Whether you’ve just been prescribed injectable Ozempic or you’re a few days into your daily Rybelsus prescription, there’s a good chance your doctor has asked you to consider some lifestyle adjustments. Part of a class of medications known as GLP-1s, semaglutide prescriptions (including Ozempic, Wegovy, Rybelsus and more) work in part to mimic a gut hormone that enables the pancreas to produce insulin when blood sugars spike. For those with diabetes, these medications help to lower a high HBA1C over time.
But semaglutide also simultaneously impacts how food interacts with your gastrointestinal tract in doing so; for patients prescribed Wegovy in particular, the drug may change the way your body processes meals which you may previously be used to eating regularly.
Doctors counsel patients who are being prescribed semaglutide about a range of lifestyle changes they’ll need to make for meds to work as intended. This is particularly true when it comes to diet and nutrition, as certain foods and grocery staples may exacerbate side effects associated with semaglutide medications. Because semaglutide is so routinely linked to gastrointestinal (GI) distress, doctors also may broach other tactics to avoid these often painful and day-ruining side effects; tools such as portion control and limiting alcohol intake, for example.
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While it’s true that restructuring your diet may indeed help you lessen side effects associated with semaglutide medications, most doctors aren’t expecting patients to eliminate entire food groups altogether. It’s more about careful moderation, especially over the first few doses of medication. Materials published by Novo Nordisk (the manufacturer of Ozempic and Wegovy) indicate that there aren’t any specific foods patients must fully eliminate entirely — but foods high in fat, added sugars and saturated in caloric intake are known to not only potentially worsen side effects, but work against patients who are working to manage type 2 diabetes and clinical obesity.
Just how does what you eat impact you while you take semaglutide, you may wonder? Common side effects include nausea, vomiting, diarrhea, constipation and fleeting or chronic stomach pain; and while appetite is indeed minimized, for most, it is not fully erased. Some foods may worsen any potential vomiting or diarrhea, while others don’t.
Read on to learn more about the kinds of dietary changes that may soften Ozempic side effects and other top-level tips from experts.
Editor’s note: Weight loss, health and body image are complex subjects — we invite you to gain a broader perspective by reading our exploration into the hazards of diet culture.
The author of this article is currently taking Ozempic as part of his prescribed medical treatment plan for type 2 diabetes. Our reporting has not been influenced by Novo Nordisk or any other pharmaceutical agency.
What doctors warn patients against before prescribing Ozempic
Because Ozempic and other semaglutide medications slow down your gastrointestinal tract — which helps you feel fuller longer, stemming your appetite — nausea and other stomach-related side effects are common. Materials published by the Food and Drug Administration (FDA) indicate that almost 20% of all people on Ozempic, in particular, experience stomach pain and discomfort at some point. It’s why semaglutide medication is often titrated, or dosed in increasing increments over a longer span of time, for many patients: to prevent severe, uncontrollable side effects.
There aren’t foods that are entirely or fully restricted while on Ozempic — but doctors advise against some food groups because they delay what’s known as gastric emptying. “It varies patient to patient, but fat intake and alcohol intake may prompt or worsen existing nausea, vomiting, heartburn, or reflux symptoms because of this,” explains Todd Worley, M.D., FACS, an obesity medicine specialist and bariatric surgeon at Houston Methodist Hospital in Texas, who is commonly prescribing patients both Ozempic and Wegovy.
More importantly, patients are asked to minimize processed foods, highly caloric foods, added sugar and alcohol because in addition to potentially worsening GI symptoms, these food groups are known to impact blood sugar. Part of the nutritional counseling that many doctors conduct before prescribing semaglutide focuses on helping this medication better control insulin production; any foods that cause blood sugar spikes work against the purpose of the medication in the first place, which is why doctors advise against them.
Alongside focusing dietary efforts to help keep blood sugar low, Dr. Worley adds that patients who are just starting a semaglutide medication regimen are advised about the following lifestyle efforts.
“The first thing is that patients taking semaglutide need to hydrate, hydrate, hydrate, even more so in the summer months,” Dr. Worley explains. Because semaglutide decreases appetite, especially initially, some patients may choose to reduce how much water they drink. “This can lead to some element of dehydration, which can lead to or exacerbate nausea, constipation, fatigue, malaise, dizziness or even more dangerous issues such as acute kidney injury.” To best avoid this, Dr. Worley suggests drinking at least 64oz of water each day, but everyone’s true hydration needs will differ based on their own activity level.
