roxy_nash said:Fiber trials in this population are thin, and most of what gets quoted is extrapolated from idiopathic constipation in people eating normally.
Saving this. It is the first explanation that did not require me to already understand it.
Clinical perspective, offered as context rather than as advice.
Gastric emptying studies and constipation: semaglutide delays gastric emptying by ~40% at steady state, as measured by acetaminophen absorption testing and scintigraphy[1].
Clinically relevant implications:
Importantly, the gastric emptying delay attenuates with continued use (tachyphylaxis), which correlates with the transient nature of GI side effects.
Dr.AddMedPHL said:Gastroparesis symptoms with constipation: the delayed gastric emptying from GLP-1 agonists can cause early satiety, bloating, and feeling "full" for…
Drug interaction alert relevant to constipation: if you take oral levothyroxine (Synthroid), GLP-1 agonists can reduce absorption due to delayed gastric emptying. My TSH drifted up after starting semaglutide.
Solution: take levothyroxine on an empty stomach, 60 minutes before any food, and have your TSH rechecked 6-8 weeks after starting or changing GLP-1 dose. My endo had to increase my Synthroid by 12.5mcg.
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Browse GL BiochemTomTeleRx 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: eliminating eggs and cruciferous vegetables. 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.
Moderator note: leaving this open. It is being argued well and the disagreement is the useful part.