How to manage gastrointestinal side effects of GLP-1s

Key takeaways

• Gastrointestinal (GI) side effects like nausea, vomiting, constipation, and diarrhea are among the most common effects of glucagon-like peptide-1 (GLP-1) receptor agonists. These occur because GLP-1 medications slow digestion and can activate nausea receptors in your brain.
• These side effects typically show up early in treatment or as your dose increases while your body adjusts to the medication. You can help manage them by slowly increasing your dose, eating smaller meals, avoiding high fat or spicy foods, and staying hydrated.
• While mild gastrointestinal effects usually go away on their own, severe or persistent abdominal pain may signal a serious complication like pancreatitis. Talk with a healthcare professional if side effects feel intolerable or if you experience intense pain that radiates to your back.

Overview

Glucagon-like peptide-1 receptor agonists (GLP-1s) like Wegovy and Ozempic can be very effective in managing blood sugar and promoting weight loss. They’re typically considered very safe and effective, but like any medication, they may have some side effects.

Some of the most common effects of GLP-1s are those that affect your digestive system, such as nausea and vomiting. These can be unpleasant, but they can be successfully managed with the right strategies.

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What are the GI effects of GLP-1s?

Gastrointestinal (GI) side effects are some of the most common side effects of any GLP-1. GI effects that you may experience include:

• nausea
• vomiting
• constipation
• diarrhea
• abdominal pain
• bloating

These side effects occur because of the ways GLP-1s affect your digestive system:

• Effect on digestion: GLP-1s slow the rate at which food leaves your stomach. When food stays in your stomach for longer, especially high fat foods, this can increase feelings of bloat and nausea. GLP-1s can also influence how waste moves through your intestines, affecting bowel habits.
• Effect on the brain: GLP-1 receptors are located in the brain area that manages nausea and vomiting. The medication can directly activate these receptors, increasing feelings of nausea.

Managing GI side effects

GI side effects of GLP-1s are most common early in treatment and tend to show up as your doctor increases your dosage and your body gets used to the medication. These side effects are typically mild and well-tolerated, and they usually go away on their own with time.

With that said, GI side effects can still be very unpleasant, but there are ways to manage these effects to reduce discomfort.

Slow dose increases

GI side effects are most common as doctors increase your dose. Starting on the lowest dose possible and increasing (or titrating) it slowly — typically every 4 weeks — can help reduce the risk of GI effects.

If you start a new dose and feel that it’s causing intolerable side effects, you can talk with your doctor about staying at the previous dose for longer to allow your body to get used to the levels.

Consider your diet

What and how often you eat can have an effect on feelings of nausea. Consider eating smaller, more frequent meals and stop eating when you feel full. You can also try to avoid foods that trigger GI symptoms, such as high fat or spicy foods that are harder to digest.

Try natural remedies

Certain natural remedies may help with GI symptoms.

Making sure you stay hydrated is important to avoid dehydration, which may worsen nausea. Make sure you take small sips instead of gulps to avoid irritating your stomach further. What’s more, you can try eating a small piece of fresh or candied ginger, or drink ginger tea, chamomile tea, or peppermint tea to settle your stomach.

Consider OTC medications

In some cases, you might consider trying OTC nausea medications, such as bismuth subsalicylate (Pepto-Bismol). Always speak with your doctor before taking a new medication alongside GLP-1s.

When to speak with a doctor

While mild GI side effects are expected early in treatment, severe or persistent abdominal pain can be a sign of a rare but serious complication of GLP-1 treatment, such as pancreatitis or a gallbladder issue. If you experience intense pain that radiates to your back, seek medical attention immediately.

Even if the GI effects don’t signal an underlying complication, you can still speak with a doctor about reducing your dose or even switching if you feel the side effects are intolerable.

For example, dulaglutide (Trulicity) is sometimes noted in comparison studies for having a slightly lower risk of severe nausea and diarrhea compared to high doses of semaglutide or tirzepatide.

Medical perspectives

How will a doctor monitor a patient’s health throughout long-term GLP-1 therapy?

“A doctor will monitor things like weight, kidney function, and blood sugar (usually with an A1c test) to see how a patient is responding to the drug and if there are any negative effects as a result of the drug.”

— Philip Ngo, PharmD

Note: Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Online care for GLP-1s

If a doctor has prescribed a GLP-1, it’s important to take the medication as directed for as long as your doctor recommends. However, some people might face barriers to accessing these drugs, including high costs and access to healthcare appointments.

Online care may make getting treatment easier. With Optum Perks Online Care, for example, you can get a refill of a weight loss prescription or get help with an existing prescription.

With this service, you can submit an online form answering a few questions about your condition, and a licensed healthcare professional will respond soon after — without the need to make an in-person appointment.

Summary

Gastrointestinal side effects like nausea or diarrhea are among the most common side effects of GLP-1s. These typically show up early in treatment and as your dosage increases while your body gets used to the medication.

These side effects are usually mild and go away on their own. However, you can try to lessen these effects with home remedies, such as considering your diet and hydration.

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