Doctors Share Common Side Effects Of Weight-Loss Drugs

In recent years, GLP-1 medications such as Ozempic, Wegovy and Zepbound have ballooned in popularity. While GLP-1s have, for years, been a prescribed treatment for type 2 diabetes, they now are an FDA-approved weight-loss drug that also reduce the risk of certain cancers, heart disease, cognitive decline and more.

“It works by making you less hungry, making your stomach empty more slowly and making your fat cells shrink hormonally,” said Dr. Holly Lofton, a doctor who specializes in obesity medicine at NYU Langone Health in New York.

While these medications have helped millions of people lose weight and reduce their risk of devastating health conditions, like all things, these medications also come with risks that aren’t as freely talked about as their benefits.

The medications are “very, very powerful,” said Dr. Naomi Parrella, the chief of lifestyle medicine and the medical director for the Weight Loss and Lifestyle Medicine Clinics at Rush University in Illinois. And the potential side effects are related to the fact that they are so powerful, she said.

While not everyone who takes GLP-1s will have side effects, some will, and they can range from mild to life-threatening.

Below, doctors share the most common side effects of GLP-1 medications and how best to avoid these symptoms:

“The most commonly reported side effects are GI-related: nausea, constipation, loose stools, vomiting,” Lofton said.

But these don’t happen to everyone. In clinical trials, nausea was the most commonly reported side effect and impacted 44% of people, she said.

“These meds are mimicking a natural hormone [GLP-1] and amplifying it … so, you can imagine it will impact people differently, because just how sensitive you are to these hormones. So the side effects that are most common are related to the impact of the medication [and] the impact it has on the movement of the food,” Parrella said.

The medication slows down the movement of food through your gut, Parrella said, which makes the above gastrointestinal symptoms common, in addition to things such as acid reflux, heartburn and burping.

Many people who take GLP-1s don’t get hunger and thirst signals as often as they would off of the medication, Lofton said. While this is a common occurrence, it can lead to problems.

“For some individuals, they might not be eating enough or drinking enough fluids, so it can cause risks related to dehydration or not having enough electrolytes, or possibly not eating enough nutrients, such as protein or fiber,” Parrella said.

People often get fuller faster, which leads to less food consumption and, in turn, fewer necessary nutrients, Parrella added.

“One of the [adverse] effects that people will talk about … would be pancreatitis, and that’s an inflammation in the pancreas. … This medication is intended to make your pancreas work a little bit [harder], so that it pumps out more insulin when you eat foods that increase blood glucose,” Parrella said.

“So, basically, the starchy carbs and the sugary foods, if you eat those, your pancreas has to work harder with these medications, and it pumps out a lot more insulin than usual,” she noted. This overactivity can cause pancreatitis in some people, Parrella said.

Gallstones and gallbladder inflammation are also associated with the use of GLP-1s, Lofton said.

“Also, if someone vomits too much, they become dehydrated, which can cause kidney failure,” Lofton said.

Intestinal obstruction can also occur, which is when “food stops moving through because it gets stuck,” Parrella said. Dehydration and a lack of movement of the gut can cause this food pileup, Parrella noted.

These are all health issues that require immediate medical attention, but confusingly, the signs of these problems often overlap with some of the less serious side effects of GLP-1s — vomiting, nausea, indigestion and more — both doctors said.

“There’s also this very small but serious risk of what’s called gastroparesis, which is basically where your stomach stops moving the food forward,” Parrella said. This is a permanent issue that isn’t fixed when someone stops taking the medication, she added.

There is currently litigation around this issue and lots of medical concerns, as it’s hard to predict who this may happen to, Parrella said.

According to Dr. Elizabeth Walton, clinical director at Risas Kids Dental, when it comes to dental health, the most common side effects of the use of GLP-1s are an increase in gum disease and dental decay.

GLP-1 medications reduce saliva production. “Patients taking GLP-1s often experience symptoms of dry mouth, which include increased cavities and periodontal disease,” Walton told HuffPost via email.

“Saliva produces a protective barrier over our teeth and lubricates our [gums],” she added.

“With less saliva in our mouths, we are more exposed to the acids created by bacteria that lead to gum disease and dental cavities,” noted Walton.

“I tell my patients if they have vomiting even once, they should call my office because vomiting can be a symptom of some of the other more dangerous adverse effects,” Lofton said.

If your symptoms persist or get worse, you should certainly tell your doctor, Parrella added.

While the side effects of these medications are sometimes talked about among those on GLP-1s, it doesn’t make them normal.

“So many people will say, ‘I’m just going to suck it up. I know nausea is normal,’ or ‘I know it’s common to have constipation on these meds. This is probably no big deal. It’s just how these meds work,’ or ‘I’m worried my doctor will stop prescribing this medicine for me if I complain’ … and that’s when it becomes a problem,” Parrella said.

When symptoms continue or worsen, it’s a sign from the body that something is wrong, she noted. “And when we ignore that, or don’t report, it then becomes very difficult to prevent the longer, more serious problems,” Parrella said.

It’s important that you focus on drinking lots of fluids and staying hydrated as you take GLP-1s, Parrella said.

More, you should prioritize your protein intake so you can maintain and build muscle as you are on the medication, she said. To further help muscle growth and maintenance, add strength training to your workout regimen, Parrella added.

“And then the third thing would be, because this slows the movement of food through the gut, you want to make sure you stop eating three [to four] hours before bedtime,” Parrella said.

When you lie down after eating, it’s easy for the food to come back up and cause issues like heartburn and acid reflux, she said.

“It’s important if somebody does start experiencing some new symptoms of any kind on these medications, we have to remember we don’t have very long-term data on these meds, so there are still a lot of unknown risks with these medications,” Parrella said.

“Do they cause cancer? What happens if you stop? Does it cause a metabolic rebound? What about interactions with populations outside of those who have been tested?” she added.

While medical professionals are excited about understanding this new space in medicine, it’s also important that those who use GLP-1s remain cautious and informed of the risks, benefits and proper usage.

“You also have to pay attention to the effect on your own body. So, if you don’t feel good, or you are having symptoms of any kind, be in communication with your doctor so that you have a partner in the process,” Parrella said.

Additionally, you should consider the risk versus the benefit when it comes to GLP-1s (and all medications), Lofton said. “This comes into play when we think about people who aren’t having a weight condition,” Lofton added.

If you don’t qualify for GLP-1s, you shouldn’t jump through hoops to get a prescription.

“It’s important to really stick to the guidelines for who the medication was intended for, because as providers, we always think about maximizing benefit and decreasing risk,” Lofton said.

These medications are safe and highly effective for many but aren’t ideal for every single person. More, everyone should treat GLP-1 medications as the powerful drugs they are.