Your Checkup: Health Conversations for Motivated Patients
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Health Conversations for Motivated Patients
Side Effects Broken Down: GLP-1 Weight Loss Medications Explained
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On this episode discuss the side effects of GLP-1 medications like Ozempic and Wegovy, Zepbound, and Mounjaro offering practical strategies to manage these effects while still benefiting from the medications.
• GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound) help manage type 2 diabetes, obesity, and can reduce cardiovascular risk
• Most common side effects are gastrointestinal: nausea, vomiting, diarrhea, bloating, and constipation
• "Sulfur burps" are a frequently reported side effect that some manage with Pepto-Bismol
• Start with low doses and increase slowly to minimize side effects
• Eat smaller portions, avoid greasy/spicy foods, and practice mindful eating to reduce GI symptoms
• Stay hydrated and increase fiber intake to prevent constipation
• Gallbladder problems and pancreatitis risk may increase with rapid weight loss
• Some evidence suggests potential vision changes requiring regular eye check-ups
• Medications like insulin or blood pressure drugs may need adjustment when on GLP-1s
• Most side effects improve with time as your body adjusts to the medication
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Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Dolesky, a family medicine doctor in the Philadelphia area.
Speaker 2:And I'm Nicole Ruffo. I'm a nurse.
Speaker 1:And we are so excited you were able to join us here again today. As promised on the last episode, we did watch the poop cruise.
Speaker 2:Yeah, we did.
Speaker 1:We did. What did you think?
Speaker 2:Um, what did? I think Everyone was kind of weird that they interviewed. Am I allowed to say that? Yeah, you're out to say that you're all weird and I mean, is pooping in a red bag really that awful? Thank you yeah, I feel like it's not thank you.
Speaker 1:I, that's really where I like came to it, like you're on a floating vessel for anyone who, like isn't gonna watch this but is curious to catch up. Um, there were these people that left from like in the gulf of mexico. They left from somewhere I don't know. They were on a cruise galveston maybe and they left on a cruise it was carnival cruise and they went over to mexico, stayed there for a day or two and then came back and, like the engine caught on fire and then led to several different like power problems throughout the ship, including the toilets, and they were out there for like a week or so and so there were like no working toilets and they had to. Like the people on the boat were like, oh, you need to poop in these red bags he's like biohazard bags and then we'll dispose of them and, like some people just like refused to do that and then they pooped in the plumbing and like wouldn't you know what happened?
Speaker 1:it overflowed like well, like we're talking like that, like I don't know if they were close to passing away or this was close to being like a really, really big tragedy. Get over yourself.
Speaker 2:Poop in the bag, come on in the bag. Poop in the bag, I mean people poop on our street.
Speaker 1:So Excellent point, yeah, so I couldn't help. But like it was then, like the tugboat came along and changed the angle of the cruise, that was sick, that actually was sickening. So, with all these people pooping and peeing in the like not functioning plumbing, when the ship tilted a little bit, so did, like its equilibrium and all of the, the contents, the contents, if you like. Pick up what I'm putting down, smelling what I'm stepping in.
Speaker 2:Yeah, that was gross. I don't think I like needed any more endorsement to not go on a cruise, because I just don't think that's for me.
Speaker 1:They tend to look very crowded.
Speaker 2:Yeah, I feel like claustrophobic thinking about them. Yeah, like all those people on a boat, and then you're just stuck in the middle of the ocean.
Speaker 1:It does seem like a lot. Yeah Right, I'm like, and then there are always something to do. It seems like touch land.
Speaker 2:I mean I know you like get off and like do things and then get back on, but I don't know, I don't think it's for me.
Speaker 1:Maybe it's not, so if you're curious what we're talking about here, maybe you go check it out. It's on Netflix the poop cruise. Yeah, I can't help but think that this ties in well to what's happening in Center City.
Speaker 2:Center City, actually all of Philadelphia, has turned into a poop cruise Because what are they called District 33. The union is on strike and part of that union includes all of the sanitation workers. So there is no trash collection in Philadelphia. And it's been three days, two days.
Speaker 1:I actually think today was the first day that there would have been trash collection, but like the word's been out there that this has been happening since like tuesday at midnight or so, and no tuesday, because over that way their trash is on tuesday oh, oh, yeah. So then this has been happening since then. Yeah, it's, it's not bad yet. Um, there were definitely some people who didn't get the get the word, so they put out their stuff yeah, I'm wondering how long it's going to be on our.
Speaker 2:It's like we're, we're like our house is on the corner. Yeah, so that's where they put their trash.
Speaker 1:So I wonder how long it's going to be sitting in front of our house for probably um, if there was any excuse to get out of the city um we're leaving promptly after work tomorrow 20 hours from now.
