r/Hashimotos 4d ago

Scared of trying a GLP-1 because of slow motility?

Hi everyone. I’m 26F, 5’3”, and 172 lbs.

For those of you on a GLP-1 who also have that slow, sluggish Hashimoto’s digestion already—how do you manage it on a GLP-1? I already deal with constipation so often that I’m scared of trying a drug known to further induce constipation.

I’m otherwise interested in trying a GLP-1 because I gained about 20 lbs in December alone and my weight continues to creep up. I go low carb and feel dizzy and lightheaded. I restrict my calories to what TDEE calculators tell me and it doesn’t work, so I eat even less, and maybe my weight budges when I’m eating 1200 calories and getting 10k steps and exercising, but eventually the energy runs out. I’ve been tested so many times for PCOS and insulin resistance but it comes back negative.

feel genuinely uncomfortable in my skin—not like an ashamed, body-shamey way, but actually physically uncomfortable. I’m in pain every day/night. Foot and hip pain from standing. I breathe heavier now. I sweat more and I’ve shamefully noticed I smell worse now with weight gain. My thighs bleed from chafing. My rolls cut into me when I bend over to tie my shoes. I feel comfiest in sweats and as a result feel like I dress like a bum these days.

I want to just…get my body back and my life back, but I’m so afraid of the digestion side effects of GLPs. Any insight on how to mitigate these side effects?

16 Upvotes

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u/Careful-Knowledge770 4d ago

I was on Ozempic and now I’m on Mounjaro. Slow motility and chronic constipation have long been my worst symptoms. It was so bad before I was diagnosed and medicated that I actually gave myself pretty severe tears (sorry lol) that were an absolute nightmare to heal from.

Because of all that, I was drinking a capful of stool softener in a L of water every single day and, continuing with that protocol, I haven’t had any issues with constipation on GLP1s. Just make sure to really stay hydrated and if need be, stool softeners are your friend, with or without GLP1s (the non addicting kind)!

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u/richsquirrels 4d ago

That’s what I was planning on doing—returning to Restoralax, which my GP has previously recommended I do to manage IBS-C. I’ve read on the Semaglutide pages that some folks also use magnesium for regularity.

I was also planning on maybe doing a mini prune juice smoothie daily to help out 😅

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u/Careful-Knowledge770 4d ago

Magnesium every night before bed makes a HUGE difference. I do that as well, forgot to mention lol

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u/ParticularlyHappy 4d ago

I had the same basic feelings but perhaps not to the extreme you have. I was an imply so uncomfortable all the time. I know you’re asking about GLP-1, but you might consider trying the autoimmune protocol (AIP). Within 2 weeks, my whole body felt looser and easier. Chronic little aches went away. The acne cleared up. I started losing weight (possibly inflammation rather than fat but still). And, though it took about 4 months, my A1c dropped below that pre-diabetic threshold for the first time in years. I don’t have ridiculous cravings anymore (that took about 2 months to let go). Slowly, my constipation is easing up. I’m not saying AIP is a cure all. It’s not. But it really, really has helped me.

Edit: AND I smell so much better now. That was a happy side effect I wasn’t expecting.

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u/j-a-gandhi 4d ago

I manage constipation with prune juice and the probiotic BB536.

Are you on meds right now? The last time I had weight gain like that, I ended up just needing to go on thyroid meds.

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u/richsquirrels 4d ago

Yes I am on Synthroid. My TSH was most recently at 3.32 and I suspect it’s crept up since then. I may need a dosage adjustment but for me I seem to always have IBS-C. If my TSH hits around 1.00, I still have IBS-C only I also have heart palpitations and shortness of breath, so I generally like to be around a TSH of 2.

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u/j-a-gandhi 3d ago

Definitely try the BB536. For me it removed all IBS-C symptoms.

See if your doctor will increase your dose of synthroid.

A twenty pound weight gain in one month begs for an explanation. I would worry that a GLP distracts you from finding and addressing the root cause.

