Ozempic sulfur burps and diarrhea, explained

So you recently started taking Ozempic (semaglutide). And while you’re likely excited to experience the drug’s benefits, you may be a little less thrilled to learn it can cause side effects — some of which can be a little, err, weird, such as sulfur burps and diarrhea.

Both of these symptoms can occur because Ozempic slows down the movement of food through your digestive tract. Although this mechanism of action can be effective for reducing blood sugar levels and promoting weight loss, it can also lead to rotten egg-scented belches (sulfur burps) and an uptick in toilet time (diarrhea). 

The good news is that there are several simple strategies to manage Ozempic sulfur burps and diarrhea, including avoiding certain foods (think: those high in sulfur, like eggs and garlic) and staying hydrated. And if push comes to shove, over-the-counter (OTC) treatments may do the trick — just be sure to consult your healthcare provider first. 

Keep reading to learn more about Ozempic sulfur burps and diarrhea, from what can cause these side effects to how to manage them. 

Sulfur burps are burps that have a foul odor similar to the smell of rotten eggs. They usually occur when hydrogen sulfide gas builds up in the gut. 

Hydrogen sulfide gas can build up in the digestive tract for many reasons. As the body digests food, certain by-products, such as gas, are released. Eating foods that are high in sulfur, like garlic, onions, eggs, and dairy products, may specifically lead to the release of hydrogen sulfide gas as they’re broken down. Health conditions that increase gas in the digestive tract, such as irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD), can also play a part. 

And last but certainly not least among the potential causes of sulfur burps is taking medications that alter the natural digestive process, including GLP-1s like Ozempic.

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Yes, Ozempic can cause sulfur burps.  

Gastrointestinal (GI)  side effects, such as sulfur burps, diarrhea, and nausea, are relatively common in people who take the drug. In clinical trials, eructation (burping) occurred in 2.7% of participants taking 0.5 mg of Ozempic and 1.1% of participants taking 1 mg after an average of over eight months of treatment. 

Ozempic may cause sulfur burps due to its effects on digestion. As a glucagon-like peptide-1 (GLP-1) receptor agonist, it works by mimicking the natural GLP-1 hormone in the body and, in doing so, delays gastric emptying (i.e. slows the movement of food through the digestive tract). Keeping food in the gut longer can lead to an increase in the production of hydrogen sulfide by gut bacteria — a process that produces hydrogen sulfide gas, which is responsible for the rotten egg smell of sulfur burps. Studies have shown that slowing down gut transit decreases fecal sulfate, meaning more sulfate remains available in the gut for bacterial metabolism (and, thus, hydrogen sulfide gas production!).

Research has shown that most people develop digestive side effects from Ozempic within one week to one month of starting treatment. The risk increases with higher doses of the medication; however, the side effects are usually temporary and improve over time. Therefore, the amount of time Ozempic sulfur burps last varies from person to person. 

To lower the risk of Ozempic sulfur burps and other GI side effects, healthcare providers typically start with a low dose of Ozempic and gradually increase the dosage over time. 

Yes, diarrhea is one of the most common side effects of Ozempic. In studies, 8.5% of participants taking 0.5 mg of Ozempic weekly experienced diarrhea, while 8.8% of those taking 1 mg weekly reported this side effect. The majority of cases occurred while people increased their dosage. (Reminder: Ozempic follows a titration schedule, in which you gradually increase your dosage of the drug over a period of weeks to months until you find a dose that’s effective and tolerable for you, i.e. therapeutic benefits with manageable side effects, if any.) 

It’s not fully clear why Ozempic can cause diarrhea. In some people, it actually causes constipation, which makes sense because Ozempic is known to slow down the gut.  Researchers believe diarrhea can occur because Ozempic changes how the intestines absorb certain nutrients, such as sugar and fats. This makes it difficult for the body to digest these nutrients properly, which can lead to diarrhea. Ozempic may also increase gut irritation due to alterations in bile acid processing, which could result in diarrhea. Ozempic may also change the gut microbiome itself in some people, which can cause a diarrheal effect. Researchers are still theorizing regarding why diarrhea happens in some people, and no definitive answer is available at this point. 

While you may not be able to get rid of them completely, there are several ways to minimize Ozempic sulfur burps, such as diet and lifestyle changes. 