The best foods to eat while taking Ozempic
Because there isn’t one set “Ozempic diet” for all patients, many healthcare providers often ask those on semaglutide prescriptions to meet with registered dietitians and nutritionists to better understand their nutritional needs. There isn’t just one kind of diet that is used to better treat type 2 diabetes or address clinical obesity — but in general, doctors ask patients to eat foods that are considered low-glycemic, meaning they do not raise or lower blood sugar levels rapidly after they are consumed. Eating these foods alongside low-fat, fiber-rich staples is also less likely to trigger or worsen gastrointestinal distress.
According to the American Diabetes Association (ADA), for those with diabetes specifically, you’ll want to lean into low-glycemic foods that are high in protein naturally, packed with gut-friendly fiber and saturated in healthy fats. Frontloading your diet with fiber-rich foods can also help you feel full and more satiated for longer during the day. And for most patients, introducing new sources of dietary fiber into meals should be done slowly over time — too much fiber (and fiber supplements) may worsen gas, bloating or constipation in the end.
Alongside lowering calorie intakes and controlling portion sizes, these foods may have the best sort of effect on keeping blood sugars steady. Some examples of these kinds of foods and food groups include:
- Fresh fruits that are considered diabetes-friendly due to sugar content, which includes apples, berries, peaches, pears and more.
- Vegetables of all kinds, including fiber-rich leafy greens.
- Whole grains and unprocessed starchy sides.
- Low- and non-fat dairy products, including yogurt, cottage cheese and milk.
- Most any meal or foods that are favored in low-fat, low-carbohydrate diets — some commonly referred programs, according to ADA materials, are the Mediterranean diet as well as vegetarian diets.
While these general dietary tentpoles are applicable to most, all patients who are prescribed a semaglutide medication spend significant time discussing nutritional needs and lifestyle approaches with their primary care doctor and additional specialists as needed.
It is crucial that you seek medical advice about your diet and lifestyle from a healthcare provider that is familiar with your in-depth medical history, and is aware of any other medical conditions you may have.
Foods to avoid while on Ozempic
Nothing is entirely off limits to those who are on Ozempic or other semaglutide medications — rather, moderating certain food groups can help you ease side effects and gastrointestinal symptoms if they are impacting you during treatment. “In general, patients should avoid added sugar and processed food — or what we may know as ‘junk food’ — as much as possible,” Dr. Worley summarizes.
Minimizing the following foods may help reduce the likelihood of experiencing gastrointestinal side effects, including nausea, vomiting, heartburn and reflux symptoms, Dr. Worley explains.
1) High-fat foods
This is a wide umbrella to consider, but generally focuses on fried foods and greasy meals that make use of full-fat dairy and oil-heavy styles of cooking. Research has long indicated that even those without diabetes or non-obese individuals can experience upset stomach and digestive issues when eating deep-fried foods, which means those on semaglutide medications are facing a higher likelihood of GI issues if they regularly eat fried, greasy meals.
2) Trans and saturated fats
Closely related to fried, greasy foods and snacks, highly saturated fats (including trans fats) are known to exacerbate GI issues. Every day staples like whole milk, heavy cream, full-fat cheese, butter, ice cream and most red meats may cause additional gastrointestinal distress for someone on Ozempic. You’ll want to pivot to food groups that make use of healthier fats, namely monounsaturated and polyunsaturated fats, including lean fish, olive oil and most nuts.
3) Added sugar
Sugar has a way of sneaking into items you wouldn’t expect — including foods like sauces and salad dressings, savory bakery items like bread, and frozen, ready-to-eat meals. For those with diabetes in particular, high-glycemic foods (or foods that contain a lot of sugar and subsequently spike blood sugar) can work against the nature of semaglutide medication. For that reason, you’ll need to seriously budget how much candy, soda, fruit juice and dessert you enjoy. They should be heavily moderated and substituted when possible.
4) High-sodium foods
This often translates into highly processed food, including grab-and-go snacks like potato chips, canned foods including soups and a lot found in drive-thrus or frozen aisles in the grocery store. Many Americans consume too much sodium currently; around 90% of all Americans over the age of two are eating too much salt, according to figures released by the Centers for Disease Control and Prevention (CDC). Added sodium in your diet often increases blood pressure and leads to heart disease, a potentially deadly combo for anyone who is diagnosed with type 2 diabetes. Because added salt often is found in overtly caloric and fat-laden foods, seeing high sodium counts on a nutrition label should give you pause if you’re worried about an upset stomach.