Speaker 2:Um from the time this time tomorrow we'll be at the beach. Yeah, I will be settled into the beach.
Speaker 1:It's late, it's already 8 30 yeah, I, I hope they figure this out. I hope that, like, by the time this comes out, they like have this settled already. Um, they have an alternative setup for anyone wondering like, what will they do?
Speaker 2:like they're apparently like several different places to go drop your stuff off yeah, I don't know if that's getting collected, because it looks like it's all just sitting there yeah, if there was an opportunistic waste management group, like privately that wanted to rake it in. I don't know who's going to pay you, but no, I don't either. Bill the mayor.
Speaker 1:It's her fault. You could probably get the locals to pitch in to a private fund of all the people on any street that you can get them to just come by and do it. Maybe they would do that.
Speaker 2:I think that would be a prime business opportunity we'll see what it's like when we come back after oh, the fourth of july.
Speaker 1:That was gonna be awful but for the moment you've been waiting for where did you go? Because we left them off on a cliffhanger last week. We're gonna get into our dinner review, uh, part of the episode here before we break into the meaty part of the side effect episode of glp ones. Where did I take you for dinner?
Speaker 2:we went to kaleia, which is a thai restaurant, and it was I feel like we say this every time we go somewhere it was like one of my favorite dinners we've ever had. It's up there with saraya and they're in the same actually. Soraya and they're in the same actually end picnic and they're in the same group, which I think we talked about last week. But whatever they got going on at what is it? Divine hospitality?
Speaker 1:Is that?
Speaker 2:what it's called. Whatever they have going on there Like.
Speaker 1:I love it. They're winning, it's for us.
Speaker 2:And the um, I don't know who she was. She was like the HBIC of the restaurant and she kind of reminded me of the grandmother from Crazy Rich Asians. She gave that energy and she was just like walking around, I don't know. She was like the owner.
Speaker 1:Yeah, I think she was the owner of the chef, because like when you, when they came out with the bill and you flipped it over, it was like a picture, yeah out with the bill and you flipped it over.
Speaker 2:It was like a picture, yeah, and like the menu was, it was all inspired by places where, like the main chef's grandmother or mother was from in thailand. So I wonder who that was.
Speaker 1:But that's always like a nice touch when, like the owner or like oh my god someone like because she was like thanks for coming in right, like going around to everyone, like seeing how everything was.
Speaker 2:Yeah because that's what? Um, when we were in ashville, when we went to curate the oh, I forget her name that the like chef owner person like was like going around to everyone oh really yeah, don't you remember no, this was like that was so early on in, like the restaurant experience, like going to this place and he's never been to a restaurant, no, but
Speaker 2:no, but like I now, having lived here, yeah, because remember that restaurant like won some award or like she won something specifically and I only knew that because I was like looking up on their instagram and stuff before, and then I was like oh my god, that's her.
Speaker 1:And she just like thanked us for coming in yeah, no, I that was so early on in my like lived experience of enjoying food like this so there was no way that I remembered that I would love to go back and to like relook at the menu and take a different perspective. But to bring it back to kalea. Our server was great, he was awesome. Michael michael was awesome, very warm welcoming. As soon as you sat down you went in big space, big like, bright space, lots of windows. I tried to deke you out a little bit and make you think that we weren't going there by like.
Speaker 2:I knew exactly where we were going when you said one thing. I know, you picked me up from work and I was like okay, so like what time do we need to be ready to go? And you like said the time and you're like, yeah, you know, give us time to like get up there and get parking.
Speaker 2:So you said get up there and there there are like two places up there that we haven't been. The only thing I knew is that we haven't been to this restaurant, that we haven't been, that we've talked about and that we've wanted to try I know I was like oh my god, are we going to kalaya?
Speaker 1:there's like no way to get.
Speaker 2:Can you try to play it off?
Speaker 1:I did. I was like trying so hard and like I I'm so impressed that you can just like snap it out of thin air and just like find where we're gonna go. It's. It's a little demoralizing to truly like surprise you, um, but all in all, terrific. So the very bright and open they were all like bright-eyed and bushy tail when you walk in um, sit down very cozy and you know, nice tap water. Tap water was great, um, but let's get into it, I mean. So the beverages were delicious. We've gotten some comments that we talked too much about beverages here, so we'll leave it at that.
Speaker 2:Yeah.
Speaker 1:Um, but the take me through your feelings on the dumplings cause. It's only going to go up from here.
Speaker 2:Yeah, we got some sort of like dumpling. What was it? It was a chicken. It was like a little spice. They were blue. That was interesting. Yes, they were tasty.
