GLP 1 supplements like Ozempic, Wegovy, and Mounjaro are widely used for diabetes and weight management. If you already have a longstanding digestive or liver condition, you may wonder whether these medications are right for your gut or liver conditions.
How these drugs affect digestion
They work by slowing stomach emptying and overall transit time in the bowels and influence the release and actions of gut hormones that regulate appetite and digestion. These mechanisms help lower blood sugar and promote weight loss.
However, they can also lead to common gastrointestinal side effects such as:
- Feeling full very quickly (desirable for those looking to lose weight)
- Nausea and vomiting
- Bloating, indigestion, and reflux
- Constipation or diarrhoea
Most people find these effects settle with time or a slower dose increase. However, for those with pre-existing gastrointestinal conditions, symptoms may be more intense or persistent.
Gastroparesis (Slow Stomach Emptying)
Gastroparesis is a condition where the stomach takes too long to empty its contents, leading to bloating, early satiety, nausea and in severe cases vomiting, regurgitation and worsening reflux. These medications slow gastric emptying as part of their mechanism, which can mimic or exacerbate symptoms of gastroparesis.
There are case reports of patients developing severe symptoms that resolved after discontinuing GLP 1 supplements. There are no clinical trials on GLP‑1 use in patients with diagnosed gastroparesis.
If you suspected delayed gastric emptying or have been diagnosed with it, it is strongly advised to consult a Gastroenterologist prior to- and if on these medicines.
IBS (Irritable Bowel Syndrome)
IBS is a gastrointestinal disorder that causes abdominal pain and altered bowel habits. This is usually due to a disordered interaction between the gut and the brain. It includes subtypes such as constipation-predominant (IBS‑C), diarrhoea-predominant (IBS‑D), or a mixed variety.
GLP‑1s may worsen IBS‑C by further slowing gut transit. For IBS‑D, the effect is less predictable and may vary between individuals with some finding them beneficial.
Remember IBS is diagnosed once other causes have been ruled out. There are many situations where an initial diagnosis of IBS ultimately turns out to be an Inflammatory Bowel Disease.
Speak to your Gastroenterologist if you need further clarification prior to taking GLP 1 supplements or if your symptoms flare whilst on them.
What About GLP 1 supplements and Inflammatory Bowel Disease (IBD)?
If you have Crohn’s disease or ulcerative colitis—or a family history of IBD—you may wonder whether weight-loss or diabetes medications like Ozempic or Mounjaro are safe to use.
Current available research suggests GLP-1 injections do not increase the risk of developing IBD. In fact, some studies suggest they may have a mild anti-inflammatory effect in the gut. Large observational data from Scandinavian countries even hint that people taking GLP 1 supplements may be less likely to develop new-onset IBD compared to those on older diabetes medications.
That said, people with active Crohn’s disease, bowel strictures, or previous bowel surgeries should be cautious. These medications can slow down gut motility, which may not be ideal if you already have narrowed or inflamed bowel segments.
Always discuss with your gastroenterologist before starting and alert them of any change in symptoms.
Reflux & Functional Dyspepsia
Gastro-Oesophageal Reflux Disease (GORD-reflux or short) occurs when stomach acid/fluid backs up into the oesophagus.
Functional dyspepsia includes symptoms like bloating, early fullness, and upper abdominal discomfort without a clear cause.
GLP‑1 drugs may increase the risk of reflux by delaying gastric emptying. This simply means food and other contents stay in the stomach longer and tends to move into the Oesophagus easier, and for longer.
Managing reflux is difficult. Over the counter drugs and acid suppressants only do so much to alleviate reflux (not all reflux is acid). Weight loss ultimately improves reflux and its symptoms.
Your gastroenterologist will advise on the best course of action if your reflux worsens. There are tests that can correlate your symptoms with reflux.
Gallstone & Gallbladder Disease
GLP‑1 medications are associated with an increased risk of gallstone formation, particularly during rapid weight loss. They slow gallbladder movement, leaving the bile in for longer and increase biliary cholesterol concentration. This effect is potentiated by fasting due to reduced food intake.
Studies have shown a 30–55% increased risk of gallstones or gallbladder complications in GLP‑1 users, especially at higher doses or with prolonged use.