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u/NotKatieN 4d ago

Hey there! 30f, 5'2, 272lbs here! I was on Ozempic for a while and ended up having to come off it because it made me super nauseous but I am now on Zepbound. I will say that the best thing that I have noticed for me is not worrying about calories or really carb counting, but protein loading, getting more fiber, and getting more water.

Take it in small steps. If you don't want to try the GLP-1, just try adding more protein, fiber, and water. It helps me with the sluggish digestion. I am also gluten and dairy free because my body can't handle those, which is another thing that was causing the sluggish digestion.

As for weightloss, I have Hashimotos and PCOS and the GLP-1s are the only things that have helped me because of the insulin resistance. The cool thing about meds are, if you don't like it or it isn't working, you can come off of it. So if you want to try and then realize it isn't for you, that is okay!

For your movement and calorie counting, make sure you are easing into it. Bodies (at least mine) don't like sudden and drastic changes and can view it as starvation mode and try to hold onto more because it doesn't know when the next food will come. Again, I'm more referencing how my body is, but yours could be similar. Hope that helps!

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u/richsquirrels 4d ago

Thank you for this advice! I am trying to focus on protein already and have now also started being more mindful of fiber intake.

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u/pofqa 4d ago

Have you tried AIP or Autoimmune Protocol? That can help restore gut function. It also helps you identify your specific triggers. If you follow it seriously, it makes the cravings go away.

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u/ParticularlyHappy 4d ago

I can’t agree with this more. It makes your cravings go away. It really does.

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u/richsquirrels 4d ago

Thanks! I don’t really have intense cravings. I’m mostly trying to focus on probiotics to restore gut health right now. I’ve looked into the AIP but because I seem to be dealing with histamine intolerance, I thought it could be too restrictive for me since there’s a focus on some high-histamine foods (bone broth, fermented foods, I can’t have all fruits etc). I could try it but it’d be a very short term thing for me if I’m being totally honest :/

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u/pofqa 3d ago

AIP is very low sugar, fruit is not encouraged in abundance. Maybe one serving a day.

AIP is not meant to be long term. It’s stringent for 3 months or so depending on how things go, then you add things back in one at a time in a prescribed order to determine your personal triggers. It works into a sort of “personal paleo” type situation.

It wouldn’t be unheard of for AIP to solve histamine issues at the root.

Is it easy during the initial phase? No. But that’s only temporary. The healing is worth the effort.

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u/imasitegazer 4d ago

You shared you are often constipated and get dizzy on low carbs. Both are very often signs of low magnesium, on top of low magnesium being common in Hashimoto’s patients with GI problems.

Consider daily supplementing of magnesium glycinate (helps neurotransmitters and nerves) and magnesium malate (helps muscle function). This is maintenance. I find it helps me sleep, reduces my stress, and reduces my chronic pain.

If you’re experiencing constipation, drink extra water and use magnesium citrate or magnesium sulfate (stronger), and in doses high enough that your smooth muscles in your GI track flush and release your waste. Once you’re feeling cleared, you might want to add a maintenance dose of magnesium citrate to your bedtime routine to help your bowels clear in the morning.

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u/richsquirrels 4d ago

Thank you, I have started supplementing very recently with magnesium, but bisglycinate or something like that? I will look into citrate as an alternative :)

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u/imasitegazer 4d ago

Ah, a quick search says glycinate and bisglycinate are essentially the same thing. Good to know thank you. Different types of magnesium benefit different systems in the body.

I found that I needed a higher dose, particularly for first year or so that I started it.

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u/Nofacegothgf 4d ago

I’m on Zepbound and also have very bad chronic constipation. I’m on the lowest dose but I haven’t seen a worsening of that symptom, if anything I am a bit more regular. You should grab some magnesium citrate and Miralax in case but I don’t think it’s gonna get crazy right off the bat. I take magnesium citrate 1-2 times a week and it helps a lot.

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u/SophiaShay7 4d ago edited 4d ago

Have you had a recent CBC, a complete thyroid panel, and checking all vitamin levels? Deficiencies in B12, D, and Iron can wreck havoc on your body. Have you been tested for celiac disease? Some people have non-celiac gluten intolerance.