Avoid foods that are high in sulfur

Diet can play a significant role in managing Ozempic sulfur burps. This is because bacteria in the gut release hydrogen sulfide gas when breaking down sulfur-containing foods, which can lead to foul-smelling belches. 

To minimize sulfur burps or lower your risk of experiencing them in the first place, try to limit eating foods that are high in sulfur during treatment. These include: 

• Garlic

• Onion

• Eggs

• Broccoli

• Kale

• Kidney beans

• Chicken

• Lobster

• Milk

• Yogurt

• Cheddar cheese

Stay hydrated

Not only can drinking plenty of water help ease some of Ozempic’s other less pleasant side effects, like nausea, but it may also indirectly reduce the likelihood of sulfur burps. Here’s the deal: Keeping up with your fluids and maintaining adequate hydration can help food move more efficiently through the digestive tract and support the breakdown of food. This can indirectly reduce the buildup of gas in your stomach and intestines and, in turn, burping. And — as an added bonus for those taking Ozempic off-label for weight loss — regularly sipping on water can also support your slim-down goals. 

Limit carbonated drinks

Carbonated drinks are known to release large amounts of gas in the stomach due to their carbon dioxide content. This can increase the frequency of burping. Therefore, it may be a good idea to avoid bubbly beverages, such as beer, soda, and sparkling drinks, if you’re experiencing or trying to prevent sulfur burps. Instead, try flat water, juice (in moderation), or non-carbonated drinks. Make sure to avoid beverages with artificial sugars, since they can worsen symptoms of an upset stomach. 

Eat smaller, more frequent meals

Eating large meals or overeating can lead to an accumulation of gas in the digestive tract. Eating smaller portions more frequently can help ease the workload on the digestive system at any given time, which can improve digestion and reduce the risk of Ozempic sulfur burps. 

Limit foods that increase gas in your digestive tract

Some foods are more likely to cause gas than others. These include:

• Beans

• Wheat

• Carbonated drinks

• Milk and milk products

• Artificial sweeteners

• Apricots

• Brussels sprouts

Limiting gas-promoting foods can help reduce the likelihood of sulfur burps from Ozempic. Instead, try to incorporate foods that are less likely to cause gas, such as lettuce, tomatoes, zucchini, poultry, and fish. 

Consider OTC treatments

Over-the-counter (OTC) remedies, such as probiotic supplements or simethicone, may help with your sulfur burps. Probiotic supplements can improve your gut bacteria to help the body digest food, while simethicone can help break up gas in the digestive tract to relieve pressure, fullness, and bloating. However, OTC products aren’t right for everyone and come with risks and potential side effects. They are also not typically recommended as permanent solutions. Therefore, it’s important to talk to a healthcare provider before starting any OTC treatments. And on that note…

Consult your healthcare provider

If your Ozempic sulfur burps are very bothersome or won’t go away, it’s a good idea to talk to your healthcare provider. In some cases, they may recommend lowering your Ozempic dosage to relieve your sulfur burps. (Remember, research suggests side effects of the drug tend to be dose-dependent.) Your provider can also recommend other ways to manage your symptoms. 

Diarrhea is another common side effect of Ozempic, affecting up to almost 9% of participants in studies. Fortunately, there are ways to manage the digestive issue, including staying hydrated, avoiding foods that trigger symptoms, eating a bland diet, and taking OTC antidiarrheal medications (if approved by and under the guidance of your healthcare provider, of course). 

Drink plenty of fluids

Diarrhea causes the body to lose fluids, which can increase the risk of dehydration. Therefore, it’s important to stay hydrated with clear fluids, such as water and tea, and water-rich foods, such as soup. Oral rehydration solutions that contain glucose and electrolytes may be helpful as well in limited quantities. 

Avoid foods and drinks that trigger symptoms

We hate to be the bearer of bad news, but your beloved morning coffee may not be doing you any favors if you’re dealing with Ozempic diarrhea. Unfortunately, caffeine can speed up your digestive system and worsen diarrhea. On the beverage front, additional culprits you might want to cut back on include alcohol and carbonated drinks.

Certain foods can also soften the stool and increase the risk of or worsen Ozempic diarrhea. These can include: 

• Fried or greasy food

• Fiber-rich foods, such as beans and vegetables, when eaten in excess

• Dairy products

It may be helpful to track what you eat and drink along with your bowel movements to determine what may be triggering or worsening your diarrhea while on Ozempic. 

