Nausea is one of the most frequently reported side effects of GLP-1 agonist medications used in obesity treatment, such as Zepbound, Wegovy, Mounjaro, and Victoza. Although not everyone will experience it, the nature of these anti-obesity medications can often lead to nausea, caused by the slowing of gastric emptying.
Anyone who has experienced nausea before, especially during pregnancies, will understand just how debilitating it can be, impacting your daily life and work. So, what level of nausea should you expect from weight loss medications? And how can we effectively manage this side effect? In this episode, I'm sharing practical strategies to mitigate nausea, advice on when to seek medical advice, and insights on using medications like Zofran to ease discomfort.
Remember: This podcast provides general educational information. Always consult your doctor and medical team for personalized advice and guidance on any symptoms you’re experiencing.
00:58 - Dr. Rentea explains why most anti-obesity medications contribute in some capacity to nausea and describes the nature and impact of this common side effect.
06:05 - Dr. Rentea encourages us to be mindful of the types of foods consumed while on anti-obesity medications as certain foods can trigger nausea more than others.
08:20 - We hear the importance of hydration in managing nausea and Dr. Rentea explains how cold drinks and electrolyte products can alleviate symptoms.
13:05 - Dr. Rentea shares some general tips and changes you can make to your diet to help manage nausea.
17:35 - Dr. Rentea stresses that vomiting is not normal and urges consulting a doctor if it occurs, as adjustments to eating habits or medication dosage may be necessary.
Quotes
“You need to be spacing out your food because most people will not be able to eat these bigger meals at once.” - Matthea Rentea MD
“If you are avoiding fried stuff, greasy, or really high sugar foods, it's going to be really helpful.” - Matthea Rentea MD
“Vomiting is never normal. You always need to talk to your doctor.” - Matthea Rentea MD
“Electrolytes can oftentimes be helpful for nausea and headaches.” - Matthea Rentea MD
“Something like Zofran, if you're not allergic, is just nice to have in your toolkit. But you need your physician to walk you through when and how to use it.” - Matthea Rentea MD
Nausea is one of the most frequently reported side effects of GLP-1 agonist medications used in obesity treatment, such as Zepbound, Wegovy, Mounjaro, and Victoza. Although not everyone will experience it, the nature of these anti-obesity medications can often lead to nausea, caused by the slowing of gastric emptying.
Anyone who has experienced nausea before, especially during pregnancies, will understand just how debilitating it can be, impacting your daily life and work. So, what level of nausea should you expect from weight loss medications? And how can we effectively manage this side effect? In this episode, I'm sharing practical strategies to mitigate nausea, advice on when to seek medical advice, and insights on using medications like Zofran to ease discomfort.
Remember: This podcast provides general educational information. Always consult your doctor and medical team for personalized advice and guidance on any symptoms you’re experiencing.
00:58 - Dr. Rentea explains why most anti-obesity medications contribute in some capacity to nausea and describes the nature and impact of this common side effect.
06:05 - Dr. Rentea encourages us to be mindful of the types of foods consumed while on anti-obesity medications as certain foods can trigger nausea more than others.
08:20 - We hear the importance of hydration in managing nausea and Dr. Rentea explains how cold drinks and electrolyte products can alleviate symptoms.
13:05 - Dr. Rentea shares some general tips and changes you can make to your diet to help manage nausea.
17:35 - Dr. Rentea stresses that vomiting is not normal and urges consulting a doctor if it occurs, as adjustments to eating habits or medication dosage may be necessary.
