Short answer first, then the reasoning. The escalation order that reflects the mechanism: water and salt first, then soluble fiber, then magnesium or an osmotic agent, then a stimulant only briefly and only if the osmotic has failed. Stimulants first is the commonest error and the one most likely to end in a cycle of dependence.

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…

Acid reflux and constipation: I developed GERD symptoms around week 4 that I'd never had before. The delayed gastric emptying means food and acid sit in your stomach longer.

Management that works for me: elevate head of bed 6 inches, don't eat within 3 hours of lying down, avoid trigger foods (tomato, citrus, spicy, chocolate), and famotidine 20mg at bedtime. Much better now.

Dr.SurgeonPGH said:

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

Can confirm the pattern Dr.SurgeonPGH describes. Fiber trials in this population are thin, and most of what gets quoted is extrapolated from idiopathic constipation in people eating normally. The extrapolation is not unreasonable but it is an extrapolation, and it fails specifically for insoluble fiber at low intake — the case that comes up here most often.

Correct me if the detail matters more than I have assumed.

Adding the clinical framing, because it changes how the question reads.

Gastroparesis symptoms with constipation: the delayed gastric emptying from GLP-1 agonists can cause early satiety, bloating, and feeling "full" for hours after a small meal.

Tips: eat your protein FIRST (most important macro), then vegetables, then carbs last. Chew thoroughly — 20-30 chews per bite isn't excessive. Avoid carbonated beverages with meals. If symptoms are severe, your doctor may recommend a gastric emptying study.