Introduction
If you or someone you know suffers from type 2 diabetes or obesity, we’re sure you already know about Ozempic. You might have heard about semaglutide’s side effects, the most common of which include diarrhea. Why does semaglutide cause diarrhea? How bad is it? Does everyone who takes semaglutide get diarrhea? We tackle questions like these in this article.
What is semaglutide?
As massively popular as Ozempic may be, not everyone knows about its active ingredient semaglutide. Also, how it works in Wegovy and Rybelsus, another semaglutide brand.
Ozempic and Rybelsus are both FDA-approved to treat type 2 diabetes, while Rybelsus is FDA-approved to treat obesity.
In our gut is a hormone called glucagon-like peptide-1 or GLP-1. Whenever we finish eating and our blood sugar levels are high, GLP-1 kicks into action to help bring these down.
Semaglutide falls under a class of drugs called glucagon-like peptide-1 receptor agonists, or GLP-1 Ra for short. Whenever our blood sugar levels are elevated, it mimics GLP-1 and does the same thing.
Another effect is it delays gastric emptying or the process where food exits the gut and enters the small intestine. This causes you to feel fuller for longer, so you don’t think about food as much and have fewer cravings. Because you don’t eat as much food, you end up losing weight. Apart from slowing digestion, semaglutide also sends a signal to the brain that you’re full.
Eligibility for semaglutide
Although Ozempic, Wegovy, and Rybelsus all have FDA approval for their safety, not just anyone can take semaglutide. Before you can receive a prescription from a healthcare provider, you need to first meet certain diagnostic criteria.
With Ozempic and Rybelsus, you need to have type 2 diabetes. Sometimes, doctors may prescribed these for heart disease patients as they have additional approval for reducing risk of cardiovascular problems. Healthcare providers may at times also prescribe these for those dealing with insulin resistance.
With Wegovy, meanwhile, you must have a body mass index (BMI) of 27 or greater and have one weight-related health condition. Alternatively, you can also take Wegovy if you have a BMI of 30 or greater.
Oral and subcutaneous semaglutide
There are two ways you can take semaglutide: either orally or subcutaneously (by injecting under the skin).
You can take Rybelsus orally or by mouth as it is in tablet form. You administer Ozempic and Wegovy, meanwhile, subcutaneously or under the skin as they come in injectable dosing pens.
Dosage and administration
The proper dosage, administration, and storage of semaglutide is vital to maintaining its efficacy. In most cases, the dosage can have an impact on the severity of certain side effects such as diarrhea.
Ozempic comes in 0.5 mg, 1 mg, and 2 mg doses. Meanwhile, Wegovy comes in five various dose strengths, from 0.25 mg to 2.4 mg. The different doses come in pens of different colors.
Rybelsus, meanwhile, comes in 3 mg, 7 mg, and 14 mg doses, available in 30-tablet bottles with caps of various colors.
As your body will need to adjust to semaglutide, your doctor will typically start you off on a low dose. He or she will gradually increase this until you reach a maintenance dose.
You must inject Ozempic and Wegovy once weekly with or without meals in the upper arm, the thigh, or the abdomen. For Rybelsus, on the other hand, take it once daily on an empty stomach.
Safety and efficacy
Semaglutide received FDA approval after having gone through extensive clinical studies. The following are highlights from the research that proves semaglutide’s safety, efficacy, and tolerability.
In the STEP 5 trial, researchers looked at the two-year effects of semaglutide in adults who were overweight or with obesity. Participants lost an average of 15 percent of their body weight with semaglutide. Meanwhile, those in the placebo group lost approximately 2.6 percent of their body weight.
Participants on semaglutide also lost 14.4 centimeters or 5.7 inches off their waistline and saw improvements in their systolic blood pressure by 5.7 mmHg. Participants in the semaglutide group also experienced better diastolic blood pressure, blood sugar levels, total cholesterol, and triglycerides.
A study conducted in December 2022, meanwhile, found that participants on semaglutide lost more body fat than body mass. They ate less due to a weaker appetite, better food control, and fewer food cravings, especially for greasy foods.
Side effects of semaglutide
If you’re considering taking semaglutide or have just started taking it, you must know about its potential adverse effects. Here is an overview:
Gastrointestinal reactions account for 10% or more of semaglutide’s side effects. These include:
- nausea (up to 44% of cases),
- diarrhea (up to 30%),
- vomiting (up to 24%),
- constipation (up to 24%),
- abdominal pain (up to 20%),
Other common side effects of semaglutide which occur in 1 to 10% of cases include indigestion, belching, gassiness, and gastroenteritis. Gastroenteritis is the short-term infection and inflammation of the digestive system and gastritis the inflammation of the stomach lining.
