Constipation replaced nausea at around week five and has been the more persistent of the two by a wide margin.
Solved, and the fix was not the one I had assumed, so the reasoning is worth more than the answer.
What it turned out to be: 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.
What would genuinely help is knowing whether fiber actually helps GLP-1 constipation or whether the evidence is borrowed from a different population. Tell me what I have not thought of.
Short answer first, then the reasoning. 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.
DataDave said:Fiber trials in this population are thin, and most of what gets quoted is extrapolated from idiopathic constipation in people eating normally.
Acid reflux and constipation: I developed GERD symptoms around week 6 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.
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View ResultsDr.GutHealth 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…
Can confirm the pattern Dr.GutHealth describes. The mechanism is slowed transit plus reduced intake, and that combination determines which interventions work. Less food means less bulk, slower motility means more water reabsorbed, and the result is a smaller, drier, slower stool. Insoluble fiber adds bulk to a system that is already moving slowly, which is why it frequently makes things worse. Soluble fiber holds water and is the better first choice, and an osmotic agent works with the mechanism rather than against it.
From the other side of the consultation, briefly.
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.