Expert Tips for Managing GLP-1 Medication Side Effects

Glucagon-like peptide 1 (GLP-1) medications have become a powerful weight loss tool in a country where 40% of the population is obese. Patients taking these medications can experience weight loss, a life changing amount for those who have been struggling with weight and related health problems for much of their lives.

But despite substantial weight loss, many patients find staying on the medications difficult because of a lengthy list of uncomfortable side effects including nausea, vomiting, constipation, gastroparesis, dehydration, and gallstones. And in some cases, patients undergoing surgery have also experienced some more serious digestive side effects, including aspiration of foods into the lungs.

Still, experts contend that before discontinuing use of a GLP-1 medication, patients should consider adjusting dosage, taking prescribed and over-the-counter drugs that can help with symptom management and dietary changes that allow them to achieve weight loss without sacrificing their quality of life.

It’s worth noting that while these symptoms are called side effects, the drug is doing exactly what it’s supposed to do: Slow gastric emptying so that you feel fuller longer and can lose weight. Slowed digestion causes food to sit in the gut, which in turn, leads to sometimes unpleasant symptoms.

Correct Dosage and Dietary Changes

The first step in reducing side effects, the most common of which is nausea, is pinpointing the ideal dosage, said Patrick M O’Neil, PhD, director of the Weight Management Center at the Medical University of South Carolina (MUSC) in Charleston.

“Symptoms usually occur when the dosage is escalated,” said O’Neil.

As a result, it’s best to gradually increase the dosage over a number of weeks so that patients are losing enough weight but aren’t overwhelmed by the side effects. If a patient has difficulty tolerating the drug, consider lowering the dosage or at least delaying any increase until they’re able to adjust, said O’Neil.

Diet also plays an important role, said Tonya F. Turner, RDN, associate director for clinical services at MUSC’s Weight Management Center. Patients should be eating mini meals throughout the day that are easier to digest. Even when the dosage is low enough that they aren’t feeling side effects, starting off with smaller meals helps to establish positive habits once dosage increases.

“This avoids getting overly full, which causes nausea and other gastrointestinal side effects,” said Turner.

Consuming plenty of fiber is also important for tolerating these medications. Whether it’s coming from whole grains, fruits, vegetables — or in the event patients aren’t getting enough fiber from food — supplementing with Metamucil or Benefiber to reach 25-35 g daily.

“It’s often difficult to get enough fiber because patients are eating very little, so supplementing can be key,” said Turner.

Adding fiber supplements to coffee, water, or a smoothie can also be helpful. Patients should avoid artificial sweeteners especially sorbitol, mannitol, xylitol, and maltitol in candy, gum, and beverages because they can add to stomach discomfort.

Hydration is also important to staving off constipation. Often, when patients don’t feel hungry, they end up not drinking enough water because it makes them feel overly full. Heavier foods that take longer to digest tend to make people feel poorly. These include higher fats foods like fried foods or fattier meats, especially red meats.

“Many patients may also have an aversion to alcohol because it doesn’t settle well and it slows digestion,” said Turner.

In some cases, a temporary liquid diet can reduce symptoms, said Andres J. Acosta, MD, PhD, an associate professor of medicine and an expert on food intake regulation at the Mayo Clinic in Rochester, Minnesota. Allowing the bowels to rest via a liquid diet can reduce nausea and vomiting symptoms. Consider foods like protein and meal replacement shakes or simply blending up healthy meals.

“It basically means anything that you can drink through a wide straw,” said Acosta.

Prescribed and Over-the-Counter Medication Interventions

Doctors can also prescribe certain medications to help patients manage side effects including Prucalopride, which can be used off-label to help with constipation, said Ali Rezaie, MD, a gastroenterologist at Cedars Sinai in Los Angeles.

Other medications, including Metoclopramide, can help with symptoms of slow gastric emptying, or gastroparesis. And for nausea, the most common complaint, prescribed medications like Ondansetron and Domperidone, can help as can some over-the-counter medications like Dramamine.

In addition to more common unpleasant symptoms, some rare but serious side effects have been associated with these medications. A March 2022 study published in JAMA, found an association between the use of GLP-1 medications and gallbladder diseases, eg, gallstones. It’s important to note that’s these issues are rare and some experts contend that the symptoms could be the result of extreme weight loss, rather than the medication itself.

Also, in patients undergoing surgery that requires anesthesia, GLP-1s can increase the risk of pulmonary aspiration when a patient is under deep sedation during surgery, according to a July 2024 study published in the journal Gastroenterology. This can cause aspiration pneumonia, a lung infection that occurs when food or liquid is inhaled into the lungs. “Routine fasting before a surgery doesn’t seem to be enough, so it’s suggested that patients stop these medications at least 1 week prior to surgery,” said Rezaie.

The bottom line when it comes to tolerating GLP-1 medications is quality of life. In order to sustain the weight loss, you really have to stay on the medications. And while watching the scale tick down can be exciting, if these medications are keeping you from doing the things you enjoy, they might not be worth it. In this case, consider a lower dosage or maybe getting off them entirely. “It’s worth revisiting what’s more important as well as what’s sustainable for weight loss in the long term,” said Turner.