Managing Nausea, Vomiting, and Diarrhea on GLP-1s

Why do I have nausea, vomiting, or diarrhea after starting a GLP-1?

Medications such as semaglutide (Wegovy, Ozempic, and Rybelsus) or GLP-1s (glucagon-like peptide-1) have known gastrointestinal side effects. GLP-1s are incretin hormones that are released after the ingestion of a meal. They stimulate glucose-dependent insulin release from the pancreatic islets. They also slow gastric emptying, regulate postprandial glucagon, and reduce food intake, which can all contribute to gastrointestinal side effects.

How common are these side effects?

Nausea, vomiting, and diarrhea occur in 10-15% of patients in clinical trials on GLP1s. Below are some recommendations for managing these side effects, as well as sample meal and snack ideas.

Talk to your providers.

Make sure you report any of these symptoms to your providers at Miga. If any of these side effects are persistent or severe, please go to your local ER.

Recommendations for Management

For Nausea

• Eat smaller more frequent meals and snacks.
• Avoid high fat, greasy, spicy, or overly sweet foods.
• Avoid foods with strong odors.
• Emphasize bland, easily digestible foods.
• Choose soups or smoothies which are sometimes better tolerated than solid foods.

Nausea may wane with duration of therapy and can be reduced with dose titration.

For Vomiting

• Eat smaller more frequent meals and snacks.
• Avoid high fat, greasy, spicy, or overly sweet foods.
• Avoid foods with strong odors.
• Emphasize bland, easily digestible foods.
• Choose soups or smoothies which are sometimes better tolerated than solid food.
• Include fluids with electrolytes (ex. Gatorade Zero, Pedialyte, Nuun tablets, Liquid IV).

For Diarrhea

• Eat small portions of soft, bland foods.
• Choose easy-to-digest protein foods such as chicken, turkey, fish, and eggs.
• Decrease intake of foods high in insoluble fiber (ex. raw fruits and vegetables).
• Eat foods high in soluble fiber (ex. applesauce, bananas, canned peaches, potatoes without the skin).
• Limit lactose-containing milk and milk products; substitute with lactaid, soy milk, almond milk, coconut milk, or other dairy substitutes.
• Avoid gas-causing foods that contain sugar alcohols (ex. sorbitol, xylitol, mannitol) such as sugar-free drinks, candies, and gums.

Sample Meal/Snack Ideas

1. Baked chicken (without skin) with brown rice and cooked asparagus
2. Oatmeal with lactose-free milk
3. Chicken noodle soup
4. Banana with peanut butter
5. Turkey breast with mashed potatoes and cooked vegetables
6. Hard boiled eggs
7. Salmon with pasta and cooked vegeatbles
8. Hummus with crackers

Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. UptoDate. October 2023.