Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are indicated for the treatment of type 2 diabetes mellitus and cases of obesity associated with comorbidity due to its high efficacy in glycemic control and induction of body weight loss. However, it is possible that the administration of this medicine culminates in the development of various gastrointestinal side effects, among them the most common are nausea, vomiting, diarrhoea and/or constipation. In this way, discover the nutritional strategies to decrease the side effects of Semaglutide
Therefore, to minimize the severity and duration of these symptoms, health professionals and patients should be properly equipped with appropriate measures to be followed during treatment and, thus, prevent people with DM2 and/or obesity from abandoning treatment with GLP-1 RAs, thus benefiting from its superior effect on glycemic control and weight loss.
Therapeutic Applicability of GLP-1
GLP-1 receptor agonists (GLP-1 RAs) represent a paradigm shift in the treatment of type 2 diabetes (DM2) and obesity, since depending on the incretin effect, i.e., its ability to significantly increase insulin secretion in response to glucose intake, induced by GLP-1 RAs allows glycemic control more efficiently than other therapeutic classes without increasing the risk of hypoglycaemia.
In addition, interestingly, some of them are able to cross the blood brain barrier and act on the brain to stimulate satiety, which leads to reduced food intake and, consequently, to body weight loss, which occurs at the expense of adipose tissue. As a result, the risk of progression to DM2 decreases and improvements in lipid profile, blood pressure or sleep apnea are observed. In addition, GLP-1 RAs also exercise positive effects on liver, renal and cardiovascular metabolism.
Literature interpretations of the side effects of Semaglutide
Extensive clinical evidence from trials and real-world scenarios highlights that gastrointestinal complaints associated with glp-1 RA administration arise independently of the medically half-life, i.e., it does not depend on whether it is of long or short action as well as the form of administration, whether subcutaneous or oral. Meanwhile these symptoms are usually transient, usually starting during the dose escalation period and disappearing shortly after the maintenance dose is reached and in most cases, and in most cases they are mild to moderate in severity.
Despite this, the literature shows that the results seem to be better with GLP-1 RAs administered once a week when compared to those requiring injections once a day. Therefore, considering that the associated symptoms may lead to temporary or permanent discontinuation of treatment with GLP-1 RA, it is of paramount importance to adequately manage the condition to potentially improve the patient’s experience during treatment with GLP-1 RA.
Pharmacological support for side effects of semaglutide
Once symptoms persist, it is possible to consider the insertion of antiemetic and/or prokinetic drugs. In this context, domperidone can be given in doses of 10 to 20 mg three to four times daily, oral dose, except in children under 12 years of age and in older patients it is shown to be safe as it minimizes the risk of extrapyramidal side effects. Among replaced benzamides, cytopriapride may be an alternative to metoclopramide.
However, in the case of use of oral semaglutide, there should be a 30-minute interval between medications. Furthermore, if medications to mitigate gastrointestinal discomforts are required for more than one month when the maintenance dose of GLP-1 RAs is reached, a dose reduction should be considered so that the patient tolerates the drug without the need for pharmacological intervention.
Clinical practice
Initially, it is extremely necessary to promote an education of the patient in terms of how to obtain and deal with satiety or even treat their expectations when starting treatment, how to prevent and treat side effects if they appear. Thus, among the recommendations to minimize the occurrence/severity of gastrointestinal complaints are improves eating habits such as eating slowly, eating only if you are very hungry, fractionating in servings, avoiding lying down after eating, stop eating when you reach a feeling of satiety, increase the frequency of meals, eat without distractions and enjoying food, do not engage in intense activities after the meal and avoid eating near bedtime.
In addition, it is also interesting to adapt the composition of food as give preferences for easily digesting foods, low-fat diets, opt for oven-based preparations, baking plate or boiling, adequacy of water intake and avoid the consumption of sweets, seasoned foods, spicy, canned or with industrialized sauces.
Furthermore, working with the realization of a food diary can be useful to identify foods or schedules that worsen symptoms and, in cases of persistent nausea, include foods such as biscuits, apples, digestive teas, mint and ginger in the patient’s routine.
Bibliographic references
Reading Suggestion:
ANVISA approves the use of semaglutide injection against obesity
Watch the video of doctor Thiago Cabral on the Science Play –
Semaglutida platform (Wegovy and Ozempic): What do you need to know?
Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gómez J, Castro A, Cebrián-Cuenca A, de Torres-Sánchez A, García-de-Lucas MD, Núñez J, Obaya JC, Soler MJ, Górriz JL, Rubio-Herrera MÁ. Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus. J Clin Med. 2022 Dec 24;12(1):145. Doi: 10.3390/JCM12010145. PMID: 36614945; PMCID: PMC9821052.
