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Drs Akshay Jain and Girish Joshi discuss clinical considerations to keep in mind when someone on GLP-1 therapy is undergoing elective procedures. https://www.medscape.com/viewarticle/glp-1-guidance-reduce-regurgitation-and-aspiration-risk-2024a1000d35?src=soc_yt -- TRANSCRIPT -- Akshay B. Jain, MD: Welcome back to ADA 2024 updates. I'm endocrinologist Dr Akshay Jain from Vancouver in Canada, and today we've got a very special guest. We've got Professor Dr Girish Joshi. Dr Joshi is a professor of anesthesiology and pain medicine at UT Southwestern in Dallas, Texas. He was one of the speakers at a very impactful session that was talking about the postoperative and intraoperative considerations for people who are on GLP-1 therapy. He's here to talk with us about clinical considerations that one needs to keep in mind when someone on glucagon-like peptide 1 (GLP-1) receptor agonist therapy is undergoing elective procedures. Welcome, Dr Joshi. Girish P. Joshi, MD: Thank you, Akshay. It's an honor. Jain: I was attending your session, and I found it very clinically impactful. This is something that we are seeing more and more in clinical practice. For our viewers today, can you share with us, as an anesthesiologist, the potential risks for aspiration and the rates of aspiration that you're seeing in people who are on GLP-1 therapy? Joshi: We don't know the exact rate of aspiration with GLP-1 therapy because there are no good studies, but there are several anecdotal reports, including several personal communications where people have contacted me and the American Society of Anesthesiologists (ASA). I'm the chair of the task force for these GLP-1 recommendations developed by the ASA. To give an example, one of the cases reported to me was from a colleague in Dallas where a patient, otherwise completely healthy, came in for a shoulder arthroscopy — a simple outpatient procedure in a freestanding ambulatory surgery center. Surgery went fine. At the end of the procedure, she regurgitated gastric content and aspirated, and then had to be taken to the intensive care unit (ICU) and she spent 7 days in the ICU. Retrospectively, it was recognized that she was on GLP-1 therapy for weight loss, which was not disclosed. This was just before the ASA came up with the guidance, basically, so people didn't know that GLP-1 receptor agonists do increase the risk for aspiration. Jain: That's a really good point straight from your clinical practice. For our viewers who may not be familiar with the guidelines, could you tell us, in a nutshell, for people on GLP-1 therapy who are going in for an elective procedure that requires general anesthesia, what would be the recommendations for holding GLP-1s? Joshi: I have to first emphasize that currently, the evidence to provide any guidance is sparse, and whatever studies are available are basically questionable or of poor quality. With that said, the reason why the ASA came up with the guidance was to inform our colleagues, anesthesiologists, as well as our colleagues from surgery and other proceduralists of this concern about increased regurgitation and aspiration in patients on GLP-1 receptor agonists. That was the primary aim. Because the evidence is sparse, we basically came up with different approaches to decrease or mitigate the risk for regurgitation and aspiration. It starts with having a collaborative discussion, including the patients, or shared decision-making with the physicians and the patient regarding the potential risks, so mention to the patient that there is a potential risk. Then, avoid the elective procedures in patients at high risk. Examples of patients at high risk would be those who are basically in the escalation phase of the GLP-1 therapy, patients with prior history of gastroparesis, or patients on drugs that can cause gastroparesis. I don't know whether you remember I had an algorithm I developed and presented at the American Diabetes Association (ADA) meeting, where I presented the potential risk factors. If the patients are at risk for regurgitation and aspiration, that's the patient population we've got to be extra careful with. Maybe start off withholding the drug if the patients are on, say, a weekly therapy, then 1 week before, though the evidence is minimal. Nevertheless, more importantly, avoid elective procedures during that escalation phase in this patient population. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/glp-1-guidance-reduce-regurgitation-and-aspiration-risk-2024a1000d35?src=soc_yt

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Many users have reported being highly satisfied with their experience using 6Pack Keto ACV Gummy. The gummies are easy to incorporate into your daily routine and provide a convenient way to support your weight loss and health goals. With a delicious taste and powerful ingredients, these gummies offer a unique and effective way to enhance your ketogenic lifestyle.

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Die richtige Ernährung spielt eine entscheidende Rolle bei der Gewichtsreduktion. Salate sind eine gesunde und leichte Option, um Kalorien zu reduzieren und den Körper mit wichtigen Nährstoffen zu versorgen. In diesem Artikel werden wir verschiedene Salatrezepte vorstellen, die speziell für die effektive Gewichtsreduktion entwickelt wurden. Diese Rezepte sind einfach zuzubereiten, schmackhaft und ermöglichen es Ihnen, auf gesunde Weise abzunehmen.

Gurkensalat mit Avocado und Lachs

Gurkensalat ist eine erfrischende Option für heiße Sommertage. Die Kombination von Gurke, Avocado und Lachs sorgt für eine gute Protein- und Omega-3-Fettsäuren-Zufuhr. Die Gurke ist kalorienarm und reich an Ballaststoffen, Avocado liefert gesunde Fette und der Lachs liefert hochwertiges Protein.

Um diesen Salat zuzubereiten, schneiden Sie eine Gurke und eine Avocado in Scheiben und mischen Sie sie in einer Schüssel. Fügen Sie dann geräucherten Lachs hinzu und beträufeln Sie alles mit Zitronensaft und Olivenöl. Mit frischen Kräutern wie Dill oder Petersilie garnieren und genießen!

Dieser Salat ist nicht nur gesund und lecker, sondern auch sättigend und hilft Ihnen, übermäßiges Snacken zwischen den Mahlzeiten zu vermeiden. Er eignet sich perfekt als leichtes Abendessen oder Mittagessen.

