The Night My Stomach Won

A surgeon's lesson in nausea, projectile vomiting, and why the smartest thing you can do on a GLP-1 is listen to your stomach.

One of the most uncomfortable side effects of GLP-1 medications is nausea, and if you don’t treat it properly, it can progress to vomiting.

Last night, because of several poor decisions, I experienced projectile vomiting, which impressed me.

My job is to keep you from making those same decisions.

I’ve dealt with nausea and vomiting throughout my career as a surgeon, with post operative patients, bowel obstructions, ileus, and when I was in the pediatric wards - well, you can imagine.

Because GLP-1 drugs keep things in the stomach longer than normal (GLP-1 medications “delay gastric emptying”), and that can lead to nausea and vomiting.

What a normal Stomach Does

Normally, your stomach empties liquid quickly. A glass of water leaves the stomach in about 15 minutes. Solid food stays longer. If you eat a steak, the stomach will grind the steak up, attack it with acid and enzymes. After two hours, the steak will have the consistency of a milkshake. The valve at the end of the stomach (the pylorus) will open, and food will go into the first part of the small bowel, called the duodenum. Before that, the pylorus opens only enough to let small amounts of liquids and small particles of food out.

GLP-1 medications Delay That Opening

When you are on a GLP-1, your stomach empties a lot slower. It doesn’t mean you cannot challenge the stomach and add more food, but your stomach will not always appreciate it.

Some see this as one of the reasons we lose weight. We feel full longer. Although I think what happens in the brain is far more important. Still, feeling full with less food is a benefit.

But if your stomach is having an “off” day after you inject (and for some people this could be 1-3 days), it is time to treat it with care. And knowing that high fat foods can cause a problem, it might be time to put pizza, fried foods aside for a bit. Yes, I know the purists out there will say we should never eat such foods, but this isn’t a discussion of perfect nutrition, it’s about what your stomach can handle today.

Foods that Delay the stomach -

Fatty foods delay stomach emptying, fried foods, pizza, cheese, fatty meats. So do high fiber meals. The soluble fibers found in oats and beans form a gel that travels slowly through the stomach. So do large volume meals, high calorie density meals, and smoothies and milkshakes.

If you are feeling a bit full, and the stomach isn’t emptying, the last thing you want is a fried chicken wing and ice cream. Don’t ask me how I know that - OK, I proved that at 2 am.

Comfort Foods

We all want comfort, especially when we don’t feel well. But the comfort foods of our past are often not friendly to a stomach that isn’t emptying well. There is a big difference between how the stomach treats a fried chicken wing, and a bit of chicken breast that is oven roasted. Pizza might be comfort food or even a college diet, but this isn’t the time for that food. Your stomach will rebel. It also isn’t the time for alcohol.

The first priority is hydration.

Not all hydration solutions are created equal. This is not the time to fear a bit of sugar. Pedialyte is found in most grocery stores and pharmacies. It is based on the formula for rehydration solutions that we physicians have used for decades.

Glucose (sugar) helps the intestine absorb the electrolytes more effectively than those products without sugar. I’ve written a post about rehydration solutions on Substack for more information.

I keep Pedialyte popsicles in my freezer. If I get sick, or a member of my family, rehydration can begin sooner. Even diluted apple juice with a bit of salt. There are other high-quality solutions, like Oral Rehydration Salts (ORS), Liquid I.V., or diluted sports drinks.

Instead, think about foods that are easy on the stomach. Toast. Crackers. Applesauce. Rice. Soup. Plain cereal with oat milk. A banana. Plain grilled chicken. They may not sound exciting, but remember, your goal isn’t culinary adventure. Your goal is to let your stomach catch up.

One thing surprised me. Yesterday, my usual protein smoothie didn’t sound good at all. Normally I love it. That’s another lesson. Don’t force food, because it’s on your meal plan. If your stomach says no, listen. There will be another day to get your protein.

Last night taught me something I should have known as a physician. When your stomach talks, listen. Once you have nausea, it is time to pay attention. Most people on a GLP-1 will have a day when their stomach says, "Not today." Knowing how to respond can make the difference between an unpleasant afternoon and a miserable night.

When to Worry, How to take care of yourself

Here is how I took care of myself. Yes, it was a horrible time. But knowing how to recover, what traps to avoid, and when to call for help is important.