Gallstones may move into the bile duct to cause severe pain, jaundice or infections and less commonly, pancreatitis. This may require procedures such as EUS and/ or ERCP (where gallstones are looked for and removed), usually performed by a Gastroenterologist.
Speak to your Gastroenterologist if you have Gallstones and are planning on taking GLP-1 drugs.
Pancreatitis (Pancreas Inflammation)
Acute pancreatitis has been reported in some individuals using GLP‑1 medications, although this remains uncommon. It is postulated that pancreatitis may be secondary to gallstones, however we do not know this with certainty.
Post-marketing surveillance and observational studies have raised some concern, prompting regulatory reviews. In fact, patients are encouraged to report pancreatitis whilst on GLP-1 drugs here :https://yellowcard.mhra.gov.uk
People with a prior history of pancreatitis are generally considered at higher risk. These drugs are best avoided in this scenario. Symptoms such as severe abdominal pain, nausea, vomiting, or fever should prompt immediate evaluation by calling 111 or attending A&E.
For those with chronic pancreatitis, it is advised to closely follow up with a Gastroenterologist while on GLP-1 drugs.
Chronic Liver Disease & Liver Fibrosis
Chronic liver disease includes a spectrum of conditions from fatty liver (MASLD/MASH) to cirrhosis. In fatty liver disease, GLP 1 supplements show promising benefit.
A study called the LEAN trial found a similar drug called Liraglutide improved liver inflammation and fibrosis in patients with MASLD. Ozempic has shown a 59% resolution rate of steatohepatitis in trials, though fibrosis improvement was less clear.
In patients with other chronic liver diseases, such as viral hepatitis or alcohol-related liver disease, evidence is limited but early data suggest GLP‑1s may help reduce liver fat and improve liver enzymes. This is best followed up by a Gastroenterologist or Hepatologist.
There are increasing reports of reduced alcohol intake due to effects on addictive behaviours, whilst on Ozempic and Mounjaro. This appears to suggest an indirect benefit, although no recommendations can be made to use these drugs for this purpose.
However it is important to remember that any medicine can cause an acute inflammation of the liver.
Speak to your Gastroenterologist, test and evaluate liver enzyme elevations. It is always better to follow up to look at the trends of these enzymes over time.
Autoimmune Liver Diseases
Autoimmune liver conditions such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis have not been studied in GLP‑1 clinical trials.
There is no data to suggest harm or benefit, so these medications should be used cautiously and only with specialist input. Immune-modulating effects, if any, of these drugs are not well understood in this context.
Speak to your gastroenterologist in these situations.
Rare But Important Risks
Though uncommon, serious adverse events like acute pancreatitis, gastroparesis requiring hospitalisation, intestinal obstruction, and rare vascular events have been reported.
If symptoms such as severe or persistent abdominal pain, vomiting, jaundice, or inability to tolerate food occur, urgent medical attention is advised by calling 111 or attending A&E.
These events should not be ignored, especially in individuals with known gastrointestinal or hepatobiliary vulnerabilities.
What We Still Don’t Know
There are significant gaps in evidence regarding the safety of GLP 1 supplements in people with existing gastrointestinal or liver diseases. We lack trials that specifically include patients with these conditions, and long-term effects are unclear.
More research is needed to guide decisions about the use of these medications in complex patients, especially when considering long-term therapy.
Why a Coordinated, Multi-disciplinary Care Matters
These drugs are here to stay, with overall positive effects for much of the population.
People with digestive or liver conditions considering GLP‑1 therapy should be managed through a multidisciplinary approach. This may include input from an endocrinologist, gastroenterologist, hepatologist, and a primary care physician. Monitoring symptoms, lab tests, and imaging should be standard.
Never stop or start GLP‑1 therapy without medical guidance. Personalised decisions offer the safest and most effective outcomes.
Final Takeaway
GLP 1 supplements can be safe and effective—but their use in chronic gastrointestinal and liver conditions must be considered carefully.
There is evidence of benefit in fatty liver disease, but caution is needed for conditions like gastroparesis, gallstones and pancreatitis
Work with your care team, ask questions, and ensure monitoring is in place before and during treatment.
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