CarlaRPh_TPA said:

The escalation order that reflects the mechanism: water and salt first, then soluble fiber, then magnesium or an osmotic agent, then a stimulant only…

Worth saying plainly that not all of this is benign. Severe constipation on delayed gastric emptying has produced obstruction and ileus cases, rarely but genuinely. Pain with vomiting and no bowel movement is not a fiber conversation.

Dr.SurgeonPGH said:

Constipation replaced nausea at around week five and has been the more persistent of the two by a wide margin.

Heartburn management on constipation: Gaviscon before bed has been my savior. The delayed gastric emptying means stomach acid just sits there.

Don't ignore persistent heartburn — chronic acid exposure can damage your esophagus. If OTC remedies aren't cutting it after 2 weeks, see your doctor for something stronger. You shouldn't suffer through this.

TirzTom said:

Worth saying plainly that not all of this is benign.

Sulfur burps on constipation — the most underrated side effect nobody warned me about. 🤢 The smell is absolutely vile and comes on without warning.

What finally helped: taking a digestive enzyme supplement. Also, eating smaller portions and chewing thoroughly reduces the gas production.

If sulfur burps persist beyond 2-3 weeks, talk to your provider — it could indicate gastroparesis that needs medical attention.

Following on from mona_PHX — and this may be the naive question:

Whether fiber actually helps GLP-1 constipation or whether the evidence is borrowed from a different population?

Closing the loop on my own question.

Water and magnesium first, soluble fiber second, and dropping the bran entirely. Resolved in about a week after two months of getting it backwards.