey Kirshner, Patrick J. Flynn, Jane T. Hickok, and Gary R. Morrow. "Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients." Supportive Care in Cancer 20, no. 7 (2012): 1479-1489.

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