Quotes
“You need to be spacing out your food because most people will not be able to eat these bigger meals at once.” - Matthea Rentea MD
“If you are avoiding fried stuff, greasy, or really high sugar foods, it's going to be really helpful.” - Matthea Rentea MD
“Vomiting is never normal. You always need to talk to your doctor.” - Matthea Rentea MD
“Electrolytes can oftentimes be helpful for nausea and headaches.” - Matthea Rentea MD
“Something like Zofran, if you're not allergic, is just nice to have in your toolkit. But you need your physician to walk you through when and how to use it.” - Matthea Rentea MD
Welcome back to another episode of the podcast. I'm so excited you're all joining me. I hope you are having an amazing start to the week. We're going to, I'm going to call this part two because we're just hitting all the different common side effects. Like I shared in the last episode, these are the type of things that I really do deep dives with on my patients. We do workshops on this a little bit more practically. You know, you hear this information, but how do you apply it? So they have it in one place. And this is sort of the, The light version if you would and today I want to talk about nausea. So to give you background again, you heard in the intro, but i'm an obesity medicine board certified physician and There's pretty much, I want to say, no medication that we write within the anti obesity medications that will not contribute in some capacity to nausea. And not everyone's gonna experience this. I don't mean to say that any medicine we write you're gonna feel this way, but I'll give an example, even naltrexone, which is part of Contrave, which is a medication we've had a long time, that can contribute a little bit to it. So there's a reason, for example, with that medicine that we would, that we titrate up over a few weeks the first month you're on it. and then same thing with the GLP 1 class of family. Again, those are medications like Zep Bound, Wigovi, Menjaro, Victosa, things like that. So when we are using these medications, Because we are slowing down how quick food is moving, the motility, how quick food is moving through the stomach and the intestine, sometimes there can be some nausea associated with that. And that physically makes sense. Again, not everybody experiences it, but some do. And so what are things that we can do to mitigate that? So if we know that this is something that can happen and we can be a little bit strategic going into it, then that doesn't necessarily need to be the reality. So that's the thing I really want to stress is that. If we know what to expect and we know a little bit how to change things, then it will help us out greatly. So when I think about nausea, it's a little bit that, I assume everyone has experienced this, but if you have not, if you're privileged enough to not have experienced nausea in your lifetime, it's really a queasy stomach sensation where it just really doesn't feel good. And then the other thing I want to say that's interesting with nausea is that sometimes people can get a little bit sweaty and it can lead to other symptoms as well. So it's an interesting thing because it's not just, Oh, my stomach feels upset, but it can become a little bit more. I use the word systemic. It can become a little bit more involved and it can be quite debilitating because sometimes if the nausea is bad enough, you think, am I going to vomit? And if anyone here has gone through pregnancies or times of having vomited a lot, you know, that it is, It's really hard to function in your day, at work, just all the things. Okay. So realize when I'm talking about these topics, I just want to stress this again, and I say to my podcast in intro, but I need to harp on this a million times. You will always talk to your doctor first. Okay. Repeat after me. I will always go talk to my doctor first. This is for general educational purposes. This is also not comprehensive. Okay. So I'm not writing a dissertation paper right now when I put this out. These are just some things that came top of mind to me when I'm thinking about nausea. So the first thing when I think about this is, are you spacing out your food? So with these medications, it's really not going to work. If you do a big lunch, a big dinner, oftentimes that is going to create nausea for you because the meals are just too big. Okay. Even if, hear me, hear me with this, even if it's smaller than what you normally ate, it might still be too much for your body at this point. But you're in a catch 22 because you want a little bit of a calorie deficit, you a little bit need to be in a deficit for weight loss, but we don't want to be so much that we shut things down. And so, You need to be spacing out your food because most people will not be able to eat these bigger meals at once. And so spacing it out is not only going to help with you not getting malnourished, but it's also going to help from a standpoint of you not getting nauseous. One of the most common things that I hear with people is that they get up in the morning and they're like, like that little kind of like stomach not feeling good, that nausea. And it's usually most classically the, the first one or two days after an injection, you are someone that is really experiencing side effects. If you have a day three and beyond, then again, I would look to your doctor for other things to get adjusted, but very commonly that first, especially if you're newly started on it or you're up titrating the dose. So first thing I would look at is, am I spacing out my food? And even if you're not hungry in the morning, if you're nauseous, can we have a bite or two of something? And oftentimes it's about finding what, what is that? That doesn't make me feel worse. Very bland foods oftentimes do a good job there. And it might even be, let's say it's so extreme where you might even just. have like a bite of a cracker or like a little piece of bread or something like that might go down easiest for you. I will say in this scenario, I know this is going to sound like a strange time to have a chip, but sometimes if you're still trying to hit that protein goal, but you're dealing with this