Spinatsalat mit Erdbeeren und Mandeln

Spinat ist ein superfood, das reich an Eisen, Vitamin K und Ballaststoffen ist. Die Kombination von Spinat, Erdbeeren und Mandeln sorgt für eine perfekte Balance zwischen Süße und Herzhaftigkeit. Erdbeeren sind reich an Antioxidantien und Mandeln liefern gesunde Fette und Proteine.

Um diesen Salat zuzubereiten, waschen Sie den Spinat gründlich und geben Sie ihn in eine Salatschüssel. Fügen Sie geschnittene Erdbeeren und geröstete Mandeln hinzu. Für das Dressing mischen Sie etwas Olivenöl, Balsamico-Essig, Senf und Honig zusammen und beträufeln Sie es über den Salat.

Dieser Salat ist nicht nur farbenfroh und appetitlich, sondern auch reich an Nährstoffen und Ballaststoffen. Er eignet sich perfekt als gesunde Beilage oder leichtes Mittagessen.

Quinoasalat mit Gemüse und Feta

Quinoa ist eine glutenfreie und proteinreiche Alternative zu herkömmlichen Getreidesorten. Die Kombination von Quinoa, buntem Gemüse und Feta-Käse sorgt für eine ausgewogene Mahlzeit, die den Körper mit wichtigen Nährstoffen versorgt. Quinoa ist reich an Ballaststoffen und Proteinen, Gemüse liefert Vitamine und Mineralstoffe und Feta-Käse liefert gesunde Fette und Proteine.

Um diesen Salat zuzubereiten, kochen Sie Quinoa nach Packungsanweisung und lassen Sie es abkühlen. Schneiden Sie Ihr Lieblingsgemüse wie Paprika, Tomaten, Gurke und Zwiebeln in kleine Stücke und mischen Sie sie mit dem Quinoa. Fügen Sie dann gewürfelten Feta-Käse hinzu und beträufeln Sie alles mit Olivenöl und Zitronensaft.

Dieser Salat ist nicht nur einfach zuzubereiten, sondern auch vielseitig und anpassbar nach Ihrem eigenen Geschmack. Er eignet sich perfekt als gesunde Mahlzeit für unterwegs oder als Beilage zu gegrilltem Fleisch oder Fisch.

Rote-Bete-Salat mit Ziegenkäse und Walnüssen

Rote Bete ist reich an Antioxidantien und Ballaststoffen und sorgt für eine gute Eisenversorgung. Die Kombination von Rote Bete, Ziegenkäse und Walnüssen sorgt für einen einzigartigen Geschmack und eine gute Portion gesunder Fette. Rote Bete ist auch bekannt für ihre entzündungshemmenden Eigenschaften und kann dazu beitragen, den Blutdruck zu senken.

Um diesen Salat zuzubereiten, kochen Sie die Rote Bete, schälen Sie sie und schneiden Sie sie in kleine Stücke. Mischen Sie die Rote Bete mit Ziegenkäse und gehackten Walnüssen in einer Salatschüssel. Für das Dressing mischen Sie etwas Balsamico-Essig, Honig und Walnussöl zusammen und beträufeln Sie es über den Salat.

Dieser Salat ist nicht nur gesund und nahrhaft, sondern auch reich an Geschmack und Textur. Er eignet sich perfekt als elegante Vorspeise oder als Beilage zu gegrilltem Fleisch oder Fisch.

Paprika-Mais-Salat mit Schwarzen Bohnen und Avocado

Paprika ist reich an Vitamin C und Antioxidantien und sorgt für eine gute Immununterstützung. Die Kombination von Paprika, Mais, Schwarzen Bohnen und Avocado sorgt für eine herzhafte und nahrhafte Mahlzeit. Schwarze Bohnen sind eine gute Proteinquelle und liefern Ballaststoffe, die die Verdauung unterstützen.

Um diesen Salat zuzubereiten, mischen Sie gehackte Paprika, Mais, abgetropfte Schwarze Bohnen und Avocado in einer Schüssel. Für das Dressing können Sie Limettensaft, Kreuzkümmel, Knoblauch, Salz und Pfeffer zusammenmischen und über den Salat geben.

Dieser Salat ist nicht nur einfach zuzubereiten, sondern auch sättigend und proteinreich. Er eignet sich perfekt als Hauptmahlzeit für Vegetarier oder als Beilage zu gegrilltem Fleisch oder Fisch.

Zusammenfassung

Salate sind eine gesunde und leichte Option für die effektive Gewichtsreduktion. Die vorgestellten Salatrezepte bieten eine Vielzahl von Nährstoffen und sind einfach zuzubereiten. Durch die Wahl von frischen Zutaten und gesunden Dressings können Sie Ihren Salat zu einer schmackhaften Mahlzeit machen, die Ihnen hilft, auf gesunde Weise abzunehmen.

Experimentieren Sie mit verschiedenen Zutaten und Dressings, um Ihren perfekten Salat zu finden. Vergessen Sie nicht, auch auf die Portionsgröße zu achten und variieren Sie Ihre Salate, um eine ausgewogene Ernährung zu gewährleisten. Genießen Sie Ihre Salate und nehmen Sie aktiv an Ihrem Gewichtsreduktionsziel teil!

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I found a dinner that is delicious, chewy, filling, high in both fiber and protein- and comes in at about 400 calories. And perhaps even better- no cooking (just microwaving). This video is actually the following week- I ran out of time and willpower to do the whole series in one week. But I tried not to stray too far from my set meals and I managed to lose about a pound over the intervening week.