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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Can Ozempic Cause Constipation? Yes, But It Doesn’t Have To

Written by Michael Ruscio on May 16, 2024

Natural Strategies for Improving Ozempic Constipation

Key Takeaways:
  • Ozempic is an FDA-approved drug for the treatment of type 2 diabetes.
  • Ozempic is being prescribed off-label for weight loss.
  • Semaglutide drugs can come with GI side effects like constipation, nausea, diarrhea, and vomiting.
  • Natural strategies like a wholesome meal plan, exercise, stress management, and probiotics can combat Ozempic constipation and other side effects.

 

Ozempic has skyrocketed in popularity for its blood sugar benefits and potential to induce significant weight loss. But, as with most medications, it can have side effects—especially in the GI tract.  

In this article, I’ll share science-backed tips for mitigating Ozempic constipation (and other side effects). And since this drug is being prescribed off-label for weight loss, I’ll also dig into the best ways to build a healthy foundation for reaching and maintaining a healthy weight. 

Let’s start off with a little background on Ozempic and how it works.

What is Ozempic?

You’ve likely heard of Ozempic and Wegovy but may not realize what these drugs are and what they do. Let me share some background before getting into how to mitigate their potential side effects.

Ozempic is the brand name of an injectable drug called semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). It’s a diabetes medication prescribed (along with diet and exercise) for adults with type 2 diabetes mellitus to better control blood sugar levels [1]. 

In addition to better blood sugar (glucose) control, Ozempic can also help to reduce the risk of stroke, heart attack, or death in people with type 2 diabetes who also have a heart or blood vessel problem [1].  

Said more simply, Ozempic is meant to help people with type 2 diabetes avoid the serious complications that can come with unmanaged blood sugar and to help improve their overall health [1].

Wegovy is another form of semaglutide that helps people with obesity or excess weight (and possibly high blood pressure, type 2 diabetes, or high cholesterol) lose weight [1]. 

With that background out of the way, let me get into how these drugs work.

How Does Ozempic Work?

People with type 2 diabetes have too much sugar hanging out in their bloodstream because they either don’t produce enough insulin or they can’t use their insulin effectively. Insulin is the pancreatic hormone that helps move sugar from the bloodstream into the cells so it can be used for energy. 

If blood sugar levels stay too high over time, serious health complications like diabetic retinopathy, heart disease, and kidney problems can result. This is where semaglutide drugs come to the rescue—they help the pancreas release the right amount of insulin to lower blood sugar when needed, allowing for better blood sugar control.  

For those of you who want more detail—semaglutide activates receptors in the pancreas and brain called GLP-1 receptors. GLP-1 receptor activation increases the efficiency of a gastrointestinal hormone called incretin. Incretin tells the pancreas to produce insulin when blood sugar levels are too high so the sugar can be moved out of the bloodstream. In addition to increasing insulin secretion when needed, semaglutide also [2]:

  • Stops the release of a pancreatic hormone (glucagon) that increases blood sugar.
  • Reduces the amount of sugar the liver produces, when fasting and after meals.
  • Helps the beta cells in the pancreas work better to produce insulin. 
  • Helps the body become more sensitive to insulin.

All of these benefits lead to better blood sugar control to help prevent type 2 diabetes complications, but semaglutide drugs are not a cure for diabetes and are not used to treat low blood sugar (hypoglycemia) [1].  

Where Does Weight Loss Come In

Ozempic is prescribed to treat people who have type 2 diabetes, but both Ozempic and Wegovy are being used as weight loss drugs. If you’re wondering how they support weight loss, it seems to be related to appetite changes and GI-related drug side effects, and here’s how.

Semaglutide drugs may slow down the movement of food through the stomach. When motility is slower, appetite may be reduced—eating less food may translate into weight loss [1, 2]. 

