Week 6 on 10mg tirz and the sulfur burps are back, which is annoying bc I barely had them going from 5mg to 7.5mg, or from 7.5 to 10. They showed up AFTER I stabilized, not during the dose jump. I’ve been trying to figure out why and my working theory: post-sleeve, gastric emptying is already altered from surgery. When tirz first hits a new dose, your GI tract is adjusting to two things at once. But once the dose holds steady, the GLP-1 receptor agonism on gastric motility kind of settles into a new slower baseline, and that’s when the protein-heavy meals my dietitian has me eating (still 80-100g/day, non-negotiable post-op) sit longer and ferment more. Non-surgical people on these meds seem to get the worst GI stuff in the first few weeks of a new dose. My pattern is the reverse. It’s not unbearable, just persistent. Things that have helped: ginger tea over lemon water, smaller protein portions spread across 4 windows instead of 3, cutting the string cheese snack I was grazing on at 9pm. Anyone else post-WLS noticing this timing difference? Curious if the sleeve anatomy is doing something specific here or if this is just me.
makes sense mechanically. post-sleeve already means slower motility, and protein sitting longer just ferments once tirz adds suppression. have you had gastric emptying studies, or is this observation-based? that’d actually tell you if it’s the surgery-tirz interaction.
the post-op mechanism makes sense, but did the sulfur burps actually start at week 6, or were they present during uptitration too and just quieter because appetite suppression was already flattening your total intake? weeks 3-5 usually trash digestion enough that you wouldn’t catch a baseline odor issue. if they truly weren’t there weeks 1-5, the dose-stabilization theory holds. but if they were subtle the whole time, then 80-100g daily on slower motility is just your constraint now, regardless of when in the cycle the tirz dose settled
observation-based only, no formal emptying study. i asked my bariatric surgeon about getting one when i was about 8 months post-op and she said sleeve patients aren’t typically referred unless there’s a stricture suspicion or severe dumping, so i just never had baseline data. which means i can’t actually quantify how much the surgery changed my motility vs. how much tirz layered on top. frustrating bc “the sleeve did something, tirz did something else” is basically what i’m working with. if you’ve seen anyone with actual scintigraphy data comparing pre/post GLP-1 in WLS patients i’d genuinely want to read it.
the pattern you’re seeing IS the data though. you don’t need a pre-op baseline to know something shifted once your dose stabilized - that’s a mechanistic signal on its own. the fact that most GLP-1 users get their worst symptoms during titration and you’re hitting them at holds actually strengthens your hypothesis about sleeve+motility, not weakens it. not having scintigraphy numbers is frustrating, but this relative timing difference is genuinely informative.
The reverse timing pattern you’ve described makes sense to me, and the gastric motility explanation tracks with what I’ve read about sleeve physiology specifically. fwiw What I’d gently add is that the “settling into a new slower baseline” framing might be doing some work you haven’t fully accounted for: the sleeve’s altered fundus means you’ve lost most of the stretch receptors that normally signal fullness and trigger coordinated emptying, so tirz acting on motility is landing on anatomy that’s already compensating in unusual ways. That compensation probably isn’t linear or predictable, which could explain why the disruption comes after stabilisation rather than during it. The bit about spreading protein across four windows rather than three is the most useful practical finding here and I’d be curious whether timing relative to your injection day makes any difference too.
Some people I’ve seen post about this find the first three days post-jab are quieter GI-wise, then things slow down mid-week when serum levels are still elevated but the acute receptor hit has passed. Not post-WLS myself, on tirzepatide for insulin resistance with PCOS, but I’ve had the delayed-onset pattern too, just without the surgical anatomy complicating things.