It was a shocking story and a warning for those looking to get thin quick. Last week it was reported a 19-year-old American law student living in London had died after taking a weight-loss drug containing tirzepatide – the active ingredient in NHS-approved Mounjaro.

Josephine Nasr, from California, had suffered a heart rhythm complication in her room at the University of East London in September 2025. A post-mortem examination concluded she had an undiagnosed heart condition, but also suggested a drop in blood sugar caused by the drug could have triggered the complication.

Hers is one of a growing number of deaths linked to weight-loss drugs. According to official figures, in the UK there have now been 216 people who have died due to possible side effects – though there is no way to know for sure the medicine was the primary cause, only that it was suspected.

But perhaps the most important of these cases is the death of Caroline Savage, a 73-year-old grandmother from Norfolk, because it reveals an under-discussed risk.

Caroline began taking the jab in 2024 after years of failing to lose weight. She also suffered from lipedema – a chronic condition that causes fat to build up in the legs, hips and arms, which Mounjaro has been shown to ease.

Within four months, Caroline had lost two stone. However, in October 2024 she developed severe stomach pain – before collapsing at home. She died in hospital.

What is so significant is the cause of death – faecal peritonitis, where faecal matter leaks from the intestines. It’s a condition that, until now, has not been associated with weight-loss drugs.

However, I worry that countless Britons on these medicines could be at risk. This is because we know one of the main risks is ordinarily not life-threatening: constipation.

Josephine Nasr, from California, had suffered a heart rhythm complication in her room at the University of East London in September 2025

Constipation – often defined as no more than three bowel movements a week – affects around one in five adults, and a third of over-60s.

This is largely due to poor diet. Fibre is crucial for regular bowel movements, but under 5 per cent of Britons consume the recommended daily 30g. Widespread dehydration is also thought to be a cause. And growing evidence suggests weight-loss jabs can super-charge constipation. This is because they slow down the gut, meaning it takes longer for the body to expel food.

Over time, this can cause the bowels to get backed up, which puts pressure on the bowel lining and raises the risk of a rip occurring and faeces entering the intestines. This is even more of a risk for older people.

It’s possible that there are thousands of weight-loss jab patients at risk. The best way to protect against constipation? Change up your diet.

Kiwis and prunes are particular anti-constipation favourites, but there are many fibrous foods out there, including nuts, seeds, pulses, legumes, oats and certain vegetables. We should all be drinking more water – six glasses at a minimum or, in hot weather, at least eight.

Interestingly, is also good evidence that regular exercise – such as walking, running, and swimming – can ease constipation.

But finally, for weight-loss jab users, there is some even more important advice: don’t rush to raise your dose.

Caroline Savage, 73, grandmother who died after developing sudden and severe pain following an increase in the dose of her Mounjaro jab

Patients are started on a low dose, which is slowly increased over several months. It is when patients make the jump to the next dose that the most uncomfortable symptoms, like constipation, happen.

Taking a few extra weeks before upping the dose, giving the body more time to get used to the drug, may ease some of the side effects.

Or, for anyone who believes they are making good progress, there may be no need to increase the dose at all.

NHS cost-cutting patient cull is stopping elderly seeing their GP

I’m worried that many thousands of people may have been removed from their GP surgery’s list without their knowledge.

Over the past year, GPs have been instructed by the NHS to remove patients who have not come to practice in a while. This is a cost-cutting measure, because GP surgeries are paid for each patient they have on their books.

However, I’ve heard from colleagues that the software used to carry out this cull is overzealous and many elderly, vulnerable patients have been kicked out of their surgery – meaning they won’t be able to book an appointment.

Patients who haven’t been to their GP for some time should check they are still on their list.

Have you recently been removed from your GP surgery list? Write in and let me know.

Your questions answered

I wake up every morning with a cough and a phlegmy throat. It goes away eventually but always returns. What could it be?

Dr Ellie replies: A morning cough could be due to allergic reactions, heartburn – or something more sinister.

A cough is one of the common complaints that GPs deal with, and it can take some time to work out the cause. Often it is a matter of trial and error.

Allergies can often be the culprit. Most people think of allergic reactions as a runny nose and itchy eyes, but it’s possible that a reaction to dust, hay fever or animal hair can trigger a cough and nothing more.

This is typically caused by post-nasal drip – where mucus drips from the nose into the back of the throat. This can get worse while lying down, hence why the resulting cough can feel worse in the morning.

A simple way to work out whether allergies are the cause would be to try a daily antihistamine tablet, which can be bought at most high street pharmacies. If, after a few days, the coughing subsides, then the cause is likely to have been allergies.

However, another trigger of a morning cough might be heartburn. Also known as acid reflux, the condition occurs when stomach acid rises into the throat. Just like post-nasal drip, this can be worse in the morning as the acid is more likely to get into the throat during sleep.

Heartburn is typically treated through diet changes, such as eating less fatty food, as well as avoiding alcohol and fizzy drinks.

In rarer occasions, a morning cough can be triggered by a serious lung condition called chronic bronchitis. This is where the airways remain inflamed, which causes the body to overproduce mucus.

This mucus can accumulate in the lungs at night, leading to a morning cough.

Other chronic bronchitis symptoms include wheezing and chest pain. It is typically caused by smoking – and the symptoms can often be relieved simply by quitting.