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Dr David Johnson highlights new preoperative recommendations to protect against consequences of some diabetes and weight loss drugs that delay gastric emptying. https://www.medscape.com/viewarticle/994762?src=soc_yt -- TRANSCRIPT --- Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology in Eastern Virginia Medical School in Norfolk, Virginia. Recent national media attention has focused on the gastrointestinal (GI) side effects of glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs are used to treat type 2 diabetes and weight loss. The GI side effects include nausea, vomiting, and gastroparesis-like symptoms. I wanted to emphasize two key points especially important to clinicians providing this class of therapy. One: Clinicians need to be increasingly aware of the potential GI side effects and inform their patients when they start to prescribe these medications. And two: The American Society of Anesthesiologists (ASA) has recently released consensus-based recommendations for preoperative assessment and management of adults and children undergoing surgery who are taking these medications. The recommendations also apply to endoscopic procedures whereby anesthesia will be delivered. Gastric Impact of GLP-1 Agonists What are these GLP-1 agonists? The drugs for weight loss include liraglutide (Saxenda and Victoza) and semaglutide (Ozempic, Wegovy, Rybelsus, among others). The type 2 diabetes medications include semaglutide, dulaglutide (Trulicity), and exenatide (Byetta, Bydureon BCise), among others. They can be taken daily or by injection once a week. The GLP-1 agonist drug class works at the GI level to increase insulin secretion and decrease glucagon release, both of which mediate glycemic control, particularly postprandially. The drugs slow the gastric motility through decreased peristalsis and increased tonic contractility of the pylorus, essentially causing a delay in gastric emptying. Dr Michael Camilleri and his colleagues at the Mayo Clinic, in Rochester, Minnesota, conducted a small randomized, placebo-controlled double-blind study of the GLP-1 agonist liraglutide to investigate the mechanism of weight loss in patients who were overweight. They showed that there was a diminution in gastric emptying over 16 weeks in patients taking liraglutide. They found evidence of tachyphylaxis, but the rate of gastric emptying of solids remained slow compared with placebo, even at 16 weeks. Despite the observed waning of the gastric impact, we just don't know how long significant side effects persist when patients stop the drug for good. There are some reports of patients with protracted symptoms a year or more after they've stopped their GLP-1 agonist medications. Guidance for Preoperative Management These drugs would commonly be reviewed before patients go through procedures, and we need to be better aware as we start to see these patients for endoscopy. The ASA recommendations address the potential consequences of delayed gastric emptying and provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents. In patients on daily dosing, the ASA recommends holding these agents the day prior to the procedure. For patients on weekly dosing, the recommendations suggest withholding the dose a week before the procedure. Importantly, this should be in consultation with their diabetologist, just to assess any need for a bridging therapy to avoid hypoglycemia. On the day of the procedure, if GI symptoms, such as severe nausea, vomiting, retching, abdominal pain, and bloating, are present, clinicians should consider delaying the elective procedure and discuss the risks of the potential risks for aspiration. If the patient has no symptoms and the GLP-1 agonist has been withheld as advised, then you should proceed as usual. But if the patient has no symptoms and has not held their GLP-1 agonist, you should proceed with what the anesthesiologists call the "full stomach" precaution, which considers patients at potentially high risk for aspiration. There's a way of checking for that. Some centers can do a quick ultrasound on the stomach and see if there's food, debris, or liquid, and if that is not the case, they could proceed with no delay. But if there is no way to check gastric contents, then you should manage accordingly, which may require intubation or postponing an elective procedure for another day. These are new and changing issues. In our world as gastroenterologists, we should be considering — very strongly — mitigating strategies to protect the patients on this wonderful class of therapy. Sometimes these drugs can have significant side effects that we need to at least be aware of. Nothing is perfect, but let us be better informed. https://www.medscape.com/viewarticle/994762?src=soc_yt
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Eine erfolgreiche Ernährungsumstellung kann entscheidend sein, um Gewicht zu verlieren und einen gesünderen Lebensstil zu erreichen. Viele Menschen sind jedoch unsicher, wie sie am besten vorgehen sollen, um langfristige Erfolge zu erzielen. In diesem Artikel werden wir Ihnen einen Leitfaden zur erfolgreichen Ernährungsumstellung zum Abnehmen präsentieren, der Ihnen helfen soll, Ihre Ziele zu erreichen.
Warum ist eine Ernährungsumstellung wichtig?
Die Ernährung spielt eine entscheidende Rolle beim Abnehmen und der allgemeinen Gesundheit. Indem Sie gesunde und ausgewogene Mahlzeiten zu sich nehmen, können Sie Ihren Stoffwechsel ankurbeln, den Blutzuckerspiegel regulieren und Fett verbrennen. Eine Ernährungsumstellung kann auch dazu beitragen, dass Sie sich energiegeladen und satt fühlen, ohne auf wichtige Nährstoffe zu verzichten.
Es ist wichtig zu verstehen, dass eine Ernährungsumstellung keine kurzfristige Lösung ist, sondern ein langfristiger Prozess, der Geduld und Disziplin erfordert. Indem Sie Ihre Essgewohnheiten langfristig verändern, können Sie nicht nur Gewicht verlieren, sondern auch Ihre Gesundheit verbessern und das Risiko für chronische Krankheiten reduzieren.