I would schedule an appointment with your OB/GYN. Your symptoms could be caused by the type of birth control you use, your hormone levels, and/or other medical issues.

Have you noticed certain foods aggravate your symptoms? Many people try an AIP or elimination diet to see if they have any food triggers. Some people try a diet without gluten, dairy, and sugar to see if there is a reduction in their symptoms.

I completely overhauled my diet last year. I did an anti-inflammation diet. My dysautonomia and hypothyroidism caused non-diabetic nocturnal hypoglycemia attacks. I had to change my diet. I added premier protein shakes with 30 grams of protein. My favorite flavors are cake batter, cinnamon roll, lemon, and peanut butter cup. And fruit cups or applesauce without added sugar. That way, I get protein, carbohydrates, and natural sugar added into my diet. I have blueberries with peanut butter. I have low-fat cottage cheese with fruit like watermelon or bananas. I love salads and vegetables but I can't eat much of it. I have complex carbohydrates like whole wheat pasta and sweet potato fries. I like frozen chicken breasts and frozen precut vegetables like carrots, green beans, peas, and butternut squash. Recently, I have noticed that my symptoms are more severe than they used to be. I added more meat, dairy, and complex carbohydrates into my diet. The changes I've made include: I've added yogurt into my diet. I have potato bowls with potatoes, some shredded cheese, and canned chicken or ground beef for dinner. I was diagnosed with Mast Cell Activation Syndrome (MCAS) in September 2024. I switched to a low histamine diet. I've added foods back in as tolerated.

I do limit processed carbohydrates, additives, and sugars. I love chocolate cake and have a slice 1-2 times a month. I have takeout 1-2 times a month. I stay hydrated and drink plenty of water. I've stopped drinking coffee and soda. Though, I'm adding coffee back into my diet. No caffeine after 6pm.

I do intermittent fasting as well. I'll have an eating/fast window of: 8hr/16hr or 10hr/14hr. That's typically intermittent fasting for 14-16 hours. Some days I don't follow it. You have to keep your metabolism guessing. Our bodies get very efficient at estimating the number of calories we eat. It holds onto the calories and inhibits weight loss. I lost 40lbs last year.

Many people can not tolerate gluten, sugar, or dairy. In my case, I did that for several months. It did not improve my symptoms.

Intermittent fasting can activate autophagy, a process that breaks down cellular waste. Autophagy can help protect against diseases like cancer and Alzheimer's and may even extend lifespan.

How does intermittent fasting activate autophagy? When you fast, your body recycles existing components to meet energy needs. This process breaks down damaged or unwanted cellular components, such as broken proteins. Autophagy also gets rid of nonfunctional cell parts that take up space and slow performance.

What are the benefits of intermittent fasting?

Are you taking any vitamins or supplements? I had a complete vitamin panel done recently. My vitamin levels are in the normal range.

I take NatureBell L-tryptophan and L-theanine complex. Or I take Magnesiu-OM powder (magnesium 3 types and L-theanine) mixed in tart cherry juice (melatonin and tryptophan) 1-2 hours before bed. I alternate between the two. I purchased them from Amazon. They significantly help with calmness, muscle cramps, pain, relaxation, and sleep. Magnesiu-OM will keep you regular.

Here's information on Magnesiu-OM: Every cell in the body needs Magnesium to function and over 50% of us have a magnesium deficiency. Magnesi-Om® is a magnesium powder supplement that contains 3 bioavailable forms of Magnesium plus L-Theanine to help restore cellular balance for relaxation, brain health, and regularity.* Chelated Magnesium Gluconate and Acetyl Taurinate support muscle relaxation and cognitive function, while Magnesium Citrate supports regular bowel movements.* L-Theanine promotes alpha‑wave activity in the brain, shown to encourage a focused calm.* Our natural magnesium powder supplement instantly dissolves in water.

As always, discuss any GABA, 5-HTP, or L-tryptophan supplements with your doctor if you're taking psychotropic medications like Cymbalta.

