Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes by slowing gastric emptying and improving blood glucose control. Whilst effective, this delayed stomach emptying may contribute to gastrointestinal side effects, including the development of sulphur burps—belching with a distinctive rotten egg odour caused by hydrogen sulphide gas. Although not explicitly listed as a common adverse effect in UK prescribing information, the mechanistic link between Trulicity's action on gastric motility and sulphur burp occurrence is plausible. This article examines the relationship between Trulicity and sulphur burps, explores management strategies, and clarifies when medical advice should be sought.

What Are Sulphur Burps and Why Do They Occur?

Sulphur burps are characterised by an unpleasant odour resembling rotten eggs when belching. This distinctive smell results from hydrogen sulphide gas produced during the digestive process. Whilst occasional burping is entirely normal and helps release swallowed air from the stomach, sulphur burps indicate specific digestive activity involving sulphur-containing compounds.

The primary cause of sulphur burps relates to the breakdown of foods rich in sulphur by bacteria in the gastrointestinal tract. Common dietary triggers include:

• Red meat and poultry

• Eggs and dairy products

• Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts)

• Garlic and onions

• Protein supplements and certain preservatives

When these foods are digested, particularly if they remain in the stomach longer than usual, bacteria produce hydrogen sulphide gas as a metabolic by-product. This gas then escapes through belching, creating the characteristic sulphur smell.

Beyond dietary factors, sulphur burps may indicate underlying digestive conditions. Delayed gastric emptying (gastroparesis) allows food to ferment in the stomach for extended periods, increasing bacterial activity and gas production. Other potential causes include small intestinal bacterial overgrowth (SIBO), gastroenteritis, food intolerances, and certain gastrointestinal infections such as Giardia lamblia. Helicobacter pylori infection may contribute to general dyspepsia and belching symptoms, though its specific link to sulphur burps is less established.

Occasional sulphur burps following a rich meal are generally benign and resolve spontaneously. However, persistent or recurrent episodes—particularly when accompanied by other symptoms such as abdominal pain, diarrhoea, nausea, vomiting, progressive difficulty swallowing, unexplained weight loss, or blood in stools—warrant further investigation to identify any underlying digestive disorder requiring treatment. People with diabetes, including those taking medications like Trulicity, may be more susceptible to delayed gastric emptying, which could contribute to these symptoms.

Can Trulicity Cause Sulphur Burps?

Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for treating type 2 diabetes mellitus. Administered as a once-weekly subcutaneous injection, it works by enhancing insulin secretion in response to elevated blood glucose, suppressing glucagon release, and importantly, slowing gastric emptying. This delayed stomach emptying improves glycaemic control but also creates conditions that may contribute to gastrointestinal side effects.

Whilst sulphur burps are not explicitly listed as a common adverse effect in the Trulicity Summary of Product Characteristics (SmPC) approved by the MHRA, there is a plausible mechanistic link. The medication's effect on gastric motility means food remains in the stomach for longer periods, potentially allowing increased bacterial fermentation of sulphur-containing foods. This extended transit time creates an environment conducive to hydrogen sulphide production.

Gastrointestinal side effects are well-documented with Trulicity, affecting a significant proportion of patients, particularly during treatment initiation or dose escalation. According to the MHRA/EMC SmPC, the most commonly reported adverse effects include:

• Nausea (affecting up to 21% of patients at higher doses)

• Diarrhoea (approximately 9-13%)

• Vomiting (around 6-13%)

• Abdominal pain and discomfort

• Decreased appetite

• Dyspepsia and flatulence

These gastrointestinal effects typically diminish over several weeks as the body adapts to the medication. The occurrence of sulphur burps in patients taking Trulicity likely represents an indirect consequence of delayed gastric emptying combined with dietary factors, rather than a direct pharmacological effect. Anecdotal reports suggest some individuals experience this symptom, though robust epidemiological data quantifying its prevalence remain limited.

It's important to note that Trulicity is not recommended in severe gastrointestinal disease, including severe gastroparesis. Additionally, when used with insulin or sulfonylureas, there is an increased risk of hypoglycaemia which may require dose adjustments of these medications. If you experience persistent sulphur burps after starting Trulicity, this warrants discussion with your healthcare provider to ensure appropriate management.

