Glp1 Gi Ae Symptom Advisor

GLP-1 GI AE — Symptom-Specific Advisor

Purpose

When a GLP-1-treated patient develops a specific GI symptom, deliver the targeted dietary/behavioural rules for that symptom — not a generic handout. Pharmacological rescue lives in glp1-gi-ae-pharmacological-rescue.

Activation

Trigger when user names a symptom on GLP-1:

• "Patient on semaglutide has nausea — what to advise?"
• "Liraglutide diarrhoea management"
• "Vomiting on Wegovy"
• "Constipation on Mounjaro"

Workflow

1. Confirm baseline: patient is following the general rules (eat slowly, smaller portions, low-fat, no lying down post-meal). If not — anchor those first.
2. Pick the symptom branch below.
3. Add the universal escalation rule (bottom).

Symptom Branches

Nausea

• After at least 30 min from the GLP-1 dose, eat: crackers, apples, mint, ginger root or ginger-based drinks.
• Avoid strong smells.
• Smaller, more frequent meals.

Vomiting

• Hydration is the priority — sip clear fluids steadily.
• Smaller amounts of food, more frequent meals.
• If severe/persistent: see pharmacological rescue and consider dose hold.

Diarrhoea

• Generous hydration: water, lemon, a teaspoon of bicarbonate.
• AVOID: dairy, laxative juices, coffee, alcohol, soft drinks, very cold or very hot foods, sugar alcohols ending in "-ol" (sorbitol, mannitol, xylitol, maltitol), candy, gum.
• AVOID isotonic sports drinks (intended for exercise context, not GI loss).
• Temporarily REDUCE high-fibre foods: whole grains, nuts, seeds, rice, barley, whole-grain bread, vegetables (artichoke, asparagus, beans, cabbage, cauliflower, garlic, onion, snow peas, lentils, mushrooms), skinned fruits (apples, apricots, blackberries, cherries, mango, nectarine, pears, plums).
• EAT: chicken broth, rice, carrots, very ripe fruit without skin.
• Reintroduce fibre gradually as symptoms improve.

Constipation

• Ensure adequate dietary fibre.
• Increase physical activity.
• Healthy, balanced diet.
• Generous water (or other sugar-free liquids).
• If on metformin: GLP-1 may aggravate — discuss possible metformin reduction with HCP (especially if also on omeprazole).

Universal Escalation Rule (apply to ALL symptoms)

• If nausea/vomiting is severe or persistent: NO drinks during meals — drink 30–60 minutes BEFORE and/or AFTER meals instead.
• If any GI AE persists despite following all guidelines → contact HCP for pharmacological rescue, dose adjustment, or switch.

Rules & Constraints

1. One symptom at a time — if patient has multiple, ask which is dominant; advice for diarrhoea (low fibre) directly conflicts with advice for constipation (high fibre).
2. Do not advise pharmacology here — defer to glp1-gi-ae-pharmacological-rescue.
3. Time-bound diarrhoea fibre restriction — must be temporary; reintroduce gradually.
4. Constipation in obesity — note prevalence is higher (up to 25–35% in obesity trials vs 4–12% generally).

Reference

Gorgojo-Martínez JJ et al. J Clin Med 2023;12:145. Table 2, Figure 2, Figure 3.