Something nobody mentions — peppermint. Peppermint oil capsules (enteric-coated so they don't dissolve in your stomach) helped me more than ginger honestly. I take one before each meal.
Also B6 (pyridoxine) 25 mg twice daily. It's what they give pregnant women for morning sickness and the mechanism is surprisingly similar to GLP-1 nausea.
Good point on B6. The combination of doxylamine + pyridoxine (sold as Diclegis/Bonjesta for pregnancy nausea) does have some off-label use in GLP-1 patients. The evidence is anecdotal but the safety profile is well-established.
One caution on peppermint: it relaxes the lower esophageal sphincter, so if you're also experiencing reflux (common on GLP-1s), peppermint can make that worse. Pick your battles.
5 months in and my nausea trick is stupid simple — I eat a handful of plain saltine crackers 20 minutes before any real meal. Something about having a little starch base in there prevents the worst of it. Also I switched to injecting in my thigh instead of my belly and swear the nausea is milder, though that might be placebo.
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Browse GL BiochemFor what it's worth, the STEP trials showed nausea was dose-dependent and time-limited for most participants:
- Median onset: within first 8-12 days of starting or increasing dose
- Median duration per episode: 3-5 days
- Resolution without intervention: ~70% of cases by week 20
- Discontinuation due to nausea specifically: only about 3-4% of trial participants
So statistically, the odds are strongly in your favor that it resolves. The people who post about nausea are self-selecting — the 56% on sema who never experienced significant nausea aren't posting about it.
Great contributions everyone. Pinning a summary at the top:
The Nausea Toolkit:
- Ginger capsules 250 mg QID or ginger tea
- Smaller, more frequent meals
- Avoid high-fat foods 48h post-injection
- Evening injection timing
- B6 (pyridoxine) 25 mg BID
- Saltines or bland starch before meals
- Slow sips of electrolyte drinks
- Talk to your prescriber about ondansetron if severe
- SLOW YOUR TITRATION if needed
Red flag: if you can't keep fluids down for 4+ hours, contact your provider or go to urgent care. Dehydration can cause serious complications.