Semaglutide: Preventing/Dealing with Side Effects

[Pacman]

Hi all!

I just received my Semaglutide medicine. I am planning to take it later today for the first time.

I am excited about it (due to the fact that I have always had weight issues my entire life) but also very nervous (because I tend to have GI issues easily, usually in the form of bloating/gas/pain/etc unless I am very very careful).

The thing is, when they say that a certain percentage of people get GI issues from the drug, they never seem to elaborate on some very important variables that could make a huge difference in the outcome of side effects experienced, even with those same exact people. (That I have seen at least)

For example, does the person have GI issues to begin with? Are they making it worse with their eating habits prior (or after) injecting? Were they stuffed with food right before injecting? Are they taking any other drugs/compounds that could impact how the GI is reacting to begin with?

My hypothesis is that because it slows GI emptying, having a lot of food in there to begin with could contribute to it. All they say is that people have GI issues, but they don't freaking tell us the circumstances of that!!

I have googled recommended food to have and avoid with Semaglutide (mostly found results for recommendations with Ozempic, but same thing), and they seem to give all the same recommendations. For example: What foods to avoid while taking Ozempic - NiceRx

Everything on that list makes sense to me (for both the foods to avoid and foods to consume), except for high fiber foods, at least in the beginning stages of taking Semaglutide.

It does not make sense to me that they would recommend high-fiber foods when starting this medication especially for an obese population that most probably does not typically ingest such foods. High fiber foods could cause severe GI distress if your body is not used to them, and they slow digestion down.

In my experience, even without any medications that affect GI distress, introducing a lot of fiber to my diet (which slows digestion), while healthy, did cause me a ton of GI distress in the past, because my body was not used to it.

So with a GLP-1 agonist (which also slows digestion), wouldn’t that be a double-whammy?

So I am thinking it makes more sense to have several very light meals, but also meals LOW IN FIBER and to avoid slow digesting animal proteins since both are slower digesting than other foods, and the Semaglutide itself causes slow digestion to occur.

(side note: slow digesting animal proteins would be things like meat, and fast digesting animal proteins would be things like whey or nonfat Greek yogurt)

I was considering taking ephedrine to help reduce appetite today but I decided not to since ephedrine itself does sometimes cause stomach burning and uncomfortable sensations in my stomach, and I think it is wiser to control all variables that could potentially cause by themselves GI distress, so I can prevent as much as possible all potential GI distress while giving an objective assessment of how my body reacts to this drug.

So summed up, my plan

Light meals today!! Keep stomach as empty as comfortably possible today!

Do EVERYTHING to reduce eliminate ANY gastro distress PRIOR to injection:

1) No ephedrine!!!! - even though it will help reduce food intake, it also causes stomach pain sometimes, so do NOT take it same day prior to injection! (it also apparently delays gastric emptying, which is exactly what Semaglutide does).

2) NO artificial sugars or sugar alcohols today!!

3) LIGHT healthy meals, on the lower end of fiber. Aiming for 400 calories or less per meal. Preferably 200-300 cals per meal if possible.

4) Empty GI track as much as possible prior to injection. Try to aim for “fasting” as much as possible. Also psyllium husks (which I am already used to taking in moderate amounts).

5) For when I do eat, at least for today (and maybe tomorrow), try to ingest fast digesting foods. Do not have a lot of fiber today (not too much at least) as the slow digestion process could by itself cause GI pain. So foods like white bread with egg whites, maybe oatmeal (no sweeteners), white rice, nonfat greek yogurt with berries, whey protein with soy milk, everything bland and as plain as possible.

6) No garlic extract (which I take to help with cholesterol) or spicy foods. Everything as bland as possible today!! (and maybe tomorrow too)

7) No slow digesting foods.

And if I am able to stave off sides this time, I can further test my hypothesis by going directly against my own plan this time, but next time I inject, since I can safely rule out such sides from the same dosage. But I am not sure I will do this, as I am not sure I want to deal with sides in the name of science. haha

What are your guys' thoughts on my plan? Have any of you taken similar precautions prior to taking Sumeglatide for the first time and/or prior to increasing the dosage?

If GI distress DOES occur, here is what I have in my arsenal:

Pepto Bismol, cannabis, and lots of mint tea. That's it. Hopefully that will suffice.

