@tkdesign, I have many digestive issues. I was only able to tolerate a half dose of Tymlos. It never made my GERD worse, but at the higher dose 50 mcg (5 clicks) I had nausea, dizziness and orthostatic hypotension. I am now on Forteo, with no digestive issues. For the first 4 months, I had no real issues with Forteo. Now in my 5th month, I have a lot of joint pain, some fatigue, some brain fog, and swollen veins in my legs. I also got belly fat originally from the half dose of Tymlos, but was willing to put up with that for stronger bones.