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Comprehensive guide to understanding and eliminating sulfur burps (rotten egg burps) on Mounjaro: why they happen, how to prevent them, and effective treatment strategies.
Sulfur burps affect 3-8% of Mounjaro users, caused by delayed gastric emptying allowing food to ferment and produce hydrogen sulfide gas. They're characterized by a distinct "rotten egg" smell and taste. Most cases are temporary and manageable through dietary changes, eating smaller meals, and avoiding trigger foods. Severe or persistent sulfur burps may indicate small intestinal bacterial overgrowth (SIBO) requiring medical treatment.
Good news: sulfur burps usually resolve within 4-8 weeks as your body adapts to Mounjaro. Simple interventions are highly effective for most people.
Mounjaro dramatically slows stomach emptying - food sits in stomach for 4-8+ hours instead of 2-4 hours. Prolonged fermentation produces hydrogen sulfide (H₂S) gas, causing the sulfur/rotten egg smell.
Slow gut motility allows bacteria to migrate from colon into small intestine. These bacteria ferment food, producing excessive hydrogen sulfide and methane gas.
Certain foods contain high levels of sulfur compounds that produce H₂S when broken down, especially problematic with slow digestion.
For persistent SIBO: Your doctor may prescribe rifaximin (Xifaxan) antibiotic. Highly effective for bacterial overgrowth.
Most sulfur burps resolve within 4-8 weeks as your stomach adapts to delayed emptying. They're most common during weeks 2-8 when doses are increasing. About 70-80% of people who experience sulfur burps see them disappear by month 3. If they persist beyond 2-3 months, see your doctor to rule out SIBO or adjust your dose.
Yes, Pepto-Bismol (bismuth subsalicylate) is very effective. Bismuth binds to hydrogen sulfide in your stomach, neutralizing the gas before it becomes burps. Take 2 tablets when burps start, repeat every 30-60 minutes if needed (max 8 doses/24 hours). Most people notice significant improvement within 1-2 hours. It's the most recommended OTC treatment by gastroenterologists.
Usually no - they're a benign side effect of delayed gastric emptying. However, persistent sulfur burps (lasting months) may indicate SIBO, H. pylori infection, or other GI conditions requiring treatment. Red flags: severe pain, fever, vomiting, blood in stool, unintentional weight loss. If burps are manageable and improving over time, they're likely just a temporary adjustment to Mounjaro.
Proactive strategies work well: avoid high-sulfur foods (eggs, red meat, cruciferous veggies) especially during early months on Mounjaro. Eat smaller, more frequent meals. Take digestive enzymes before meals. Chew food thoroughly. Stay upright after eating. Don't lie down for 2-3 hours post-meal. These habits significantly reduce sulfur burp occurrence for most people.
Try dietary modifications and Pepto-Bismol first. Most sulfur burps are manageable without dose reduction. However, if they're severe (multiple episodes daily), preventing you from eating adequately, or persisting despite all interventions, discuss options with your doctor: staying at current dose longer before escalating, temporarily reducing dose, or pausing treatment. Most people can continue Mounjaro successfully with proper management.
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