But research suggests that these drugs aren’t a great tool for significant weight loss on their own [1]. A strong meta-analysis showed that taking semaglutide drugs for 6–12 months led to a loss of about 7.2 pounds. And when used for more than a year, the average weight loss was about 6 pounds. This suggests that the weight loss benefits may decrease over time [3].

You may know people who have lost a significant amount of weight on Ozempic or Wegovy. What explains these outliers if the research suggests that weight loss isn’t a significant effect of semaglutide? It could be simple calorie reduction due to the impact semaglutide drugs can have on appetite. But may also be related to unwanted GI side effects. One 2021 literature review suggested that some people may lose a significant amount of weight on these drugs due to nausea and vomiting [4]. 

GI-related side effects are fairly common with Ozempic. So, let me unpack how this drug impacts the GI tract before I get into what can be done to mitigate some of those effects.

Ozempic Side Effects

As with most medications, Ozempic can come with unwanted side effects. Some are more bothersome than others, and not surprisingly, higher doses of Ozempic tend to be more problematic [3].  

The most common side effects of Ozempic are digestive system-related and may impact more than 5% of patients taking the medication [5]. A 2022 study of 5,442 cases of semaglutide side effects in people with type 2 diabetes found the following GI symptoms and their prevalence [6]:

  • Nausea (44%)
  • Vomiting (25%)
  • Diarrhea (22%)
  • Constipation (12%)
is constipation a side effect of Ozempic

Constipation appears to be the least-reported side effect, but that doesn’t mean it should be ignored. It’s not clear as to why Ozempic causes constipation, but it may be related to:

  • Delayed gastric emptying—when GLP-1RA activates GLP-1 receptors, it may slow down gut motility, making it easier for stool to back up in the colon [4].
  • Central nervous system effects [4].
  • Feeling too full (an effect of the medication) to drink an adequate amount of fluid to keep stool moving through the GI tract [7].

Other less common possible side effects of Ozempic may include indigestion, burping, flatulence, heartburn or GERD, and gastritis (stomach inflammation) [5].

Outside of the gut-related impact, Ozempic may have some serious side effects that affect the kidneys, liver, mood, and heart, and could increase the risk of acute pancreatitis and thyroid cancer (thyroid tumors) [1, 6].

If you’re taking Ozempic and struggling with constipation (or other GI side effects), there are many natural strategies for getting things moving in the right direction, so let’s discuss. 

Resolving Ozempic Constipation & Other Side Effects

Normal, healthy bowel movements are key for ridding the body of toxins. But they’re also important for quality of life—if you’ve ever experienced a bout of constipation, you know what I mean, it can be miserable. While it’s one of the less common complaints of patients taking Ozempic, constipation still may impact 12% of users [6]. The great news here is we don’t have to just tough it out, there are a lot of natural options for managing Ozempic constipation.

Nutrition for Ozempic Constipation

I’m a food-first clinician, which means I believe diet is one of the most impactful ways to improve overall health and quality of life. So, it’s not surprising that a healthy, balanced diet is a foundational tool for preventing and treating Ozempic constipation [7]. There isn’t a one-size-fits-all diet, but here are some general tips to consider when planning your meal pattern [7]:

  • Consider opting for whole, unprocessed foods over ultra-processed ones (the Mediterranean or Paleo meal plans are great examples)
  • Experiment with adding more dietary fiber from fruits, vegetables, whole grains, and beans
  • Cook food well
  • Limit cheese or other foods that may tend to cause constipation
  • Incorporate more foods that have high water content, like soups, fruits, and vegetables
  • Avoid concentrated sweets
  • Limit dressings and spicy foods if they cause symptoms

If you’re not sure which foods constipate you, you can always keep a food journal for a week or so to track your symptoms—this is a great way to pinpoint any foods that may cause symptoms outside of constipation as well [7]. 

What we eat is important for constipation, but how we eat also matters. The process of digestion is extremely complex with a lot of moving parts—if we tend to grab food on the go or eat mindlessly in front of the TV, we may be more likely to experience constipation. 