Speaker 1:Super tasty, glad we did it.
Speaker 2:Yeah, they had a couple other like dumpling things that we probably will try again. Yeah, but they were good. And then the appetizers we got. Oh, here we go. Well, first it was this like coconut rice something.
Speaker 1:Which was great. I don't know, it was delicious.
Speaker 2:I loved it. And then the best appetizer, which was probably our favorite thing. What was actually? I'm going to pull up the menu.
Speaker 1:Give them credit so that they can find it if they're going to go.
Speaker 2:I haven't ever had anything like this. It was the best thing. I would go back, kalaya oh my God, am I okay, kalaya? Ever had anything like this? It was the best thing. Like I would go back. Wait, kalaya, oh my god, am I okay, kalaya? Um, I would go back just for this appetizer.
Speaker 1:Okay, menu, so, and then, if you can, leave that up so that we can talk about it, not just butcher these names um, oh, here it is.
Speaker 2:Okay, I don't know how you pronounce it. It's the first appetizer on the menu. It's crispy, garlic, chive rice cakes with a spicy, sweet soy sauce. So we saw rice cake and we thought it was going to be like a thin, crispy situation that you like put soy sauce on, which also sounds good. But this crunch it was like a brick. It was like three square bricks, crispy on the outside, and then you, I don't know what's inside there was some like spinach, something happening it was like sounds gross, it was delicious, it did not taste like spinach and it was like gooey in the middle, and then you put this soy sauce on it.
Speaker 1:It was the best soy sauce that was just like spicy sweet soy sauce.
Speaker 2:I don't know what's in it, but it was not your average soy sauce. It was delicious and it was oh my god, it's so good yeah, I would go back for that, like that has to be on the thing when you go there yeah that, like you got to try it.
Speaker 1:That was amazing.
Speaker 2:I loved that and I mean, that was just the beginning, yeah they do have a tasting menu, which we we typically love a tasting menu. We just decided not to do it this time because there were things off of the tasting menu that we wanted to get more, yeah, so we just like did that, but the tasting menu also looked good and the people next to us oh, yeah, yeah.
Speaker 2:We're like interruption of the review here for this I just like, sometimes I'm like you, just like, don't know how to act in public to people and like they, the royal, you right.
Speaker 1:The royal, you, yeah, yeah.
Speaker 2:People and okay, like tasting menus. Sometimes on a tasting menu you you get the options of like pick from this, like this section, this section and this section. This tasting menu was set and like this is what you got on the tasting menu. And then people next to us are like I don't eat beans, can I sub this with this? And they're subbing like four out of the seven things on the tasting menu. Like what?
Speaker 1:Yeah.
Speaker 2:Just order off the menu. That's not like. The tasting menu is curated, like by the people for a reason. That's what it's for Yeah's what it's for.
Speaker 1:Yeah, like, if you're gonna.
Speaker 2:If you're gonna order whatever you're gonna order, just you should probably just order your own dish.
Speaker 1:I get it like one off or asking yeah, they went in a couple times.
Speaker 2:I don't eat this, I don't eat beans, I don't eat this. Okay, maybe you should go to a different restaurant it was the tone of the delivery too.
Speaker 1:It was. Michael was very gracious.
Speaker 2:And Michael had to wait on them too. He did.
Speaker 1:Look it was. There are people with dietary restrictions out there and, like you know, they want to go on the tasting menu too. But there was the delivery and the like going in multiple times. Dip in like. Can I change four out of the seven? It's a little too much.
Speaker 2:Okay, back to our full food review. So then we got a curry. That was also so good.
Speaker 1:So delicious.
Speaker 2:It was the yellow curry with chicken, and then served with something else that I can't pronounce and the like coconut turmeric rice. This, that rice, was so good too.
Speaker 1:I mean, I didn't know rice could be like different and amazing, but it was. I loved how she like invited us to be like. Oh, do you want to like know how you should eat this Please?
Speaker 2:Yeah, there's a whole experience to putting it together with the rice and then they give you a boiled egg and you like crush that egg down crush the egg into the rice and then you put the chicken and then like the curry over it. Wow, it was so good it was a little spicy.
Speaker 1:It was like the medium spice option on the menu. It seems it was pretty spicy. Um, so just be mindful of that if you're gonna go. It was, I can't stop thinking about it. And the chicken two restaurants in a row with chicken, I know um, amazing. Uh, it was delicious. We meant to go there with karthik and mike.
Speaker 2:Um, at an I have to say, mike, if you're listening to this in your basement doing basement things, I'm I think you would enjoy it. However, I'm so happy eddie did not go with you and karthik to kalaya, so I could enjoy it.
