Vitamin D, adiposity, and a volume-of-distribution problem
A monitoring schedule requires evidence about incidence. For this population, that evidence does not exist.
Nutrition
Page 8 of 11 of this archive, newest first.
The out-of-range flag is a statistical convention with a printer attached
A flag is a probability statement about a population. It is not a statement about the person holding the printout.
Constipation is the one that responds best to boring measures
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
What the trials counted as intolerance
We set out the questions that distinguish a symptom to manage from a dose to change.
Why your endoscopist wants to know about your injection
Holding a dose before a procedure has a kinetic problem: a weekly drug with a seven-day half-life cannot be cleared by skipping one injection.
The mechanism behind the mechanism
The receptor populations that produce satiety and the ones that produce nausea overlap substantially. That is why the ceiling of this drug class is where it is, and it is…
Bone density during rapid weight loss: what is known, which is less than you would hope
The evidence base is one secondary analysis, several small studies and a large amount of extrapolation from bariatric surgery.
Why "muscle-sparing" is a marketing term and not a measurement
The rule that a quarter of weight lost is lean tissue has been in textbooks for decades and does not survive close reading.
Discontinuation rates, read honestly
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
What was pre-specified, what was exploratory, and what was calculated afterwards by people who did not run the trial.
The one randomised trial that combined an incretin with supervised exercise
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 trials monitored, and what that implies about routine practice
Timing is the whole of the post-cessation panel: draw it too early and it measures the treatment period.
Gallstones during rapid weight loss: drug, or weight loss?
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.
What actually helps, ranked by evidence
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
Two scans, six weeks apart, and the arithmetic of believing the difference
A body-composition report gives four decimal places and no confidence interval. That is the whole difficulty in one sentence.
The effect profile, predicted from an expression map
Delayed gastric emptying is a mechanism that becomes an adverse effect above a threshold. It is not a complication in the ordinary sense.
Discontinuation rates, read honestly
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.
Reflux, early satiety, and the volume the stomach will accept
The receptor populations that produce satiety and the ones that produce nausea overlap substantially. That is why the ceiling of this drug class is where it is, and it is…
Delayed emptying explains some of this, and not all of it
The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.
Residual stomach content on endoscopy: the studies
This is the single interaction with ordinary medical care that patients most need to disclose, and it is the one most often not asked about.