GLP-1 and gastroparesis — what worked for you?

Dr.GastroMayo 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…

Worth saying plainly that not all of this is benign. Severe constipation on delayed gastric emptying has produced obstruction and ileus cases, rarely but genuinely. Pain with vomiting and no bowel movement is not a fiber conversation.

That is the short version; the long version is somebody else's post.

PeptideSynthNJ said:

I added fiber, made it noticeably worse, and only later worked out that I had added the bulk without adding the water.

Acid reflux and constipation: I developed GERD symptoms around week 4 that I'd never had before. The delayed gastric emptying means food and acid sit in your stomach longer.

Management that works for me: elevate head of bed 6 inches, don't eat within 3 hours of lying down, avoid trigger foods (tomato, citrus, spicy, chocolate), and famotidine 20mg at bedtime. Much better now.

BenResearch_OR said:

Worth saying plainly that not all of this is benign.

Heartburn management on constipation: Gaviscon before bed has been my savior. The delayed gastric emptying means stomach acid just sits there.

Don't ignore persistent heartburn — chronic acid exposure can damage your esophagus. If OTC remedies aren't cutting it after 2 weeks, see your doctor for something stronger. You shouldn't suffer through this.

A narrower follow-up, since the general answer is now clear:

What the mechanism is, because if it is transit rather than water then fiber is the wrong lever?

Reporting back.

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.