#28: GLP-1 Side Effects Explained: What’s Normal and What Helps

GLP-1 medications like Ozempic, Wegovy, and Zepbound can improve weight loss and blood sugar regulation, but they also come with side effects. In this episode of The Vitality Formula, physician Dr. Marie Livesey explains the most common GLP-1 side effects and what actually helps.

You’ll learn why symptoms like nausea, constipation, fatigue, reflux, hair shedding, and muscle loss can occur when starting these medications and what is happening physiologically inside the body. Dr. Livesey also shares practical strategies that can make GLP-1 treatment more manageable while supporting long-term metabolic health.

GLP-1 medications influence appetite signaling, gastric emptying, and blood sugar regulation, which means many of the side effects people experience are predictable physiological responses rather than random complications. Understanding these mechanisms can help patients navigate treatment with more confidence.

What You’ll Learn

• Why nausea is the most common GLP-1 side effect
• Why constipation occurs and how to improve gut motility
• Why some patients experience fatigue when starting GLP-1 medications
• How slower gastric emptying can contribute to reflux symptoms
• Why hair shedding sometimes occurs during weight loss
• How to protect muscle mass while losing weight on GLP-1 medications

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Connect with Dr. Marie today!
Instagram: @dr.mlivesey
LinkedIn: www.linkedin.com/in/drmlivesey
Website: https://www.livelyholistichealth.com

This podcast is for informational purposes only and does not constitute medical advice or establish a provider–patient relationship.

