Glucagon-like peptide-1 receptor agonist (GLP-1RA) medications such as Ozempic, Wegovy, and Mounjaro may cause common gastrointestinal (GI) side effects such as nausea, diarrhea, and constipation. Studies indicate that these side effects can occur in up to 50% of patients receiving treatment, with nausea being the most frequently reported. Fortunately, most cases involve mild-to-moderate side effects that are usually temporary.

These side effects are typically drug and dose-dependent and may arise at the start of treatment or when the dosage is increased, but tend to subside over time as the body adapts to the medication.

The following provides education and tips for managing adverse gastrointestinal side effects related to GLP1 medication but is not a substitute for instructions from your healthcare provider.

Preventing Nausea

Stay hydrated. Drink plenty of water and/or sugar-free beverages throughout the day, as dehydration can worsen your nausea.
Eat slowly and stop when satisfied. By eating slowly, you can better tune in to your body's signals of fullness and avoid the pitfalls of overeating. This approach also allows you to chew your food more thoroughly, easing the digestive workload on your stomach.
Eat smaller meals. Smaller meals can help alleviate nausea by reducing the amount of food that needs to be digested at once. Additionally, smaller, more frequent meals can help to stabilize blood sugar levels, which can help to prevent nausea caused by dips in blood sugar.
Avoid high-fat foods. High-fat foods take longer to digest and result in slow stomach emptying. Food sitting in the stomach for longer than usual can cause discomfort, bloating, and nausea.
Avoid spicy foods. Spicy foods can irritate the stomach lining, leading to nausea or abdominal discomfort.
Limit or avoid alcohol. Alcohol is a toxic substance that can irritate the stomach lining, leading to inflammation and nausea. Additionally, alcohol can also affect the balance of fluids and electrolytes in the body, which can further contribute to nausea. Excessive alcohol consumption can also lead to a hangover, which can cause symptoms such as headache, nausea, and vomiting. Additionally, the type and amount of alcohol consumed can influence the likelihood and severity of nausea.
Avoid eating too close to bedtime. Wait at least 2-3 hours after eating a meal before lying down. This can help reduce the pressure on your stomach.
Avoid vigorous activity after meals. Instead, opt for light activities like walking.
Try to relax. Techniques such as guided imagery can help to control nausea.

Tips for Managing Nausea

Don’t eat and drink simultaneously: Separate fluids 30-60 minutes before and after meals when experiencing severe nausea or if you notice that you become full too quickly.
Choose mild-smelling foods: Steer clear of strongly odorous foods, as these can exacerbate nausea. Instead, opt for chilled foods or at room temperature, which tends to be less aromatic.
Ginger and peppermint: Consider drinking ginger or peppermint tea, which may help alleviate your symptoms.
Eat: And finally, don’t skip meals! If you have nausea, it is understandable that you may not feel like eating. However, skipping meals is generally not recommended, as this can lead to low blood sugar and fatigue. Furthermore, it is still essential to consume adequate protein during weight loss. Simply put, if you cannot eat it, drink it! Opt for light options like a protein shake, a meal replacement supplement, bone broth, or soup with chunks of protein and soft vegetables. It does not have to be a large meal, but something is better than nothing.

Tips for Managing Constipation

Fluids: Drink plenty of water or sugar-free beverages.
Foods with a high fiber content: Increase your fiber intake by consuming these types of foods.

Eat more whole grain products like barley, oats, farro, brown or wild rice, and quinoa.
Look for choices with 100% whole wheat, rye, oats, or bran as the first ingredient listed.
Check Nutrition Facts labels and choose products with 4 grams of dietary fiber or more per serving.
Add more beans to your diet
Eat more fresh fruits and vegetables with the skins on

Exercise: Increase physical activity. Exercise helps stimulate gastric motility, which moves stool through the digestive tract.
Fiber supplements: If you're experiencing a decreased appetite and find it hard to add fiber to your diet, you may need a fiber supplement. Talk to your doctor or dietitian before doing so, as fiber supplements may interfere with the absorption of some medications.
Medications: If your symptoms do not improve or worsen, talk to your clinician about more advanced treatments.

Tips for Managing Diarrhea

Do:
1. Sip fluids throughout the day. Drink various liquids such as water, broth, and low-sugar electrolyte beverages.
2. Eat small, frequent meals.
Avoid lactose, caffeine, alcohol, sugary drinks, and/or juices.
Avoid beverages and products sweetened with sugar alcohols (sorbitol, mannitol, xylitol)
Eat small, frequent meals instead of large meals.
Eat foods that are low in fat and fiber. Examples include:

Canned and/or soft fruit like applesauce or a ripe banana
Turkey and cheese sandwich
Broth-based soups like chicken and rice soup
Well-cooked vegetables without seeds or skin, like cooked carrots or green beans

Avoid spicy foods if they make your symptoms worse.

Final Word
To keep track of your symptoms and possible triggers, it's helpful to maintain a food diary. It's important to note that the gastrointestinal side effects of GLP-1RA medication are usually mild-to-moderate and tend to resolve on their own. However, if you encounter severe or persistent side effects, it's crucial to contact your healthcare provider immediately, as this could indicate a more serious issue.

Peer review provided by Michael Albert, MD

Disclaimer: This blog post is for informational purposes only and should not be considered medical advice. Please consult with a qualified healthcare professional before starting any weight management program.

References:

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