Managing Sulphur Burps While Taking Trulicity

If you develop sulphur burps whilst taking Trulicity, several practical strategies may help minimise this troublesome symptom without compromising your diabetes management. These approaches focus on dietary modification, eating habits, and supportive measures to reduce hydrogen sulphide production.

Dietary adjustments represent the first-line approach. Consider temporarily reducing or eliminating high-sulphur foods from your diet, then gradually reintroducing them to identify specific triggers. Maintain a food diary to track which items correlate with symptom onset. Reducing portion sizes of protein-rich meals may also prove beneficial, as smaller amounts place less burden on delayed gastric emptying.

Optimising eating habits can significantly impact symptom severity:

• Eat smaller, more frequent meals rather than large portions

• Chew food thoroughly to aid digestion

• Avoid lying down immediately after eating

• Reduce carbonated beverages, which introduce additional gas

• Limit fatty foods, which further slow gastric emptying

• Stay well-hydrated throughout the day

Probiotics may help rebalance gut bacteria and reduce excessive fermentation. Whilst evidence specifically for sulphur burps remains limited, some probiotics containing Lactobacillus and Bifidobacterium species have demonstrated benefits for various digestive symptoms. Consider a time-limited trial after discussing with your pharmacist or clinician.

Over-the-counter remedies such as activated charcoal, bismuth subsalicylate, alginates/antacids or simeticone may provide temporary relief by absorbing gases or reducing bacterial activity. Important cautions apply:

• Activated charcoal can reduce absorption of oral medications; separate doses by at least 2 hours

• Bismuth subsalicylate (e.g., Pepto-Bismol) contains salicylates and should be avoided in children under 16, during pregnancy/breastfeeding, with aspirin allergy, or if taking anticoagulants

• Bismuth may temporarily darken stools and tongue (this is harmless)

• Always consult a pharmacist before using these products alongside your prescribed medications

If symptoms persist despite these measures, consult your GP or diabetes specialist. They may consider adjusting your Trulicity dose, switching to an alternative GLP-1 receptor agonist with different gastrointestinal tolerability, or investigating other potential causes. Never discontinue Trulicity without medical supervision, as this could compromise your glycaemic control and increase diabetes-related complications.

When to Seek Medical Advice About Trulicity Side Effects

Whilst sulphur burps alone rarely constitute a medical emergency, certain accompanying symptoms require prompt medical evaluation. Understanding when gastrointestinal side effects warrant professional assessment ensures patient safety and optimal diabetes management.

Contact your GP or diabetes care team if you experience:

• Persistent or worsening nausea and vomiting preventing adequate food or fluid intake

• Severe abdominal pain, particularly if localised or progressively worsening

• Signs of dehydration (dark urine, dizziness, reduced urination, dry mouth)

• Unexplained weight loss beyond expected therapeutic effects

• Blood in vomit or stools

• Persistent diarrhoea lasting more than 48 hours

• Right upper abdominal pain, fever or jaundice (yellowing of skin/eyes) which may indicate gallbladder problems

• Symptoms suggesting pancreatitis: severe upper abdominal pain radiating to the back, often with nausea and vomiting

If pancreatitis is suspected, stop taking Trulicity immediately and seek urgent medical attention.

Seek immediate medical attention (call 999 or attend A&E) if you develop:

• Severe, unrelenting abdominal pain

• Persistent vomiting with inability to retain fluids

• Signs of severe allergic reaction (anaphylaxis): difficulty breathing, facial swelling, widespread rash

• Severe hypoglycaemia (if also taking insulin or sulfonylureas) that doesn't respond to treatment

Non-clinical studies of Trulicity in rodents showed thyroid C-cell tumours, though the relevance to humans remains uncertain. Report any neck lump, persistent hoarseness, difficulty swallowing, or shortness of breath to your doctor promptly.

Regular monitoring remains essential for all patients taking Trulicity. Your healthcare team should review your glycaemic control, weight, renal function, and tolerability at appropriate intervals according to NICE guidance for type 2 diabetes management. If gastrointestinal side effects significantly impair your quality of life or adherence to treatment, discuss alternative therapeutic options. Modern diabetes management offers numerous evidence-based treatments, and your regimen should be individualised to balance efficacy, safety, and tolerability.

Report any suspected side effects to the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or via the Yellow Card app). Open communication with your healthcare providers ensures optimal outcomes whilst minimising adverse effects.

Frequently Asked Questions