How do I stop nausea on a GLP-1?

Nausea is the toll booth of GLP-1 therapy — most people pay briefly, around dose increases, and then it fades. The management stack, from food upward: Food mechanics (the 80% solution): - Half-size the meals. A slowed stomach handles volume poorly; portion size is the #1 trigger. - Fat last. Fried and fatty meals empty slowest and provoke most. Save the burger experiment for a stable-dose week. - Cold and bland beats hot and aromatic during rough patches: yogurt, smoothies, toast, crackers, cold chicken. - Drink between meals, not during — liquid plus food stretches the stomach. - Stop at first fullness. The “clean your plate” reflex now has consequences. The supplement tier: ginger (real evidence, cheap — capsules, chews, or tea) and vitamin B6 (first-line for pregnancy nausea; the reason some compounded GLP-1s build it into the tablet). The prescription tier: many programs prescribe ondansetron (Zofran) 4 mg dissolving tablets as needed — a sensible backstop for dose-increase weeks that some telehealth programs (NexLife among them) build into the protocol by default. Two caveats: it constipates (already a GLP-1 theme), and needing it daily means the dose schedule, not the nausea, is the problem. The dose lever (the real fix for persistent nausea): there is no prize for climbing the ladder on schedule. Extending a step by 4 weeks, or stepping down once and re-climbing, preserves the therapy and is standard practice — titration is the side-effect strategy. Sensitive patients sometimes do best on deliberately slower or fractional-dose protocols. When it’s not routine nausea: vomiting that prevents keeping fluids down, nausea with severe abdominal pain, or signs of dehydration — that’s a call-your-clinician situation, not a push-through situation.