The effect profile, predicted from an expression map
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.
Nutrition
Page 6 of 11 of this archive, newest first.
Gallstones during rapid weight loss: drug, or weight loss?
A small number of serious gastrointestinal events occur in people taking these drugs. Distinguishing them from the expected effect profile is the most consequential…
Pancreatitis, obstruction, gallbladder: three things nausea can be
A small number of serious gastrointestinal events occur in people taking these drugs. Distinguishing them from the expected effect profile is the most consequential…
The precision question nobody puts to a body-composition report
A body-composition report gives four decimal places and no confidence interval. That is the whole difficulty in one sentence.
Vitamin D, adiposity, and a volume-of-distribution problem
Reduced intake is a plausible mechanism for deficiency. Reduced absorption is not, and the two are conflated in most of the advice.
The advice is mostly reasonable. The certainty is not earned.
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
The mechanism behind the mechanism
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.
Load, not cardio: the distinction the general advice keeps losing
Mass and function are different endpoints and training affects them differently. Most coverage treats them as one.
Two sessions a week, and the evidence behind the prescription
The older-adult diet-and-exercise trials are the closest analogue to rapid pharmacological weight loss, and they are twenty years old.
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.
Antiemetics, laxatives and the thin literature underneath them
Constipation is the most tractable of the effects and the most consistently under-managed.
What the older diet-and-exercise trials found in the hip
A plausible mechanism, a measurable change, and no outcome data. This is what an open question looks like.
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.
Why the recent month counts for half the number
The assay is not the problem. The interpretation of a lagging integral as a current measurement is the problem.
What the trials counted as intolerance
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.
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.
Holding the dose before surgery: for whom, for how long
A drug that delays gastric emptying complicates the assumption behind every fasting instruction in perioperative medicine. The professional bodies have moved twice on this…
Tolerability is the ceiling, and the ceiling is personal
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
A few hundred participants carry the whole body-composition argument
A substudy powered to describe a mean is not a substudy powered to detect a clinically meaningful individual change.
Which results are findings and which are consequences of the weight loss
Three different explanations for the same abnormal number, and how to tell them apart.