Anyone else get weird vivid dreams on sema??

This one has a reasonably settled answer, so here it is. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

Dr.GutHealth said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

No disagreement with Dr.GutHealth. One condition attached. The meal advice is right and incomplete without the hydration point. People stop drinking because drinking makes them feel full, then attribute dehydration symptoms to the drug.

SleepFixSam said:

Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

Can confirm the pattern SleepFixSam describes. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

Adding the clinical framing, because it changes how the question reads. Worth answering the question that was asked rather than the one behind it. The narrow version usually has an answer; the broad version usually does not, and answering the broad one is how a thread stops being useful.

I would rather be corrected than agreed with, if it comes to it.