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Obesity, a driver of inflammation, is prevalent in patients with HFpEF. Ileana Pina asks Ambarish Pandey about GLP-1 inhibitors and SGLT2 inhibitors in HFpEF. Are these drugs anti-inflammatory? https://www.medscape.com/viewarticle/993980?src=soc_yt -TRANSCRIPT- Ileana L. Piña, MD, MPH: Hello, everyone. I'm Ileana Piña, professor of medicine at Jefferson University Hospital in Philadelphia. I'm the chief of quality. This is my blog. We have been hearing a lot of conversation about obesity. It's coming out of our endocrine division and our weight management division. And the patients are asking for things like bariatric surgery and maybe a holistic program of weight loss. A lot of the primary care doctors are starting to recommend glucagon-like peptide-1 (GLP-1) receptor agonists for those patients. But we deal with patients with heart failure with preserved ejection fraction (HFpEF), and a lot of our phenotypes are patients with obesity who happen to have hypertension and/or diabetes, and they are difficult to manage. Inflammation, Obesity, and HFpEF Piña: For today's conversation, there is nobody better than Dr Ambarish Pandey, who has a HFpEF program at the University of Texas Southwestern. Ambarish, welcome. Give me your thoughts overall about the link between obesity, inflammation, and HFpEF. Ambarish Pandey, MD: Thank you, Dr Piña. I'm excited to be on your blog and I'm glad that we are discussing such an important topic. The burden of heart failure, particularly HFpEF, has been increasing and is not just affecting older individuals. We see more younger folks with obesity in our HFpEF clinic coming in with symptoms of shortness of breath and fluid buildup. Our understanding of HFpEF has evolved quite a bit over the past two or three decades. Initially, it was thought to be a disease of largely impaired myocardial relaxation. And then Walter Paulus was one of the pioneers who proposed the concept of inflammation leading to HFpEF, and obesity being one of the important drivers of the inflammation that leads to the development of HFpEF. Now our understanding of HFpEF has evolved to it being a multisystem disorder that leads to dysfunction in different organ systems. One of the cardinal features that drives this dysfunction is upregulation of inflammatory pathways, increased inflammatory burden — and a lot of that is driven by obesity. Obesity is one of the most important modifiable risk factors for HFpEF. Piña: It is so common. In my clinic the other day, probably 3 out of 4 patients were obese. Pandey: Up to 75% of patients that we see in our program are over the 30 BMI cut-off, and a lot of the literature that has come from US HFpEF cohorts shows a very high average BMI in these patients. Piña: When we talk about inflammation, what are the chemical pathways of inflammation? For example, a long time ago, we tried to block TNF-alpha and it didn't quite work out. So, what pathways are we talking about? Pandey: I think a lot more work needs to be done to really understand the key drivers of inflammation and what pathways are being upregulated. As we know, inflammation is most commonly identified by elevation in levels of C-reactive protein (CRP), which serves as a marker of increased inflammation, but the upstream upregulation in IL-1– and IL-6–mediated pathways has been implicated in inflammation that drives development of diseases like HFpEF. There is an ongoing trial of ziltivekimab, which is an IL-1 inhibitor in patients with HFpEF. That's the HERMES trial led by Paul Ridker, one of the pioneers of inflammatory therapies in heart disease. We are starting to understand more about the key molecular pathways that are driving it. And now we're starting to target them, with the hope that we can actually halt the progression of HFpEF and improve the symptom burden as well as the risk for adverse outcomes in these patients. Are GLP-1 Inhibitors Anti-inflammatory? Piña: Do you think that the GLP-1s, or even now the SGLT2 inhibitors, are anti-inflammatory since we really don't know all the pathways? Pandey: I do think that GLP-1s, by virtue of causing weight loss and reduction in visceral adiposity and the bad fat depots that exist in our body, have a significant anti-inflammatory effect. And if you look at the data from the STEP trials that were done, looking at weight loss effects of semaglutide, a commonly used GLP-1 inhibitor, there was a good 30%-40% reduction in CRP levels, and that suggests that there is a significant anti-inflammatory effect. Now, whether it's a direct effect on anti-inflammatory pathways or is related to weight loss is a matter of debate. Piña: Are you using GLP-1 inhibitors in your HFpEF clinic? And what trials can we look forward to seeing concerning the use of these agents? https://www.medscape.com/viewarticle/993980?src=soc_yt

