People keep asking if I am sick and it is getting old

This one has a reasonably settled answer, so here it is. The practical protocol is dull and it works: smaller meals, stop eating at the first sign of fullness rather than at the end of the plate, drop the fat fraction of meals in the two days after dosing, and do not lie down straight after eating. Most of what people call unmanageable nausea is a meal-size and meal-composition problem interacting with a stomach that is emptying slowly.

Dr.NutriCornell said:

The practical protocol is dull and it works: smaller meals, stop eating at the first sign of fullness rather than at the end of the plate, drop the…

Dr.NutriCornell has the substance of this right. The condition it depends on is worth stating. 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.

ricardo_MIA said:

Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

Can confirm the pattern ricardo_MIA describes. 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.

Clinical perspective, offered as context rather than as advice. The distinction that resolves most of these threads is between what is true on average and what is true for one person. Both are real; they answer different questions and get quoted as if they were the same one.