Can’t stop burping? It could be your GLP-1

There are lots of great things about GLP-1 weight-loss medications, but the infamous “Ozempic nausea” and “Ozempic burping” aren’t on the list. These pesky, gastrointestinal side effects are common, and they may occur whether you’re on Ozempic, Wegovy, Foundayo, Zepbound, or any GLP-1. That said, you shouldn’t have to deal with them the entire time you’re on GLP-1 medication. There are a handful of lifestyle changes you can make — and medications you can talk to your doctor about, if needed — that can help keep these issues in check. Here’s a closer look at what can cause them in the first place, plus how to help minimize them.

KEY TAKEAWAYS

• Nausea and burping, including stinky sulfur burps, are common GLP-1 side effects, caused in part by slowed digestion. 

• Nausea is usually worse when starting or increasing your dose, and typically eases over time — especially if you make simple food and habit tweaks to feel better, such as eating smaller meals and avoiding fried or sugary foods. 

• Burping can be reduced by avoiding certain things, like eating too quickly, cruciferous vegetables, carbonated drinks, and chewing gum.

• If symptoms don’t ease with these tips or get in the way of your life, talk with your clinician; there are medication options that may help.

“Nausea is likely triggered through effects in the nausea centers in the brain, but in some cases can also be from reduced motility of the stomach,” says Dr. Eduardo Grunvald, M.D., FACP, director of obesity medicine at the University of California San Diego Bariatric and Metabolic Institute. The latter means that because GLP-1s impact gut hormones and slow down gastric emptying (how quickly you digest food), food sits in the stomach longer. That’s part of what makes users feel full when eating less — but it also can trigger issues that researchers recognize as side effects of Ozempic and other GLP-1s.

Nausea is one of the most common side effects for GLP-1 users, occurring in around 16-20% of people on Ozempic vs. about 6% on a placebo. “For most users, nausea is considered mild to moderate and short-lived,” says Dr. Robert Kushner, M.D., professor emeritus at Northwestern University Feinberg School of Medicine. There’s a typical pattern to the nausea: It tends to occur when you first start taking the GLP-1 or when you increase your dosage. It should improve and ultimately go away over time as your body adjusts to your treatment.

Nausea can be a sign that the GLP-1 is impacting your gut hormones and digestion speed, but the best way to tell if your medication is really working is to consider the following questions:

• Am I feeling less hungry?

• Do I have fewer cravings?

• Do I get full more quickly with less food?

• Am I more satisfied after meals and snacks?

Compared to before starting a GLP-1, you may not be able to finish your favorite pasta dish at a restaurant, or you might realize you’re thinking less about food throughout the day.

Nausea is a bothersome side effect that can get in the way of feeling good. These lifestyle changes, which include following which foods to avoid on Ozempic and other GLP-1s, can help significantly.

Eat slowly and in smaller portions

GLP-1s slow gastric emptying, so it’s helpful to space out your meals (by a few hours; you still don’t want to go more than four or five hours without eating) so that your body has enough time to digest the food in your stomach before you eat again. Also, it’s recommended that you eat smaller amounts, since it will take your body longer to digest what you eat. 

Avoid greasy, fried, or sugary foods

“Greasy, fried, and very sugary foods can induce nausea, vomiting, indigestion, and cramps while taking GLP-1s,” says Grunvald, so you’ll want to skip them. That could be because “dietary fat slows stomach emptying,” says Kushner. So it is helpful “not to compound the problem that GLP-1 drugs cause.” 

Don’t lie down right after eating

Again, GLP-1s delay how fast your food goes through your digestive system, which can cause reflux, a burning sensation, or even regurgitation. “Because the stomach is sluggish, there is a higher risk of food coming back up,” says Grunvald. Lying down only exacerbates the issue, so stay upright for a few hours after eating. When you do lie down, keep your head raised with a second pillow or wedge, and lie on your left side —  this can help keep stomach acid from flowing back up through the esophagus.

Stay hydrated and choose soothing drinks 

In addition to reducing hunger, “GLP-1 meds can also reduce the drive to drink in some people,” says Grunvald, so you need to stay extra vigilant about how much water you’re consuming. Aim to drink at least 64 ounces of fluids every day to avoid dehydration; you’ll feel better if you stay hydrated. Drink ice-cold or hot beverages instead of room temperature; as a bonus, ginger and lemon herbal teas can soothe the stomach.

When you’re too nauseous to eat 

When nausea gets really bad, it can be difficult to eat or drink — but it’s important you do, so your body gets the nutrients it needs. If you are not able to eat much, at least hydrate well with an electrolyte beverage like coconut water, a sports drink, or electrolyte powders or tablets that are added to water.

For liquids that are a little more filling, try smoothies or soups, which can be both nutritious and easily digestible. (You want to keep your protein intake up if possible, since consuming it helps “reduce excessive loss of muscle mass” while on a GLP-1, says Grunvald). Try adding protein to a smoothie or sipping warm bone broth. If you can handle it, go for other good protein-rich soups like lentil, chicken noodle, or beef and barley. (Avoid creamy soups, which can cause an upset stomach.)

Stay away from strong smells, which can make nausea worse. Cold foods tend to have less of an odor, so you may want to try fruit, cold rotisserie chicken, or simple carbs like toast or crackers.

