The common ones
Nausea, constipation, diarrhoea, fatigue, and the sulfur burps nobody warns you about — the rotten-egg ones that arrive around week three and feel like a malfunction.
They are not a malfunction. They come from the same slowed digestion that makes the drug work at all: food sits longer, and everything downstream of that adjusts late. Which is also why they are worst in the days after a dose, and worst again after every step up.
The timeline
The pattern most people describe is a peak during titration — the first weeks, then each increase — that settles once a dose has been held long enough to become ordinary.
Plenty of people hold a dose for an extra few weeks rather than push through misery on schedule. That is a conversation with your prescriber, not a decision to make alone, but it is a conversation worth having with dates in hand rather than an impression.
What helps
- Smaller meals, lower in fat. Grease is the most reliable trigger there is.
- Eat slowly, and stop at around eighty per cent full — the fullness signal arrives late now.
- Fluids and fiber for the constipation, which is largely a fiber-and-water problem wearing a scarier name.
- Don't lie down straight after eating.
- Write down which foods set you off. The pattern is personal and it moves with the dose.
When to ring your prescriber
Severe or persistent vomiting, signs of dehydration, or severe abdominal pain — particularly pain that radiates through to the back, which can indicate pancreatitis. These are uncommon and they are real, and none of them is something to wait out until the next appointment.
The rule that has never failed anyone: if it frightens you, ring. Nobody has ever been scolded for that call.
Where a notebook comes in
Lean Protocol logs each side effect on a nought-to-four scale, day by day, so a titration step that is settling looks visibly different from one that is getting worse. Log a four and it tells you to ring your prescriber — that is the limit of what software should ever do with that number.
It also builds the trigger-food map out of your own entries, which is the only version of that list worth having. Educational, not medical advice.