Speaker 1:Yeah, that would have been a tough one to come back from, because you went to laser wolf and then they gave me some like reviews and like it.
Speaker 2:We aren't jumping to go there, it sounds like it was great, but like this one was better than laser well, I would have felt guilty coming back after this.
Speaker 1:Yeah, that was, that was something. Do you have any more love notes for the yellow curry chicken?
Speaker 2:no, all around 10 out of 10. And then we got whatever they're, like crab fried rices, which I think is like a popular menu item it seemed that was also delicious. Oh, did you eat that today?
Speaker 1:no, we still haven't. It seems a little misleading because it's like written as colossal crab, and maybe that's just me like. Maybe colossal crab means something else than a giant hunk of crab. It was absolutely delicious. I have no notes on it.
Speaker 2:I can't make anything like that I feel like I don't know everything we got. I would maybe get a different dumpling just to try another one. Yeah, but everything I would just order that same thing.
Speaker 1:I think I may I may be interested in trying, because I'm really happy we got that coconut rice and then now knowing that there was rice that came with the curry chicken, like I may, we did have a lot of rice, there's a lot of rice and then now, knowing that there was rice that came with the curry chicken, like I may.
Speaker 2:We did have a lot of rice.
Speaker 1:There's a lot of rice and I may explore different options, but that was just like out of this world. Somehow it always feels like a superlative comes out of these meals, which really just makes me feel amazing about the city of Philadelphia and like coming in here nearly four years ago being like oh yeah, the food scene is great is what they say?
Speaker 2:no, it really no it truly is.
Speaker 1:It is truly great.
Speaker 2:I know every. I was saying this to you last night when we left.
Speaker 1:Like every time we go somewhere, there's always something that's like the best thing we've ever had, like the crispy rice cakes, like best thing we've ever had yeah, I like, I mean, and then, how often do you like these are experiences that like we feel compelled to talk about and remember, and you know, I think we do a great job of keeping pace and trying to like explore and do new things, but like it's, I mean, there's a lot of them too. Like we got to go to pizzeria badia.
Speaker 1:Same like yeah, that's on the list that like does all of this stuff.
Speaker 2:So like I'm gearing up for what may be the best pizza of my life I think they also have people say I think it's there, I have to check, but I think they have this like sweet cream, ice cream or something. I think it's there and I think that's what it is.
Speaker 1:And if it's?
Speaker 2:not, then I just sound dumb. But also people say it's like the best.
Speaker 1:Oh, wow, and we didn't even get the chance to have like a dessert because we were so full, which is totally fine. We enjoyed a cookie when we came back.
Speaker 2:We did. Maybe we'll spend your summer break trying a new restaurant every week. It's for work technically. Yeah, it's for the podcast. It's for the podcast.
Speaker 1:This is not for anything else. This is academic and exploratory is really what it is. All right, I think that's everything on my list. Is everything on the?
Speaker 2:list. I think so All right. Well, let's watch love island. I have to see why everyone's being mean to our queen amaya. Oh, poor lady everyone just wants her to win. Did we talk about this real quick, about love island, that?
Speaker 2:not since the last time we recorded um amaya is like the only one besides jalen because he didn't have social media. She's the only one who, because everyone else like, they go on love island and then they give one of their friends their instagram login so that they can like, post stuff about it and like when there's like voting and stuff, so like, all their instagrams are still active and then is that how that works? They'll like repost stories that people are posting and like tagging them in because they don't have their phones.
Speaker 1:Right.
Speaker 2:One of their friends is doing it and like she's the only one that hasn't like her Instagram isn't active and she's like the only one who everyone's like. She's the only one who didn't go on there for more followers and she actually just wants to find love.
Speaker 1:Oh wow, no kidding, I didn't realize that that was how that worked. I was curious how these people are. Yeah, their friends are doing it Okay. Some of them are in full-on sponsorships already and advertising for items influencing Well, some of them.
Speaker 2:So Nick was like I saw him in like a figs ad, like he was doing like model stuff. And sierra was like a micro influencer in like wherever she lives. But then she's also fishy because she's friends with um, this girl who's like problematic, but then she was like a huge fan of the show. She had a love island themed birthday a couple years ago. One of her good friends was on it. It was like a whole thing. So everyone's like oh, you just came on here to like which, honestly, like, if I was trying to make the trajectory of my life being an influencer, I will go on Love Island. Sure, it doesn't even matter about the money, cause when you leave Love Island now you have a million followers, right, and like I mean the money from Love Island. It's a hundred thousand dollars split between two people, so you get like 25 grand of that. You're going to make that in a sponsorship, yeah.
