On a November morning, Derron Borders, while welcoming prospective students at a graduate school in New York, began experiencing sulfur burps. Despite his efforts, foul-smelling clouds kept escaping his mouth. Curious, he turned to Google, searching for “burps that taste and smell like rotten eggs.”
After some time, Borders discovered that his diabetes medication was the cause. Sulfur burps have been identified as a rare side effect of GLP-1 receptor agonists like semaglutide, tirzepatide, and other similar drugs. These drugs, marketed as Ozempic, Wegovy, and Mounjaro, have gained popularity for their use in diabetes treatment and weight loss. However, as prescription numbers rise, so does the occurrence of this peculiar and unpleasant side effect.
Gastrointestinal symptoms such as abdominal pain, diarrhea, and vomiting are commonly associated with GLP-1 receptor agonists. Clinical trials of semaglutide for weight loss revealed that 44 percent of participants experienced nausea and 31 percent had diarrhea. In comparison, these conditions affected only about one-sixth of participants who received a placebo. Sulfur burps were reported by approximately 9 percent of those who took the drug, as opposed to less than 1 percent of those who took a placebo. The FDA recognizes eructation (burping) as a potential side effect of both semaglutide and tirzepatide.
However, specific information regarding sulfur burps is scarce in clinical trial reports and FDA fact sheets. Requests for information from Novo Nordisk and Eli Lilly, the companies behind these drugs, went unanswered. Laura Davisson, the director of medical weight management at West Virginia University Health Sciences, revealed that more than 1,000 patients at her clinic are currently using GLP-1 receptor agonists, and approximately one-fifth of them experience sulfur burps initially. For the majority, this issue subsides after a few months. Holly Lofton, an obesity-medicine specialist at NYU, estimates that only 2 percent of her patients are affected.
Experts are uncertain about the exact mechanism that causes GLP-1 receptor agonists to result in smelly burps, but they have some theories. Davisson proposed that semaglutide increases the number of bacteria in the digestive tracts of patients, which produce hydrogen sulfide gas, known for its rotten egg smell. She also suggested that the drugs slow down digestion, giving the stomach more time to break down food and produce gas. Lofton explained that the lighter, putrid air may escape through the mouth more easily because it rises to the top of the stomach, surpassing the heavier liquids and semi-solids. Lofton stated, “Whatever’s on top will come up.”
Consuming larger quantities of food while taking these medications appears to be a common trigger. Davisson mentioned that certain foods, such as dairy, can also contribute to more odorous emissions. She suggests recommendations like avoiding heavy meals, consuming smaller portions, and refraining from eating right before bed. Additionally, Craig Gluckman, a gastroenterologist at UCLA Health, recommends antacids and anti-gas medications to patients experiencing sulfur burps due to GLP-1-agonist intake. However, he does not recommend using apple cider vinegar as a solution, despite its popularity online.
In general, patients tend to experience sulfur burps when starting a medication similar to Ozempic or when increasing their dosage. Crystal Garcia, an HR administrator in Texas, started taking semaglutide after being informed of her prediabetic condition by her doctor. Three months into her treatment, while having breakfast at a restaurant with her family, they began complaining about a foul, eggy smell. Initially thinking it was the food, Garcia soon realized the smell lingered even after the meal and suspected her young son had an accident. However, after burping again, she had to accept that she was the source of the odor.
Many patients are unaware of sulfur burps being a potential side effect until they actually experience them. Borders had no idea that his diabetes medication could be the cause, and it wasn’t even mentioned during his visit to a physician’s assistant. According to Lofton, sulfur burps were not commonly reported with earlier versions of GLP-1 receptor agonists. In fact, Lofton only learned about sulfur burps from her patients after Ozempic entered the American market in 2018. She admitted, “I’d never heard of sulfur burps before I started prescribing this medicine.”
While sulfur burps are physically harmless, they can lead some patients to discontinue their diabetes or weight-loss medications. However, most individuals, including Garcia and Borders, choose to persist with their treatment. Despite the severity of the side effects, patients believe that the benefits of these drugs outweigh the unpleasantness. Davisson recalled a patient who described her burps as smelling like poop, yet she still didn’t want to stop taking the medication.
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