There’s probably nothing worse than horrific pain, cramps, gas, bloating, and getting overall sweaty with your head in the toilet, clinging to it as if your life depended on it; you really feel like it is your best friend. Few in life have escaped this porcelain-friendly experience, myself included. The toilet becomes your emergency intestinal outlet receptacle. The scientific term for the procedure is "Up-Chucking" and it occurs when your anatomical intestinal release device isn’t the one down South. We’ll be right back to chucking up after a brief Diarrheal Diversion.

The science of South is easily explained this way: When the food you digest is processed to non-nutrient remains, the resulting toxic by-products are supposed to be delivered, with ease and regularity, from the large intestine into the toilet. Flush and put the seat down.

Now let’s talk "regular." Standard wisdom has it that Southern Storms should happen once each day. When this doesn’t happen, it’s either diarrhea or constipation. To broaden the context of this wisdom, Nutrition Power gives looser end-points: Two or even three regular garbage dumps a day aren’t bad so long as they don’t hurt, and aren’t thin and watery. Floaters are the best form. On the other cheek, if you skip a day or two, and if it’s regular for you, then that’s OK too, so long as the big events pass with ease and the resultant debris isn’t a bowl full of hardball sinkers -- if you know what I mean. So much for the Southern drain; I’ve written a lot about this many times over many years, so the rest of this wisdom is focused on the Northern anatomical expulsion area.

There are a whole lot of words for this situation, like vomit, throw up, puke, and emesis, it’s medical name. (I’ll just sort of toss ’em in as I go along.) There are three major emetic categories that I’m reporting here. I’m not covering, for example, vomiting from the nausea of morning-sickness, though it is an important topic. No writer can write all things for all people all the time. Anyway, my selected chunk abatement types round out to three broad categories.

Category Number One: First there’s simple plain ol’ ordinary vomiting; it happens sometimes, HIV or not. It’s kind of like the time you ate airplane food and spent the night at O’Hare, among others on cots, in an emergency recovery row near the gate seating area. That’s a one-timer example. Except now you’ll heed the warnings about airplane food and bring along your personal chef to handle your air-borne food concerns.

Even if you fly often, and you’ve gotten by OK on airplanes (in the past), why worry? What if it really is you next time? How much do you want to gamble, and how hard is it to pack a lunch? My own personal technique is a peanut butter and fruit preserve sandwich on a whole-grain english muffin, a cup of nonfat yogurt, an apple and a banana and, for longer flights, some scones and pre-packed cans of fruit. I even use my own knife and fork from home; food tastes better that way, instead of the plastic utensils you’ll get from your flight crew. But I’m lazy too, I do drink airplane coffee unless Starbucks has a vending location on board. Or, if I’m lucky enough to fly first-class!

This will conclude our discussion of one-timers. After all, there really isn’t much to do just for one terrible happening. The once-in-awhile hurl probably won’t do any more damage than the unpleasantries of having just heaved. How lovely -- and lucky -- that it was a "just once" barf incident. It could have been worse -- read on. But a word of wisdom: You’ll spill out your medications too, so you should consider re-taking them if not much time as passed.

Category Number Two: Next are the "dry heaves" -- there’s nothing left in your stomach anymore; you pitched it all out. Then, reverse intestinal pressure pushes partly-digested intestinal remains out and up -- North, in this discussion. With luck, there may be enough "internal" warnings to get you to the bathroom in time. After lunch is gone, down the drain, it’s not the end -- unfortunately. The emetic "materials-supply" requirement calls for more -- so the action proceeds southward to your intestines where digestive enzymes are made.

Bile is a just such a digestive actionary -- it’s so dark it looks black, but they swear it’s green (it’s really black). Imagine the horror of seeing this eau de toilet spewing forth from your own mouth. Even if you didn’t feel like heaving before, you’ll see your outcome and really want to launch one now -- who’d want something that looks this horrifying inside their body? Happens all the time!

Category Number Three: Our third puking genre, my personal favorite, is projectile vomiting. If you’re uncertain as to just what this is, I suggest the movie The Exorcist for a brief tutorial. Projectile vomiting means, as the name implies, that the material being hurled forth needs no toilet; no sink -- you spew an odiferous blow-out over to the plate of a woman eating at a nearby table. This can be a bit embarrassing, but take comfort; it’s worse for her! Often, the projectile catapult is reserved for allergy-related mortification.

If you do have barfing-type allergic reactions to foods, medications, odors, and so on, prevent contact with these toxins unless you’re willing to pay the price. With meds, you can’t always be able to do this, so you may need a medical remedy -- stay tuned. In restaurants, even if you ask what’s in or not in what you’re ordering, be warned: your job isn’t done. When your meal is served, examine the food very well before you bite in -- there’s still the chance of getting an unwelcome demon.