I encourage my clients to prepare their bodies to accept and digest food well by practicing a few minutes of deep breathing before meals. When it’s time to enjoy food, avoid distractions, consider choosing smaller portions, eat more slowly, and chew thoroughly. 

I also encourage my clients to pay careful attention to how they’re feeling and to stop eating when they’re full [7]. And instead of lying down or sitting after meals, consider some physical activity—a brisk walk can help improve post-meal blood sugar and also reduce bloating [8, 9]. 

Along with eating wholesome foods and creating a digestion-friendly meal environment, it’s important to focus on hydration. When we’re not hydrated, it’s more difficult for stool to move smoothly through our digestive tract. A good rule of thumb is to drink about 70–105 ounces  (9–13 cups) of water per day, depending on body weight, activity, and age [10]. And consider avoiding straws when drinking as they can introduce air into the GI tract and lead to constipation [7]. 

Exercise for Ozempic Constipation

We’ve already seen that walking after meals can improve bloating, but exercise, in general, may help to improve the symptoms of constipation. In a 2019 meta-analysis, people with constipation who exercised aerobically had improved constipation symptoms, along with better quality of life and well-being [11]. Additionally, a 2020 systematic review showed exercise improved constipation related to hormonal issues [12]. 

While a brisk walk after meals is probably helpful, it may be best to avoid intense exercise right after eating to avoid constipation [7].

Additional Natural Therapies for Ozempic Constipation

Nutrition and exercise are foundational for preventing and resolving constipation, but additional supportive measures like reducing stress and adding in some supplements can also aid in regulating bowel movements.

Stress Management for Constipation

Unmanaged stress is a known trigger for irritable bowel syndrome symptoms like constipation [13, 14, 15, 16, 17, 18, 19]. While we can’t eliminate all of our stress, there are many natural strategies we can use to mitigate it.

I’m a huge fan of spending time outdoors in nature, and research supports this practice for managing stress and improving mood. Taking a 20-minute walk outside without sunscreen is a great way to boost vitamin D levels, capitalize on the stress-relieving benefits of nature, and promote healthy digestion [20, 21, 22, 23, 24, 25, 26, 27]. 

Additionally, even 5 minutes of mindfulness meditation or breathing exercises [28, 29] and three yoga sessions a week are also very effective [17, 30].

Supplements for Constipation

When it comes to supplements for constipation, probiotics have a lot of research supporting their use.   

High-quality clinical trials show that probiotics improve IBS symptoms, including bloating, abdominal pain, gas, diarrhea, and constipation [31, 32, 33, 34, 35, 36, 37]. Research also shows that the beneficial bacteria in probiotic supplements help improve constipation by:

  • Significantly improving stool frequency [38, 39, 40]
  • Increasing intestinal transit time [38, 39, 40]
  • Improving stool consistency [39]
  • Reducing bloat [39]
  • Improving quality of life of [41]

In addition to probiotics, psyllium (a soluble fiber supplement) may be helpful for Ozempic constipation. Research suggests psyllium improves constipation and global IBS symptoms [42, 43, 44, 45]. I encourage my clients to pay close attention to their symptoms, as fiber can trigger bloating, gas, and stomach pain in some people [42]. 

And finally, digestive enzymes improve constipation. In a 2018 randomized controlled trial, digestive enzymes doubled the amount of bowel movements, improved stool consistency, and reduced IBS-like abdominal discomfort in people with moderate constipation [46].

You’ve probably noticed that the strategies to improve Ozempic constipation are also foundational strategies for better gut and overall health. I would be remiss if I didn’t point out that creating a healthy foundation that addresses nutrition and lifestyle can be very effective for blood sugar and weight control—and these strategies rarely have side effects. I’m not anti-medication, and I’m not recommending that anyone discontinue a medication prescribed by their healthcare provider—my hope is to provide a road map to better health that may also potentially reduce your need for medication.  

