What the protein literature actually shows, and in whom it was shown
The denominator matters more than the ratio: per kilogram of body weight, of ideal weight, or of lean mass gives three different targets.
Nutrition
Page 7 of 11 of this archive, newest first.
Attribution is the hard part
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.
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…
Why the bone question is harder than the muscle question
A plausible mechanism, a measurable change, and no outcome data. This is what an open question looks like.
When to stop escalating and when to stop entirely
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 the trials counted as intolerance
We set out the questions that distinguish a symptom to manage from a dose to change.
The interventions with trial support, and the much longer list without
Almost nothing in the standard management repertoire has been tested in a randomised trial in this specific population. We say what is extrapolated and from where.
Percentage of loss, absolute kilograms, and the sleight of hand between them
The trials measured mass. Nobody measured whether the participants got weaker.
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.
Hydration, protein and the two failures that compound each other
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
Why "muscle-sparing" is a marketing term and not a measurement
Grading six widely repeated claims against the studies actually behind them.
Why "muscle-sparing" is a marketing term and not a measurement
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
Antiemetics, laxatives and the thin literature underneath them
Constipation is the most tractable of the effects and the most consistently under-managed.
The visceral fat result nobody quotes, from the substudy everybody cites
The trials measured mass. Nobody measured whether the participants got weaker.
A guide to the results that will resolve themselves
The panel drawn during a week of vomiting is measuring the vomiting.
What the older diet-and-exercise trials found in the hip
Weight loss reduces bone mineral density at load-bearing sites. Whether that translates into fractures in this population is unmeasured.
Sarcopenia is a diagnosis, not a synonym for losing lean mass
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
Delayed emptying explains some of this, and not all of it
What scintigraphy and breath-test studies established about emptying rate, and what they did not.
Tolerability is the ceiling, and the ceiling is personal
Roughly four to seven per cent of trial participants discontinued for adverse events, mostly gastrointestinal, mostly during escalation. That is the empirical size of the…
The interventions with trial support, and the much longer list without
We separate what is supported, what is reasonable, and what is folklore, and we do not pretend the boundaries are crisp.