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doi: 10.1126/science.aam9690

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weeks 1-16 on tirzepatide Semaglutide GI rate / 44.2% nausea, 31.5% diarrhea, 23.4% constipation in STEP-1 (N=1,961) Tirzepatide GI rate / approximately 80% of patients on 15 mg reported at least one GI effect in SURMOUNT-1 (N=2,539) First-line fix / avoid high-sulfur foods (eggs, garlic, cruciferous vegetables) on injection days Medication option / simethicone (Gas-X, 125 mg) or bismuth subsalicylate (Pepto-Bismol) may reduce odor and frequency Serious warning / new right-upper-quadrant pain plus burping may signal gallbladder disease, not routine GI upset Discontinuation / roughly 7% of semaglutide 2.4 mg patients stopped due to GI side effects in STEP-1 Dose strategy / slower titration reduces GI burden without meaningfully reducing weight loss outcomes What Causes Sulfur Burps on GLP-1 Drugs GLP-1 receptor agonists slow gastric emptying as a deliberate pharmacological effect