Tolerability is the ceiling, and the ceiling is personal
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
Patient Notes in 2025
Page 9 of 11 of this archive, newest first.
Micronutrient monitoring: which panel, how often, and on whose evidence
A monitoring schedule requires evidence about incidence. For this population, that evidence does not exist.
What the new the United Arab Emirates guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What the new South Africa guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Which results are findings and which are consequences of the weight loss
The estimated glomerular filtration rate is calculated from creatinine, creatinine comes from muscle, and muscle mass is falling. The arithmetic is unforgiving.
Gauge, pain and flow rate
The insulin injection-technique literature is large, well conducted and directly transferable on questions of depth and tissue. We say where it stops transferring.
Sarcopenia is a diagnosis, not a synonym for losing lean mass
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
Japan pharmacy body issues counselling standards for exenatide initiation
The evidence base is thin and the document says so, which is to its credit.
What the new Australia guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What we would need to randomise to answer this properly
One randomised trial has combined a GLP-1 receptor agonist with supervised exercise. Its result is the single most useful piece of evidence in this area.
What the new Italy guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Denmark pharmacy body issues counselling standards for exenatide initiation
The evidence base is thin and the document says so, which is to its credit.
India pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
What happens when the drug is taken away: three randomised answers
What was withdrawn, from whom, after how long, and what was measured afterwards.
Nigeria pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Spain pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
The United Kingdom pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
Do you need the top of the ladder?
What the trials measured was continuation against withdrawal. What patients want to know is continuation at a lower dose, and that study has largely not been done.
What the new the United Kingdom guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
The reference change value: the number that tells you whether a delta is real
A flag is a probability statement about a population. It is not a statement about the person holding the printout.