7 Tips for Navigating Nausea on a GLP-1 Medicine
GLP-1 drugs like Ozempic and Mounjaro can be very effective for managing blood sugar and weight, but early digestive side effects – especially nausea – can be tough to handle. Find out how to help manage these symptoms.
I've had type 1 diabetes since I was 10, and since my diagnosis, I've dealt with insulin resistance. Insulin – for all its life-giving charms – promotes fat storage and prevents fat breakdown. Trying to manage your weight while taking insulin can sometimes feel like a losing cause.
Newer diabetes and weight management medicines can deliver impressive benefits for people with diabetes. Medicines like Ozempic, Wegovy, Mounjaro, and Zepbound can help people lose weight and manage blood sugar, all while protecting heart and kidney health.
To help with both blood sugar and weight loss, I've tried several of these incretin-based medicines. Though currently only FDA-approved for type 2 diabetes and obesity, the FDA does not restrict people with type 1 from using these drugs. Some doctors also prescribe them for people with type 1 diabetes "off-label" to help manage blood sugar and weight.
I can say firsthand that the benefits have been great. I typically struggle to lose weight even when I've tried intermittent fasting, working out, and caloric restriction. But when using a GLP-1 medicine, my insulin works better – and I take about 20% less of it (talk with your doctor about insulin dosage adjustments before starting one of these medicines to avoid potentially serious hypoglycemia.). Post-meal blood sugar spikes are reduced, and weight comes off steadily. Yet, I've had bouts of nausea with each of these medicines I tried.
Research shows nearly half of people with type 2 diabetes stop taking GLP-1 drugs within a year due to factors like cost and side effects. People with moderate or severe gastrointestinal issues were much more likely to stop taking the medication than others.
While I've experienced other GI-related issues on a GLP-1, nausea has been the most difficult to manage. Daily life – especially meals, work, and family time – can be disrupted. It’s also hard to stick with a treatment plan when your stomach feels like it’s on an ocean liner.
As your body adjusts, common GI-related side effects tend to go away. But especially when starting out – or your dose is increased – stomach problems can make day-to-day life challenging.
That led me to seek out and share expert advice on how to ease nausea and other digestive side effects to hopefully help people stick with their treatment plan. And in doing so, it was helpful to be reminded that in the not-too-distant future, things will settle down – while the protective benefits remain.
1. Go low and slow
Incretin-based medicines are typically started at a minimum dose, and the dose increases each month or so. But Dr. Lee Kaplan, chief of obesity medicine at Dartmouth, said the approach should be more of a marathon than a sprint. Going slow can be a powerful way to reduce nausea and other digestive side effects, which usually resolve as your body adjusts.
"Escalating should not be a race to the maximum tolerated dose," Kaplan said. "For people who have developed nausea, continuing the current dose for a longer period, slowing further escalation, or even temporarily lowering the dose one step, can be very effective."
Staying hydrated is crucial during these dose adjustments, he said, as dehydration can worsen nausea.
2. Be gentle on an empty stomach
Nausea can often be worse first thing in the morning when your stomach is empty – so proceed carefully, advised Dr. Michelle Hauser, obesity medicine director of the Stanford Lifestyle and Weight Management Center.
"People often say: ’I'm really nauseous when I wake up in the morning,’” Hauser said. Even brushing teeth first thing can trigger nausea for some people, so she advises them to wait until after eating.
In the morning, bland foods can help – for example, plain yogurt (Greek or liquid), toast, crackers, and mild fruits like bananas, pears, and apples.
I would typically eat a small amount of bland carbs and protein – saltines with peanut butter, for example, or a pancake (no butter or syrup), and a boiled egg. Some people like smoothies with protein powder.
3. Know your triggers
Hauser described the effect GLP-1 medicines have on some people like a volume knob for nausea that's been turned up. If certain foods – for example, things that are spicy or acidic – gave you trouble before, a small amount may have an amplified effect.
"You're much more likely to be sensitive to these foods when taking the medicine," she said.
Again, keep in mind that nausea tends to occur early in the process. Everyone is different, but about six weeks in, I noticed I was interested again in favorite foods I might have avoided earlier.
4. Avoid high-fat meals and large portions
Especially early on when starting GLP-1 medications, it can help to avoid large or heavy meals. Fatty meats, high-fat dairy, fried foods, and fast food can all heighten potential digestive side effects, Hauser said.
"Those – or large portions of anything really – for people who are sensitive to the medications – can be problematic," she said.
5. Stick with glucose-friendly foods
While heavy and greasy meals can make nausea worse, Hauser said, foods that are better tolerated also tend to be ones that are good choices for blood sugar management. She recommends lean meats, plant-based proteins, fruits, vegetables, whole grains, beans, and lower-fat foods.
I've also found that some light exercise and fresh air can be stomach and blood sugar-friendly.
6. Eat this, not that
A 2022 study offered a helpful list of general recommendations, such as eating more slowly, avoiding lying down after a meal (which can slow digestion and increase acid reflux), and steering clear of strong smells.
Other guidance was more specific, such as avoiding sweet meals, dressings, spicy foods, and sauces that aren't homemade. Instead, the study recommended healthy foods that contain water – like soups, yogurt, and gelatin – and ginger-based drinks. The guidance also included waiting 30 minutes after taking the medication before trying foods that can help with nausea, like chicken broth, rice, and carrots.
7. Talk to your doctor if it keeps up
For milder symptoms, over-the-counter medications like antacids or anti-reflux medications can help, Kaplan said.
For more severe nausea or vomiting, doctors may prescribe ondansetron (Zofran). Kaplan cautioned, however, that it has potentially serious side effects, such as increasing the risk of heart rhythm problems in patients with preexisting heart disease.
"It should be used only for short periods to quell acute nausea, not chronically to permit rapid dose escalation. It is better to slow the dose escalation and stop the ondansetron as quickly as possible," he said.
Fortunately, the digestive side effects of GLP-1 drugs tend to resolve as your body gets used to the medicine. Kaplan said it's important to remember these symptoms are uncommon once you're on a stable dose.
The bottom line
Newer GLP-1-based drugs can lead to powerful benefits for blood sugar, weight, and heart health, but nausea can make treatment unpleasant – especially during the first few weeks of treatment or shortly after increasing the dose.
Fortunately, these symptoms tend to fade as your body adjusts. In the meantime, there are things you can do to help.
Plant-based foods – like vegetables, beans, and whole grains that don't spike blood sugar – can be more agreeable. Heavy, spicy, and greasy foods are likely to make nausea worse. Staying hydrated is key and can assist other GI side effects, such as dehydration from weight loss, vomiting, constipation, and diarrhea.
If you're experiencing nausea, talk to your doctor about sticking with your current dose until stomach issues subside before going to a higher dose. If nausea lingers or worsens, talk to your doctor about possible adjustments to your plan, such as reducing your dose or exploring other potential treatments.
Finally, while these medicines can reduce insulin resistance and insulin needs, it's important to discuss dosing adjustments with your doctor – especially to basal/long-lasting insulin – before taking a GLP-1 medicine. Continuous glucose monitoring (CGM) can help. People with type 1 diabetes also need to keep taking their insulin to avoid diabetic ketoacidosis (DKA), when insulin levels are too low.
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