Speaker 1:If you have a million followers, you know what happens after. Yeah, yeah I, I mean, I don't begrudge anyone for, but not our sweet amaya.
Speaker 2:No, she's just a nurse from new york city especially this show.
Speaker 1:I mean, like love is blind. I would feel more strongly like that one hurts that people go on there to do the whole influencer life, Like it's not what it was in the beginning where people actually did it. This one who's actually? I don't I'm kind of with Mary on this one Like that. I don't actually think people are going on there with the true intent aside from Amaya and Jalen to like find the love of their life.
Speaker 2:I mean, yeah, no one goes on reality tv to to like not be in the public eye sure, but like although the people from season six are like still together and then there's like tommy and molly from a couple years ago.
Speaker 1:You know, but it does. I feel like it, like it does box you into this certain life, or like you're with these people who have this like understanding of what you all went through, which creates this common ground. That's very relatable. It's like going to the same high school with someone being like, oh yeah, I remember when, and then like there's like only so many memories you have because, like, you went to high school with them and like you call back on those like, oh yeah, remember when we were in fiji. I don't know, but I hear you though. No, I'm excited to. I mean, we'll see what happens. I'm excited to see why people are now trashing her, not our queen amaya, but sierra oh, I do know why oh, don't tell me me.
Speaker 2:It doesn't have to have with the can't talk. It doesn't have anything to do with last night's episode.
Speaker 1:Oh, it's like outside of all of this.
Speaker 2:They've like discovered something about her. Yeah, I'll tell you. I'll tell you offline.
Speaker 1:Okay, all right. Why don't we dive in? All right. So what are we going to talk about today, nick?
Speaker 2:Today we're talking about something people love talking about, for sure, in general, which are side effects, but today we're talking about the side effects of GLP-1 medication.
Speaker 1:That's actually not where I thought you were going to go with it, but what?
Speaker 2:did you think I was going?
Speaker 1:to say you were going to be like oh yeah, everyone loves GLP-1s, we're going to talk about them.
Speaker 2:But no, everyone loves GLP-1s. We're going to talk about them, oh no.
Speaker 1:Everyone loves a side effect they do. Everyone loves the side effect.
Speaker 2:They love to forget, nobody loves an effect. They all love the sides.
Speaker 1:Correct you know, yep, no one likes the main dish, everyone likes the side dish. Yeah, no-transcript. So, like Nikki said, we are talking about these GLP-1 medications and if someone hasn't had the chance to interact or understand with what these medications are, they are medications that go by the names of Ozempic, mogovi, zepbound, moonjaro, and they are medications that are used to manage type 2 diabetes and manage the chronic disease of obesity. They also have some other indications that are being used far and wide, including cardiovascular risk reduction, treatment of sleep apnea, the list goes on and on.
Speaker 1:At this point, what we do know is that they help lower blood sugar and they can support people by helping them lose weight as well, and, as we are seeing more and more, these are becoming prescribed all the time, all over the place, because these tend to be very widespread issues that people deal with, and so, like you were saying, these medicines have effects. We were kind of going through what those effects are a little bit there, but, like all medicines, they also cause a side effect, and that's really what we want to get down to the nitty gritty of today, so we can talk about them and we can shed some light, because that, I mean, this is all over the place. We've probably spent our most time on threads and like this, they're also entire Facebook groups of people and the side effects for GLP-1 medications People talk about all the time.
Speaker 2:Yeah, they love it.
Speaker 1:They do, can you? One other disclaimer is that we're going to talk about the most common side effects. We won't be hitting every single side effect that someone has experienced or discovered under the sun. These are just the most frequent ones that come up, and also things come up more as we learn more about medications and people are on them for longer periods of time. But without further ado, why don't we get into it and talk about the most common side effects? Nick, is there a certain class of side effects that come up most frequently with these meds?
Speaker 2:Yeah, the most common are that I'm sure you've heard about are the gastrointestinal side effects, and that's because the GLP-1 medication slows down your digestion. And that's because the GLP-1 medication slows down your digestion, which is great for weight loss, but not so much or not as great for your stomach at first. No-transcript.
Speaker 1:Because that's like how it's working Right. Yeah, some of it is a lot of. It is the appetite regulation in the brain. That happens as these medications work and for a period of time they do slow down the gastric emptying, but that eventually goes away. And so when someone eats a lot of food, really quickly it distends their stomach and that can give the sensation of nausea. But those symptoms, right there, are exactly what people may be experiencing most frequently. Really quickly, it distends their stomach and that can give the sensation of nausea, but those symptoms, right there, are exactly what people may be experiencing most frequently. There's also another class. It's heartburn and acid reflux. These can be slightly more common with these medications. There are also some types of bariatric surgery that lead to. While these are not bariatric surgery, the types of bariatric surgery like lead to that. While these are not bariatric surgery, the types of bariatric surgery like a sleeve gastrectomy can lead to increased GERD or acid reflux symptoms, so those also bother people.
