KPV peptide for inflammatory bowel — January 2024

Dr.EndoIndy said:

The escalation order that reflects the mechanism: water and salt first, then soluble fiber, then magnesium or an osmotic agent, then a stimulant only…

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:

• Explains early satiety and nausea
• Affects absorption of co-administered oral medications
• Creates aspiration risk for procedures under anesthesia
• Contributes to constipation via slowed GI transit

Importantly, the gastric emptying delay attenuates with continued use (tachyphylaxis), which correlates with the transient nature of GI side effects.

One thing that is still open after Dr.GastroMayo’s answer:

Whether fiber actually helps GLP-1 constipation or whether the evidence is borrowed from a different population?

DanielChem_CHI said:

Gastric emptying studies and constipation: semaglutide delays gastric emptying by ~40% at steady state, as measured by acetaminophen absorption…

Gastroparesis symptoms with constipation: the delayed gastric emptying from GLP-1 agonists can cause early satiety, bloating, and feeling "full" for hours after a small meal.

Tips: eat your protein FIRST (most important macro), then vegetables, then carbs last. Chew thoroughly — 20-30 chews per bite isn't excessive. Avoid carbonated beverages with meals. If symptoms are severe, your doctor may recommend a gastric emptying study.

Closing the loop on my own question.

Resolved: water and magnesium first, soluble fibre second, bran gone entirely. Two months of doing it in the wrong order and a week to undo.

Dr.PainCLE 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.