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Holly Lofton, MD, an obesity expert at NYU Langone Health, discusses the differences between GLP-1 agonists for weight loss and glycemic control. https://www.medscape.com/viewarticle/995911?src=soc_yt -TRANSCRIPT- I'm Dr Holly Lofton, clinical associate professor of surgery and medicine at NYU Langone Health, and I direct the medical weight management program. My practice is solely based on chronic weight management for adults. Today I'll talk about the various doses of GLP-1 agonists that you may prescribe to your patients. Being that this is based around weight management, I'll start with the weight management medications, the first of which is Saxenda. This is liraglutide 3 mg for chronic weight management. The studies that were done with this medication were intended to get the patient to the 3-mg dosing, which is what's prescribed for weight management, and not the 1.8-mg dosing which is prescribed for type 2 diabetes. However, you may deliver different doses to your patients depending on your goal. You see that this makes a lot of clicking noise. When the patient starts Saxenda and has their pen, there will be this clear fluid. It's important to remind them that this is a multiuse pen and that they should use it over and over again until it's empty. This medication has various doses in the same pen. You want to increase weekly as long as the patient is tolerating it. And by that, I mean not having significant side effects such as nausea, constipation, or other stool changes. When a patient receives the pen, it will start with 0. In the first week, we do 0.6 mg daily. The next week we do 1.2 mg daily. The third week we do 1.8 mg daily. The next week we do 2.4 mg daily, and then the goal is to get the patient to 3 mg, which is the maintenance dose. Ideally, the patient would stay there for their chronic weight management. However, if a patient can't tolerate the dose, you can also have them go to a lower dose for 7 more days and try again. Wegovy, which is semaglutide 2.4 mg, is also prescribed for chronic weight management. This is a single-use cartridge, so the pen will deliver only the dose that you prescribe to the patient. This as well is intended to increase monthly as long as the patient is tolerating it and not having too many significant GI side effects such as nausea, constipation, or loose stool. With this pen, the doses are 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg. You increase it monthly or every 4 weeks, depending on the patient tolerance. However, if a patient is not able to tolerate the highest dose, you can prescribe the maximally tolerated dose for that patient. The next new GLP-1 I'll talk about is Ozempic [semaglutide] prescribed for type 2 diabetes. The goals of titrating this medication really depend more on your patient's glycemic control, as this is used for glycemic management. Here we have the red labels and big pen, and this delivers either 0.25 mg or 0.5 mg. The recommendation for this medication is to use 0.25 mg for 4 weeks. Assess the patient's glycemic control, and if needed, increase to 0.5 mg after 4 weeks. Again, this pen delivers either 0.25 mg or 0.5 mg only. This blue-green–label Ozempic [semaglutide] delivers 1-mg dosing, so when your patient turns this one all the way to the end, the only number they will see will be 1. If your patient does not have optimal glycemic control with the lower doses, a 1-mg pen can be prescribed and the patient can continue on that, optimizing their glucose, or you can increase to a 2-mg pen [yellow label], which delivers only 2 mg. This is a single-use cartridge for Trulicity [dulaglutide]. The various doses of Trulicity are 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg. This pen will deliver only the dose that's prescribed, and you can titrate up to optimize glycemic control for your patient. The higher the dose, the better the improvement in glucose and hemoglobin A1c. This is the pen for Mounjaro, which is tirzepatide. At the time of this recording, this medication is intended for type 2 diabetes management. It's a single-use cartridge, and the different doses vary from 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, to the highest dose, 15 mg. Again, this should be titrated to optimize glycemic control for your patient, and you can increase or decrease the dose based on the patient's tolerance. https://www.medscape.com/viewarticle/995911?src=soc_yt

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20 doctors talk about their experience with the low carb ketogenic diet. PBN INSIDERS: https://plantbasednews.org/insiders In association with: https://plantricianproject.org/ https://www.bluehorizon.com/ https://switch4good.org/ https://www.plantbasedhealthprofessionals.com/ https://www.pcrm.org/ https://nutritionstudies.org https://wellnessforumhealth.com/ The introduction was taken from PlantPure Nation: https://www.youtube.com/watch?v=A_i_vp9Vfho REFERENCES: 1. De Biase SG, Fernandes SFC, Gianini RJ, Duarte JLG. Vegetarian diet and cholesterol and triglycerides levels. Arq Bras Cardiol. 2007 Jan;88(1):35–9. 2. Saslow LR, Mason AE, Kim S, Goldman V, Ploutz-Snyder R, Bayandorian H, et al. An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial. J Med Internet Res. 2017 Feb 13;19(2):e36. 3. Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015 Oct;102(4):780–90. 4. Dr. Bernstein’s Diabetes Solution, low carbohydrate diet, control blood sugars [Internet]. Dr. Bernstein’s Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site. [cited 2016 Mar 5]. Available from: http://www.diabetes-book.com/ 5. Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS, et al. Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials. Am J Epidemiol. 2012 Oct 1;176(Suppl 7):S44–54. 6. de Bock M, Lobley K, Anderson D, Davis E, Donaghue K, Pappas M, et al. Endocrine and metabolic consequences due to restrictive carbohydrate diets in children with type 1 diabetes: An illustrative case series. Pediatr Diabetes. 2017 Apr 11; 7. Noakes TD, Windt J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med. 2017 Jan;51(2):133–9. 8. Noto H, Goto A, Tsujimoto T, Noda M. Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies. PLoS ONE [Internet]. 2013 Jan 25 [cited 2014 May 9];8(1). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/ 9. Ranjan A, Schmidt S, Damm-Frydenberg C, Holst J, Madsbad S, Nørgaard K. Short-term Effects of Low Carbohydrate Diet on Glycaemic Parameters and Cardiovascular Risk Markers in Patients with Type 1 Diabetes - A Randomised Open-label Cross-over Trial. Diabetes Obes Metab. 2017 Mar 27; 10. Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5(1):e000354. 11. Hegsted DM, McGandy RB, Myers ML, Stare FJ. Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr. 1965 Nov;17(5):281–95. 12. Grundy SM, Barrett-Connor E, Rudel LL, Miettinen T, Spector AA. Workshop on the impact of dietary cholesterol on plasma lipoproteins and atherogenesis. Arterioscler Thromb Vasc Biol. 1988 Jan 1;8(1):95–101. 13. Hopkins PN. Effects of dietary cholesterol on serum cholesterol: a meta-analysis and review. Am J Clin Nutr. 1992 Jun 1;55(6):1060–70. 14. Ference BA, Mahajan N. The Role of Early LDL Lowering to Prevent the Onset of Atherosclerotic Disease. Curr Atheroscler Rep. 2013 Apr 1;15(4):312. 15. Kahn HA, Phillips RL, Snowdon DA, Choi W. Association between reported diet and all-cause mortality. Twenty-one-year follow-up on 27,530 adult Seventh-Day Adventists. Am J Epidemiol. 1984 May;119(5):775–87. 16. Orlich MJ, Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, Knutsen S, et al. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern Med. 2013 Jul 8;173(13):1230–8. 17. Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng C-W, Madia F, et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014 Mar 4;19(3):407–17. 18. Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med. 2016 Aug 1; 19. Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, et al. Meat consumption and mortality--results from the European Prospective Investigation into Cancer and Nutrition. 20. Djoussé L, Gaziano JM. Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. 21. Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort Studies.

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