GLP-1 Weight Loss Medications’ Biggest Side Effect

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The newest miracle drug for weight loss is changing the lives of thousands of people who have battled obesity for extended periods of time….These GLP-1 medications are also treating or preventing the diseases that go with long term obesity: Diabetes, Heart Disease, Joint replacements, Arthritis, Sleep Apnea, and Alzheimer’s Disease. Researchers are finding more indications every day for patients to take these weight loss medications.

But like anything else there is no perfect answer to any problem.  Among the few side effects of this drug, the most frequent side effect is reflux, also called acid indigestion, or GERD (gastroesophageal reflux disease).  Often my patients don’t even know what their diagnosis is, they just tell me about their symptoms.

The symptoms of GERD include:

• Asthma symptoms
• A bad taste in the mouth
• Difficulty swallowing
• Dry, hacking, cough
• Chest pain after meals

These symptoms are worse after a big meal, at bedtime, after spicy food, or dose related.  Most of my patients don’t want to discontinue the GLP-1 inhibitors because they are finally losing weight!  We manage the GLP-1 side effect of GERD by decreasing dose of the medication and slowly increase the dose back to an effective level. We also offer lifestyle and dietary treatments before we offer prescription medication.

Therefore, if reflux is not constant, and is not causing any lasting damage to the patient’s esophagus, we can treat it with lifestyle changes and over the counter medication, to lower the stomach acid that is refluxing into the esophagus.

The lifestyle changes patients can employ on their own are described below.

Lifestyle changes needed to avoid or treat Gastric Reflux caused by GLP-1 agonists. What can you do to prevent and treat this side effect:

• Eat smaller meals: Large meals expand your stomach and put pressure on your lower esophageal sphincter (LES).
• Don’t go to bed less than 2 hours after eating
• Avoid trigger foods see below
• Sleep on your left side
• Elevate the head of your bed
• Avoid tight clothing:
• Chew your food well– chew each bite for 20 seconds.
• Quit smoking: Smoking weakens your LES and makes your stomach more acidic.
• Stop drinking alcohol
• Chew (non-mint) sugar-free–gum

 In addition to changing your active lifestyle, changing your diet is necessary as well.

There are trigger foods to avoid minimizing your reflux symptoms.

 tomato sauce and other tomato-based products

• high fat foods, such as fast food and greasy foods
• fried foods
• citrus fruit juices
• soda-diet and regular
• Caffeine
• Garlic
• onions
• mint of any kind
• milk based products

My patients ask me, “So what can I eat?” …I admit I did take away some of the most exciting foods, however my patients ask me what they can eat so the list of foods that help avoid and treat GERD are listed below.

• High-fiber foods: vegetables, fruit, and whole grain bread.
• Alkaline foods. Foods fall somewhere along the pH scale (turns litmus paper blue).
• Drink alkalinized water (PH > 8)
• Ginger—fresh sushi Ginger from Asian food stores.
• Apple cider vinegar on salads and a Tablespoon in water every morning
• Lemon water—just squeeze a slice of lemon in your water.
• Coconut water
• Honey.
• Lean Protein including meat
• Low-Fat and Nonfat Dairy Products.
• Non-Citrus Fruits like apples, pears, bananas, and melons
• Vegetables like broccoli, Carrots, Corn, Cucumbers, Green Beans, Green peppers, Potatoes and Sweet potatoes

 

For my patients who take herbal and other supplements, the following is a list of the supplements that may decrease your symptoms of GERD.

• Chamomile Tea
• Licorice
• Marshmallow
• Slippery Elm Tablets
• Probiotics-Mega Brand
• Prebiotics-Mega
• Digestive Enzymes
• Aloe Vera Juice
• Baking Soda
• Magnesium glycinate

What happens when you have made all the lifestyle changes you can and have lowered your GLP-1 dose or changed to a different type of GLP-1 Agonist, and you still have GERD?

As a physician I prescribe medications to help my patients treat their GERD, however most of the medications have been placed over the counter so I can recommend them to my patients, and they can buy the medication without a script.

The class of medication that treats GERD include Antacids, H2 Blocker, and Proton Pump Inhibitor.

 Antacids neutralize stomach acid, but they typically only work for short periods. They are generally made of calcium. This type of medication is best used prn for symptom relief.  Side effects of antacids may include constipation and diarrhea.

The second option for treatment of GERD is an H2 blocker. These drugs reduce the amount of acid the stomach releases. Eg. Pepcid, Tagamet, Gaviscon.

Proton pump inhibitors (PPIs): These drugs are available by prescription from a healthcare provider, and now some doses are over the counter. PPIs help reduce the amount of acid the stomach makes.  They should be used for a two-week period only for severe attacks and then you should change to an H2 blocker or antacid.

WHY stop a PPI after 2 weeks?   Omeprazole is an example of a PPI.  Theses medication kill the good bacteria in your intestines, change your breath and can affect how you absorb your nutrients. If you must take them chronically to treat and prevent the progression of damage to the esophagus.

What if I did everything and GERD is still a problem:

If your condition is severe, your doctor may recommend a consultation with a GI doctor for an endoscope or other diagnostic procedure.  In addition, you may have to hold your GLP-1 Agonist for a period of time while you treat your esophageal inflammation.

Just as in all medical issues there are many ways to treat side effects of drugs. Your provider will prescribe the medication that she or he is most comfortable with.

What next?

So if you have reflux and are on a GLP-1 inhibitor, you may be advised to decrease your dose or switch to Tirzepatide medication (Mounjaro, Zepbound).

There are many steps you can take before you need prescribed medication. Your doctor may even change your GLP-1 agonist prescription or refer you to a GI doctor, but before this is necessary you should try the lifestyle and dietary changes that I recommend in this Blog first.

This side effect of GLP-1 agonists doesn’t affect every patient and can be managed as you see above, however the lifestyle changes and dietary changes can only be done by you, so the ball is in your court!