Jane from Houston sent us this question: “I am currently taking Mounjaro to help me lose weight. I lost 26 pounds so far. However, I am waking up at night with food regurgitation. I tried to sleep on my left side and elevate the head of my bed. I also avoid eating late at night before going to sleep. My heartburn is still controlled by Nexium but sometimes I feel nauseated. I also feel more bloated. What can I do?”. Thank you.

Dear Jane,

GLP-1 agonists like Mounjaro and the newly introduced Zepbound are commonly used now for treatment of obesity and type 2 diabetes. GLP-1, (glucagon like peptide-1), decreases appetite, increases satiety, and it slows down gastric emptying. The most common side effect of delayed gastric emptying is nausea. Around 20% of patient on Mounjaro and Zepbound experience nausea. Vomiting and abdominal pain occur in 10% of patients.

Furthermore, delayed gastric emptying increases bloating, intragastric pressure, food retention and stomach acid secretion. Consequently, if you have acid reflux disease, delayed gastric emptying may worsen your acid reflux symptoms. Acid reflux patients on Mounjaro are particularly prone to food regurgitation during sleep. Nocturnal acid reflux symptoms are quite disruptive. Your quality of sleep will suffer. This will negatively affect your mood and energy levels. Food regurgitation at night also increases the risk of aspiration and pulmonary problems.

Food regurgitation is poorly controlled with PPIs like Omeprazole and Nexium. Head of bed elevation and avoiding food intake within 3 hours of going to bed may help.

Surgical therapy in the form of a properly performed hiatal hernia repair and Nissen fundoplication is the most reliable treatment for food regurgitation. Once the acid reflux barrier is restored, you can safely resume Mounjaro. A second option to consider is hiatal hernia repair and weight loss surgery like sleeve gastrectomy. This approach is preferred when your BMI is more than 35. A properly performed sleeve gastrectomy and hiatal hernia repair can reliably alleviate acid reflux symptoms and at the same time help you lose weight without the need for GLP-1 agonist medications.