It’s worth noting that these common side effects of semaglutide are mild and can be managed. Semaglutide’s more serious adverse effects, meanwhile, are rare.
Diarrhea as a side effect
In clinical trials using Ozempic, diarrhea occurred in about 8% of participants, a close third to nausea and vomiting. Diarrhea is characterized by loose and watery stool, along with more frequent than usual bowel movements. Sometimes it is accompanied by other symptoms like nausea, vomiting, stomach pain, or weight loss, all common effects of semaglutide.
With Wegovy, meanwhile, around a third of participants reported diarrhea as a side effect. Probably because Wegovy’s maximum doses are higher than Ozempic’s.
On average, most Ozempic-related side effects—which typically included diarrhea—subsided after a few weeks. Note that diarrhea tends to occur when patients increase their dose of semaglutide.
Other GLP-1 Ras such as tirzepatide (Zepbound, Mounjaro) and liraglutide (Saxenda) also have similar side effects. These include diarrhea, nausea, vomiting, heartburn, constipation, and gassiness.
Why does semaglutide cause diarrhea?
It’s not clear why semaglutide causes diarrhea, but studies suggest it may be associated with its effect on the gut. Apart from impacting digestion duration, it also affects the absorption of nutrients, which may cause the “stooling reflex.” The stooling or defecation reflex refers to how feces passes into the rectum, signaling involuntarily that a person has defecated.
Apart from this, semaglutide also causes constipation. When someone has constipation, hard stool stays in the colon and blocks it from working. When the new stool is produced, the old, hard stool blocks it on its way.
This contrast in liquid and solid stool is referred to as overflow diarrhea. This is when the new, liquidy stool leaks around the old, hard stool. Some experts believe that overflow diarrhea may be causing diarrhea in many semaglutide patients.
Dealing with diarrhea
Thankfully, there are ways to reduce the severity of diarrhea while taking semaglutide. With changes in your diet, you can help get relief and keep such symptoms at bay. Avoid:
- caffeine, alcohol, sugar-sweetened drinks, and milk
- high-fat foods like milk, cheese, ice cream, or yogurt, fatty meats
- highly processed foods like processed meat and most packaged food
- fried foods like fried chicken, burgers, French fries
- spicy foods
- sugary foods and artificial sweeteners
- legumes (chickpeas, beans, peas)
- nuts
- raw vegetables
Alternatively, you may want to boil, broil, grill, or bake food.
Choose to eat bland foods as well such as boiled potatoes, plain crackers, and oatmeal. These help prevent upset stomachs as well as help get rid of diarrhea.
Usually, it is advisable to consume high-fiber foods for good digestion. However, when you have diarrhea, you’ll want to eat more low-fiber foods as it keeps the digestive system active.
Some people have noted positive results in managing diarrhea by adopting the “BRAT diet”: bananas, rice, applesauce, and toast. These are foods that contain potassium and pectin, which can help control diarrhea.
Staying hydrated with clear drinks or water also helps to replace the fluids you lose because of diarrhea. Although most sports drinks have electrolytes that help hydrate, they’re also usually packed with sugars, which you want to avoid.
As with any side effects, inform your doctor, and all medications you are taking as these might clash with semaglutide. There may be a need to discontinue or change one of these to prevent diarrhea. Your doctor may also prescribe you over-the-counter (OTC) drugs Imodium (loperamide) or bismuth subsalicylate (Pepto Bismol) to address your diarrhea.
On top of these tips, patients should get plenty of rest to recover from the stress of diarrhea. They should refrain from strenuous physical activity to prevent further dehydration.
Conclusion
Diarrhea is among semaglutide’s most common side effects. The cause is still unknown, although it may have something to do with how semaglutide affects digestion.
Thankfully, symptoms can be managed through changes in one’s diet, such as choosing low-fiber and bland foods. Other solutions are minimizing the intake of high-fat, highly processed, and high-sugar foods and drinks.
Diarrhea, among other side effects of semaglutide, tends to subside after a few weeks.
Glossary of terms:
- GLP-1: Glucagon-like peptide-1 is a gut-based hormone involved in the secretion of insulin to lower blood sugar levels typically elevated after meals.
- GLP-1 Ra: Glucagon-like peptide-1 receptor agonist. It mimics the actions of GLP-1.
- Stool/defecation reflex: The process by which feces passes into the rectum, signaling to involuntary receptors that a person has stool.
