Dr.EndoIndy said:

The mechanism is slowed transit plus reduced intake, and that combination determines which interventions work.

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: Gas-X (simethicone) daily. 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.

One thing that is still open after Dr.EndoEP’s answer:

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

NicoleRaleigh said:

Sulfur burps on constipation — the most underrated side effect nobody warned me about.

Acid reflux and constipation: I developed GERD symptoms around week 3 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.

Reporting back.

Update — the osmotic agent was the thing. I had been reaching for a stimulant, which was making the next day worse.

EndoResFellow said:

Acid reflux and constipation: I developed GERD symptoms around week 3 that I'd never had before.

Heartburn management on constipation: Tums as needed 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.