Constipation On GLP-1s

Constipation doesn’t have to derail your progress on GLP-1 medications. We break down why these therapies slow the gut, how to spot true constipation using the Bristol stool chart, and the practical steps that restore comfort without sacrificing your metabolic goals. From hydration tactics that actually stick to a fiber plan you can build meal by meal, we map out a routine that fits real life and keeps your gut moving.

We go deeper than quick fixes. You’ll learn how delayed gastric emptying changes transit time, why thirst cues can fade on GLP-1s, and how to use clear feedback—like urine color and stool form—to adjust in real time. We outline the pros and cons of common tools: psyllium and methylcellulose for daily support, senna plus docusate for short-term rescue, and osmotic options like polyethylene glycol and milk of magnesia when you need a stronger nudge. We also explain where movement fits, why walking after meals helps, and how to phase in changes to avoid gas and cramping.

If constipation has been your sticking point, this conversation gives you a two-week action plan and a safety net. You’ll know when to escalate, what red flags demand urgent care—no gas, vomiting with minimal intake, sudden severe pain—and how to talk with your clinician about prescription options that keep you on your GLP-1. Subscribe for next week’s guide to adding more fiber without the bloat, share this with someone navigating GLP-1 side effects, and leave a review so more listeners can find practical, evidence-based help.