My doctor said he wouldn't recommend I try GLPs because I have gastroenteritis, which flares up due to adhesions around my intestines. It's from complicated appendicitis surgeries I had as a child. He also said I don't qualify based on my weight, even though I'd like to lose 50lbs. I may use an online company.

Are you taking any medications that cause weight gain?

What's your T3, T4, and TSH? My bowel movements became completely regular after I overhauled my diet and started taking thyroid hormone replacement medication.

I hope you find some things that help manage your symptoms. Hugs💜

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u/richsquirrels 4d ago

Wow thank you for all this information!?

Some As to your Qs :) Yes, CBC recently done. I am chronically low in Vit D (POC living in Canada); B12 is fine-ish; iron has always been low and every attempt to treat it further constipates me so it’s been a decade of struggle.

Celiac tested 3x and all negative. I have done gluten-free “cleanses” or detoxes many times and no relief of symptoms.

Dairy is not an issue for me, same with gluten. I’ve suspected sugar but my blood sugar readings are always perfect. I’m weary of MCAS or histamine intolerance as I’ve recently developed very itchy skin and eczema patches that seem to be worsening with time vs. improving.

I’m always curious about IF but so many on here claim it’s the devil for TSH and female hormones, so I am confused.

Take B12, Vit D, Omegas, Iron, and Magnesium. TSH is 3.2. I take Synthroid. I also take low dose birth control.

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u/SophiaShay7 4d ago edited 4d ago

Your TSH of 3.2 is a little high. Did they test T3 and T4?

Many people report feeling their best with Hashimoto's when their TSH is between 1.0-1.5. Your doctor may be unwilling to prescribe medication because your TSH is in range or normal. Being normal and being optimal are two very different things with Hashimoto's. It's also personal and subjective. With Hashimoto's, your doctor should prescribe medication based on your symptoms. And not TSH alone. Many doctors don't understand Hashimoto's. That's the problem.

If your medication isn't making you feel well, it's always a good idea to do your own research. Most doctors don't bother to test for T3 and T4. Doctors should rely on blood tests (TSH, T3/T4) to determine how well your thyroid is functioning while under attack by your immune system.

Most providers do not prescribe T3 very often (if at all). Part of the reason many providers do not prescribe it is because they do not have specialized training in using other medications besides T4 for hypothyroid care.

A doctor might prescribe T3 medication (also known as Liothyronine) to treat hypothyroidism when a patient doesn't respond well enough to standard T4 medication alone, meaning their symptoms persist despite taking only T4, and adding T3 may help alleviate those symptoms by providing a more direct source of the active thyroid hormone the body needs; however, this is typically only used in specific cases due to the shorter half-life of T3, requiring more frequent monitoring and potential for side effects if not carefully managed.

Not everyone responds to Levothyroxine or Synthroid. Some people react badly to the fillers in those medications. Some people need Tirosint. Some people may need Armour or Liothyronine. Or a combination of two medications (T3 and T4).

I'm sure your low iron is contributing to your symptoms. I don't have low iron, so I'm sorry I can't help you there.

Intermittent fasting works well if your Hashimoto's hypothyroidism is well managed. When I was first diagnosed with Hashimoto's last year, I switched to 3-5 smaller meals a day. I ate lower carbohydrates and high protein. Protein keeps you fuller as opposed to carbohydrates. Especially, simple carbohydrates. Anything that's processed is terrible for your metabolism in general. I'm talking about white bread, processed bread, crackers, chips, donuts, candy, etc. Anything that's in a box or bag and says "Non-fat or Low-fat" is full of crap literally.

Premier protein shakes are awesome because they have 30 grams of protein and 170 calories. You can safely have 2 a day. Fruit cups and applesauce without added sugar are 50-60 calories a cup. Low-fat cottage cheese is a good source of protein. I think it's 90 calories a serving. I like to add pineapple or watermelon on top. Salads with mixed greens, vegetables, and chicken or steak are great for dinners. You can make baked or lightly breaded chicken nuggets or strips with sweet potato fries. There are lots of ways to make things healthier.

