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Dr David Johnson highlights new preoperative recommendations to protect against consequences of some diabetes and weight loss drugs that delay gastric emptying. https://www.medscape.com/viewarticle/994762?src=soc_yt -- TRANSCRIPT --- Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology in Eastern Virginia Medical School in Norfolk, Virginia. Recent national media attention has focused on the gastrointestinal (GI) side effects of glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs are used to treat type 2 diabetes and weight loss. The GI side effects include nausea, vomiting, and gastroparesis-like symptoms. I wanted to emphasize two key points especially important to clinicians providing this class of therapy. One: Clinicians need to be increasingly aware of the potential GI side effects and inform their patients when they start to prescribe these medications. And two: The American Society of Anesthesiologists (ASA) has recently released consensus-based recommendations for preoperative assessment and management of adults and children undergoing surgery who are taking these medications. The recommendations also apply to endoscopic procedures whereby anesthesia will be delivered. Gastric Impact of GLP-1 Agonists What are these GLP-1 agonists? The drugs for weight loss include liraglutide (Saxenda and Victoza) and semaglutide (Ozempic, Wegovy, Rybelsus, among others). The type 2 diabetes medications include semaglutide, dulaglutide (Trulicity), and exenatide (Byetta, Bydureon BCise), among others. They can be taken daily or by injection once a week. The GLP-1 agonist drug class works at the GI level to increase insulin secretion and decrease glucagon release, both of which mediate glycemic control, particularly postprandially. The drugs slow the gastric motility through decreased peristalsis and increased tonic contractility of the pylorus, essentially causing a delay in gastric emptying. Dr Michael Camilleri and his colleagues at the Mayo Clinic, in Rochester, Minnesota, conducted a small randomized, placebo-controlled double-blind study of the GLP-1 agonist liraglutide to investigate the mechanism of weight loss in patients who were overweight. They showed that there was a diminution in gastric emptying over 16 weeks in patients taking liraglutide. They found evidence of tachyphylaxis, but the rate of gastric emptying of solids remained slow compared with placebo, even at 16 weeks. Despite the observed waning of the gastric impact, we just don't know how long significant side effects persist when patients stop the drug for good. There are some reports of patients with protracted symptoms a year or more after they've stopped their GLP-1 agonist medications. Guidance for Preoperative Management These drugs would commonly be reviewed before patients go through procedures, and we need to be better aware as we start to see these patients for endoscopy. The ASA recommendations address the potential consequences of delayed gastric emptying and provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents. In patients on daily dosing, the ASA recommends holding these agents the day prior to the procedure. For patients on weekly dosing, the recommendations suggest withholding the dose a week before the procedure. Importantly, this should be in consultation with their diabetologist, just to assess any need for a bridging therapy to avoid hypoglycemia. On the day of the procedure, if GI symptoms, such as severe nausea, vomiting, retching, abdominal pain, and bloating, are present, clinicians should consider delaying the elective procedure and discuss the risks of the potential risks for aspiration. If the patient has no symptoms and the GLP-1 agonist has been withheld as advised, then you should proceed as usual. But if the patient has no symptoms and has not held their GLP-1 agonist, you should proceed with what the anesthesiologists call the "full stomach" precaution, which considers patients at potentially high risk for aspiration. There's a way of checking for that. Some centers can do a quick ultrasound on the stomach and see if there's food, debris, or liquid, and if that is not the case, they could proceed with no delay. But if there is no way to check gastric contents, then you should manage accordingly, which may require intubation or postponing an elective procedure for another day. These are new and changing issues. In our world as gastroenterologists, we should be considering — very strongly — mitigating strategies to protect the patients on this wonderful class of therapy. Sometimes these drugs can have significant side effects that we need to at least be aware of. Nothing is perfect, but let us be better informed. https://www.medscape.com/viewarticle/994762?src=soc_yt

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When it comes to achieving weight loss and muscle gain goals, strategic nutrition plays a crucial role in maximizing results. While a balanced diet is essential, many individuals turn to supplements to enhance their progress. For men looking to shed excess body fat and build lean muscle mass simultaneously, choosing the right supplements is key. With a plethora of options available on the market, it can be overwhelming to navigate which products are most effective. In this article, we will delve into the world of strategic nutrition for male weight loss and muscle gain, exploring the supplements that can help men in achieving their fitness goals.

Protein Powders

Protein is a fundamental nutrient for muscle building and repair. For men aiming to increase muscle mass, incorporating a high-quality protein powder into their diet can be highly beneficial. Whey protein, in particular, is a popular choice due to its fast absorption rate and high amino acid content. Consuming a protein shake post-workout can help replenish protein stores and support muscle recovery. Additionally, protein powders are convenient for individuals with busy lifestyles, allowing them to meet their protein requirements without having to prepare a full meal.

Creatine

Creatine is another supplement that is widely utilized by men seeking to enhance their muscle growth and strength gains. Creatine monohydrate is the most researched form of creatine and has been shown to improve performance during high-intensity, short-duration activities such as weightlifting. By increasing the body’s creatine stores, this supplement can help individuals lift heavier weights, perform more repetitions, and make faster progress in the gym. Additionally, creatine supplementation may also aid in muscle recovery, allowing for more frequent and intense workouts.

BCAAs

Branched-chain amino acids (BCAAs), consisting of leucine, isoleucine, and valine, are essential nutrients that play a crucial role in muscle protein synthesis. BCAAs are particularly beneficial for men looking to preserve muscle mass while cutting calories for weight loss. During periods of calorie restriction, the body may break down muscle tissue for energy. Supplementing with BCAAs can help prevent muscle breakdown, allowing individuals to maintain their hard-earned gains. Additionally, BCAAs can reduce muscle soreness and fatigue, enabling men to recover more quickly between workouts.

Omega-3 Fatty Acids

Omega-3 fatty acids are essential fats that offer a myriad of health benefits, including improved cardiovascular health and reduced inflammation. For men focusing on weight loss and muscle gain, omega-3 supplementation can aid in promoting a leaner physique. Omega-3s have been shown to enhance insulin sensitivity, which is crucial for regulating blood sugar levels and promoting fat loss. Additionally, these fats can support muscle recovery and reduce exercise-induced inflammation, allowing for quicker recovery and improved performance in the gym.

Green Tea Extract

Green tea extract is a powerful antioxidant that has gained popularity for its weight loss properties. This supplement contains a compound called epigallocatechin gallate (EGCG), which has been shown to increase metabolism and promote fat oxidation. For men looking to shed stubborn body fat, incorporating green tea extract into their routine can aid in boosting energy expenditure and enhancing fat loss. Additionally, green tea extract has been linked to improved exercise performance and endurance, making it a valuable addition to a weight loss and muscle gain regimen.

Summary

In conclusion, strategic nutrition plays a vital role in optimizing male weight loss and muscle gain efforts. By incorporating the right supplements into their diet, men can enhance their progress and achieve their fitness goals more efficiently. Protein powders, creatine, BCAAs, omega-3 fatty acids, and green tea extract are just a few examples of supplements that can support weight loss and muscle gain simultaneously. While supplements can be beneficial, it is important to remember that they are intended to complement a well-rounded diet and exercise routine. Consulting with a healthcare provider or nutritionist before adding supplements to your regimen is recommended to ensure safety and effectiveness.

Ultimately, with the proper combination of supplements, nutrition, and training, men can unlock their full potential and sculpt their desired physique. Stay dedicated, stay consistent, and reap the rewards of your hard work and commitment to a healthier, stronger you.

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