Speaker 1:Their gallbladder problems have been described in the literature. Specifically gallstones can happen, especially if you're losing weight really quickly and that's just a function of how your body is changing. If you go much above the one to two pounds a week, you can possibly end up with gallstone issues. However, that's relatively rare. Low blood sugar is something that can happen. These specific medications themselves aren't branded to cause hypoglycemia, but oftentimes people are put on these medications while they might be on other medications and those together can cause low blood sugar or hypoglycemia. Another side effect people might get isn't related to the medicine, but it's related to the way that most of them are administered, with an injection site reaction which can look like redness, swelling, itching at the site of injection, and so basically anytime you put something into your body, there's a chance that it reacts less than ideally. Even if you're putting a needle through your skin, it can become irritated, and something that we're going to probably bounce out and do a whole different episode on is that there is a hint in the literature that there are some vision changes that can happen retinopathy. So we already have it.
Speaker 1:Or people who get really quick resolution or correction of their blood sugar are at increased risk of developing some eye problems and, more specifically, the rapid correction can maybe worsen diabetic retinopathy. There is some signal in the literature that that might happen, and there is this other entity that people have probably seen headlines about called non-arteritic anterior ischemic optic neuropathy it was a mouthful for me to say too. It's abbreviated to NAION, and there also is a small signal that a lot of ophthalmologic journals are looking into thinking do these medicines increase the risk of this? A little bit Right now there's a signal for it, meaning that it's something to think about, but the American Diabetes Association doesn't say this is a reason to not try this medicine. But it's something to think about. But the American Diabetes Association doesn't say this is a reason to not try this medicine. But it's something to keep an eye out. If you have an eye doctor, you should probably let them know that you're taking this medicine.
Speaker 1:And this is an evolving situation, with papers coming out monthly about what these things are. How should we think about them? Is there anything else going on? What these things are, how should we think about them? Is there anything else going on? And for the most part, I mean some things we didn't cover were like any associated muscle loss that might happen from taking these medications, which also might just be an effect. That's something that we already talked about in a different episode, so I'm going to go back and forth Some of the next part of the episode. We're going to talk about the real meat of this. We talked about what the side effects might be we didn't cover an exhaustive list but we're going to talk about how to ease the side effects or maybe even prevent them, which will be a really interesting thing and helpful for people at home.
Speaker 1:I'll start us off here. So the first thing to do would be to start low and go slow. There really is no need to rush with these medicines. This is the long game You're going to. A gradual dose escalation is the most favorable way to go. That's why you see the pace of like maybe trying out a dose for a month, but it doesn't even have to be that fast, like you can go longer than that before you go up and your body gets used to it, so it doesn't have to be every four weeks. This is something that's on your own personal body.
Speaker 1:There's a lot of schools of thought that may invite that you try to squeeze out everything you can out of a certain dose before going up on the next one, which is something to do. So if you're thinking about ZepBound 2.5 milligrams, some people would say you need to try to get as much as you can out of that dose before going up to the next dose. Some people try to escalate up and get up as high as they can, as fast as they can, and that may predispose them to having some side effects. So the big takeaway there is start low and go slow. You don't need to rush.
Speaker 1:So the next thing is thinking about eating small meals and slowly eating. The idea here is that this can help with the nausea, maybe some bloating and feeling overly full. One key piece of it not advice, but key thing to think about would be to cut the portion size of your meal in half preemptively, so that you aren't over distending your stomach. So you see what your plate has. Cut it in half and that may help stave off some of that nausea from that over distension. Something that we think about a lot is mindful eating, and by this I mean like be present while you are eating what you are eating, because when you're not, we have a tendency to go further along than we need to. Like if I'm standing watching you eat soup and I'm shoveling chips into my mouth and I'm just like looking at you, like I'm mindlessly eating. So when you're trying to do this, don't eat. Don't eat while you're like watching TV, maybe, or don't be on your phone while you're eating. Again, these are all very easy things to say but harder things to do in practice. But they could help not to overeat, which can lead to that nausea and that bloating.
Speaker 1:There are some over-the-counter medications and some medications that may be prescribed from your doctor. It's a reasonable thing to think about anti-nausea medicines. If you're taking your first couple doses or you're going up on the doses and things aren't going your way and you're feeling nauseous, you can ask. There are options out there that might help, and there are over-the-counter medications for anti-diarrhea as well, so you can think about those if these medications are giving you diarrhea. But the good thing is, mostly the side effects go away. They should. They should go away as you're on a longer period of time.