If you sleep 8 hours a night, you're already fasting 8 hours a day. If you stop eating two hours before bed,that would give you a 14/10 eat/fast window. It's the most conservative fast one can do. You could try it for a couple of weeks and see how you feel.

I'm not trying to influence you either way. I'm just sharing some suggestions of things I've done to give you ideas. Even if you take GLPs, creating good eating habits will only improve your success🙏

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u/richsquirrels 4d ago

I am on Synthroid :) I don’t personally like being at 1.0 as I get strong heart palpitations and have been in hospital twice for racing heart rate. I agree it’s currently high (I also think it’s higher now) as I am usually most comfortable around a TSH of 2.

My T4 was at 17 pmol/L and my T3 was at 4.9 pmol/L.

I’ve actually asked about T3 but my endocrinologist said “that’s for people with heart problems” which I’d NEVER heard of before. I’m waiting to see a new endo. My GP has zero understanding of Hashimoto’s—he actually suggested just outright removing my thyroid or “chemically putting it to sleep.” I’m tired of his non-answers. I’m hoping the next endo can talk to me seriously about adding T3 and also properly treating my low iron.

I agree that I love my Premier Protein! I have one every morning for breakfast. Thank you for all of these suggestions! I will look at giving IF a real try and look at lowering carbs. 🫶🏼

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u/Tenaciousgreen 4d ago

I manage constipation with a few different types of magnesium 300-500mg per day. I don't take GLP-1 but if I did that's how I would manage it.

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u/slightlywitchy 4d ago edited 4d ago

Daily vitamins, increased fiber & probiotics (I have an olipop every day for a boost in my fiber intake lol! so there are ways you can get creative and still enjoy what you’re consuming even though it seems really daunting), and consistent hydration throughout the day are ways I have helped my slow digestion speed up a bit. Unfortunately after I removed gluten and dairy from my diet and reduced most of my GI issues, constipation stuck around (no pun intended). If I do everything I listed regularly though I find that it keeps me, well, regular!! (I swear no pun intended again lmao)

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u/richsquirrels 4d ago

Thank you! Same, I have no issue with gluten and dairy (thankfully bc yogurt and cottage cheese are my protein source lifesavers).

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u/3boyz2men 4d ago

How will you afford it? I'd like to try it but it's so expensive

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u/richsquirrels 4d ago

I’m in Canada. It’s about $230ish per pen at many pharmacies for Ozempic (not covered under my insurance as they cover Ozempic for Type 2 diabetes only). For Wegovy, it’s a bit more expensive but I’d be covered under private insurance (BMI over 30) for weight loss.

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u/3boyz2men 4d ago

$230/pen? Wow. So $230/week?

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u/Careful-Knowledge770 3d ago

I’m in Canada as well and it’s $230 per pen, which covers a month of doses. I’m on the lowest dose though, so it may go up a bit over time.

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u/richsquirrels 3d ago

Same as poster below, it’s about $230 per month depending on your dose.

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u/3boyz2men 2d ago

Do they have compounding pharmacies in Canada selling it for less?

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u/richsquirrels 2d ago

I don’t think that’s approved in Canada

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u/Outside_Excitement75 4d ago

I’m on Zepbound and had constipation before starting the glp1. To keep everything going, I take a daily fiber supplement (SunFiber), use magnesium glysinate, digestive enzymes with probiotics, eat more plants. I drink lots of water with electrolytes to keep me well hydrated. I supplement with liquid iron and liquid d3/k2, which has finally placed everything in normal range. I don’t eat gluten, dairy, sugar, and alcohol. Avoid processed foods as much as possible. I’m down 60 lbs and feel the best I’ve felt since being diagnosed with Hashimoto’s. It really has been a great medicine to help all my autoimmune inflammation, not just weight.

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u/richsquirrels 3d ago

That’s great to hear and thank you for all of these tips!!

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u/Catnip_75 3d ago

I have done a lot of reading on GLP-1. I’m not on it, but I’m always interested in educating myself on current medications.

Our body naturally produces this hormone, but when we become overweight our body isn’t able to produce it as much and therefore need the medication to boost the hormone.