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The keto diet has gained immense popularity in recent years for its ability to help people achieve weight loss and improve overall health. However, maintaining ketosis – a state where the body burns fat for fuel instead of carbohydrates – can be challenging. Many people turn to exogenous ketone supplements like Keto XS ACV Gummies to support their ketosis journey.

Understanding Ketosis and the Role of Exogenous Ketones

Before diving into the efficacy of Keto XS ACV Gummies in supporting ketosis, it’s essential to understand the concept of ketosis and the role exogenous ketones play in this metabolic state. Ketosis is a natural metabolic state where the body produces ketones from fat to use as fuel instead of glucose from carbohydrates. This process occurs when the body is in a carbohydrate-deficient state, such as when following a ketogenic diet high in fats and low in carbs.

Exogenous ketones are ketones that are consumed from an external source, such as supplements like Keto XS ACV Gummies. These ketones can help the body reach and maintain ketosis more easily, even when carbohydrate intake is higher than what is typically recommended on a ketogenic diet. By providing the body with additional ketones, exogenous ketone supplements can support energy levels, mental clarity, and fat burning.

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When it comes to selecting an exogenous ketone supplement, consumers have a plethora of options to choose from. From ketone salts to ketone esters, the market is flooded with products claiming to enhance ketosis and support weight loss. One such product that has been gaining attention is Keto XS ACV Gummies. These gummies combine the benefits of exogenous ketones with apple cider vinegar, a popular ingredient known for its potential to aid weight loss and improve digestion.

Assessing the Efficacy of Keto XS ACV Gummies

Now, let’s dive into the specifics of Keto XS ACV Gummies and assess their efficacy in supporting ketosis. These gummies are formulated with exogenous ketones in the form of beta-hydroxybutyrate (BHB) salts, which are known for their quick absorption and ability to raise blood ketone levels. Additionally, the inclusion of apple cider vinegar in these gummies may provide additional benefits such as improved digestion and appetite control.

One key factor to consider when evaluating the efficacy of Keto XS ACV Gummies is how they fit into an individual’s overall ketogenic lifestyle. While these gummies can be a convenient way to boost ketone levels and support ketosis, they should not be seen as a magic pill for weight loss. To maximize their benefits, it’s essential to pair them with a well-rounded ketogenic diet and regular exercise.

Some users of Keto XS ACV Gummies have reported experiencing increased energy levels, reduced cravings, and improved mental clarity while using the product. However, individual results may vary, and it’s crucial to listen to your body and adjust your intake of exogenous ketones based on your specific goals and preferences.

FAQs: Common Questions About Keto XS ACV Gummies

1. Are Keto XS ACV Gummies suitable for everyone?

Keto XS ACV Gummies are generally safe for healthy individuals looking to support their ketosis journey. However, it’s always recommended to consult with a healthcare provider before starting any new supplement regimen, especially if you have any underlying health conditions or are pregnant or nursing.

2. How should I incorporate Keto XS ACV Gummies into my daily routine?

For best results, it’s recommended to follow the dosage instructions provided by the manufacturer. Typically, you can consume 1-2 gummies a day or as directed on the product label. It’s also essential to continue following a ketogenic diet and staying hydrated while using exogenous ketone supplements.

3. What are the potential side effects of using Keto XS ACV Gummies?

While Keto XS ACV Gummies are generally well-tolerated, some individuals may experience minor side effects such as digestive issues or an upset stomach. These side effects are usually temporary and can be mitigated by adjusting the dosage or frequency of consumption.