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Declining estrogen affects body composition and fat storage in measurable ways

That's going to increase the shuttling of the triacyl glycerols to the liver

Our guides on foods to eat on semaglutide , foods to avoid on tirzepatide , and GLP-1 breakfast ideas provide practical meal planning guidance

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Several factors increase your likelihood significantly: History of GERD or acid reflux , even if it was well-controlled before starting tirzepatide Hiatal hernia , which already weakens the lower esophageal sphincter Obesity , which increases abdominal pressure (though this improves as you lose weight on the medication) Smoking , which relaxes the esophageal sphincter Certain medications like NSAIDs, calcium channel blockers, or bisphosphonates that independently increase reflux risk Eating large meals or eating close to bedtime If you had occasional heartburn before starting tirzepatide, the medication can amplify it significantly during the early weeks