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June 14, 2025

Constipation from GLP-1 Medications: Causes & Natural Fixes

Constipation is one of the most common side effects of GLP-1 medications like Ozempic or Wegovy. Discover why it happens and how functional medicine can help.

Constipation from GLP-1 Medications: Causes & Natural Fixes

Constipation from GLP-1 Medications: Functional Medicine Solutions for Relief

GLP-1 receptor agonists such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound) are transforming the treatment of obesity, insulin resistance, and type 2 diabetes. But one common and frustrating side effect continues to plague many patients: constipation.

If you're dealing with slow or painful bowel movements after starting a GLP-1 medication, you are not alone. Constipation is one of the most frequently reported adverse effects in clinical trials and real-world practice.

Fortunately, there are safe, natural, and effective ways to manage GLP-1-induced constipation, especially when viewed through the lens of functional and integrative medicine.

Why GLP-1 Medications Cause Constipation

To understand why constipation happens, we need to look at how GLP-1 receptor agonists work.

Slowed Gastric Motility

GLP-1 medications mimic the action of glucagon-like peptide-1, a hormone that:

  • Enhances insulin secretion

  • Suppresses glucagon release

  • Delays gastric emptying

  • Reduces appetite

That delayed gastric emptying is a double-edged sword. It promotes satiety and helps with blood sugar control but also slows down the entire gastrointestinal tract, leading to:

  • Reduced peristalsis (gut contractions)

  • Longer intestinal transit time

  • Harder, drier stools

Reduced Caloric and Fiber Intake

Patients on GLP-1 medications often eat significantly less food due to appetite suppression. With that drop in total intake comes a corresponding drop in:

  • Fiber

  • Fluid

  • Magnesium, potassium, and other motility-supporting nutrients

This creates the perfect storm for sluggish bowels.

Dehydration

Many patients also drink less water without realizing it. Less fluid in the gut means:

  • Less lubrication

  • Firmer stools

  • Slower transit

Dehydration also concentrates electrolytes like calcium, which can have constipating effects.

How Common Is It?

In the STEP and SURMOUNT trials:

  • Constipation was reported in up to 24% of patients on semaglutide

  • 18-23% of patients on tirzepatide experienced constipation

It is one of the top three side effects of these medications and is more frequent in those who:

  • Lose weight rapidly

  • Eat low-fiber diets

  • Are female (due to hormonal factors affecting gut motility)

Conventional Treatment Approaches

Most providers recommend over-the-counter (OTC) remedies such as:

  • Stool softeners (docusate)

  • Fiber supplements (psyllium, methylcellulose)

  • Laxatives (PEG 3350, senna, Mag Citrate)

These can help in the short term but do not address the root cause. Some even worsen the problem over time, especially stimulant laxatives that impair long-term bowel function.

Functional Medicine Approach to GLP-1-Related Constipation

Rather than masking symptoms, functional medicine seeks to restore balance in digestion, hydration, and microbiota to promote regular, healthy elimination.

1. Optimize Hydration

  • Aim for half your body weight (lbs) in ounces of water daily.

  • Add a pinch of sea salt or an electrolyte mix to water to improve cellular absorption.

  • Warm liquids (like herbal teas) stimulate gut motility.

2. Increase Soluble and Insoluble Fiber

Many patients consume less fiber on GLP-1 medications due to reduced appetite. Yet fiber is essential for stool bulk and bowel regularity.

Key sources:

  • Ground flaxseed (great for both soluble and insoluble fiber)

  • Chia seeds (form a gel that eases passage)

  • Cooked vegetables like spinach, carrots, zucchini

  • Low-sugar fruits like berries, kiwi, and pears

Be cautious when adding fiber:

  • Increase slowly over 7-10 days

  • Always increase water intake alongside

3. Support the Gut Microbiome

A diverse and healthy microbiome is essential for motility. Dysbiosis (imbalanced bacteria) can worsen constipation.