 

[Vtail]

FWIW: I personally know 2 people that started Ozempic at roughly the same time. They both started at .25mg/week for 4 weeks, then increased to .5mg for 4 weeks and both are now up to 1mg. Both are women approx 50+ years old. One of them was immediately hit hard with GI issues - nauseous at times and unable to even look at certain foods. The other seemed to just shrug it off as if she were injecting water. As they both increased their dosage, the GI side effects (or lack thereof) were the same. One feels queasy most of the time, and the other feels nothing. So, like everything else we talk about here, whether or not someone will suffer GI issues from Ozempic seems to vary from person to person.

 

[Pacman]

FWIW: I personally know 2 people that started Ozempic at roughly the same time. They both started at .25mg/week for 4 weeks, then increased to .5mg for 4 weeks and both are now up to 1mg. Both are women approx 50+ years old. One of them was immediately hit hard with GI issues - nauseous at times and unable to even look at certain foods. The other seemed to just shrug it off as if she were injecting water. As they both increased their dosage, the GI side effects (or lack thereof) were the same. One feels queasy most of the time, and the other feels nothing. So, like everything else we talk about here, whether or not someone will suffer GI issues from Ozempic seems to vary from person to person.

Yes, I do realize that different people react in different ways.

What I was saying was more along the lines of those who do tend to react poorly, whether or not there are factors within their control to mitigate the side effects? Like for example, if someone tends to have GI distress as a reaction to Sumeglatide, surely it is much worse if they are eating junk food all day? Or on the other hand, if they do a complete 180 from all junk food to a mostly plant based, high fiber diet? If someone is not used to a high fiber diet, that alone would cause GI distress.

I imagine that whatever GI distress you would get otherwise, Sumeglatide sounds like it would compound those sides... So one most probably needs to be extra careful. That seems to be the most logical conclusion in regards to this topic.

That being said, I took my first dose of 0.25mg Sumeglatide about 40 minutes ago, and so far, no sides. I am going to go eat something light now. Fingers crossed, I hope this goes well.

 

[captain]

It takes 4-5 weeks to reach peak concentration at a given dose. Look for side effects at 40 days not 40 minutes. I have used Phentermine with it and had no problems. I have been on Ozempic for a year and now switching to Trizepatide because of the Semaglutide shortage. Pharmacy says no more 2mg Ozempic till November.

 

[Nelson Vergel]

Good info here:

Semaglutide Forum: Game Changer for Weight Loss

Mark A. Moyad, MD, MPH & Martin M. Miner, MD, discuss the potential benefits of semaglutide, a newly approved weight-loss drug. Semaglutide is a medication that has been approved by the FDA to treat type 2 diabetes and has also been approved for obesity management under the brand name Wegovy...

www.excelmale.com

 

[nodoctor]

As a very enthusiastic vegan I must point out that everything on their list of foods to avoid is total crap, and everything on their list of foods to eat is vegan and very healthy.

I have had only very slight gastric distress with Semaglutide, and loved it overall. My personal opinion is that to treating up the dose makes a ton of sense, and if you go with the list of stuff you were supposed to eat but maybe gradually introduce the fiber, that seems like a sensible plan. Frankly, I think one of the reasons they emphasize what your diet should be it so that everyone will report lots of weight loss, because eating their list of recommended foods with no Semaglutide would still result in significant weight loss and most people.

Happy to answer any other specific questions as well.

 

[Jon H]

I tried Semaglutide a few months ago, and hated every minute of it. I don't have very much body fat, but I thought that it might help with a little remaining visceral fat. I also thought I'd try it to help with blood sugar and for its touted positive effect on any metabolic issues. My GI tract has always worked very well, with no issues. Within two days of using it, even at a low starting dose, my entire GI tract seemed to slow to a crawl and I felt nauseous all day long. What I ate during this time made no difference in side effects whatsoever. Even my poop started looking and smelling horrible. I only used it for three weeks at a low dose. It took at least one month after stopping it for me to feel normal again.

I don't have time to write a full review, but (for me) that drug seems to fall into the same category as something like gastric bypass surgery. If someone doesn't have self control over what they put in their body then it may be a great tool to help overcome a morbid condition. For people that do have some self control I honestly can't understand the hype on this product.

As always....for those that have had a completely different experience and opinion, and think it's the best dietary tool ever, more power to you.

 

[Pacman]

Okay so update, I felt nothing from this first dosage.

I did "feel" some nausea in the first evening and next morning, but I think it was all in my head because I was looking out for it and feeling anxious the whole time waiting for it to happen, so the nausea was either psychosomatic or just a result from me stressing myself out.