When to ask about anti-nausea medication 

Nausea is a common GLP-1 side effect, which tends to occur when you first start taking the medicine or when you increase your dosage. It should improve over time as your body adjusts to your treatment. If it doesn’t, definitely talk to your doctor, says Grunvald, as they may prescribe an anti-nausea medication like Zofran (ondansetron). It provides quick relief by blocking substances in your body that can cause nausea and vomiting.

“Depending upon the severity of nausea, your healthcare provider may lower your medication dose or have you maintain the current dose for a longer period of time before increasing to the next dose,” says Kushner. It is important to make sure you can comfortably tolerate a particular dose before increasing.

Let’s face it: Gas is embarrassing, and it can be stinky — especially on a GLP-1. Since food hangs around for longer in the stomach when you’re on this type of medication, it can lead to “more belching from swallowed gas accumulating in the stomach,” Grunvald says. 

Burps are usually not smelly — they’re just trapped, excess air in the stomach that gets into the esophagus and comes out through the mouth. But some people on a GLP-1 experience burps with a signature scent, called “sulfur burps” because they smell like rotten eggs. Interestingly, this name is actually a misnomer because sulfur gas is odorless. This egg-like odor actually comes from the gas hydrogen sulfide. 

So, why would a GLP-1 burp potentially smell like this? Well, hydrogen sulfide is a natural part of the digestive process. When food — especially certain foods like meat, dairy, and cruciferous veggies — gets broken down, a small amount of hydrogen sulfide gas is produced. “Because food is sitting and fermenting longer in the stomach a little longer [with a GLP-1], you can get more of that hydrogen sulfide gas,” says Grunvald.

If you’re having an issue with smelly burps, there are some simple lifestyle changes you can make to reduce the amount of hydrogen sulfide in your body.

Limit sulfur-rich foods 

Foods that are high in sulfur naturally lead to more hydrogen sulfide when they’re broken down in your body. Annoyingly, they’re often in healthy foods like lean meats and certain vegetables, though there are lots of other veggies and protein sources that won’t lead to as much gas. Foods to reduce — or to eat mindfully — include:

• Red meat

• Seafood

• Poultry

• Dairy products

• Eggs

• Broccoli

• Cabbage

• Brussels sprouts

• Kale

• Garlic

• Onions

Eat smaller meals, slowly

Burping is caused by accumulated gas in your stomach, so the less air you suck down by accident, the better. You can do that by eating mindfully, including chewing well, eating slowly, and not overeating. That way, you’ll ingest less gas, and thus burp less.

Cut back on carbonated drinks

The thing that makes carbonated drinks so delightful — the bubbles — are another burping culprit, as they’re additional gas you’re introducing into your stomach. Try avoiding carbonated beverages like sodas and seltzer and see if you notice you’re burping less.

Stop chewing gum

You may not have drawn a connection to gum and burping, but chewing gum can cause you to swallow air, which can contribute to increased burping, says Kushner.

What to do when burping signals reflux or GERD 

Most of the time, burping is “not dangerous, just a nuisance,” says Grunvald. For some people, though, burping can be a less-common sign of GERD (gastroesophageal reflux disease), a condition that can occur more frequently in people on a GLP-1. GERD is acid reflux that’s more severe, frequent, and long-lasting, and can have serious effects on your body. “Severe GERD can cause regurgitation that can be aspirated into the lungs, which can be dangerous for people with underlying lung disease,” Grunvald says.

GERD is also largely preventable — by eating small meals, sleeping with your head raised, and avoiding potential trigger foods including tomatoes, citrus, chocolate, caffeine, coffee, tea, carbonated beverages, fatty or fried foods, spicy foods, and alcohol. You can also pop a calcium-carbonate antacid for occasional, in-the-moment relief. If those don’t provide enough relief or you’re going through a bottle every couple days, the next step is often an over-the-counter short-acting histamine blocker drug like famotidine or a longer-acting proton pump inhibitors like omeprazole. You should also talk to your doctor to see if a prescription is right for you, says Kushner.

Just because side effects like nausea and burping are common, doesn’t mean you have to just tough them out and live with them. If your nausea is “prolonged or persistent, associated with vomiting, severe enough where it interferes with your normal function or quality of life, or interferes with getting enough nutrition or hydration,” definitely talk to your doctor, says Grunvald. And if you’re noticing more frequent burping that isn’t responding to dietary and lifestyle changes, talk with your doctor about being evaluated for GERD.

For long-term health, using a GLP-1 requires more than just taking the medication. That’s why Weight Watchers Med+ doesn’t just offer access to GLP-1s  — but to a whole program designed to support them (and you). You can track nutritional targets like protein, fiber, and hydration, along with key habits like strength training and sleep, all of which can help minimize side effects…even the stinky ones. In fact, 73% of Med+ members given the GLP-1 Success Program say that Med+ program helps minimize weight-loss medication side effects.* The program also gives you plenty of inspo to hit your targets, with 12k+ recipes, expert-led workouts, and virtual Workshops throughout the day. 

Nausea and burping are common GLP-1 side effects caused by slowed digestion. It’s usually worse when starting or increasing your dose, and typically eases over time. You can also improve symptoms by eating bland foods, smaller amounts, and spacing out your meals. If your nausea or gas is more severe or doesn’t seem to be improving, talk to your healthcare provider to see if you need to adjust your dose or add a prescription anti-nausea medication. If you need support making lifestyle changes to better manage your side effects on a GLP-1, Weight Watchers can help — with nutrition and lifestyle support designed specifically for life on GLP-1s to help minimize side effects and maximize results.