Day 3 on sema and I feel like death warmed over

Taking the question as asked, rather than the general version of it. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

CarlaRPh_TPA said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

Agreeing with CarlaRPh_TPA, and the qualification matters more than the agreement. The meal advice is right and incomplete without the hydration point. People stop drinking because drinking makes them feel full, then attribute dehydration symptoms to the drug.

jason_sac26 said:

The nausea I get is not really nausea, it is an aversion.

Same position here, arrived at the long way round. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

From the other side of the consultation, briefly. Order of operations matters more than any single choice here: establish a baseline, change one thing, wait long enough for it to express itself, then measure again under the same conditions.