This is further evidenced by last night (about 36 hours after the injection) I totally binged on a bunch of food. Total calorie count for yesterday (one day after injection): 3650. That's about a 500 calorie surplus for me. (I was pretty active the entire day, plus 45 min cardio in addition to an intense weight workout, so yes I was naturally very hungry)

So virtually no effects from my first 0.25mg injection. Given that is the case, should I really be dosing the same amount for 3 more weeks before upping the dose? (That is the instructions I received and also the general recommendations I see online, to increase the dosage slowly)

It takes 4-5 weeks to reach peak concentration at a given dose. Look for side effects at 40 days not 40 minutes. I have used Phentermine with it and had no problems. I have been on Ozempic for a year and now switching to Trizepatide because of the Semaglutide shortage. Pharmacy says no more 2mg Ozempic till November.

Are you sure about this? Based on what I read, it takes 4-5 weeks to reach steady state, as in, your body ingests it and eliminates it at the same rate. Not peak concentration. Peak concentration is the first 48 hours post injection, based on my research. Maybe you meant steady state? And also based on what I read, the side effects decrease over time, they don't appear 4-5 weeks later with nothing in the beginning.

If I am wrong though, can you post the source that says what you wrote here? (regarding both peak concentration and sides)

Phentermine stresses me out, so I try to use it only sparingly. Ephedrine is much better for me symptomatically, but unfortunately it is not as safe as Phentermine. So that also I try to use as sparingly as possible.

As a very enthusiastic vegan I must point out that everything on their list of foods to avoid is total crap, and everything on their list of foods to eat is vegan and very healthy.

I have had only very slight gastric distress with Semaglutide, and loved it overall. My personal opinion is that to treating up the dose makes a ton of sense, and if you go with the list of stuff you were supposed to eat but maybe gradually introduce the fiber, that seems like a sensible plan. Frankly, I think one of the reasons they emphasize what your diet should be it so that everyone will report lots of weight loss, because eating their list of recommended foods with no Semaglutide would still result in significant weight loss and most people.

Happy to answer any other specific questions as well.

In the STEP trials, the placebo group who followed the dietary advice also reported weight loss, albeit not as high as the one who got the medication. So you are right about that.

Luckily for me, I do eat a mostly (like 60-70%) plant based diet high in fiber anyway.

What dosage are you taking and at what frequency? If you experience only minor GI discomfort, how did you titrate up? Did you go slowly or did you just adjust it from week to week until you found your sweet spot?

And is your entire supply from Peptide Sciences?
(I ask that because you mentioned you use them, so I was curious if they are your entire supply or just supplementing the stuff you get from the pharmacy, I am thinking that I might do the same if I end up needing a much higher dose to save money)

I tried Semaglutide a few months ago, and hated every minute of it. I don't have very much body fat, but I thought that it might help with a little remaining visceral fat. I also thought I'd try it to help with blood sugar and for its touted positive effect on any metabolic issues. My GI tract has always worked very well, with no issues. Within two days of using it, even at a low starting dose, my entire GI tract seemed to slow to a crawl and I felt nauseous all day long. What I ate during this time made no difference in side effects whatsoever. Even my poop started looking and smelling horrible. I only used it for three weeks at a low dose. It took at least one month after stopping it for me to feel normal again.

I don't have time to write a full review, but (for me) that drug seems to fall into the same category as something like gastric bypass surgery. If someone doesn't have self control over what they put in their body then it may be a great tool to help overcome a morbid condition. For people that do have some self control I honestly can't understand the hype on this product.

As always....for those that have had a completely different experience and opinion, and think it's the best dietary tool ever, more power to you.

Thank you for sharing your experience. So far I am lucky enough to report none of these side effects (I only took one dose though, of 0.25mg)... I hope you find something that helps you without such sides.

 

[Pacman]

Update to the update:

It's definitely working. Just not in the way I was expecting.

I was expecting to be nauseous all the time and barely able to hold food down (as you can tell by my first post I was preparing for the worst). That is not what is happening luckily.

It's very mild in its effects (as of right now at least, week 1 @ 0.25mg). Appetite is noticeably lower, not by a huge margin, but certainly a noticeable margin.

And the sides (for now) are very mild. There is a tiny bit of nausea, but it comes and goes and usually it is in response to eating a large amount of food, it doesn't typically happen by itself. I do notice also that when I eat a large 800-900 calorie meal, the satiety seems to be lasting much longer than I am used to. So that's good.

On Saturday (the day I was ravenously hungry and binged, the day after injection) I did eat 3650 calories for the day. Still pretty high, roughly 500 calories above maintenance.

At first I thought "okay this is obviously not working, since I binged, it is supposed to prevent that from occurring".