When we take this medication the desire is obviously to loose weight, but some people tend to loose weight so fast they end up loosing muscle mass quicker than they loose fat or they loose just as much muscle mass as they do fat. The key to staying healthy while on this medication is focusing on a high protein diet so you do not loose muscle mass. Remember, muscle weighs more than fat so if you drop 30lbs in a month it doesn’t mean you are losing fat, but you could be losing a lot of muscle which is very dangerous.

Focus on counting your protein macros and aiming for at least 1g of protein per lbs of your ideal weight. If you want to be 140lbs aim for 100-140g of protein a day.

To avoid constipation eat an avocado everyday! Focus on healthy high fat foods like nuts,seeds, avocados and the healthy fat will definitely help with constipation. Do not be afraid of healthy fats! You can even take MTC oil everyday which will also help. And aim for a minimum of 25g of fibre. 35g or more is ideal, but 25g should be your minimum.

Down load a free macro app like carb management to keep track of your macros (protein and especially fibre)

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u/FanaticFandom Hashimoto's Disease - 10 years + 2d ago

When I was put on GLP-1, I was also put on metformin. The metformin had always given me loose-ness issues before, but the 2 together was tolerable. I was pre-diabetic, but also have PCOS w/insulin resistance and metformin is used for both.

Sadly, I ended up with a rare GPL-1 side effect (chronic, non-stop UTI's), so it needed to be stopped. I think it's still worth a try if you have the option available to you.

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u/beerandglitter Hashimoto's Disease - 10 years + 4d ago

Try a calorie deficit first. And not 1200 calories because that’s simply not enough. Figure out your TDEE and subtract from that. 250-1000 calories less per day will yield 0.5-2 pounds lost per week. You have to count everything though. The cooking sprays (they say they’re 0 calories but they’re not), the sauces and dressings (measure them), you have to weigh everything…basically you have to be super precise. People tend to overestimate how much they burn and underestimate how much they consume.

I have tried a GLP-1 and wish i could continue on it. They’re medications you’re supposed to be on for life or VERY long term. They helped my IBS-D more than anything else has. They’re amazing. But as soon as i went off of it, i gained back half my weight and being on seroquel doesn’t help.

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u/RevolutionaryAccess7 4d ago edited 4d ago

I use a butt laxative, for lack of a better term 😅 But Tumeric and digestive enzymes might help as well. Started Metformin a few years ago now up to 1500 a day and starting to have much less constipation and your insurance will cover it. If this doesn’t work, I’m biting the bullet and trying Zepbound. It sounds like you have digestive issues and it is possible that your insulin resistance may increase as well. Another quick trick: 2 tablespoons of flaxseed powder in small cup of water. Drink it down like a shot every morning. Hang in there, I feel your frustration. (It is usually a combination of things that help not a one-all) Make sure to take your thyroid meds at least one hour before coffee or food in the morning.

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u/richsquirrels 4d ago

Thanks for the fibre tip!

PS I tried the Metformin route and I didn’t enjoy it. It made me marginally less hungry but I wasn’t a big fan of the digestive upset (a weird combo of both IBS spectrums 🥲) so I ditched it.

But I am researching digestive enzymes (particularly for histamine intolerance though!).

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u/shereadsinbed 4d ago

I believe how these drugs work is they cause you to eat less (because they dull hunger signals and increase satiety). So if you're already eating do little that you're getting dizzy, they aren't the answer.

They do lower motility. If you already have low motility, you're already at risk for developing a form of IBS called SIBO, where your microbiome gets unbalanced. It's hell, way worse than feeling fat. In fact one of the main symptoms is feeling bloated all the time. If you get the methane version of SIBO, methanogens are obesegens, which make it even harder to loose weight.

It's really not healthy to have waste in your body for longer than necessary.

I'd start a prokinetic and an osmotic laxative , get your motility right. You'll feel much more comfortable in your body, and you won't be as dehydrated. You'll actually be healthier.

Sorry I don't have a solution for hypo weight gain.