5) Refined carbohydrates
Foods and grocery staples that are high in carbohydrates — especially those that are overly processed and don’t offer many holistic nutrients — can easily spike your blood sugar. White bread, boxed pasta, sugary cereals and starchy bagels are prime examples of grocery staples that may wreck your blood sugar counts if you’re not careful. Compared to whole, unprocessed grains that may add fiber and other nutrients into the mix, refined carbs miss many nutrients available in staples like wild rice, quinoa, buckwheat and farro. Fiber-rich carbohydrates are usually much easier to digest than others, too.
6) High-glycemic starchy vegetables
While you shouldn’t often discriminate against vegetables available to you, some veggies are worth more nutritionally than others, especially when it comes to reducing risk of GI distress. Potatoes are a prime example: They may spike blood sugar when consumed due to their carbohydrate counts. Others to limit include corn, carrots, and peas. While all vegetables are nutritious and should be enjoyed as much as possible, swapping out starchy vegetables for diabetes-friendly options like broccoli, zucchini, or green beans can help your medication work better in the long run.
A special note about alcohol: Because semaglutide slows down digestion, eliminating alcohol or restricting it as much as possible may save you from irritating your stomach. Alcohol is a known irritant to gastrointestinal systems and, when combined with semaglutide, consumption may raise your risk of developing what’s known as hypoglycemia, or low blood sugar.
Why can’t I eat much on Ozempic?
Ozempic and many other semaglutide-based medications work to suppress your appetite by influencing hormones in your body. They also cause your stomach to process food more slowly, leaving you feeling fuller, longer; all of this translates to many patients feeling less hungry than they’ve ever felt before, explains Dr. Worley.
If you’re feeling nauseous while injecting or taking semaglutide medications, you’re not alone — nausea and upset stomach are among the most commonly reported side effects for Ozempic, in particular. Healthcare providers have established that many side effects associated with Ozempic lessen as the patient increases their dosage and acclimates to the medication.
“Hydration is key to preventing or minimizing nausea, especially when starting semaglutide,” Dr. Worley explains. “For more severe or refractory cases, people should contact their provider for guidance. Often times, a short-term antiemetic — or anti-vomit medication — may help during the initial few doses.”
What you eat may also play a role in how hungry you feel while taking Ozempic and other semaglutide medications. Adapt your approach to meals with the following tips if you find your appetite is being hampered by side effects:
- Eating smaller amounts with an increased frequency during the day; splitting meals into snacks over multiple hours, for example
- Eating more slowly and chewing more thoroughly with each bite
- Avoiding alcohol consumption
- Cutting out spicy foods
- Reducing the amount of added sugar you eat to avoid sky-rocketing blood sugar spikes
The bottom line: There isn’t a one-size-fits-all diet approach for those on Ozempic, Wegovy or other semaglutide medications currently on the market. Anyone starting a new medication regimen, including semaglutide, must consult their healthcare provider to ensure proper nutritional needs are being met. Doctors often direct their patients to see registered dietitians for this reason, and to address other damaging food habits that may be particularly risky for those with diabetes.
Because semaglutide medications have been linked to side effects like nausea, vomiting, diarrhea and constipation, streamlining your diet may help reduce the likelihood of experiencing these potentially chronic side effects. More often than not, foods outlined above make it harder for semaglutide medications to control insulin release, making it well worth your time to limit your exposure to added sugar, fatty, greasy meals, refined carbohydrates, alcohol and excessive sodium.
Zee Krstic is a health editor for Good Housekeeping, where he covers health and nutrition news, decodes diet and fitness trends and reviews the best products in the wellness aisle. Prior to joining GH in 2019, Zee fostered a nutrition background as an editor at Cooking Light and is continually developing his grasp of holistic health through collaboration with leading academic experts and clinical care providers. He has written about food and dining for Time, among other publications.
Associate Professor of Clinical Medicine and Attending Endocrinologist at the Weill Cornell Medical College
Rekha Kumar, M.D. is recognized as an international leader in the field of obesity medicine. She is a practicing endocrinologist in New York City and served as the former medical director of the American Board of Obesity Medicine. Dr. Kumar has lectured internationally on the topic of the medical assessment and treatment of obesity. She has published several papers and textbook chapters in her field and serves as an associate editor of the journal Obesity. She is frequently quoted in the media on topics ranging from the diabetes epidemic in the United States to discussing fad diets, exercise trends, and the complications of Covid-19 in patients with obesity. Dr. Kumar’s areas of expertise include the clinical assessment of patients’ obesity and metabolic syndrome, the effect of obesity on reproductive health and fertility, as well as thyroid disease, and metabolic bone disease.