What the Heck Is ILEUS?
A Short History of GLP-1 Agonists:
Liraglutide:
Semaglutide:
Tirzepatide:
The Hottest Drugs In America:
What About Side Effects?
One acknowledged side effect, vomiting, can have deleterious effects on tooth enamel. Some physicians are also worried that rapid weight loss could encourage excessive bone loss leading to osteopenia or osteoporosis. Fat loss can also affect the pads on the soles of the feet and make standing or walking much less comfortable. That, in turn, could lead to alterations in gait that could affect muscles or joints and interfere with the ability to exercise.
Most experts believe that the benefits of weight loss far outweigh such possible risks for people suffering from obesity. These reports serve as a reminder, however, that we are still learning about the long-term consequences of these medications.
Not Everyone Can Tolerate Ozempic:
Reflux is a common complication as this reader reports:
Q. I started out on a low dose of Ozempic for type 2 diabetes. The nausea and fatigue were daily side effects that were difficult to live with. I also experienced acid reflux and constipation. My A1c came down nicely, but I am still dealing with digestive side effects. Do you have any suggestions?
A. Congratulations on the good results with your HbA1c, a measure of how well you are controlling your blood sugar. Ozempic (semaglutide) is a GLP-1 agonist, prescribed for type 2 diabetes. Similar drugs are also prescribed for weight loss.
Nausea, vomiting, diarrhea and constipation are relatively common side effects of such medications. Health care providers often suggest eating small meals, eating slowly and choosing easily digested foods (Journal of Clinical Medicine, Dec. 24, 2022). They also recommend not eating too close to bedtime and not lying down after a meal.
We have lots of remedies in our eGuide to Overcoming Digestive Disorders. This online resource can be found under the Health eGuides tab.
In it you will find tips to combat constipation, such as hot lemonade, flaxseed tea and Power Pudding with bran, applesauce and prune juice.
To cope with reflux, some people find that sugarless gum stimulates saliva, which is the body’s natural heartburn combatant. Do not overdo, though, as the sweeteners may lead to diarrhea.
Others prefer finishing a meal with a few almonds or tea (chamomile, ginger or lemon balm). One other time-honored approach involves DGL (deglycyrrhizinated licorice). This dietary supplement has had the dangerous ingredient in licorice (glycyrrhizin) removed. Some people report good results for digestive distress.
This reader was prescribed Ozempic for type 2 diabetes:
Q. My doctor prescribed Ozempic for type 2 diabetes. I got the dose up to 0.5 mg after several weeks. Then I began to have severe nausea and constipation.
I lowered the dose back to 0.25, but eventually experienced the same symptoms. I had to stop taking Ozempic. The severe nausea, loss of appetite and constipation I had developed all resolved about a week or two after discontinuing Ozempic.
Sure, I lost about 20 pounds (I started at about 220), but the gastric side effects were intolerable. How can anyone tolerate higher doses of this drug?
A. People are highly variable in their reaction to drugs like semaglutide (Ozempic, Wegovy). We have heard from many people who experienced minor discomfort from these medications. But a few, like you, could not tolerate them.
While you had constipation, others have experienced diarrhea. A few readers found that the “intestinal apocalypse” they experienced was too intense to stay on the drug.
We discuss the pros and cons of Ozempic and Mounjaro as well as many other options for blood sugar control in our eGuide to Preventing & Treating Diabetes. You will find this online resource under the Health eGuides tab.
Another example of nausea and constipation:
Q. I have prediabetes and need to lose some weight to qualify for back surgery. That’s why my doctor prescribed Ozempic.
The first month, I was on a low dose and had minor nausea. After it was increased to 0.5 mg a week, I suffered persistent nausea and constipation. I could barely stand to look at food.
This drug limited my social interactions for fear of throwing up. I felt like I was in my first trimester of pregnancy, so I could not continue. What other options will help me control blood sugar levels?
A. Some people find the nausea, vomiting, diarrhea or constipation associated with semaglutide (Ozempic, Wegovy) intolerable. There are many other ways to manage blood sugar, though, including older medications such as metformin. You can learn about the pros and cons of diabetes drugs and non-drug approaches in our eGuide to Preventing and Treating Diabetes.
A Serious Complication of GLP-1 Agonists:
Nausea, constipation and diarrhea are certainly unpleasant. More recently, anesthesiologists have been warning about a related complication that can be even more serious.
Q. You recently answered a letter from a woman whose daughter had a reaction after anesthesia while taking a type of diabetes medication. In your response, you referred to gastroparesis.
I am a recovery room nurse. While gastroparesis might be a concern, it is nothing compared to euglycemic ketoacidosis that has been associated with surgery and taking SGLT2 drugs.
At our hospital we won’t do surgery on anyone who has taken any medication in the GLP-1 or SGLT2 classes within 72 hours unless the condition is life threatening. We have cancelled many surgeries due to this. Please inform your readers of this risk, and suggest they follow instructions before surgery, or they might have their operation cancelled.
A. Thank you for a helpful warning. To help people understand it, we need to offer some explanations.
The original question centered on semaglutide (Ozempic, Wegovy), a GLP-1 agonist that helps manage insulin and appetite. SGLT2 medicines like empagliflozin (Jardiance) keep the kidneys from reabsorbing sugar from the blood stream, so that excess sugar is removed in the urine.
Gastroparesis is essentially stomach paralysis. (Keep reading to learn more about this problem.) Food retained in the stomach can be regurgitated under anesthesia, leading to life-threatening pneumonia.
The ketoacidosis you refer to occurs when the body uses fat rather than sugar as its fuel. In some cases, the blood becomes acidic, a life-threatening complication. Anyone using one of these medicines to control their blood sugar (or lose weight) must discuss it thoroughly with the anesthesiologist prior to surgery.
What About Stomach Paralysis with Ozempic and Wegovy?
Gastroparesis = Stomach Paralysis with Ozempic and Wegovy:
Why Would People Experience Stomach Paralysis with Ozempic and Wegovy?
The authors describe what happened:
“We describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA [receptor agonist] semaglutide for weight loss and had last taken the medication two days before their scheduled procedure.”
The physicians conclude:
“Patients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.”
Consider the Implications of Stomach Paralysis with Ozempic and Wegovy:
A Lawsuit Involving Regarding Stomach Paralysis with Ozempic and Mounjaro:
A July 25, 2023 report from CNN quotes the FDA:
“The FDA has received reports of gastroparesis with semaglutide and liraglutide, some of which documented the adverse event as not recovered after discontinuation of the respective product at the time of the report.”
What Are the Symptoms of Gastroparesis?
•feeling full soon after starting a meal•feeling full long after eating a meal•nausea•vomiting•too much bloating•too much belching•pain in your upper abdomen•heartburn•poor appetite
Final Words About Stomach Paralysis and Ileus with Ozempic and Wegovy:
Symptoms of Ileus:
Learn More:
Citations
- Gulak, M.A. and Murphy, P. "Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report," Canadian Journal of Anaesthesiology, Aug. 2023, doi: 10.1007/s12630-023-02521-3
- Jones, P.M., et al, "Anesthesia and glucagon-like peptide-1 receptor agonists: proceed with caution!," Canadian Journal of Anaesthesia, Aug. 2023, doi: 10.1007/s12630-023-02550-y
