What Patients Should Know About GLP-1s and Gastroparesis

Over the past few years, GLP-1 medications have been capturing national attention. These drugs were first developed to treat type 2 diabetes, but now GLP-1s such as Ozempic and Wegovy are also being used for weight loss, often with dramatic results. “Some of my patients have lost about 30 to 40 pounds over the course of two or three months,” reported cardiologist Andrew Freeman, MD.

This new option has been welcomed in the fight against obesity in the U.S. But as prescriptions have increased, so have questions about side effects. One of these is gastroparesis, also called stomach paralysis.

“Gastroparesis is essentially a delay in the emptying of the stomach,” explained gastroenterologist Pranav Periyalwar, MD, who has seen cases increase as a direct result of GLP-1 usage. “Sometimes it's caused from diabetes and years of desensitizing the nerve endings in the gut, which can decrease the motility of the stomach. Sometimes it can be idiopathic, meaning there's no clear cause. And sometimes, it’s caused by a GLP-1.”

According to Dr. Periyalwar, this side effect comes from the way GLP-1s affect the digestive tract. The same sense of fullness, or “early satiety,” that prevents overeating can also slow the gut down. “In some cases, this slowing down of the process causes both diarrhea and constipation. So, we really want to alert people on GLP-1s about this possibility.”

Is GLP-1-Caused Gastroparesis a Chronic Condition?

Gastroparesis caused by diabetes or other health issues can be chronic, sometimes lasting for months or years. But when it’s linked to GLP-1s, gastroparesis usually isn’t permanent. “The gastroparesis symptoms are side effects of GLP-1s,” said Dr. Periyalwar. “Stopping the GLP-1 or cutting down the dose will usually improve it.”

The overall risk also seems to be low. “Studies have shown rates of less than 2% with gastroparesis side effects,” said Dr. Periyalwar. He explained that broader “motility issues” — changes in how food moves through the digestive system — are more common. “Motility issues can happen anywhere from the esophagus, the stomach, small intestine or large intestine. All of those things can potentially result in symptoms,” he said. Constipation is the most frequent problem, but it can often be managed with fiber or laxatives.

Balancing Risks and Benefits

Although gastroparesis is rarely dangerous, its symptoms — nausea, constipation, or diarrhea — can still affect daily life. “They’re not life-threatening, but I always tell patients that these side effects are a possibility. You can lose weight, but it also may affect your digestion. So, it's a double-edged sword there,” said Dr. Periyalwar.

Even with these side effects, doctors often see the benefits of GLP-1s outweighing the risks. The drugs help with diabetes and weight loss, but they may also treat other conditions. “It can help prevent metabolic syndrome,” said Dr. Periyalwar. “And it actually has been very effective with fatty liver. We haven’t had a good treatment for metabolic-associated liver disease, and so this is something which actually can help reduce visceral fat accumulation.”

However, because GLP-1 drugs are still fairly new in widespread use, some questions remain. “We still don't know for sure about the long-term effects of GLP-1 use,” said Dr. Periyalwar. “I think knowing that going in, while understanding the current side effects of GLP-1s, is your best tool for making a decision about the medication.”

Published (August 2025)