Wegovy and Ozempic (semaglutide) are glucagon-like peptide-1 (GLP-1) receptor agonists and Mounjaro and Yurpeak (Tirzepatide) are dual combinations of glucagon-like peptide-1 and gastric inhibitory polypeptide (GIP) receptor agonists that have become more prominent in managing type 2 diabetes and obesity. While they are effective, these medications can influence gastrointestinal motility or delay gastric emptying, potentially leading to a condition known as gastroparesis or stomach paralysis.
What is gastroparesis?
Gastroparesis or stomach paralysis is a condition where the stomach muscle slows down or stops working properly, causing the food to move slowly or not at all sometimes. These contractions are weak or uncoordinated, leading to delayed gastric emptying without any physical blockage.
Gastroparesis develops when signals between the brain, vagus nerve, and stomach muscles become disrupted. This causes the stomach to hold onto food longer than normal, leading to discomfort, poor nutrient absorption, and unstable blood sugar in people with diabetes.
It can also occur after viral infections, abdominal surgeries, or as a side effect of any gut motility medications, Mounjaro, Ozempic and Wegovy-like medications.
Symptoms of gastroparesis are:
- Feeling quickly after starting a meal.
- Bloating or upper abdominal discomfort.
- Nausea or vomiting of undigested food hours after eating.
- Loss of appetite and unintentional weight loss.
What happens in Gastroparesis?
The mechanical action of these medications is by mimicking the natural incretin hormones, enhancing insulin secretion, suppressing glucagon release, and delaying gastric emptying. The delay in gastric emptying contributes to increased satiety and weight loss.
The delayed gastric emptying decreases the contractions of the stomach’s antrum, which is the lower part of the stomach which is responsible for churning and grinding food. It also reduces the force put by the pyloric sphincter, the muscle that controls the opening of the stomach and small intestine. Due to these mechanisms, the food stays longer in the stomach. It decreases ghrelin secretion (the hunger hormone) and increases peptide YY hormone levels.
These semaglutide and Tirzepatide medications delay gastric emptying and make you feel full longer, leading to reduced calorie intake and eventually, you start to lose weight.
When the food stays long in the stomach, it disrupts normal digestion. You may feel nauseous when food is in the stomach for an extended time due to irritation of the stomach lining and excess stomach acid production.
Due to poor motility, undigested food is expelled through vomiting. In some cases, people tend to vomit hours after eating due to undigested food present in the stomach.
Gas build-up from slow digestion can lead to bloating and discomfort. When the food accumulates in the stomach, it also causes a feeling of fullness even after eating small amounts.
Other gastrointestinal problems like acid reflux due to increased gastric acid production, abdominal pain and discomfort due to retained food in the upper abdomen and poorly digested food may ferment and cause gas and cramping.
Some people experience constipation due to reduced motility, while others develop diarrhoea due to bacterial overgrowth from prolonged food retention.
People with diabetes who rely on insulin timing to match food absorption often face erratic blood sugar levels as food is absorbed at an unpredictable rate.
How to prevent gastroparesis?
You can minimise the development of gastroparesis while on semaglutide and tripeptide.
- Start with the lowest dose possible and titrate slowly. This helps your gastrointestinal system to adapt to the medication and reduce its adverse effects.
- Follow a well-balanced diet rich in whole grains, lean protein and vegetables. You can also get professional help from a dietitian to plan a personalised diet to support overall health and also help with gastrointestinal symptoms.
- Monitor your symptoms of delayed gastric emptying and report any adverse effects to your healthcare provider.
- Make sure to stay hydrated to help with digestion and reduce gastrointestinal symptoms. If the gastrointestinal side effects are persistent, consider discussing alternative treatments with your healthcare provider.
