How do I deal with constipation on a GLP-1?

The physiology stacks three slowdowns: the drug slows GI transit directly, you’re eating much less (less bulk in = less bulk through), and most people quietly under-drink because thirst blunts alongside hunger. Countermeasures, in build order: 1. Water first. This is the highest-yield fix and the most skipped. Anchor drinking to habits — full glass on waking, before each meal, mid-afternoon — and judge by pale-yellow urine. Fiber without water makes things worse. 2. Fiber, ramped gradually. Target 25–35 g/day. Psyllium husk (Metamucil and generics) is the workhorse; build up over 1–2 weeks to avoid bloating. Food sources — beans, oats, berries, vegetables — pull double duty with protein-forward eating. 3. Move daily. A 20-minute walk genuinely stimulates motility; post-meal walks help digestion generally. 4. Gentle pharmacological staples: magnesium citrate or glycinate at bedtime (300–400 mg) or PEG 3350 (Miralax) — both safe for regular use and widely recommended in GLP-1 practice. Stool softeners (docusate) are fine but weaker. 5. Rescue tier, occasional only: stimulant laxatives (senna, bisacodyl). Using these weekly means the foundation tiers need work. What to skip: “detox teas” (harsh stimulants in costume) and ignoring it entirely — untreated constipation compounds into hemorrhoids, impaction, and misery. Clinician thresholds: no bowel movement for 5–7 days despite the above, severe abdominal pain or distension, blood in stool, or alternating constipation/vomiting (rule out obstruction — rare but serious). If constipation is intractable at every dose, that’s a legitimate reason to discuss dose reduction; ondansetron users should also know it contributes.