nausea, sometimes the Quest chips, they can be helpful in that scenario. So I'm just throwing out, or they have, Quest has these little, they look like they're Cheez Its, but they're cheddar crackers. and you will not want to eat the whole bag. Like they're good, but you will not want to overeat it. So something like that, if you are really struggling with this. So spacing out your food, I want to recommend number one. And then in the morning, actually having something if you're struggling, because ironically in the past you thought, well, I'm nauseous, don't eat. But in these situations, it actually helps. The other thing I want to go over is that It actually matters the type of foods that you're eating and what you're doing. And you know when we talk about these medications, how we're like, we're not putting you on a diet, and, you know, we're going to worry about your nutrition from like a health standpoint, but we're not sitting there and like cutting all the things out. But this is a scenario where I need you to be a detective. So I talk a lot about, using a nutrition log. And the reason I talk about this is that often, if you are avoiding so much fried stuff or greasy or really high sugar foods, it's going to be really helpful. And so I want you to be a detective when this stuff is happening to think, I'll tell you the classic scenario. You have started on these meds or you've been on these meds a year, however long it is. And the classic scenario that I hear from patients is that They went out to eat at a Mexican restaurant and they thought they were making great choices, right? Like they're not even sitting there feeling like they overate, but it's just, there's different oils and different things that were used. And then they spend that evening. They're so nauseous. Maybe they even vomit again. Vomiting is never normal. You always need to talk to your doctor. I'm going to briefly touch on that, but I want to tell you, this is not routinely part of these meds. That's a problem. Please talk to your doctor. So, What we're usually able to identify if there's this high level of nausea and it's acute, it's like what actually led to it. So fried food, greasy food, I'm, I'm just going to generalize here. Most people that's when you're going out. I usually, I don't have patients that are like deep frying things. I mean, I practice in the Midwest. It's not culturally part of what we routinely do here. I'm in no way laying judgment. If that's the way in which you eat, just know that it can be contributing worse to the nausea. So that those are things to look for and then when I say high carbohydrate high sugar foods, it might be that you thought Oh, it's gonna be such a treat to have this piece of cake or to have this candy and you actually don't feel good So realize this is usually like a tripwire situation where a little bit you're okay with but too much just doesn't agree with you I have a patient where with pizza. It's like they can do a bite or two. Not that they're not going to eat other food. So I always have to really watch the words I'm using, but they will just notice that if it's a whole piece or two pieces, things like that, they're going to have a problem. Okay. The other thing that I want to go through is that oftentimes, Obviously hydration is important for everything all the time. I can't stress enough if you're well hydrated, it's going to help avoid so many things. But oftentimes if you're nauseous, you don't actually want to sit there and drink a bunch. So what I think can be really helpful is if you have a cold drink. So this might really be a time when you use some ice water. This might also be a time when you add some electrolytes to a fluid. So oftentimes the day after an injection this is when people will use a ton of different products and oh my lord have I been experimenting with these recently. I, I think I've told you in the past, I'm sorry I'm just not a fan of things like IV hydration, but I had a recent video on TikTok and I did a review for One of these electrolyte products and it's stevia sweetened and I said that people will share with me what you like and I got so many amazing ideas. I, I'm really someone that loves to try different stuff so I can really find what I love and there's a million different electrolyte products so you can do that. You could literally keep in mind electrolyte just literally means. anything dissolved in a fluid. So, for example, it could just have salt in it. It could have sodium and potassium. It could have magnesium in it. It could have, there's a million different things. So, all these companies have different versions of this and that's why you need to experiment. So we're going to do this in a future episode as well, talking more about potential headaches that patients experience on these meds. But I want to tell you that the electrolytes can oftentimes be helpful for the nausea and the headaches, things like that. So experimenting with either the day of the shot or the next day, do I do some cold water, some cold electrolyte products and just see, do any of these work for me? I want to open your mind to the fact that I'm not going to sit here and recommend like one product specifically, but they have products that are like in a powder format, like little, like, okay, well I did, I said, I wasn't going to, I said, I wasn't going to recommend one. I'll tell you, I really like HydroFlex from Devotion, but again, you need to experiment. Does it have all the stuff that you need in it? Yeah. So they have these really great flavors and they don't have too much sodium in there. For me personally, I don't want to bloat. I don't want to get high blood pressure from the sodium, things like that. So that has a hundred milligrams in it, but then they'll go all the way up to a thousand if it's IV hydration. What it has in it, is it a powder format, like in a little, a little packet that you open? Some of them are already prepared in a liquid form, and then some of them are in a bottle. I want to tell you one that I've been just shocked, like I would have never expected that I would like this. But there's the ghost company, like G H O S T. I think they're new, because, I