Acid Reflux and GLP-1s: Understanding the Connection

Suffering from more acid reflux since you started taking a GLP-1 medication?  Learn why it happens—and how to quell the burn.

What Is GLP-1? 

The acronym GLP-1 stands for glucagon-like peptide-1, a naturally occurring hormone. The medications are more specifically referred to as GLP-1 receptor agonists, which mimic the actions of the natural hormone. Doctors prescribe GLP-1 agonist medications for diabetes management and weight loss. They come in either short-acting forms (that often require twice-a-day or daily dosing) and long-acting forms (once-a-week dosing). (Click here for more background on GLP-1 medications and their use for weight loss.)  

How Do GLP-1 Medications Work?

GLP-1 receptor agonists have multiple effects that together provide benefits for diabetes and weight loss. In fact, the earliest formulations were created for people with type 2 diabetes whose blood sugar levels did not respond well to other medications, such as metformin. Weight loss was also observed, and since weight management is often recommended for adults with type 2 diabetes, this finding was a beneficial side effect of taking the medication. Today, many GLP-1 medications (such as Trulicity, Byetta, Victoza, Ozempic, Rybelsus, and others) are routinely prescribed as supplemental medications to help with glycemic control in adults with diabetes. However, there is also a lucrative secondary market for them among those who do not have diabetes but are seeking weight loss.

What specifically do these medications do? Their actions include:

• managing blood sugar levels (through effects on insulin secretion and glucagon hormone)

• depressing hunger levels and influencing perception of satiety

• slowing gastric emptying

• lowering hemoglobin A1c levels

Gastrointestinal Side Effects from GLP-1 Medications

Though effective for their purposes, GLP-1s are not without side effects. According to a recent narrative review of weight loss trials using GLP-1 receptor agonists, a whopping 80% of participants experienced some adverse effects. Most of the side effects reported by users are gastrointestinal (GI) in nature. As dosages increased, so did the negative effects. With continued use, reports of GI issues tend to taper off. For some people, however, the side effects are reason enough to discontinue use of the medications.

Some of the most common GI side effects include: 

• Nausea

• Bloating

• Reflux

• Diarrhea

• Abdominal pain

• Constipation

Other side effects (including anecdotal reports and those noted in clinical studies) include gallstones/biliary disease (which is associated with speedy weight loss due to other causes as well), gastroparesis, and pancreatitis, among others. More research is needed to determine the extent to which the use of GLP-1 medications causes or is related to these conditions. 

What’s The Link Between GLP-1s and Acid Reflux? 

Scientific research supports a link between the use of GLP-1s and increased acid reflux or gastroesophageal reflux disease (GERD). The primary mechanism suggested for this effect is the delayed gastric emptying caused by the medications. So far, research does not indicate that GLP-1s increase gastric acid production or reduce pressure on the lower esophageal sphincter (LES). These two possible contributing causes need additional investigation. 

A number of the published studies where increased reflux was shown among GLP-1 users were conducted in populations who have type 2 diabetes. And delayed gastric emptying is also found in a portion of people who have diabetes. Perhaps in this population, the slow gastric emptying effects are additive, creating more gastroparesis and increasing the likelihood of reflux. 

Interestingly, a small, older study found that subjects aged 70 and older reported GERD symptoms earlier in their treatment than those under the age of 70. While advancing age is not strongly associated with GERD symptoms, it is associated with GERD complications, such as esophageal strictures.

Whether or not you have type 2 diabetes, if you already have GERD or reflux and are considering taking a GLP-1 medication (or if you are already taking the medication and are now experiencing more reflux), there are a few takeaways to consider from these studies:

1. According to the research, the link between GLP-1 medications and reflux occurs with the short-acting forms of the drugs—not the longer-acting forms. 

2. Nearly all GLP-1 agonist medications are available in long-acting forms.

3. Short-acting GLP-1 agonist medications have been linked with a higher risk for erosive reflux disease (ERD), a complication of GERD.

Managing Acid Reflux and GERD While Taking GLP-1s

Having reflux occasionally during your GLP-1 journey is likely tolerable and relatively easily addressed by avoiding overeating and trigger foods, such as using over-the-counter antacids and other short-term strategies. However, chronic reflux, such as with GERD, may be enough to deter you from taking the medication. Therefore, preventing GERD symptoms while you’re taking GLP-1 medication is preferable to trying to “cure” the burn. Since GLP-1s are taken for months at a time, or perhaps indefinitely, discussing your symptoms with your physician is important. 

Lifestyle Modifications to Tame Reflux For GLP-1 Medication Users

Making changes to your usual lifestyle habits may help with chronic reflux symptoms. Some of these changes are particularly relevant if you’re on a GLP-1 agonist medication. These include:

• Eating smaller meals — this is a common recommendation for everyone with acid reflux and GERD. However, it’s especially appropriate for GLP-1 medication users because of slowed gastric emptying and the increased perception of satiety. Portion control is of prime importance when you feel full faster than usual. 

• Drinking water throughout the day—no guzzling. Distension of the gut from water or food can trigger reflux. Also, the more you drink at mealtimes, the less food you’ll want to eat—and prioritizing a healthy balance of nutrients when you’re eating smaller amounts of food overall is important. Consider just taking small sips of water with meals and saving most of your water drinking for between-meal times. Check here for more on the water-reflux link.

Other lifestyle habits that can decrease your risk of reflux include not eating too close to bedtime, avoiding trigger foods and alcohol, not reclining after meals, raising the head of your bed for sleeping, taking a leisurely walk after dinner, and avoiding tight-fitting clothing. 

Do you have any experiences with GLP-1s and reflux? Please share!

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