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Losing weight and managing obesity can be a challenging journey for many, but the introduction of GLP-1 receptor agonists (GLP-1 RA) like Ozempic and Wegovy has helped transform the lives of countless individuals. For some, the benefits of these medications far outweigh any side effects they might experience. Some have reported significant weight loss and improved quality of life since starting Wegovy. One patient reported that not only has she lost 52 pounds, but she also finds it easier to move around and perform everyday tasks like tying her shoes.

Weight loss is not the only benefit of GLP-1 RA medications. Many patients also experience a decrease in hunger and cravings for unhealthy food. One patient recently told me that, “I am not thinking about food all day like I used to. Before I would always be so hungry all the time, I never felt satisfied even after eating a big meal.” Another Patient reported, “I feel like the hunger pains I have lived with for so long are gone! It is completely freeing.”

However, not all patients have smooth sailing on these medications. Some may experience side effects that force them to stop taking the drugs or question whether they can stay on them long term. Despite this, obesity medicine experts like myself, who prescribe Semaglutide or Tirzepatide (Wegovy, Mounjaro) believe that these drugs can significantly improve patients’ lives and health. The weight loss effects can enable patients to engage in activities they couldn’t do previously and address health issues linked to obesity and diabetes, such as an elevated risk of heart attacks or stroke.

It’s important to note however, that GLP-1 RA therapy may cause gastrointestinal (GI) side effects in some patients. Although the benefits of the medications may outweigh the side effects for many, it’s crucial to address these side effects to ensure patients can comfortably continue their treatment. In this blog post, we will discuss some common GI side effects of GLP-1 RA therapy and provide recommendations for managing them, including dietary changes and functional medicine approaches. By following these suggestions and working closely with your healthcare provider, you can minimize side effects and maximize the benefits of your treatment.

Nausea (15-50% prevalence)

Nausea is the most common GI side effect experienced by GLP-1 RA therapy patients, with a prevalence of 15-50%. This side effect is usually experienced during the first few weeks of treatment and can range from mild to moderate in intensity. To help alleviate nausea, consider the following recommendations:

 

  • Eat small, frequent meals
  • Avoid high-fat and spicy foods
  • Consume bland, easy-to-digest foods, such as crackers, toast, and rice
  • Try sipping on ginger tea or chewing ginger candies
  • Suck on peppermint candies or drink peppermint tea
  • Apply pressure to the P6 acupressure point on your wrist
    • The P6 pressure point is located on the inner forearm, about three finger-widths below the wrist crease, between the two tendons. It is also known as the Neiguan acupoint in traditional Chinese medicine.

Vomiting (5-20% prevalence)

Vomiting occurs less frequently than nausea, with a prevalence of 5-20%. This side effect can be quite uncomfortable, but it usually resolves within a few days. To manage vomiting, try these suggestions:

 

  • Maintain proper hydration by drinking water, clear broth, or electrolyte-rich beverages
  • Eat small amounts of food more frequently
  • Choose bland foods, like crackers, toast, and rice
  • Consider using ginger and peppermint, as mentioned in the nausea section
  • Consult your healthcare provider about the use of antiemetic medications if needed

Diarrhea (5-25% prevalence)

Diarrhea affects 5-25% of patients undergoing GLP-1 RA therapy. To minimize diarrhea symptoms, follow these tips:

 

  • Increase your intake of soluble fiber found in foods such as oats, apples, and bananas
  • Stay hydrated by drinking water, clear broth, or electrolyte-rich beverages
  • Avoid caffeine, alcohol, and artificial sweeteners, which can worsen diarrhea
  • Consume probiotic-rich foods, such as yogurt or kefir, to help restore gut balance
  • Consider using over-the-counter antidiarrheal medications, like loperamide, if necessary

Constipation (4-12% prevalence)

Constipation generally occurs in 4-12% of patients using GLP-1 RA therapy, with some trials reporting up to 25-35% in people with obesity. To alleviate constipation symptoms, consider the following recommendations:

 

  • Increase your intake of water and dietary fiber, especially from fruits, vegetables, and whole grains
  • Incorporate physical activity into your daily routine
  • Consider the use of over-the-counter stool softeners or gentle laxatives if needed
  • Discuss any persistent or worsening symptoms with your healthcare provider, as a reduction in the GLP-1 RA dose might be necessary

Bloating and Gas (Variable prevalence)

Bloating and gas are not as commonly reported as other GI side effects in GLP-1 RA therapy, but they can still cause discomfort for some patients. To minimize bloating and gas symptoms, consider the following recommendations:

 

  • Eat slowly and mindfully, as eating too quickly can cause you to swallow air and exacerbate bloating
  • Limit gas-producing foods, such as beans, lentils, cabbage, and onions
  • Incorporate probiotic-rich foods, like yogurt, kefir, and fermented vegetables, to help improve gut health
  • Consider using over-the-counter gas relief medications, like simethicone, if needed

General Tips for GI Side Effect Management

Consider keeping a food journal or using an app such as myfitnesspal to track your food intake. This can provide insight into what foods you are eating and identify any food triggers that may worsen your symptoms.

Remember, these recommendations are meant to help you manage gastrointestinal side effects during GLP-1 RA therapy. It is important to consult with your healthcare provider before making any changes to your diet or medication regimen. By working together, you and your healthcare team can minimize side effects and maximize the benefits of your treatment.

When To Seek Emergency Medical Attention

It’s important to know when to seek emergency medical attention for nausea, vomiting, diarrhea, or constipation. If you experience any of the following symptoms, it’s essential to seek medical attention immediately: severe abdominal pain, bloody stool or vomit, fever, signs of dehydration (e.g., dry mouth, decreased urine output, dizziness), or if you are unable to keep fluids down for more than 24 hours. Additionally, if you have underlying health conditions, such as diabetes or kidney disease, and are experiencing severe GI side effects, it’s crucial to contact your healthcare provider to discuss your symptoms and treatment options. Remember, prompt medical attention can prevent serious complications and ensure the best possible outcome.