Personally, there’s a class of foods that gives me immediate jet streams without warning. Even the smell brings on nausea and goes right toward the projectile-qualifying category. Once, after I did all of the above while ordering, still the food was tainted. I got the waiter to take it back, and he did. But when he returned it to me, an aroma-warning saved me. The guy had just taken my plate away, picked out noticeable offenders, and placed it back in fron on me. True awfulness would have happened had I not re-sniffed and returned the plate again! He didn’t get a tip.

A huge amount of vomiting is caused just from nausea-types of conditions. And nausea often results from aromatic air that doesn’t suit you at the time. As with most body functions, HIV messes with sniffer sensory power a lot; it keeps increasing the number of things that can do you in. There are lots of ways to outwit this nauseating offender. And note -- the following tricks are good to know even if it isn’t your problem just now; maybe a friend is one-upping Chuck . Just familiarize yourself with the tips in the rest of this epistle and you’ll have a lot of basic HIV nausea/vomiting prevention-and-containment knowledge. And be able to deflect a hurl or two. It’s really cool to be in control of nasty body problems. And to help out your friends.

The first thing to do, and maybe surprising: Never Never Ever Eat Favorite Foods when nauseated. This is a great way to create a food aversion that could take this delight out of your eating game plan, maybe for life. I’d hate to have you lose the love you have for your favorites. Don’t blow it!

And here's a quick life-saver: NEVER lie down flat on your back if you’re the least bit nauseated. If you should happen to up-chuck in that position, you could suffocate on your vomitus debris -- I think it would probably be unpleasant to choke to death. Be sure that your head is higher than your stomach if you need to rest after eating.

There are lots of reasons to get nauseated when you’re dealing with HIV. First, look to medications; they’re notorious for nauseating side effects. Opportunistic Infections can also be direct actionaries to make nausea happen, particularly the ones that live in and infect your gut. Which is most of them. All these water-born bugs like crypto- and microsporidia, parasites and other gut-dwellers love to provide just enough nausea for you to lose all of the food and the meds you took with the food, that are supposed to kill the bug itself! Talk about lousy luck!!

When you’re having nausea-related vomiting, before you can even start using nutrition-based therapies to correct the blow outs, you’ll have to stop the nausea first. Imagine yourself and your "other" staying at a five-star hotel suite in a fine, Southern Society Georgia hotel, and your loving other orders up a good old southern breakfast of bacon, sausage, ham, grits, eggs, biscuits & gravy, and coffee with heavy cream. This is a down home breakfast if I ever knew one -- and I’m part southern (Arkansas).

So the server brings in a tray and tray stand, you both place yourselves into a suitable position for eating, and the various plates, steaming hot, covered with heat-savers, are placed nearby. Off come the covers, and the lucky lover says "umm! does that smell great or what? I’ve never been so hungry -- Let’s Dig In!" You, the (unlucky) other, say faintly, "Well, actually, no dear, I’m launching another attack! Sweetheart, darling, clear a path to the bathroom -- now!"

This whole breakfast could have been saved had the couple read this article. That way, they would have known to leave the food covered, to let it cool down, then eat later at room temperature. Heat vapors carry aromas, while normal room temp doesn’t transmit them much at all. Now, next time you go for a holiday, your romantic morning can be saved. Have an extra helping of grits on me!

Remember: Practically everything can be served cold. Of course veggies are OK to serve cold; you see a lot of this on chip/dip buffets; even cooked leftover spinach is ok to eat cold, it just looks repulsive. Spaghetti is fine, pizza’s still high in protein and calcium when it’s cold, and other meats, fish or poultry that were well cooked before they were cooled down; can be eaten, and now, since you’ve handled the nausea, and if the taste is OK, you’re not blowing chunks: Pure enjoyment at last.

It often helps to drink something cold. I suggest fruit juices like cranberry, orange, grapefruit, apple, and fruit nectars like mango and passion-fruit. Don’t get carried away on the passion. And you should probably sip through a straw so as to not smell what you’re drinking. You know, like pinching your nose when you do cough syrup?

Also, be sure to get huge doses of liquid refreshment between meals while only sipping as you eat your meals. This can help avoid that familiar feeling-full-too-fast syndrome, which can lead to nausea, then to vomiting, then to losing important nutrients -- Nutrition Power down the drain! Now, since you’ll know how to keep what you eat in you, how nice it will be to know that your health food is actually going to do some good. Try to spread you meals out so that you’re eating six to eight mini-meals a day.