mean, if they were known before, I didn't know they existed. But I had seen them advertised a lot as a protein brand product. But then I was at the PX the other day, which is, I think, like the military, like a store you can shop at. And they had, they have these hydration drinks that Think like body armor or you know other things that you would buy already at a prepared bottle and I loved their flavors. I think they have four flavors total but there were only three at that store. I bought all three of them. One was like an orange flavor, the other one was kiwi strawberry, and then there was a, I don't know, a Sour Patch Kids flavor and it was, I think, Redberry. That one was actually my favorite. I, but you know, if you've listened to this podcast long enough that I love Sour Patch Kids. So actually the reason I bought the drink to begin with this ghost brand, the hydration drinks, it's because I was, I was in the PX. I was, I always go look where the protein bars are in the drinks and just kind of see like, what do they have? So this was for sure new because I know that they didn't have their product, the products even as of like a week ago. And I'm looking there, And I see how it said caffeine free on the bottle and I think hallelujah. I'm so sick of these drinks where there's Hidden, you know 100 milligrams of caffeine in them. So it was caffeine free and what was the other thing? Oh, and then the sour patch kid part. I was like, okay, I gotta try it and i'm actually I love it And i'm gonna go back today. I'm i'm recording this before i'm going to this self love body type of conference that I'm going to go to this next week with Corinne Crabtree. And so I like to have some electrolyte drinks on me. So that's one of them. You're going to see, by the way, if you follow, if you follow my videos, I have so many different electrolyte products and different things to put in my water, because I find with these camps, if you can stay hydrated, you get out the other side a lot better. Okay, so we took a huge random turn there, but the point is, hydration and electrolytes and all of that, I just can't stress it enough, that if you're suffering with nausea, this really might be a place that helps you. Okay, then I want to go over a few sort of more random ideas that you might not have thought about and you can kind of use this as a roadmap. One of the first things I like to think about is some people are really just going to do great with, with products like ginger, avoiding spicy foods. Those type of changes are going to make a difference for them. So those are also things to look out for. The other thing too, sometimes you have more nausea if you're having a lot of really hard to digest things. Let me give you an example, like if you're eating a bunch of raw veggies, maybe we want to take the time to either boil them or bake them. So sort of help a little bit with the digestion of them. It's potentially harder on your body if you have a raw food coming in compared to if it's already steamed, boiled, baked in some capacity in something else, right? Like, I don't know about you, let's just always go there on these episodes. I don't know about you, but like if I have raw broccoli and cauliflower, not a great situation. gas, nausea, all the things. But if things are a little bit, you know, I like to bake them in the oven or steam them, something like that, no problem So when I say easier to digest foods, I'm talking about things like yogurts, easy to digest, smoothies and things that we might not do as much of are going to be kind of those like, again, those really fibrous veggies. We're maybe going to save that for some other time. Okay. The, the other thing that's interesting is, and they've done a study on this and I'm laughing because it's total like crapola, but they've done studies that smelling an alcohol pad, like the little alcohol pad that you might wipe your skin with to clean it before you do an injection, that that actually helps acutely with nausea. Now, here's the deal. I really don't care because what are we going to do? Go around smelling alcohol pads all day. It makes no sense, right? So although that's something maybe in the moment if you're like desperate that moment you can turn to that But I don't view that as a long term thing. I can't have someone at work smelling an alcohol pad. So So those little alcohol wipes there is your little hack if you need it the other thing I will say is obviously talk to your doctor because there's medicine that we can give That if you're really either going through, you just started it, or you're going through a dose adjustment, things like that, then the medication Zofran can be used. Zofran, the other name is Undansetron, and that is something that can be used as needed about every six to eight hours for nausea. It comes in either a four or an eight milligram. There's an under the tongue dissolving version of it so that even if you're, you're actively vomiting, you can take it. The one thing I want to tell you about nausea and vomiting is that if you're, You need to treat these things before they have actively kicked off. So this is not a situation where Once it's like you're sitting there vomiting and all these things are happening, it's really hard to kind of get the horse back in the barn, if you know what I mean. So these are the type of situations where you want to have an action plan right away when these things start. You don't want to wait for it to be so out of control that it's really hard to kind of tame it down. So okay, so that's the, you know, you can talk to your doctor. Why do we not just write Zofran willy nilly long term? continuous use of Zofran has some pretty serious side effects. It's not necessarily the case if you're using it kind of just, here and there, like every so often, every few weeks, I need one or two. That is different than every day, three times a day. Most doctors will say, well, what's going on that we're needing that? That's not a medication then for you. If truly none of these other parameters can be changed and you're needing to do that. The other thing that's just not great is that Zofran can constipate you and these meds already can