Why Do People Get Constipated While on Ozempic, Wegovy, and Zepbound? Causes of Constipation While on GLP-1's and What To Do About It

Why do people tend to get constipated while taking GP-1's? Constipation is a common side effect of GLP-1 medication such as Ozempic, Wegovy, and Zepbound. Many people start to experience constipation while they are increasing the dose of their GLP-1 medication. For some patients, the constipation is unpleasant but manageable. For others, it gets bad enough that they stop the medication. I will discuss the three general reasons why people get constipated while on GLP-1's, and some solutions that can help manage the constipation.

Reasons For Constipation While on GLP-1's

One action that GLP-1's have on the body is slowing GI transit. What this means is that the muscle movements that move the digesting food through the entire GI tract are slower. This leads to the contents of the digestive tract staying there longer than it usually does. In the large intestine, fluid is absorbed out of the stool. The longer the stool sits in the intestine, the more fluid will be absorbed out of it. This leads to harder stools that are more difficult to pass.

The most well known effect of GLP-1's is that they reduce appetite and reduce food intake. With that, intake of high fiber foods is also decreased. Fiber helps hold water in the stool, keeping it softer and easier to pass. Because people taking GLP-1's are eating less food overall and less fiber specifically, they have this added factor that can make them more constipated.

The third reason is decreased fluid intake. I have noticed that many of my patients who take GLP-1's experience a decreased drive to drink in addition to the decreased drive to eat. This can lead to inadequate fluid intake, a well known contributing factor to constipation.

What To Do About Constipation While on GLP-1's

Most patients who experience constipation while on GLP-1's do not have to stop the medication. Most are able to improve their symptoms and remain on the medication with some interventions. It is helpful for patients to discuss bowel habit changes with their healthcare providers as soon as these changes start. Stools that are starting to get harder, more difficult to pass, or even somewhat less frequent should be addressed with an intervention. When patients do nothing at the earlier signs of constipation, it can get worse as the GLP-1 dose is increased, leading to constipation that could have been avoidable with earlier action.

• Fiber supplements. Fiber supplements can be helpful for mild constipation. Some fiber supplements can be taken multiple times during the day for increased effect. For some patients, a fiber supplement is all they need to regain bowel regularity. There are various types of fiber supplements that contain different fibers. The dose and frequency of the supplement can also be adjusted. With some trialing, patients often can find the right supplement and dose that works for them.

• Fiber from food. Although appetite is decreased and food intake is decreased, when patients are very intentional about what they choose to eat, they can increase their fiber intake with food. When patients optimize their diet so that most or all of their carbs are high in fiber, they can get significant amounts of fiber from food. Some of the best foods for this are beans, lentils, chickpeas, oats, and quinoa.

• Water. While certainly not a glamorous solution, adequate water intake makes a big difference! Because some patients don't feel very thirsty while on GLP-1's, they have to be very conscious about their fluid intake. Carrying a water bottle around helps, as does asking a family member to remind you to drink.

• Medication. Medication use should be discussed with your healthcare provider, such as the one who prescribed the GLP-1. Some patients may need to use an osmotic laxative regularly for some time. There are also other categories of laxatives that can be used. Stool softeners also have a role in constipation management. In cases of more severe constipation, suppositories and enemas can be used. Their necessity can be avoided by starting to manage constipation at its earliest signs rather than waiting until it gets worse. Again, all medication usage should be discussed with a healthcare provider. This article is for informational purposes to let readers know what some patients use, but not as advice.

• Expert nutrition advice. See a dietitian who specializes in working with patients on GLP-1's! Having worked with patients taking GLP-1's for obesity since 2016, I know what works for patients. I have not had a patient who had to stop their GLP-1 due to constipation. With personalized diet and supplement recommendation and communication with the prescriber, constipation can be managed well.