Eat a bland diet

Another way to stop Ozempic diarrhea? Eating a bland diet. Doing so can help make stools firmer as bland foods are easier to digest and lessen the load on the digestive system.  The BRAT diet — which stands for bananas, rice, apple sauce, and toast — is a common example. Other bland foods that can help alleviate symptoms include oatmeal, white rice, and soup. Remember to consume foods such as white rice in moderation and as part of a healthy, balanced diet.

Try OTC antidiarrheal medication

Antidiarrheal medications, such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol), are usually safe for treating diarrhea. Loperamide treats diarrhea by slowing the movement of the bowel, allowing more water and electrolytes to be absorbed. This helps reduce the frequency of bowel movements. Bismuth subsalicylate, on the other hand, works by reducing inflammation in the intestine, killing organisms that can cause diarrhea, and decreasing the flow of fluids and electrolytes into the bowel. 

However, these OTC meds are generally only recommended for short-term use and shouldn’t be taken by certain people. Ask a healthcare provider whether an antidiarrheal medication is safe for you. They can discuss the risks and benefits of these treatments and help decide which option may be best for you. 

Consult your healthcare provider

Tried some (or all) of the above strategies and your Ozempic diarrhea is still persisting? You may want to consult your healthcare provider. They can help determine if Ozempic is the cause of diarrhea and what the best course of action may be. For example, they may recommend decreasing your Ozempic dosage. 

If you’re experiencing Ozempic sulfur burps or diarrhea, you may wonder if it’s worth it to switch to an alternative treatment. While there are many other diabetes and weight loss drugs available, several of them also cause digestive side effects. In fact, all GLP-1 receptor agonists have some risk of gastrointestinal side effects — namely, nausea, vomiting, diarrhea, and constipation — due to how they work in the body. Therefore, you may experience sulfur burps and diarrhea with any GLP-1 medication.

Even so, if you have Ozempic sulfur burps or diarrhea, discussing alternative GLP-1 agonists with your healthcare provider may be worthwhile, as research shows that the side effect profile can vary between different GLP-1 medications. Examples of other GLP-1 agonists are:

• Tirzepatide (Zepbound, Mounjaro), which is a dual GLP-1 GIP agonist

• Dulaglutide (Trulicity)

• Liraglutide (Victoza, Saxenda)

• Exenatide (Byetta)

• Lixisenatide (Adlyxin)

• Exendin-4

There are many other non-GLP-1 agonists used to treat diabetes as well. (Of course, these drugs can have side effects of their own.) Common ones include:

• Metformin (which can also cause diarrhea)

• Empagliflozin (Jardiance)

• Glimepiride (Amaryl)

• Sitagliptin (Januvia)

Each drug works differently to treat diabetes. Therefore, consult your healthcare provider for help understanding your options and determining which one may be best for you.

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Ozempic can be an effective medication for a variety of conditions, but it can cause GI side effects, such as sulfur burps and diarrhea. So, if you find yourself belching some bad, err, aromas or spending more time in the bathroom, know that your treatment may be to blame. And while it’s always a good idea to consult your healthcare provider if you’re experiencing new or worsening symptoms, here’s what to keep in mind: 

• Sulfur burps are burps that have a foul odor similar to that of rotten eggs. They can occur when there is a buildup of hydrogen sulfide gas in the gut. 

• Thanks to its effects on the digestive system, Ozempic can cause sulfur burps. In fact, up to 2.7% of people taking the drug experienced burping in clinical trials.

• There are several ways to minimize sulfur burps from Ozempic, including avoiding foods that are high in sulfur, staying hydrated, eating smaller, more frequent meals, limiting carbonated drinks and foods that produce gas, and taking OTC medications when appropriate. 

• Diarrhea is one of the most common side effects of Ozempic. Strategies to address Ozempic diarrhea include drinking plenty of fluids, avoiding triggering foods, eating a bland diet, and taking OTC antidiarrheal medication if approved by your healthcare provider. 

• If you have Ozempic sulfur burps or diarrhea, your healthcare provider can help determine the best course of treatment. They may adjust your Ozempic dosage, recommend diet or lifestyle changes, or switch you to an alternative medication.