More than 40 million Americans take a GLP-1 to manage weight or help treat a condition such as diabetes or heart disease. At the same time, a Cleveland Clinic study shows nearly 15% of people quit taking the drugs due to side effects.
“While GLP-1s are powerful and effective tools to help manage weight, side effects can become problematic if not properly managed,” says Ashley Faulks, APNP, a nurse practitioner with ThedaCare Weight Wellness Solutions. “This is another reason it’s important to choose a multidisciplinary program. Our team can help manage side effects.”
Here, Faulks and Registered Dietitian Ashley Krautkramer discuss common GLP-1 side effects and how to manage them.
What to Expect When Starting
Common GLP-1s include semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound). They work partly by helping people feel full sooner and slowing how quickly food leaves the stomach. This slower digestion also explains why new GLP-1s users often experience uncomfortable stomach and bowel symptoms as their bodies acclimate to the medication.
“The good news is that most people adjust very well,” Krautkramer says.
Common Side Effects Explained
“Side effects tend to be most pronounced soon after people start the medication,” Faulks says. “They may be uncomfortable or disruptive enough to make people rethink their decision.”
Common side effects include:
- Nausea: feeling queasy or like you may vomit, especially after large or greasy meals.
- Vomiting: usually when nausea is more intense.
- Diarrhea: loose or urgent stools.
- Constipation: fewer bowel movements, hard stools or straining.
- Stomach discomfort: bloating, burping, gas, heartburn, cramps or feeling uncomfortably full.
- Reduced appetite: feeling full quickly or becoming disinterested in food.
- Injection-site irritation: mild redness, soreness, itching, swelling or bruising where the shot was given.
- Fatigue or lightheadedness: feeling tired, weak or dizzy, sometimes related to eating less or not drinking enough fluids.
Help and Hope
The ThedaCare Weight Wellness Solutions team is here to help program participants experiencing side effects.
Some symptoms can come back for a short time after a dose increase and then subside again. Krautkramer and her dietitian colleagues can offer recommendations to help.
“If a person does not feel well as they adjust to a GLP-1, and they tended to be chaotic eaters, they may not really know what their normal food intake was,” Krautkramer says. “We work together to make intentional food choices and to eat more slowly so their health and confidence improve.”
The dietetics team also may prescribe a micronutrient supplement and a B-1 (thiamin) complex vitamin for people who struggle to eat enough nutritious food as their bodies adjust.
From a medication management standpoint, a doctor or nurse practitioner may opt to reduce a person’s prescribed dose or slow their scheduled dose increases if they experience difficult side effects.
“There is also a misconception that we should titrate up to the highest dose with each patient, and that is simply not true,” Faulks says. “We work together to discover the lowest, most effective dose to reach a person’s health goals.”
Tips for Easing GLP-1 Side Effects
For nausea, vomiting or feeling too full:
- Eat smaller meals more often instead of large meals.
- Eat slowly and stop when you feel comfortably satisfied, not stuffed.
- Choose bland or cool foods when nauseated. These can include crackers, toast, rice, applesauce, bananas, soup and yogurt.
- Avoid greasy, fried, rich, spicy or sweet foods, especially around the time of a dose increase.
- Sip water throughout the day. Ginger or peppermint tea may help some people. However, peppermint can worsen heartburn in others.
- Do not lie down right after eating. Try sitting upright or taking a gentle walk.
For constipation:
- Drink enough fluids, mostly water.
- Add fiber slowly over a few weeks with foods such as oats, beans, lentils, vegetables, fruit, chia or ground flaxseed. You can mix chia, flax and other seeds into yogurt, smoothies or cereal.
- Move your body daily if you can. Walking often helps the bowels move.
For diarrhea:
- Keep sipping fluids to prevent dehydration.
- Temporarily choose simpler foods such as bananas, rice, applesauce, toast, potatoes, broth or crackers.
- Avoid alcohol, soda, greasy foods and caffeine while symptoms are active.
- Avoid sugar-alcohols found in sugar-free products like gum and cough drops.
What to Expect Long Term
Most GLP-1 side effects are digestive, mild to moderate and temporary. Together with better food choices, regular small meals and more physical movement, these medications can help people see early results that motivate them to stay the course.
“We believe a healthy weight goes far beyond the number on a scale,” Faulks says. “Whether your goal is to move better, play with your grandkids or enjoy gardening, we will help you get there. We have so many tools in our toolbox that can help.”