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Transcript

Welcome And Scope

Speaker 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Every medication comes with its potential side effects. And one of the most popular medications right now, the GLP1 agonist, have a few very common side effects. But I want to talk about one of the most common side effects today, and that is constipation. And I'm going to talk about why it happens and things that you can do to help prevent it or help manage it if you experience it while on a GLP1. And this can help with constipation for any cause. Many medications that are prescribed can lead to constipation or it can happen just on a day-to-day for it for anybody. And so these tips will help. So, warning for this video, we are going to talk about bowel movements or poop. And this is something that is not commonly talked about, but as a physician, I talk about this fairly often with my patients. I want to start with the Bristol stool chart because this can help us to give categories or classify what our poop or our bowel movements actually look like, and that can give us a lot of information and make sure that we're on the same page when we're talking about constipation and changes in bowel movements. And so ideally, we have a Bristol stool for, and that is a healthy bowel movement, and that's what we're looking for to have every day, twice a day, every other day. Like I said, it varies from person to person. If we're going more towards type one, then that indicates leaning more towards constipation. The stool is staying in our gut too long, and that is constipation. If we're leaning more towards type 7, then that is looser stools or diarrhea. And that is a whole nother topic that we are going to pass on today. I want to take a moment to actually talk about what constipation is because many people think that everybody needs to have a bowel movement every day, and that's what is normal. The truth is that there is a range of what is normal from person to person. And so some people go once a day, some people go twice a day, some people go every other day, and that is okay. The goal is to have a formed bowel movement on a regular basis and to avoid the feeling of fullness and uncomfortability. The reason that we see constipation with GLP1 agonists is because one of the mechanisms of action of GLP1 or the way that it works as a medication is that it slows the movement of the GI tract. And so food sits in the stomach for longer, and that helps us feel full on less food and for a longer period of time, so it helps with portion control. But that slowing of the GI system can lead to constipation because things are not moving as quickly as they normally do. And that can lead to less frequent bowel movements, some bloating, and an uncomfortable full feeling. If you have a history of constipation or this is something that you struggle with on a regular basis, that does not mean that you cannot take HELP1. It just means that we need to monitor it more closely and be more aggressive at managing your symptoms. We're gonna go over four things that you can do to help manage these symptoms, and then we're gonna go over signs of when to seek help from your physician. The first thing that I want everybody to do is to drink more water. If you are dehydrated, your body is going to need to keep all of the water available to it to help keep it high or to help increase the hydration. And so it's gonna pull that water out of your stool and it's going to make that stool hard and difficult to pass. And so dehydration is a major cause of constipation. And the GLP1 agonists can lead people to be more dehydrated because you may not have the typical thirst signals that you normally have. Sometimes they get blunted by the GLP1 action, and you're typically having smaller volumes of food and smaller volumes of fluid, and so you have to be very proactive and make sure that you are drinking a full glass of water with all of your meals and then drinking water throughout the day. I recommend always keeping water next to you. I always have a glass of water here or a water bottle so you can keep track of how much you're drinking. And I know for some people this can be a tricky habit to build, but just start where you are and then slowly drink a little bit more and throughout the day. There is no expectation to go from 30 ounces a day to 80 ounces a day. You can add slowly over time. If you absolutely do not like the taste of water, feel free to flavor it with cucumber, lemon, um, fruits, or you can do sugar-free electrolyte drinks. That is absolutely okay. Just make sure you get those fluids in. You know that you're hydrated enough when your urine is either clear or a very light yellow. So that will give you immediate feedback to whether or not you are hydrated. Number two that you can do is you can increase your fiber in your diet. And the main sources of dietary fiber are fruits, vegetables, and whole grains. And so making sure that you're incorporating more of these foods in your nutrition plan can be very helpful. I always recommend doing this slowly. Maybe pick one meal a day for a week to add on a source of fiber, whether that's the vegetable or the fruits or the whole grain. Add that in, let your body get used to that, and then the next week add another one and another meal, and so on and so forth. The recommended amount for men is 35 grams of fiber per day, and for women it's 25 grams of fiber per day. And so if you are not sure where you're at right now, you can do a nutrition log with an app like MyFitnessPal or another free app and add and track how much fiber you're taking in over the course of three to five days, and then you can add um by a few grams each day until you get that goal. Not only will fiber help you have more frequent bowel movements and manage your constipation, but it'll also help keep your blood sugar stable, it'll help lower cholesterol, it'll help you feel full longer, which can help with portion control as well. If you are unable to reach your fiber goals through nutrition alone, it is okay to add a fiber supplement. And there are plenty out there. The main fiber supplements are cilium husk. The most common brand is Metamucil, but you can buy um off brands. And the other most common is methyl cellulose, and I actually have some of those on hand right here, and this is just one brand, the citrusol. And these come in tablets. The metamucil comes in a powder, the xylem husk comes in a powder. Um, but even though these come in capsules, it is very important to drink with a lot of water. Um, so you take the pills and then you have the water along with it. That allows it to expand and work as the fiber in your system. So, really important to drink the water along with that. Those fiber supplements are safe to take on a regular basis, so you can take them every day or even twice a day if needed. Stimulant laxatives, on the other hand, so this is number three, things that you can do over the counter or at home. Stimulant laxatives are best utilized on an as-needed basis. And that is because these medications are telling your GI system to start going and moving forward. And if you use consistently over a longer period of time, your GI system gets used to that, and then it is very hard to go without using these medications. So the fiber supplements are good to use on a regular basis, and then the stimulant laxatives are great to use as needed. A common example of a stimulant laxative is CINAH, and this um this medication that I had on hand actually has two medicines in it. It has CINAH, which is a stimulant laxative, and then it has docuusate. And we want to do ideally the combination because the docuSate is a stool softener, so that is going to help um soften the stool so it's easier to pass when your stomach is or when your GI system is starting to move things along. If you do not have the stool softener aspect and the stool is really hard, then your GI tract is gonna squeeze against that and that's gonna cause stomach pain. And so, ideally, you want that combination. So I would look for the CINAH and the DocuSate. Again, the store brand is just fine rather than the brand name. You can save a little bit of money there. There are also osmotic laxatives that kind of fall between the fiber supplement and the stimulant laxative, and common examples include polyethylene glycol or mirlax, is the most commonly used over-the-counter version. That's another powder that's mixed with water, um, usually comes in a purple tube. There's milk of magnesia, lactolose, magnesium citrate. These options work by pulling the water back into the stool again to make it soft and easier to pass. Before you use these options on a long-term basis, I would talk with your doctor to make sure that it is safe for you. And a bonus, I love bonus tips, is moving your body. And the more that you move your body throughout the day, you're going to stimulate that GI tract movement as well. So moving your body can also help with constipation without using a medication, which is great. If those strategies are not working for you, definitely reach out to your doctor. There are some prescription medications that may need to be utilized to help you with your constipation. So I would give yourself a week or two of trying these solutions, and if you're not getting the results, getting back into a regular bowel movement routine, I would talk with your doctor because there are prescription medications that we can utilize to help treat your constipation and keep you on your GLP1 if that is best for your health long term. And lastly, red flag signs to look out for, to definitely call your doctor right away, or maybe even go to the emergency room or urgent care is if you are no longer passing gas, or if you go to drink water or eat some food and then are vomiting while you're constipated, these could be signs of an obstruction, and you want to have that evaluated and managed right away. Also, severe and sudden abdominal pain, you would want to have that evaluated too. So, in conclusion, constipation is a very common side effect of GLP1 agonist. For most, it's fairly mild and can be managed with lifestyle changes like drinking more water, moving their body, increasing dietary intake of fiber, or adding a fiber supplement, and then using a stimulant or osmotic laxative as needed. But if it is a more persistent or severe issue, then this is something that should be managed by their physician or provider and can be treated effectively. I hope you found this helpful. I'm going to do more videos about how to manage the side effects of GLP1s. If you have any particular question, definitely put it in the comment below or send me a message on my website. You can send me a message at Missouri Metabolic Health.com forward slash contact. And I would be happy to address your concern, whether directly or through a future video. And next week I'm actually going to talk about how to introduce more fiber in your diet. And so definitely subscribe and catch that video. I'm going to give you some tips that I've learned from a lot of dietitians that I've talked to. It's going to be a good one, some things that I've implemented myself. I hope to see you next week. I wish you nothing but the best. Have a happy and wonderful week, and I will talk to you next time. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.