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ForumsSide Effects & ManagementThe nausea is gone at month 3 - there IS a light at the end — 6 month update

The nausea is gone at month 3 - there IS a light at the end — 6 month update

MikeNYC_runner Thu, Aug 29, 2024 at 11:06 PM 11 replies 1,931 viewsPage 1 of 3
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MikeNYC_runner
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Aug 29, 2024 at 11:06 PM#1

The nausea I get is not really nausea, it is an aversion. Food I want in the abstract becomes repellent in front of me, which no side-effect list describes.

The question I want answered is whether holding at a lower dose for longer actually reduces total side-effect burden or just spreads it out.

Happy to be told the question itself is wrong.

44 14PedsEndoPhilly, SleepDoc_PDX, RegAffairsDC and 41 others
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Dr.NateNeph
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Aug 29, 2024 at 11:12 PM#2

Answering the narrow version, because the broad one does not have a single answer. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

43 13NauseaFreeNow, SteveThurs, B12Beth and 40 others
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LarryQC_SD
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Aug 29, 2024 at 11:18 PM#3
Dr.NateNeph said:
The line between titrate-through and stop is not severity, it is trajectory and what else is present.

Agreed on adaptation, with a caveat: adaptation applies to gastric emptying and not to everything. If your problem is the aversion rather than the fullness, waiting does less, because the aversion is central and it is the mechanism working as intended.

42 12TinaHashiRN, robert_kc, dan_philly and 39 others
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pat_auckland
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Aug 29, 2024 at 11:24 PM#4
MikeNYC_runner said:
The nausea I get is not really nausea, it is an aversion.

This matches mine closely enough to be worth saying so. The practical protocol is dull and it works: smaller meals, stop eating at the first sign of fullness rather than at the end of the plate, drop the fat fraction of meals in the two days after dosing, and do not lie down straight after eating. Most of what people call unmanageable nausea is a meal-size and meal-composition problem interacting with a stomach that is emptying slowly.

41 11MeganSA_TX, LarryQC_SD, wanda_boise and 38 others
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TrialTracker_MD
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Aug 29, 2024 at 11:57 PM#5

Clinical perspective, offered as context rather than as advice. Whatever the answer turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, and invite the correction. That is slower than asserting, and it is the only version that survives being wrong.

40 10lori_vegas, Dr.PulmRoch, maya_sedona and 37 others
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