This strategy does a pretty good job of evening things out. For the snacking lifestyle, the rationale is simple: The less that’s dumped into your stomach all at once, the less the stomach will have to stretch, so to speak, it’s limits. Vomiting, then, might happen less or not at all. Crixivan, with it’s "fasting" rule, can make this pretty hard to do, try anyway. Schedule well; you may find that you’re more clever than you thought!

Again, I remind you to chew. It makes food ever so much more digestible and since it passes the stomach and intestines with more ease, well-masticated, it won’t become a case of doom instead of dessert! Also, nutrients from your healthful diet will be absorbed better when you chew well; that’s why we have teeth. Again, the Nutrition Power Chew Rule Tool: Count your chews; if you’re not to 30, you’re not done!

Another thing to avoid: Grease! That can stay in your stomach all day, ever-ready to make hurl happen. It’s a shame for good, useful calories and nutrients to get pitched out. Also, your food time-clock could be a bit screwy. You may prefer breakfast at 3:00 am, and what’s so bad about that if it works for you? But, you might require the emergency services of a nutritionist-by-phone. Who’ll you call at 3:00 am? You didn’t really want that extra bacon anyway, did you?

For nausea, Nutrition Power suggests "go to bland." Have some bland-but-satisfying custard, tapioca, flan, puddings and angel food cake (also an excellent source of protein). There are also soups that can be served cold. By the way, they’re usually salty -- this may come in handy. Salt! Yes, it is recommended for nausea. Always keep emergency bouillon and potato chips (surprise!) at the ready -- at 3:00 am. Have some chicken noodle soup, pea soup, lentil soup, barley-vegetable soup, etc.

A lot of the ready-to-slurp noodle specialties are packed with salt and have worked well for many of my clients, and the fat content doesn’t seem to get in the way. Also, they’re surprisingly high in calories. Importantly, that can also help you gain weight. The government’s "dietary guidelines" call for less salt, but they were not drawn up with HIV-related nausea/vomiting in mind. Sometimes the government isn’t always exactly correct.

In general, remember: No favorites, eat salty foods and soups, use dry foods, try bland foods, eat cold food, drink lots of cold fluids and beverages, and eat "comfort foods" that don’t cause or contribute to nausea. Chicken noodle soup and oatmeal are real comfort foods. It’s OK! Most of this will, with any luck, prevent vomiting. We often advise pregnant women to eat ice chips and you can do that too -- it does help, I promise!

But expand your horizons; put fruity drinks into ice cube trays and nosh on "health-ice." Freeze grapes and have grape-sickles. Eat sugar-free popsicles, sorbets, and sherbets. Often, bubbles can be helpful. Ginger ale is often "just the right thing." Otherwise, try 7-Up, cream sodas and even sparkling fruit juices. If bubbles aren’t for you, "flatten" carbonation by opening the can or bottle, then stir/shake out the fizz. Even a shot of brandy can help. Though it seems to be the absolute worst thing to do; this strategy got me through a turbulent cruise once.

So, maybe we finally have nausea under control, which means we probably have vomiting under control. Now we have only two really important steps more: Replacing important lost fluids and Medical anti-emetic remedies.

Replace lost fluids when suffering from diarrhea, vomiting, fevers and night sweats; one event or a series, they’re all forms of fluid loss. We always emphasize that thirst is not our best measure of hydration status, but do pay attention to the thirst instinct. It’s not adequate, but it is a start. The requirements for rehydra- tion are beyond thirst and way-beyond our 2-quart per day minimum require- ment. For diarrhea or vomiting, knock down a ½-quart for each "event." Again, drinking for thirst alone will never be enough.

When sweating, hurling, or exploding diarrheal events, we lose electrolytes -- these keep our fluids balanced and they are absolute requirements. The degree of dehydration determines the amount of time it’ll take to repair electrolyte balance. This is really important: If you can’t fix it for yourself, medical attention may be necessary. And even though it may not seem so important to the casual reader, all good healthcare providers agree that dehydration is a lethal, insidious death-hazard. Take it seriously!

Dehydration symptoms include fevers, chills and shakes, nausea (again), vomiting (again), and diarrhea, of course. You need expert help. Being dehydrated and having electrolyte imbalances can kill you -- that sort of thing.

Nobody’s perfect: I, the nutritionist, High Priestess of hydration, some weeks ago ended up in ER for de-hydration. I was unfortunate enough to get admitted. (And they never did find the cause, because it was surely not from not drinking enough fluids. Still a mystery my medical team has not gotten to the bottom of!) Fresh from recent memory is the suggestion of an emergency kit for going to ER. Take everything you’ll ever need in case they admit you. Overnight, I desperately needed some ointment for a skin rash caused by a tape reaction, and they wouldn’t give me anything -- they needed an Rx from my doctor, and wouldn’t call him in the middle of the night just for my rash. Here’s a medical tip: Take aspirin or Motrin with you. In a hospital they will give you Tylenol for mild pain unless there’s an order not to.