Speaker 1:This next side effect to talk about, which I was kind of interested to see, doesn't have a lot of formal literature about it, but it's something that's present online a lot, which are these sulfur burps, like people describe, like they eat food and then like for hours later they're sitting there and they're just like burping up what smells like rotten eggs. Yeah, it just seems like a really nasty side effect and I looked this up and I looked it up in a lot of different ways on a lot of different tools, and there isn't a lot of formal literature out there. There also isn't. We think that the idea is that there's prolonged digestion happening when food is sitting in your stomach longer and this leads of reducing sulfur byproducts with a medicine very easily available over the counter. Remember what that medicine was?
Speaker 1:me yeah, yeah, pepto yeah, what would I have? You know, there's nothing in the literature about maybe using pepto for sulfur burps associated with glP-1 receptor agonists.
Speaker 2:Maybe we should do a study on it.
Speaker 1:Right, look into this. Just recruit a bunch of people who have these self-proclaimed sulfur burps and say if you took Pepto, did it make you feel better? This is a question I have. So I also incognito went into one of these Facebook groups to see if people were out here doing this and I, like, went anonymous and I asked the question like is anyone out here using Pepto to manage these sulfur burps? And there were a couple of people who were like, yeah, use Pepto, I've used it and it's helped and it works yeah.
Speaker 1:That's what they've said, so I thought that was very interesting. There's no evidence to back this up whatsoever, but something to consider. Can you take us through?
Speaker 2:a couple of different dietary adjustments or things we can think about that might help avoid some of these annoying GI symptoms. Yep, so not rocket science, but we're avoiding greasy and spicy food because that's not going to make any kind of GI symptom. You're having better, and hydration is your friend. Drink lots of water. Let's be honest. You're probably not drinking enough, so start drinking more.
Speaker 1:Yeah, some of my thoughts there are that, like, greasy and spicy foods bother a lot of people anyway, and I think they end up being people end up being more susceptible to being bothered by those when they're on these medications anyway, and it's like a food that already bothers someone is now extra, making them bothered, and so if you have to avoid something for a little while, maybe you try to like gently add it back into your diet. I really don't like making like big changes with people where they're like oh, I have to eliminate this completely, but it may come to it. Something that didn't make it to our outline is constipation. So many people get constipation on here with these medications and it really invites an opportunity to think about, like you mentioned, the water and increasing your fiber intake. People definitely need way more fiber than they usually are taking and there's a specific amount of fiber for your body weight and who you are as a person. There are fiber supplements. Our intern is like gnawing away at a bone, like this entire time. I don't know if it'll be picked up on the mic, but there are fiber supplements while you're trying to get more fiber into your natural diet because that's more delicious and more fun and more inviting.
Speaker 1:One other side effect that happens, and we talked about vomiting and diarrhea vomiting mainly as a function of nausea, and so we talked about using some medicines. But one thing to really think about is remaining hydrated in these moments. In a few previous episodes we've talked about having diarrhea and vomiting being dangerous, as it relates to your kidney health, and if you deplete the volume in your body enough, then you may harm your kidney. So the idea is to remain as hydrated as possible, but also with electrolytes and more fluid that looks a little bit more like the stuff flowing through our body. I'm not saying go drink blood, but, like you know, pedialyte looks more like the concentration with solute in our body than water does simply Same thing with Gatorade, too. Something else to think about is GLP-1 receptor agonists and medications that you're taking. So if you're taking insulin or you're taking a medication called sulfonylurea, it may be worth a conversation with your doctor to make some dose adjustments to make sure that you're not getting low blood sugar, as we talked about. We said that the GLP-1 receptor agonists don't themselves typically cause low blood sugar, but they overall lower the tide and increase the sensitivity to insulin. So if you're on insulin, it may beg that you have a lower dose.
Speaker 1:I've also seen it where, separately, outside of diabetes medicines, blood pressure medicines may need to be adjusted. I have a specific story of a gentleman who had sleep apnea and he lost about 30 pounds on Moonjaro and he also had hypertension. He had pretty poorly controlled diabetes and he was on the Moonjaro and he was doing really well, lost the weight. He said that his partner was looking at him when he was sleeping and that he was like not stopping breathing as one would with sleep apnea. And I would get messages back saying and we put him on a blood pressure medicine initially and he said that like, oh, my blood pressure is this, I'm feeling a little dizzy and my blood pressure is this, and it was much lower than it was ever in the office.