But I looked at my calorie count for similar days when I was just as hungry, and my average calorie intake on those days were in the 3800-4200 calorie range. So week 1 of 0.25mg Semaglutide I ate 150-550 calories less than I would have otherwise on a day that I did not hold myself back from indulging in food when I felt ravenously hungry.

And yesterday I was feeling a lot of pain in my shoulder and was also not hungry at all in the evening. Due to the shoulder pain I took Tylenol and also smoked cannabis to help me relax and deal with the pain. About 40 minutes later I got real hungry and ate. I just let myself eat what I wanted, I just wanted to relax and go to sleep.

Calorie count for yesterday 2900 calories. On days where I would get the munchies like yesterday (hunger due to weed and not due to being hungry otherwise), I would have easily eaten 3200-3500 calories without hesitation. So yesterday, even with weed munchies, I still ate roughly 300-600 calories less than I would have otherwise in similar circumstances before Semaglutide.

Btw, on both days I just responded to my hunger signals, I was paying attention to the amounts I was eating, but I was also not holding myself back. If I was still hungry, I added more food and I ate until I wasn't.

I will work on increasing my own self-discipline with eating, as I do want to take as little as possible of this medication. In my mind, Semaglutide is a tool, and not a solution by itself.

But wow so far I am impressed.

I am really hoping this is not some fluke and it will continue to work at least as well as I have observed in the past two days.

 

[Pacman]

Just wanted to post an update almost a month into taking it.

The good:
It's working REALLY well! I am also on a very low dose (as of now I am taking 0.375 mg every 5 days), and it works so well that on some days I have to literally smoke a bit in the evening to get my appetite up enough so I don't end the day on 1600 calories. (I have a planned out caloric/macro plan that I am sticking to). Not all days are like that, but just the fact that some days are shows it is working.

The bad:
Stomach pain if I eat too much. But it's fairly manageable. On a scale of 1-10, it usually doesn't pass a 6. Unless I eat like more than 900 calories in a single sitting (most of my meals are between 250-700 cals).

The weird:
I have gotten VERY sensitive to cold temperatures. The only other time this happened to me in my life was when I was about 10 pounds lighter than I am now. This is very strange because I keep my place always at a constant 65-70 degrees 24 hours a day. But ever since I start semaglutide, I am freezing if it gets below 70 degrees (occasionally it is comfortable below 70 degrees, but 98% of the time it is not). Most of the time right now my place is at 74-75 degrees.

What would cause that weird side effect? It doesn't bother me so much but I am just wondering why that would happen...

Anyway, this stuff is amazing. I really like it, and I am so happy that I found something to help control my appetite that is not a stimulant.

 

[captain]

I was sensitive to cold temperatures when I started it. It seemed to fade after being on it longer. I would still freeze but wasn't constant like in the beginning.

I am on Trizepatide now and stomach pain is worse with it. I have found that appetite control with Trizepatide seems better than Semaglutide. I don't want to eat at all with Trizepatide.

 

[Pacman]

I was sensitive to cold temperatures when I started it. It seemed to fade after being on it longer. I would still freeze but wasn't constant like in the beginning.

Ok good to know that cold sensitivity is not only occurring by me. And yes, you are right it does fade a little bit over time. I wonder why this side effect occurs at all, I did not see it listed anywhere in the potential side effects list.

I am on Trizepatide now and stomach pain is worse with it. I have found that appetite control with Trizepatide seems better than Semaglutide. I don't want to eat at all with Trizepatide.

Do you think that appetite control is better because the stomach pain is worse? What was your dose on Semaglutide?

I am currently on 0.325 mg every 5 days, I am going to increase it to 0.5 mg though and see how I deal with that. I have been having some days in which I have been eating more than expected (that's the reason for the increase).

How do you deal with the stomach pain? (prevention as well as dealing with it once it occurs)

 

[captain]

I was on 2mg Semaglutide and went to 5mg Trizepatide. Not as much pain now as it just feels like you already ate and don't want anything. I get up in the morning and feel stuffed and haven't had anything. You deal with it and hope it's worth it. You have to want to stop eating to stop. There is no magic pill or shot that will do it for you. Ask yourself next time you go to eat. You are injecting yourself full of this shit to lose weight so what the hell are you doing?

 

[BigTex]

I just got 10, 2mg vials of Semaglutide for my wife. She tried the 1st dose today. She did 150mcg just to avoid having any nasty side effects. She did feel some flushing and a very mild nausia soon after injecting. Will keep you guys up on the progress including weight loss. Getting her on the scales will be like pulling teath.