cause constipation and so if you need it you need it but then you're in this kind of double whammy situation where you might already suffer with constipation and then now there's The meds causing constipation, the GLP 1, and now you also took a Zofran. So, realize every medicine, anything we're going to put in our body has a risk and a benefit, and so your physician should walk you through that. If this is something that's needed, I want to do everything in the world before we're adding another medication to you. So, if you need it, I'm going to write for it. If you need it as a backup, no problem. I do kind of think when people are traveling, we just don't know what situation is going to present itself. whether you're going on a road trip, you're getting on a plane. So I think something like Zofran, if you're not allergic, it's just nice to have in your toolkit, but you need your physician to walk you through when and how to use it. How much is appropriate, how much in a 24 hour period, all of that kind of stuff. All right. The last comment, I'm just going to say here super, super briefly about vomiting. Vomiting is not normal. Okay, so I do not want you to think, Oh, it just happens here and there. No, we need, that's, that's not a normal thing. You can have really significant electrolyte abnormalities happening from that. It's also, it speaks to something else needing to be figured out. Number one, you will talk to your doctor about this. You should not be sitting there vomiting and not letting your doctor know. Sometimes the dose needs to be adjusted. One of the things I don't think we talk enough about with these meds is that week after week there's a stacking effect with the half lives meaning that the next week when you take the dose again It's not like a hundred percent from the previous week is out of your system So sometimes you might be starting the matter going up on a dose and you're like, I'm fine I'm fine week one and two and then week three the problem presents, right? So just realize there's that, that stacking effect happening. So sometimes that's why vomiting can happen because you just didn't understand how potent it is. Like there's a reason that we're doing each dose at least four weeks before we're considering a titration. But when we're looking at vomiting, so let's assume that, you know, you're not newly on a medicine or. You didn't, just increase the dose, things like that. Sometimes it's literally that people, they have not learned yet on the med that they can't eat that fast and they might have eaten too much. Or again, they're at a restaurant where the food was more fried or greasy than normal. And so a lot of the time it's, it's just. It just didn't agree with them that food and it is so not a pleasant experience. People learn very quickly and I would love for you to not have that as an experience. So my cautionary words to you always are, Just eat very slowly when you're out. I'm talking over a 30 to 30 minutes to an hour because then you have the chance to know, yes, I'm full or ooh, that's not starting to feel good. But when it's, the only word I can use is inhale. Am I the only one that's ever done this with food when you just like inhale it, you eat it so quick, you don't even know it happened. And if that's the, the situation you're going to run into this and I don't want that for you. So kind of slowing things down, looking at the quality of what you're eating. And then if this continues to happen, this is really time for a nutrition log, really figuring out like what leads to it. We've got to be more of a detective. And of course, you're always going to involve your doctor. Because honestly, if this keeps happening, it's not a medicine for you and you likely need to stop it. Okay, I'm going to end this one here. So isn't this Amazing that we just spent 20 minutes talking about nausea and vomiting. So save this episode and the little arsenal that you know that we've gone over this so you Maybe have somewhere to look if you need a few ideas for how to search through this But again always involve your medical team Please share this episode if you think that it's interesting And I know a lot of you have a lot of tips tricks hacks as well Remember, this was just a little sample But there's like a million things that can happen as well. That's why it's so sad that with TikTok that they're censoring these things so much, because I used to love watching everyone's videos and hearing, I would just hear some stuff where I'm like, Oh, I would have never thought to. think about it in that way or that product or whatever it is. And so hopefully we can listen to this. We can kind of, you know, gain a little bit of information here and maybe on some other platforms like Instagram, stuff like that. Maybe some of that content can come over. All right. If you're loving this episode, share it with a friend. And if you're not on my email list, this is actually a good point. I was on a TikTok live the other day. And someone said, Hey, are you doing another program in the future? And I want to tell you the best way for in September here, this program that I'm going to do coming up, it's a 12 week. small group thing that I'm doing. Lots of just us being in community and being able to connect weekly and in between with a chat thread and being able to just really help support each other and kind of work through some of these things in a small group, a little kind of intimate way. The best way is to be on my email list. If you go to renteaclinic, R E N T E A clinic. com, literally just scroll to the bottom of the page. You don't need to go searching on the website anymore. We have fixed it to be right on that first page. So again, rentiaclinic. com, scroll to the bottom and there is right, Hey, you want updates? You want to be on our email list? Remember we are not emailing you all the time. We will email you only every Monday with when the podcast is out, what the topic is, and then when it gets closer to that time, we'll send you a few, not many, we'll send you a few emails to let you know about that opportunity if you're interested. All right, have a, have an amazing rest of the week and we will talk soon.