Sulphur burps—characterised by an unpleasant rotten egg odour—are a recognised side effect of GLP-1 receptor agonist medications such as semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and liraglutide (Victoza, Saxenda). These medications slow gastric emptying to help control blood glucose and appetite, but this can lead to increased gas production and digestive discomfort. Whilst sulphur burps can be distressing, they are generally not dangerous and often improve with dietary modifications, hydration, and time. Understanding practical management strategies and knowing when to seek medical advice can help you maintain treatment adherence whilst minimising this uncomfortable symptom.

What Are Sulphur Burps and Why Do GLP-1 Medications Cause Them?

Sulphur burps are characterised by a distinctive rotten egg odour caused by hydrogen sulphide gas released during digestion. This unpleasant symptom occurs when certain foods are broken down by bacteria in the digestive tract. Whilst burping is a common side effect of glucagon-like peptide-1 (GLP-1) receptor agonists, the specific occurrence of sulphur-smelling burps may vary between individuals.

GLP-1 medications include injectable forms such as semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and liraglutide (Victoza, Saxenda), as well as oral semaglutide (Rybelsus). These drugs work by mimicking a naturally occurring hormone that regulates blood glucose levels and appetite. A key mechanism of GLP-1 medications is slowing gastric emptying—the rate at which food moves from the stomach into the small intestine—which helps with blood glucose control and weight management.

This delayed gastric emptying means food remains in the digestive system longer, potentially contributing to increased gas production and burping. The digestive changes caused by GLP-1 medications may also affect how efficiently the body processes certain foods, which could contribute to the development of sulphur-smelling burps in some patients. It's worth noting that the slowing of gastric emptying is often most pronounced during the initial weeks of treatment and may lessen over time as your body adjusts.

Whilst uncomfortable, these digestive symptoms are generally not dangerous and often improve with time and management strategies. However, understanding the potential causes can help you implement effective approaches to reduce their occurrence and distinguish between expected medication effects and symptoms requiring medical attention.

Immediate Ways to Get Rid of Sulphur Burps on GLP-1 Treatment

When experiencing sulphur burps whilst taking GLP-1 medication, several immediate interventions may provide relief. Peppermint tea can help soothe the digestive system and reduce gas production. The menthol in peppermint has natural antispasmodic properties that may ease gastrointestinal discomfort. However, be aware that peppermint may worsen symptoms if you have acid reflux or heartburn.

Staying well-hydrated is important for managing digestive symptoms. The NHS recommends aiming for 6-8 glasses of fluid daily, adjusting based on your individual needs and health conditions. If you have heart or kidney disease, speak with your healthcare provider about appropriate fluid intake. Sipping water throughout the day rather than consuming large amounts at once may be more comfortable. Some people find that adding lemon to water helps, though this may aggravate reflux in some individuals.

Over-the-counter remedies may offer temporary relief. Products containing simeticone (an anti-foaming agent) can help break up gas bubbles in the digestive tract. Antacids or alginates may help if reflux contributes to your symptoms. Ask your pharmacist for advice on the most appropriate product. Activated charcoal tablets are available from pharmacies and may help absorb excess gas, though evidence for their effectiveness is limited. If using activated charcoal, take it at least 2 hours apart from other medications as it can reduce their absorption. Always consult your pharmacist before combining any over-the-counter products with prescription medications.

Gentle physical activity, such as a short walk after eating, can stimulate digestion and help move gas through the system more efficiently. Avoid lying down immediately after meals, as this can worsen symptoms. If symptoms are severe, eating smaller, more frequent meals rather than large portions can reduce the burden on your digestive system whilst it adjusts to the GLP-1 medication. Avoiding carbonated drinks, alcohol, and artificial sweeteners may also help reduce burping.

Dietary Changes to Prevent Sulphur Burps While Taking GLP-1

Modifying your diet is an effective long-term strategy for preventing sulphur burps whilst taking GLP-1 medications. Identifying and limiting gas-producing foods that may worsen symptoms is helpful. Common culprits include:

• Cruciferous vegetables: broccoli, cauliflower, Brussels sprouts, cabbage, and kale

• Allium vegetables: onions, garlic, leeks, and shallots

• Protein sources: eggs (particularly egg yolks) and red meat

• Dairy products: which may cause symptoms due to lactose content rather than sulphur

• Legumes: beans, lentils, and chickpeas, which contain fermentable carbohydrates

Rather than eliminating these nutritious foods entirely, consider reducing portion sizes or frequency of consumption, particularly during the initial months of GLP-1 treatment when side effects are typically most pronounced.

Food preparation methods can impact digestibility. Cooking vegetables thoroughly rather than eating them raw can make them easier to digest for some people. Soaking beans and legumes before cooking helps remove some of the fermentable carbohydrates that can cause gas. Choosing lean proteins and removing visible fat from meat may also help, as fat can slow digestion further.

