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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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Welcome to another insightful video from Asher Med, where we explore "The Science of Stress" and its profound effects on weight management, particularly when using GLP-1 medications like Semaglutide and Tirzepatide. Understanding the science behind stress is crucial for anyone on a weight loss journey, as it directly influences fat loss, appetite control, and overall health. In This Video: Understanding Stress: Learn about the physiological and psychological aspects of stress and how it impacts your body’s ability to manage weight. Stress and GLP-1 Medications: Discover how stress can affect the efficacy of GLP-1 medications such as Semaglutide and Tirzepatide, and what you can do to optimize your treatment. Effective Stress Management: Get practical tips and techniques to manage stress, including mindfulness practices, exercise, and nutrition strategies tailored for weight loss. Holistic Health Approach: Understand how integrating stress management with personalized nutrition and mindset coaching can enhance your weight loss efforts and overall wellness. Asher Med specializes in personalized coaching that integrates stress management with medical weight loss solutions. Our holistic approach ensures you get the support you need to achieve sustainable weight loss and long-term success. 🔹 Want to optimize your weight loss journey and manage stress effectively? Visit JoinAsher.com for expert guidance and tailored support to help you transform your health.

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Not many people know about these incredibly important fat burning tips. Check this out. Timestamps 0:17 The relationship between sugar and fat burning 0:29 How much sugar does it take to block fat burning? 0:35 A few things that can block fat burning 1:06 The problem with counting calories 1:58 An experiment In this video, I'm going to cover sugar and fat burning. If you're looking for fat burning tips, this video is for you. You can't burn fat when you're eating sugar. It only takes a tiny amount of sugar to block fat burning for a long time. If your metabolism is slow or you're getting older, here are a few things that can block fat burning for 48-60 hours: • 1/2 glass of juice • 1/2 glass of wine • 1/2 glass of soda • 1 Ensure • 1 Slimfast • 18 grams of sugar Here is an experiment I want you to try. Don't consume any added sugar for three days. Read the back of the label to see how many grams of sugar are in the product before consuming it. Don't consume anything that has over 1 gram of sugar. Then, see how much weight you've lost. Added sugar may be why you can't lose weight. Dr. Eric Berg DC Bio: Dr. Berg, age 57, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media. Follow Me On Social Media: Facebook: https://bit.ly/FB-DrBerg Instagram: https://bit.ly/IG-DrBerg TikTok: https://bit.ly/TikTok-DrBerg ABOUT DR. BERG: https://www.drberg.com/dr-eric-berg/bio Disclaimer: Dr. Eric Berg received his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1988. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Berg is a licensed chiropractor in Virginia, California, and Louisiana, but he no longer practices chiropractic in any state and does not see patients so he can focus on educating people as a full time activity, yet he maintains an active license. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Berg and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. #keto #ketodiet #weightloss #ketosis Thanks for watching! Consider giving these fat burning tips a try and let me know how they work for you.

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Please hit that red SUBSCRIBE button! Get My Recommended Groceries: http://ThriveMarket.com/ThomasDeLauer This video does contain a paid partnership with a brand that helps to support this channel. It is because of brands like this that we are able to provide the content that we do for free. Please check out the new workout channel, Garage Built Life, here: https://www.youtube.com/channel/UCQPQImPsw74KhO0Zy2-leyA/videos Please Subscribe to my Email Newsletter Here: https://www.thomasdelauer.com/life-optimization-tactics/ Follow More of My Daily Life on Instagram: http://www.Instagram.com/ThomasDeLauer Questions that will be answered within this video: - What are the negative physiology effects of sleep deprivation? - How can HIIT offset the negative effects of one night of poor sleep? References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535701/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435718/ https://www.sciencedirect.com/science/article/pii/S2212877820301848 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473372/ https://www.frontiersin.org/articles/10.3389/fendo.2017.00228/full https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849965/ https://www.ncbi.nlm.nih.gov/pubmed/23941878