Does Ozempic Cause Heartburn?

Ozempic is an injectable medication for people with type 2 diabetes.

This medication is generally prescribed if metformin, diet, and exercise have not effectively lowered blood sugar levels and hemoglobin A1C (a three-month average of your blood sugar levels). 

Ozempic works well at reducing overnight and fasting blood sugar levels and hemoglobin A1C.

It can also help people achieve significant weight loss.

While Ozempic has positive effects, it can have undesirable side effects, such as gastrointestinal issues, including heartburn. 

Keep reading to learn about Ozempic and heartburn, tips for reducing this effect, and how a registered dietitian nutritionist (RDN) can help. 

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Does Ozempic Cause Heartburn?

Yes, Ozempic can cause heartburn, but only in about 2% of the participants from the clinical studies. 

In the prescribing information for Ozempic, heartburn is also called:

• Dyspepsia (indigestion or upset stomach).
• Eructation (burping).
• Gastroesophageal reflux disease (reflux).

Interestingly, a 1% higher rate of heartburn was reported in the lower (0.5mg) dose compared to the higher (1mg) dose.

Generally, symptoms increase with a higher dose of medication. 

Researchers evaluated the tolerance of the gastrointestinal(GI) side effects in 803 participants taking Ozempic.

Only 4.3% discontinued Ozempic altogether due to any GI side effect.  

Most people felt the benefits of taking Ozempic outweighed the undesirable GI side effects. 

How Long Does Ozempic Heartburn Last?

GI side effects are common when starting injectable medications like Ozempic and increasing the dosage. 

Most people have a resolution of the GI symptoms spontaneously while still taking the medication. 

There are no specific studies looking at how long people taking Ozempic had heartburn, only if they reported it as a side effect. 

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Potential Causes of Heartburn While Taking Ozempic 

There is no definitive reason why Ozempic causes heartburn in some people.

There are some theories based on how this medication works. 

Slowed Digestion

Ozempic is a type of medication called GLP-1 RA. 

One way GLP-1 RAs work is to slow the stomach emptying rate.

The slower rate prevents high blood sugar levels after meals and increases fullness, leading to weight loss. 

Food and drinks stay in the stomach significantly longer when taking Ozempic.

None of the clinical trials state how much slower the stomach empties. 

However, one small study on 20 women taking Ozempic found that 37% of the solid meal was still present in the stomach four hours after a meal.

Women not taking Ozempic retained no portion of their meal four hours later. 

Heartburn can happen to any person when their stomach is too full for too long. 

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Increased Pressure on the Lower Esophageal Sphincter

There is a sphincter powered by a muscle between the esophagus and stomach that opens and closes to allow food into the stomach.

This lower esophageal sphincter doesn’t work as well when the stomach is full, leading to backflow up the esophagus (heartburn). 

With Ozempic, slower digestion can lead to food hanging around the stomach longer, increasing pressure on the sphincter and resulting in heartburn. 

The Ozempic side effect of burping causes the sphincter to open more often, contributing to heartburn. 

Excess weight can also put extra pressure on the abdomen and lower esophageal sphincter. 

Changes in Stomach Acid Levels

The body produces stomach acid in the presence of food in the stomach.

Stomach acid helps to digest food to make it usable for the body. 

Food sitting longer in the stomach, like what happens when taking Ozempic, could lead to different amounts of acid than someone not taking Ozempic.

In 2001, an acid pocket was first reported in the Gastroenterology publication.

After testing patients with heartburn, researchers discovered that the pH was 4 or 5 (acidic) in the stomach, 2 (very acidic) right below the lower esophageal sphincter. Then, the pH rose to 6 or 7 (almost neutral) in the esophagus. 

The area below the sphincter has a pocket of acid floating on top of the most recent meal.

This pocket of acid is thought to be gastric acid that hasn’t mixed properly with food and floats on top instead.

The researchers stated this can occur in all individuals but is especially troublesome for those with heartburn or reflux. 

If individuals taking Ozempic have undigested food longer than the average, this acid pocket may be present longer. 

Tips for Managing Heartburn While Taking Ozempic

There are several lifestyle changes and eating changes that can help you manage heartburn. Treatment for heartburn is no different while taking Ozempic. 

Lifestyle changes are considered first. Then, healthcare professionals look to medications to help manage heartburn. 

Lifestyle changes include:

• Safe and healthy weight loss to reduce pressure on the abdomen and sphincter.
• Avoid eating three to four hours before bedtime.
• Maintain good sleep habits (undisturbed sleep correlates to decreased reflux episodes).
• Elevate the head of the bed to prevent backflow of acid into the esophagus.
• Diet modification can help reduce symptoms in some people. 

Some people find relief with diet changes.

‍Diet changes include eliminating caffeine, chocolate, spicy or fatty foods, citrus, and carbonated drinks. 

Researchers find that regular coffee and chocolate increase esophageal acid exposure.

Beer and wine increase heartburn mainly in the first hour after drinking. High-fat foods make reflux symptoms worse. 

There is less research on carbonated beverages and spicy foods causing heartburn.

‍Working with a dietitian can help you discover foods or lifestyle habits to relieve heartburn. 

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Remedies for Heartburn Relief

If you find yourself in the small percentage of people with heartburn while taking Ozempic, there are other steps to get relief. 

Non-Medicine Management of Heartburn

Many herbal remedies exist for treating heartburn.

Taking various forms or teas of ginger, chamomile, aloe vera, and licorice are some of the most common. 

There is research showing their effectiveness in reducing heartburn symptoms. 

However, some work by speeding up the digestion rate, while Ozempic is working on slowing the rate.

Speak with your healthcare provider before taking herbal remedies, as they may interact with your medications. 

Over-the-counter (OTC) Medicine Management of Heartburn

If heartburn is bothersome and not improving, your healthcare provider can recommend OTC medicines like antacids or H2 blockers such as Pepcid, Zantac, or Tagamet to help reduce side effects.

Your provider can help you determine the best medicines to try.

You should find relief from diet and lifestyle changes and the possible addition of OTC medicine. If you don’t, please seek out further help. 

Prevention Tips for Heartburn While Taking Ozempic

1. Avoid eating within 3 hours of bedtime. 
2. Eat more of your daily food before mid-afternoon to allow for digestion.
3. Elevate the head of the bed by four to six inches.
4. Lie on the left side instead of the right side while sleeping.
5. Avoid tobacco use.
6. Stay upright, especially after eating. 
7. Increase physical activity to promote stomach motility if your stomach is too full. 
8. Reduce or eliminate alcohol intake. 
9. Avoid large, high-fat meals. 
10. Chew your food well. 
11. Aim for balanced meals with lean protein, fruits, vegetables, and fiber-rich carbohydrates. 
12. Keep a food diary to identify any trigger foods. 
13. Drink fluids separate from meals to reduce stomach fullness. 

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Takeaway

Heartburn affects about 2% of people taking Ozempic. Ozempic works by slowing digestion, which can sometimes cause heartburn. 

Making diet and lifestyle changes reduces the symptoms of heartburn.

If diet and lifestyle changes are ineffective, speak with your healthcare provider about additional heartburn treatment. 

How a Dietitian Can Help

A registered dietitian nutritionist can help you change your diet to relieve heartburn and help you with other tips to manage type 2 diabetes while taking Ozempic. 

Find a dietitian near you that accepts insurance using Nourish.