Es gibt viele verschiedene Ansätze, um eine erfolgreiche Ernährungsumstellung zu erreichen. Einige Menschen bevorzugen eine Low-Carb-Diät, während andere auf eine fettarme Ernährung setzen. Es ist wichtig, einen Ansatz zu wählen, der zu Ihren individuellen Bedürfnissen und Vorlieben passt, und diesen konsequent umzusetzen.
Tipps für eine erfolgreiche Ernährungsumstellung
1. Planen Sie im Voraus: Indem Sie Ihre Mahlzeiten im Voraus planen und gesunde Snacks vorbereiten, können Sie Versuchungen widerstehen und sicherstellen, dass Sie immer eine gesunde Option zur Hand haben.
2. Essen Sie langsam und achtsam: Nehmen Sie sich Zeit beim Essen und konzentrieren Sie sich auf den Geschmack und die Textur Ihrer Mahlzeiten. Dies kann dazu beitragen, dass Sie bewusster essen und schneller satt werden.
3. Trinken Sie ausreichend Wasser: Wasser ist entscheidend für einen gesunden Stoffwechsel und kann dazu beitragen, dass Sie sich satt fühlen. Trinken Sie daher ausreichend Wasser über den Tag verteilt, um Ihren Körper optimal zu unterstützen.
Häufig gestellte Fragen zur Ernährungsumstellung
1. Wie lange dauert es, um Ergebnisse zu sehen?
Die Geschwindigkeit, mit der Sie Ergebnisse sehen, hängt von verschiedenen Faktoren ab, einschließlich Ihrer Ausgangssituation, Ihrer Ernährungs- und Bewegungsgewohnheiten und Ihrem Stoffwechsel. In der Regel können Sie jedoch nach einigen Wochen erste Fortschritte bemerken, wenn Sie konsequent an Ihrer Ernährungsumstellung arbeiten.
2. Darf ich während einer Ernährungsumstellung auch mal sündigen?
Es ist wichtig, dass Sie sich während einer Ernährungsumstellung auch mal kleine Ausnahmen erlauben und sich etwas gönnen. Der Schlüssel liegt jedoch darin, ein gesundes Gleichgewicht zu finden und sicherzustellen, dass diese Ausnahmen die Ausnahme bleiben und nicht zur Regel werden.
3. Wie finde ich die richtige Ernährungsweise für mich?
Es gibt viele verschiedene Ernährungsweisen, und nicht jede passt zu jedem Menschen. Es kann hilfreich sein, sich von einem Ernährungsberater oder Arzt beraten zu lassen, um die für Sie passende Ernährungsweise zu finden, die zu Ihren Zielen und Bedürfnissen passt.
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One of the biggest health trends in recent years is the rise in popularity of the keto diet. This high-fat, low-carb diet has been touted for its potential to aid in weight loss and improve overall health. As with any popular trend, the market has been flooded with products claiming to help individuals achieve ketosis faster and more effectively. One such product that has garnered attention is the Shark Tank Keto Pills. These pills claim to help users reach ketosis faster and burn fat more efficiently. But with so many products on the market, it can be difficult to separate fact from fiction when it comes to these keto pills.
Exploring the Claims
One of the main claims of Shark Tank Keto Pills is that they can help individuals achieve ketosis faster. Ketosis is a metabolic state where the body burns fat for energy instead of carbohydrates. By limiting carbohydrate intake, the body is forced to use fat as its primary fuel source, resulting in weight loss. The pills claim to aid in this process by providing the body with exogenous ketones, which are ketones produced outside the body. These ketones are supposed to help jumpstart the ketosis process, allowing users to burn fat more quickly.
However, some experts are skeptical of these claims. While exogenous ketones can help raise blood ketone levels, there is no concrete evidence to suggest that they can significantly accelerate the ketosis process. The body still needs to deplete its glycogen stores before entering ketosis, and simply taking exogenous ketones may not be enough to jumpstart this process. Additionally, the effectiveness of exogenous ketones may vary depending on factors such as diet and exercise habits.
Another claim of Shark Tank Keto Pills is that they can help suppress appetite and curb cravings. The pills are supposed to help users feel full for longer periods, leading to reduced calorie intake and ultimately weight loss. While some users may experience appetite suppression while taking exogenous ketones, the effects can vary from person to person. Factors such as individual metabolism and hormonal balance can impact how effective the pills are at curbing cravings.
Potential Risks
When considering trying Shark Tank Keto Pills or any other exogenous ketone supplement, it is important to be aware of potential risks and side effects. While exogenous ketones are generally considered safe for most people, they can cause digestive issues such as stomach pain, diarrhea, and bloating. Additionally, taking too many exogenous ketones can lead to a temporary state of ketosis known as ketoacidosis, which can be dangerous for individuals with certain medical conditions such as diabetes.
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It is also important to note that exogenous ketones are not a magic weight loss solution. While they may help some individuals reach ketosis faster or curb cravings, they are not a substitute for a healthy diet and regular exercise. Sustainable weight loss requires a combination of a balanced diet, physical activity, and lifestyle changes. Relying solely on exogenous ketones to achieve weight loss goals is not a long-term solution and may not lead to lasting results.
Final Thoughts
Ultimately, the decision to try Shark Tank Keto Pills or any other exogenous ketone supplement is a personal one. While some individuals may experience benefits from taking these pills, others may not see significant results. It is important to approach these products with caution and skepticism, being mindful of potential risks and side effects. As with any health product, it is always best to consult with a healthcare professional before starting a new supplement regimen. Remember, there is no substitute for a healthy lifestyle when it comes to achieving long-term weight loss and overall wellness.