Oh, good -- I’ve just given myself another opportunity to report that Tylenol can be more dangerous than you might think because it tends to kill off glutathione, our major antioxidant protector. Medical treaters tend to withhold aspirin and Motrin because both cause a bleeding trait where blood doesn’t clot well. Fish oil will do the exact same thing, and by the exact same biochemical pathway and molecular conformations. And fish is on the hospital menu. I’m not making up any of this; it’s too important to get silly about. When you have a wounded immune system, you need your antioxidant protection a whole lot more than if your immunity was in fine form. We can’t afford to give up our antioxidant defense systems; especially if it’s completely unnecessary! For now, just take charge and bring what you may need -- take care of you -- what a concept!

When electrolytes become an issue, it’s serious, and is why I was held captive at St. John’s for two days. To avoid hospitalization, my recommendation is to get Pedialyte, sold in the baby needs/baby food section of your market. Of note, whenever I shop for Pedialyte, I almost always find a store brand with the same exact balance of electrolytes of over a dollar less than the name brand. Be your own best judge; my own money is wisely spent. Crystal Light is a really good flavor-helper for this off-tasting bunch of stuff! If you happen to run into Infalyte alongside the Pedialyte, it is worth the brand price -- it has rice syrup to treat, very well, diarrhea. CeraLyte has very cost-friendly rehydration and rice solutions. Call them toll-free at (888) 237-2598. One-stop shopping!

Unfortunately, your pharmacist can only turn to a few prescription anti-emetic (anti-nausea). One is Compazine, the most widely prescribed, another is Tigan, and though Zofran is recommended usually for chemotherapy, it’s often prescribed for HIV-related nausea. Another anti-emetic is Phenergan which has worked well for me recently. There are few over-the-counter remedies, and the ones that are don’t work very well.

First, let’s look at using Marinol for nausea. This synthetic marijuana derivative has some good usefulness. First, it’s a great appetite stimulator, and since it can also work for nausea, you might get one-stop shopping again! Marinol, however, doesn’t relieve nausea the moment it is taken, and even after it’s had awhile to kick in, it often does less than a lot to help out in the nausea department. But it can work well; here’s one way it might work for you.

While I was presenting an HIV forum with a physician, a pertinent question came from a member of our audience. He was waking up in the morning so nauseated he had absolutely no appetite. Since he was already setting an alarm clock at midnight for a fasting Crixivan pop, we agreed that the best thing to do was to take a hearty Marinol dose along with his Crix, and wake up without nausea, and with a ravenous appetite for anything edible. One stop shopping again! The deals get better and better. He became a client in my practice, and told me later that this technique worked extremely well for him; he was gaining weight -- finally -- and had very little if any nausea. One lucky guy indeed!

As you may know, in California and Arizona, voters elected to make the use of medical marijuana legal. Reliable sources tell you what I’ve learned from them. They tell me that a hit or two from a joint or pipe can wipe out nausea in an instant. Is it a healthy idea to put smoke into HIV-tainted lungs? Absolutely not; don’t be ridiculous! But if quality of life is meaningful, and nausea is robbing you of yours, then that toke may be worth a little potential for lung damage, which probably isn’t going to make a pulmonary collapse happen (no guarantees, though). You’ll have to call this one for yourself.

One strategy is to secure a high-test grade of this "medical treatment" and decrease the number of hits you have to take for adequate nausea-relief. Also, remember to stop smoking once the nausea is gone. Check out buyers clubs and ask people you encounter at HIV-related activities. Sooner or later you’ll find someone who can help you secure this medical remedy. Of course, there are still a lot of people who think that a joint today is a needle in the arm tomorrow. "Thanks, but I may not have a tomorrow, and I want for today to be as nice is possible. Should I get addicted in another 10 years or so, I promise I’ll seek treatment. Quality of Living is Everything!" My client, Herb, gets credit for that statement.

First do no harm. If this information is, or seems to be, connected to adverse consequences, contact your nutritionist or doctor immediately.

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Nutrition Power is a Registered Trademark of Health and Nutrition Awareness. Copyright 1997, Jennifer Jensen, MS, MBA, RD. All Rights Reserved.

Other versions of this article have appeared with permission in Being Alive Newsletter, Arts & Understanding Magazine,and other newsletters.