Managing Diarrhea on GLP-1s Guide

Diarrhea is a common (and unpleasant) symptom as your body adjusts to GLP-1s and/or Metformin. Diarrhea usually resolves as your body adapts to medication over the course of several weeks. But in the meantime, here are a few approaches that can help.

• Stay well hydrated. Drinking enough water is important, but so is getting enough electrolytes such as sodium, magnesium, and potassium. Try adding a pinch of sea salt to every liter of water and eating potassium-rich foods such as avocados, leafy greens, zucchini, and sweet potatoes. Sipping on bone broth is also a good way to ensure you stay hydrated and prevent your symptoms from worsening. When homemade bone broth isn’t an option we are fans of Kettle & Fire. An electrolyte powder can also be very helpful here. Brands we trust include the unflavored powder from LMNT and Redmond’s Real Salt.
• Avoid foods that commonly cause loose stools. Caffeine (including coffee), dairy, sugar, fried foods, and spicy food can make symptoms worse. Warm beverages can also increase motility in your digestive tract. Avoiding these can help or at least reduce risk of making it worse.
• Increase soluble fiber. This adds bulk to your stool and holds onto water in the intestines to slow movement. Soluble fiber can be found in foods such as apples, beans, and citrus fruits. More easily, it is found in psyllium—which can be taken as the over-the-counter supplement Metamucil. Follow the instructions on the label for "Relief of Irregularity."
• Help your gut stay calm and in rest & digest mode. For about one minute before and four minutes after a meal, sit quietly and take long, slow, deep breaths into the belly. This helps to calm any overly excited GI nerves and muscles and can be repeated as often as needed throughout the day.
• Try an OTC anti-diarrhea medication. If the above isn't helping, try using an over-the-counter anti-diarrhea medication such as Bismuth Subsaliculate (Pepto-Bismol, Kaopectate) or Loperamide (Imodium). Follow the directions on the label for a maximum of two weeks. (It’s important that you do not take this medication for longer than two weeks at a time, as it’s not good for your gut long-term.)
• Consider Metformin ER. If you are taking Metformin, it may be helpful to change to Metformin ER (extended release) which can be better tolerated than standard immediate release Metformin. Stopping metformin altogether may also be an option. Please reach out to the Clinical Team to discuss these options if needed.

Your symptoms should improve after three to four weeks. If they don’t, please reach out to the Calibrate Clinical Team via the Support Center in the app. If your diarrhea gets significantly worse, or if you’re worried about being dehydrated, please stop the medication and reach out to the Clinical Team. And if you’re concerned your symptoms are urgent and may need immediate care, please seek care from your primary doctor or urgent care.