Building a Foundation for Better Health

If you’re taking Ozempic or considering taking it to help with weight management, you may want to reflect on your current nutrition and lifestyle habits. If you feel they could use some work, here are some science-backed tips for helping you reach your weight loss goals. 

Nutrition for Weight Loss

Again, there’s no one perfect diet for everyone—the key is to find what works best for your body. High-quality research has found whole-food diets like Paleo, ketogenic, and Mediterranean (when combined with exercise) to induce significant weight loss [47, 48, 49, 50, 51, 52].

These diets all have one thing in common—they focus on whole, unprocessed foods [53]. Choosing whole foods can significantly increase the amount of calories burned during digestion when compared to processed foods [53]. And incorporating intermittent fasting may also support healthy weight loss [54, 55, 56, 57, 58, 59, 60, 61, 62].

Whichever dietary pattern you choose, consider prioritizing protein. 

Higher-protein diets (15–25% of calories from protein) appear to increase the metabolic rate and promote muscle growth, which can help with weight and body fat loss. This doesn’t appear to be the case for lower-protein diets (about 5% of calories from protein) [63, 64, 65, 66, 67, 68].

Exercise for Weight Loss

Exercise tends to build and maintain lean body mass—the higher amount of lean body mass, the higher the resting metabolic rate and the more calories burned [69]. 

As with diet, there’s not a perfect exercise prescription—pay attention to what works for your body. Recent evidence suggests that resistance training, about 3 days per week, can raise the metabolic rate [70]. 

I’m a supporter of balance, so I encourage my clients to create a well-rounded exercise routine that includes both cardiovascular and resistance training exercises and as much walking as possible. 

Lifestyle for Weight Loss

We probably hear the most about diet and exercise when it comes to weight loss. But restful sleep, stress management, and building a supportive community are equally important for weight loss success. Here’s a table with some tips for creating a healthy foundation in these areas:

Lifestyle Strategy Tips for Success
Restful Sleep
  • Set a bedtime routine and a consistent bedtime and waking time [71]
  • Avoid all-nighters and shift work if possible [72]
  • Try to eat dinner at least two hours before bedtime
  • Avoid bright lights and screen use for at least two hours before bed [73]
  • Modify the bedroom environment (temperature, lights, sounds) to support good sleep [74]
  • Address breathing problems, like mouth breathing, snoring, sleep apnea, or allergies, by consulting with a medical professional [75, 76, 77]
  • Exercise regularly, but avoid vigorous exercise close to bedtime [78]
  • Try taking melatonin to help you fall asleep quickly, and try probiotics for general sleep support [79, 80, 81, 82, 83, 84, 85]
Stress Management
Community
  • Create and nurture healthy relationships [87, 88, 89, 90]
  • Get involved with people who have common interests
  • Learn a new activity with family or friends [91, 92]
  • Volunteer at a local food bank or pet shelter [93, 94, 95]
  • Join a hiking or walking group [96, 97]

Combat Ozempic Constipation with Natural Strategies

Ozempic and other semaglutide drugs are in the spotlight for their blood sugar and weight management benefits. But as with most medications, they can come with side effects like constipation, nausea, and diarrhea. The good news is it’s possible to mitigate many of these side effects by using natural strategies.

A wholesome meal plan (with adequate fluid) and routine exercise lay the foundation for preventing and mitigating Ozempic constipation (and other side effects). If these don’t provide significant relief, it’s worth it to consider layering in a daily stress management technique and supplements like probiotics, fiber, and digestive enzymes. If Ozempic constipation continues despite employing these, it’s best to seek medical advice from your healthcare professional.

To learn more about healing gut-related side effects, check out my book, Healthy Gut, Healthy You for a step-by-step guide. If you’d like a more tailored approach, contact us for an appointment at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only and is not a substitute for professional medical advice or treatment.

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

➕ References

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