Probiotic-rich foods such as natural yoghurt, kefir, sauerkraut, and kimchi may help balance gut bacteria, though evidence specifically for sulphur burps is limited. Introduce these gradually, as some fermented foods can initially increase gas production. If considering a probiotic supplement, discuss with your healthcare provider first, particularly if you have a compromised immune system. A time-limited trial (e.g., 4 weeks) may help determine if they're beneficial for you.

Meal timing and composition matter considerably when taking GLP-1 medications. Eat slowly and chew food thoroughly to aid digestion. Limit carbonated drinks, caffeine, and high-fat meals which can worsen burping and reflux. Consider keeping a food diary to identify your personal triggers. Spacing meals appropriately allows adequate digestion time, though this should be individualised to your treatment goals and comfort.

When to Contact Your GP About Sulphur Burps on GLP-1 Medication

Whilst burping is a recognised side effect of GLP-1 medications, certain symptoms warrant prompt medical attention. Contact your GP or diabetes specialist nurse if you experience sulphur burps accompanied by severe abdominal pain, persistent vomiting, or inability to keep food or fluids down for more than 24 hours. These symptoms could indicate gastroparesis (severely delayed stomach emptying) or other complications requiring medical assessment.

Seek medical advice if sulphur burps persist beyond the first 8-12 weeks of treatment or worsen over time despite dietary modifications. Whilst some adjustment period is expected, ongoing severe symptoms may indicate that the medication dose needs reviewing or that an alternative treatment approach should be considered. Your healthcare provider can assess whether dose reduction or switching to a different GLP-1 medication might be appropriate.

Red flag symptoms requiring urgent medical attention include:

• Severe, persistent abdominal pain, especially if radiating to the back and accompanied by vomiting (possible pancreatitis)

• Pain in the upper right abdomen, fever, or yellowing of the skin/eyes (possible gallbladder disease)

• Blood in vomit or stools

• Signs of severe dehydration (dark urine, dizziness, confusion)

• High fever (above 38°C) accompanying digestive symptoms

• Unexplained weight loss beyond expected treatment effects

• Severe, persistent diarrhoea lasting more than 48 hours

If you experience these red flag symptoms, call NHS 111 for advice or 999 in an emergency.

Regular monitoring is important for all patients on GLP-1 therapy. Discuss any persistent digestive symptoms at your routine diabetes or weight management appointments. For patients with type 2 diabetes, NICE guidance recommends that GLP-1 treatment should be continued only if there is adequate improvement in HbA1c and weight after 6 months. Your healthcare team can arrange appropriate investigations if needed, though specialised tests such as breath tests for bacterial overgrowth or gastric emptying studies are typically arranged by specialists rather than in primary care.

If you believe you're experiencing side effects from your medication, you can report them through the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Long-Term Management of Digestive Side Effects with GLP-1

Successfully managing digestive side effects, including sulphur burps, is crucial for maintaining adherence to GLP-1 therapy and achieving optimal treatment outcomes. Gradual dose titration is the cornerstone of minimising gastrointestinal symptoms. GLP-1 medications are typically initiated at low doses and increased slowly over several weeks or months, as per the product SmPC (Summary of Product Characteristics). This approach allows the digestive system time to adapt to the medication's effects. If side effects are problematic during dose escalation, your prescriber may temporarily pause or reduce your dose. Never adjust your dose without consulting your prescriber.

Developing sustainable dietary habits becomes increasingly important for long-term success. Rather than viewing dietary modifications as temporary restrictions, consider them as part of an overall healthy eating pattern that supports both your treatment goals and digestive comfort. Working with a registered dietitian who has experience with GLP-1 medications can be invaluable. They can help you create a nutritionally balanced meal plan that minimises digestive discomfort whilst ensuring adequate protein, fibre, and micronutrient intake.

Monitoring and adaptation should be ongoing throughout your treatment journey. Many patients find that digestive side effects, including burping, diminish over weeks to months as the body adjusts to the medication. However, symptoms may temporarily worsen following dose increases. Keeping a symptom diary can help you identify patterns and triggers, enabling more targeted management strategies.

Communication with your healthcare team is essential for long-term success. Be honest about side effects you experience—your prescriber can only help if they understand the full picture. If burping or other digestive symptoms significantly impact your quality of life despite management strategies, discuss alternative options. Different GLP-1 medications may have varying effects on gastric emptying (short-acting GLP-1s typically have greater effects than long-acting ones), and switching formulations may provide better tolerability whilst maintaining therapeutic benefits. Remember that effective diabetes or weight management requires a treatment approach you can sustain long-term, and your healthcare team is there to support you in finding the right balance.

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