Transcript

SPEAKER_00 0:00

Many people start GLP1 medications like Ozempic, We GOVI, or Gazette Bound, expecting weight loss. What they don't always expect are the side effects: the nausea, constipation, fatigue, feeling full after just a few bites of food. As a physician who works with these medications regularly, I spend a lot of time helping patients understand what symptoms are common, what's happening physiologically inside the body, and what actually helps. In today's episode, we are going to talk about what's happening physiologically inside the body, why these symptoms happen, and what actually helps make the experience much more manageable, especially for busy adults trying to integrate these medications into real life. Hello and welcome back to the Vitality Formula. I'm your host, Dr. Marie Livsey, physician, metabolism and hormone health expert, and founder of Lively Holistic Health. I help busy professionals take back control of their health, metabolism, and weight in ways that actually fit real life. GLP1 medications are changing the landscape of metabolic medicine. For many people, they improve blood sugar regulation, appetite signaling, and weight management in ways that were previously very difficult. They're also being used to treat a number of conditions, including diabetes, obesity, chronic kidney disease, fatty liver, sleep apnea, cardiovascular disease, and they're even in their early clinical trial phase for the treatment of addiction. But like any medication, they also come with side effects. The good news is that most of these symptoms are predictable based on the physiologic changes that the medicines cause. And once you understand why these side effects are happening, they're often much easier to manage. Before we talk about symptoms, it helps to understand what GLP1 medications are doing in the body. These medications mimic a natural hormone called glucagon-like peptide 1, and they influence several systems at once. That includes appetite signaling in your brain, gastric emptying in your stomach, insulin and blood sugar regulation, and satiety signals after meals. And this is just to name a few. There are many, many functions that this GLP1 does. And because they affect digestion and appetite regulation so directly, it makes sense that many of the side effects people experience are digestive or energy related. Today we're gonna walk through the most common ones as well as remedies that actually work for people. All right, so for side effect number one, nausea. This is the most common side effect that I find people experience. So why does it happen? GLP1 medications, as we said, are going to slow gastric emptying. This means that food stays in a stomach longer, which is going to increase that feeling of fullness and the satiety signals to our brain. This same mechanism can trigger nausea and lead to feelings of being overfull, especially early on in your treatment or after you have an increase in your medication. Some practical strategies to combat the nausea, and don't worry, this doesn't include an actual air campaign that almost everybody and their mom has a strong opinion on at this point. Number one, smaller meals. Because your stomach is going to empty slower, putting less food in will make you likely feel less nauseated. Number two, eating slowly. When we eat fast, several things happen. We often eat so fast we don't realize that we're full until we're actually past that point of fullness because there's usually a 15 to 20 minute delay between food starting to come in and our brain receiving fullness signals. Add in delayed digestion, and this spells disaster. And the second thing that happens is we swallow more air when we eat quickly, which is going to further increase gas bloating and abdominal discomfort that people have with GOP1 medications. So that is why slowing down when you eat is so important. Number three, limiting high fat meals, especially in early treatment. Why? High fat foods take longer for us to digest, meaning they need to spend a longer amount of time in the stomach. Reducing the amount of fat that we eat is going to reduce the amount of food and time that our food stays in our stomach, which in turn is going to keep us from feeling overly full and reduce that feeling of nausea. Number four, adequate hydration. This helps food move through your digestive system more efficiently. And this also keeps you from having your nausea further worsened by dehydration because yes, dehydration also causes nausea. And then number four is gradual dose titration. When people go up quickly on their medications and they're still having side effects, they're gonna continue to have them and it's going to compound. For many people, this nausea improves as their body adapts to the medication. Side effect number two, constipation is also extremely common. Two things that are happening simultaneously in the body when you are on a GLP1. First, we already talked about slowed digestion. Gut motility also slows with GLP1s. If your GI system is moving slower, you can also expect to poop less often. And number two, many people are eating significantly less food while on the GLP1 because they aren't as hungry and they feel more full. And less intake means less volume is moving through your digestive system, which means you're going to have less output and feel constipated. So how do we prevent constipation when on a GLP1? Number one, drinking plenty of water to help our food move along. Number two, adequate fiber intake. For many patients, this is especially difficult early on because they're nauseated and constantly so full from the slow digestion. Adding several tablespoons of metamucle can also do the trick until your body is able to handle more food. Number three, walking and daily movement to stimulate the muscles in your stomach and your intestines to move that food baby along. Number four, magnesium supplementation when appropriate. This is something that you should always discuss with your provider first to avoid an electrolyte imbalance. And finally, having balanced meals with protein and produce so that you have that bulk and volume to move through your stomach. Side effect number three, fatigue. This one I find catches a lot of people off guard. People expect the weight loss, they expect to have less appetite, they expect to have no food noise, but no one talks about this lower energy. Why does this happen? If you listened to the first side effect, nausea, you can reasonably infer that you'll be eating less food when you feel nauseated. This rapid reduction in caloric intake results in you feeling tired because you have less fuel to use. The second is blood sugar stabilization. Your body may be used to living in a hyperglycemic state, aka high sugar, lots of sugar in our bloodstream around all the time. When your blood sugars normalize, it takes time for your body to catch up and get used to this lower sugar state. And in the meantime, your body is actually going to interpret normal as too low, leading to fatigue. The third is electrolyte shifts. If you are drinking less water because you are full or you have diarrhea or vomiting, you will have an electrolyte imbalance and that will make you more tired. This electrolyte shift is also caused by the diuretic effect that these medications have on your kidneys, meaning GLP ones are going to make you pee more. And finally, changes in carbohydrate intake. Many people naturally consume less carbs on GLP1s due to fullness. Well, carbs are sugars, and having less sugar around means your body has less quick energy to use and you will feel fatigue and feel lower because you have less energy. These are all signs that your body is simply adjusting to its new metabolic baseline. How do we get around this though? Having an adequate protein intake to stabilize your energy. Drinking plenty of water and considering an electrolyte replacement, especially if you have vomiting or diarrhea. Consistent meals, so you are still fueling your body. If you are skipping two meals a day and only eating dinner, you can expect to feel tired all the freaking time. And then finally, prioritizing sleep. I find that energy often stabilizes after the initial adjustment period to these medications. Side effect number four, reflux, also known as heartburn. Some people notice increased reflux, whether or not they have it at their baseline. This happens because of what we already talked about, right? Slowed digestion. Stomach emptying has slowed, so food is going to remain in the stomach longer, and this increases pressure at that sphincter. I know I said sphincter, that is at the bottom of our esophagus, and then food can come up, and that's where you get those reflux symptoms. I find for people that eating smaller meals, avoiding spicy and fatty foods, eating three hours before bedtime, and pacing meals more evenly throughout the day really helps with reflux. Side effect number five, hair loss concerns. If you're on any Reddit thread right now, everybody is talking about the hair loss that comes with starting at GLP1 medication, and it it's it's it's a topic that's not going to stop. But in most cases, the medication itself is not the direct cause. Rapid weight loss or caloric restriction can trigger a phenomenon called telogen effluvium. And this is a temporary hair shedding phase. We can reduce rapid hair loss by having an adequate protein intake, monitoring micronutrient levels such as iron, vitamin D, bolate, and B12, and focusing on gradual, sustainable weight loss over rapid change. I find that everybody comes in wanting rapid change. And if you are one of those people, just know that with rapid change, you are also going to have a lot of hair loss. Hair growth typically resumes once your body and your weight stabilizes and underlying deficiencies are addressed if you have them. And last but not least, muscle loss. This is one of the most important conversations happening right now in metabolic medicine, whether or not we're talking about a GLP1. Weight loss can include both fat and lean muscle mass, especially when GLP1 medications are used, if patients are not intentional about preserving muscle mass. Having adequate muscle mass supports our overall metabolic health and our long-term weight maintenance, because muscle burns more calories at rest than fat. It improves blood sugar regulation because muscles can take in that sugar when insulin isn't around. And it indirectly reduces our risk of osteoporosis because the same activities that we are doing to maintain muscle mass also improve our bone density. We can prioritize maintaining muscle mass by having an adequate protein intake and resistance training, meaning picking up weights, at least three times a week. The importance of muscle mass on metabolism long term really highlights why medications work best when they're paired with supportive lifestyle strategies. The side effects we just discussed, most of them are going to improve over time, but there are situations where you need to reach out to your healthcare provider. This is going to include, but it's not limited to, severe or persistent nausea, dehydration, significant reflux, or you have just a constant burning in your chest or sour acidic taste in your mouth, and the inability to maintain adequate nutrition and keep food down. And then, of course, if you have severe abdominal pain, you're not keeping any fluid down, you have changes in your vision, you need to seek emergent help. GLP1s are powerful tools in metabolic medicine, but like most things in health, they work best when they are treated as a tool and paired with supportive habits. This includes the boring stuff, adequate nutrition, movement, sleep, stress management. These medications change appetite, digestion, and many other physiologic processes in our body, but the foundations of metabolic health still matter. Understanding the physiology behind side effects can help you navigate the process with more confidence and more ease. If this episode helped clarify how GLP1 medications work and what your body may be adjusting to, consider sharing this with somebody who is also adjusting to a GLP1 medication or considering starting one. And if you want more insights on metabolism, hormones, and sustainable health strategies for busy professionals, make sure you're following the show. If you are considering expert-guided metabolic and hormone health care that is not constrained to a 15-minute clinic visit or a stranger who simply fills your medication online, you need to get on the wait list for my upcoming telehealth offerings. Thank you so much for spending this time with me today. That's it for today on the Vitality Formula. Until next time, take care of yourself. Remind yourself you deserve to feel good in your body. And as always, I'm cheering you on.