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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

This neuroanatomical overlap raises the possibility of vagus nerve disorders, though causal mechanisms require further elucidation

If you cannot remember when you reconstituted it, that alone is a sign your protocol needs tightening

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