Speaker 1:But that's part and parcel of these medicines is that they're affecting so many different body systems where we're treating his sleep apnea by also treating his underlying obesity and his type two diabetes. So now that his sleep apnea is better, his blood pressure is better and so that blood pressure medicine that he was on because his whole body composition is different now he may not need it. So we pulled back on the dose a ton and seeing how things go, but this is also a very real thing. That happens. All right, can you take us through the next couple of things? What can we do to avoid injection site reactions?
Speaker 2:Well, it makes it more tolerable if you're rotating the injection site. So do like your stomach one time I mean, this is only like a weekly thing, but it still helps like your stomach and then a leg and then your arm, so that helps.
Speaker 1:Yeah, that's helpful. Also good to probably make sure it's clean, right.
Speaker 2:Yeah.
Speaker 1:No, any risk of infection or anything.
Speaker 2:Yeah, basic injection prep things. So what should someone be looking out for if that rare gallbladder stuff happens?
Speaker 1:So the gallbladder lives in the right upper quadrant. So if you're to kind of touch yourself in your belly, right there, right under your rib cage, is where the gallbladder lives, and if you have belly pain in that area, if you have a fever or you happen to be noticing yellowing of your eyes or skin, you should call your doctor and let them know. And this is just an FYI about when to reach out or go present for some in-person care that might be helpful. A similar thing there has been explained that there's some risk of pancreatitis from these medications themselves. Sometimes that's related to the gallstones in general.
Speaker 1:But the word of caution here is to don't overdrink alcohol. I had one colleague who asked me like oh, this guy was on a GLP-1 receptor agonist, he was at his daughter's graduation, he was having a grand old time, and then he landed in the hospital because he was drinking a lot of alcohol that day. And so they make you more susceptible to pancreatitis, this inflammation of the pancreas. That can be very dangerous and very painful. So just be mindful of that when you're thinking about those next steps and things to do or things to do less of.
Speaker 2:So let's talk about eye health. Can you remind us what we can do about that? Can you remind us what we can do about that?
Speaker 1:So if someone has diabetes, they should be getting yearly eye exams with an eye doctor, and so this becomes way more important when people are on these medications, because if you have pre-existing diabetic retinopathy, you should be getting them checked regularly. So there's no pun intended here, but just keep an eye out for vision changes. There is a signal in the literature that there is possible worsening of a few different ones, like diabetic retinopathy, maybe some signal of worsening macular degeneration or some worsening of this NAIO. The goal of this is to not get you to understand the inner workings of our very complicated optic system, but maybe you should have a relationship with an eye doctor. Maybe you ask your doctor about that, especially if you're on this for diabetes management, and if you have any vision changes, ask. That's all it is. It's something to think about, something to keep to look out for, and one last side effect that we're going to cover here today is something that isn't described in the literature significantly right now, but I expect it to be. Is this side effect of anhedonia or this just feeling of blah? I don't want to do anything, and it's been described with these medicines.
Speaker 1:If anyone was to go online or you're to ask a few people, they might just feel well. I think it has some something to do with like how, like the appetite regulation and the pleasure system in the brain is working, not necessarily the amount of calories that you're like taking in. That may invite thinking about the dose that you're currently on, and is it too high, or should we go down a dose? Or is there another medicine that might be able to help you in these times? And all I'm saying there is just, keep an open mind. If you're listening to this and you're like, oh, I might actually feel some of that, ask Because it's out there, it's a real thing, it's being figured out. Some of this comes up in time and then more research needs to be done to figure this stuff out. So if you do feel this way, think twice and maybe just reach out and ask for help, because it is a real thing, you're not crazy, all right.
Speaker 1:And so in this last little bit we're just going to do a couple highlights about when you should reach out. If you have severe, persistent nausea or vomiting, you should probably reach out because maybe something needs to change. If you have signs of pancreatitis, which is a belly pain in the upper belly that shoots to the back, maybe you should probably reach out. If you're having those gallbladder symptoms that you're thinking about in that right upper quadrant of your belly, maybe you should reach out for help. If you're having vision changes, you should probably reach out for help, and anything that feels unusual to you or doesn't improve over time is probably something that you should reach and ask for help. But overall, most side effects do improve over time, which is great news. These medications remain powerful tools for your health, but there are risks and benefits to various different things and everything we do practically. So thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or a neighbor with side effects.
Speaker 1:You can send us an email at yourcheckuppod at gmailcom. You can visit our Instagram or our website and make sure that you follow the show so that you see when other episodes come out. They come out weekly on Mondays. And, most importantly, stay healthy, my friends, until next time. I'm Ed Dolesky. I'm Nicola. Rufo Thank you and goodbye.
Speaker 2:Bye.
Speaker 1:This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. Thank you. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor. You.