Support with:

  • ProbioHealth 350: a high-potency, broad-spectrum probiotic powder

  • Fermented foods (kimchi, sauerkraut, yogurt)

  • Prebiotic-rich veggies (asparagus, garlic, onions if tolerated)

4. Use Natural Prokinetics and Bowel Support Agents

These substances stimulate natural gut movement without dependency:

  • Mag Citrate: Gently draws water into the colon

  • Vitamin C: Acts as a mild laxative when taken in higher doses

  • EZ-Go: our gentle daily bowel support formula with magnesium and herbal motility enhancers

  • Ginger and motility bitters: Stimulate digestive secretions and flow

5. Evaluate and Replete Key Nutrient Deficiencies

GLP-1 medications can lower intake and absorption of nutrients that regulate gut function:

  • Mag Citrate: critical for smooth muscle relaxation

  • Potassium: supports peristalsis

  • Vitamin B6 and B12: help produce neurotransmitters that regulate gut tone

Use our Micronutrient Lab to test levels and guide targeted supplementation. Consider:

6. Movement and Core Stimulation

Sedentary behavior worsens constipation. Physical activity stimulates bowel movement:

  • Walking post meals (especially 10-15 minutes)

  • Yoga poses like "wind-relieving pose" and spinal twists

  • Abdominal massage in clockwise direction to guide stool movement

7. Reduce Stress and Balance the Nervous System

Constipation is linked to poor vagal tone and excessive sympathetic (fight-or-flight) activity.

Interventions:

  • Deep diaphragmatic breathing (5-10 minutes before meals)

  • Vagal nerve stimulation (gargling, humming, cold exposure)

  • Adaptogenic herbs (ashwagandha, rhodiola) if stress is chronic

When to Worry: Red Flags

While constipation is common, certain symptoms require prompt medical attention:

  • Unexplained weight loss

  • Blood in stool

  • Severe bloating or pain

  • Vomiting

  • Constipation lasting more than 2 weeks despite intervention

Consult your provider if any of these are present.

Should You Stop the GLP-1?

In most cases, no. The metabolic and weight loss benefits of GLP-1 medications are substantial and typically outweigh the nuisance of constipation.

Instead, use the strategies above to manage and eventually resolve the issue.

That said, dose adjustment may help:

  • Slowing titration

  • Staying at a lower dose longer

  • Splitting the weekly dose (only under provider supervision)

Peptides That May Help

Certain peptides may complement GLP-1 therapy and relieve associated constipation:

  • BPC-157: Promotes gut healing, modulates inflammation, and may enhance motility

  • KPV: Anti-inflammatory tripeptide that supports intestinal barrier and microbiota

  • GHK-Cu: May regulate repair pathways and microbiome balance

These peptides are available through our clinic for appropriate patients seeking a more integrative approach.

A Sample Integrative Protocol

Here is a practical, foundational plan for anyone on a GLP-1 medication experiencing constipation:

Morning:

Midday:

  • 1-2 tsp ground flaxseed or chia in smoothie or meal

  • Light walk after lunch

Evening:

  • Mag Citrate or vitamin C powder to bowel tolerance

  • Wind-down yoga, breathing, or vagal stimulation practice

Weekly:

Final Thoughts: Constipation Is Common, But It Is Fixable

GLP-1 medications are a major advancement in metabolic medicine. But constipation doesn’t have to be part of the package.

Using a functional medicine framework, we can:

  • Identify underlying triggers

  • Restore gut rhythm

  • Support hydration and nutrition

  • Leverage safe, natural therapies for relief

Whether you’re on Wegovy, Ozempic, Mounjaro, or Zepbound, your bowel function can be supported and normalized without needing to stop your medication.

Take Action Now

If you’re struggling with constipation on a GLP-1 medication:

You deserve the benefits of GLP-1 therapy without the discomfort of constipation. Let us help you feel better from the inside out.

References

  1. Davies M, et al. "Semaglutide 2.4 mg Once Weekly for the Treatment of Obesity." NEJM, 2021.

  2. Frøkjær JB, et al. "GLP-1 receptor agonists and gastrointestinal side effects: Mechanisms and management." Diabetes Obes Metab, 2022.

  3. Malki M, et al. "Functional constipation: Advances in diagnosis and therapy." Nat Rev Gastroenterol Hepatol, 2020.

  4. Rao SSC. "Pathophysiology of Adult Chronic Constipation." Clin Gastroenterol Hepatol, 2007.

  5. Staller K, et al. "Mechanisms, Evaluation, and Management of Chronic Constipation in Adults." Gastroenterology, 2023.

  6. Hyams JS, et al. "Childhood Functional GI Disorders: Neurogastroenterology Approaches." Neurogastroenterol Motil, 2016.

  7. Slavin JL. "Dietary fiber and body weight." Nutrition, 2005.