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Weeks 5 to 8: the dose escalation phase Most GLP-1 protocols involve dose escalation every four weeks

exacerbating constipation in IBS-C)

This is a traditional bland-food diet that are low in fibre and easy to digest (bananas, rice, applesauce, toast) helpful during acute episodes Avoid known triggers such as spicy foods, caffeine, alcohol and fatty or fried foods Consume soluble fibre sources like oats and psyllium to add bulk to stools Eat smaller, more frequent meals rather than large portions Stay well-hydrated with water and electrolyte-containing fluids Supplement approaches Consider probiotics specifically formulated for diarrhoea Replenish electrolytes lost through diarrhoea with balanced supplements Try calcium supplements which may have mild constipating effects (consult healthcare provider first) Investigate digestive enzymes if food intolerances are suspected Use oral rehydration solutions for significant fluid losses Lifestyle adjustments Identify stress triggers that may worsen symptoms Practise stress reduction techniques such as meditation or deep breathing Maintain a food diary to identify specific food triggers Ensure easy access to toilets when outside the home Consider timing activities around predictable bowel patterns Medical interventions Over-the-counter antidiarrhoeal medications like loperamide (Imodium) for temporary relief Bismuth subsalicylate (Pepto-Bismol) for mild to moderate symptoms Oral rehydration salts (Dioralyte) to replace lost electrolytes and prevent dehydration Discuss with your clinician about adjusting your GLP-1 dosing schedule if diarrhoea is severe Ask about prescription medications for persistent diarrhoea that impacts quality of life Consider temporary dose reduction in consultation with your healthcare provider When to seek medical advice Contact your healthcare provider immediately if you experience: Diarrhoea lasting more than 2-3 days without improvement Signs of dehydration (excessive thirst, dark urine, dizziness) Blood or mucus in the stool Severe abdominal pain Fever above 38C (100.4F) Symptoms that significantly impact daily activities or quality of life Long-term outlook For most patients, diarrhoea is a temporary side effect that improves as the body adjusts to GLP-1 therapy

The change in the gut microbiota will, in turn, exacerbate the increase of uremic toxins, resulting in a vicious cycle within the gutkidney axis (74)