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Jain, MD: Welcome back to ADA 2024 updates. I'm endocrinologist Dr Akshay Jain from Vancouver in Canada, and today we've got a very special guest. We've got Professor Dr Girish Joshi. Dr Joshi is a professor of anesthesiology and pain medicine at UT Southwestern in Dallas, Texas. He was one of the speakers at a very impactful session that was talking about the postoperative and intraoperative considerations for people who are on GLP-1 therapy. He's here to talk with us about clinical considerations that one needs to keep in mind when someone on glucagon-like peptide 1 (GLP-1) receptor agonist therapy is undergoing elective procedures. Welcome, Dr Joshi. Girish P. Joshi, MD: Thank you, Akshay. It's an honor. Jain: I was attending your session, and I found it very clinically impactful. This is something that we are seeing more and more in clinical practice. For our viewers today, can you share with us, as an anesthesiologist, the potential risks for aspiration and the rates of aspiration that you're seeing in people who are on GLP-1 therapy? Joshi: We don't know the exact rate of aspiration with GLP-1 therapy because there are no good studies, but there are several anecdotal reports, including several personal communications where people have contacted me and the American Society of Anesthesiologists (ASA). I'm the chair of the task force for these GLP-1 recommendations developed by the ASA. To give an example, one of the cases reported to me was from a colleague in Dallas where a patient, otherwise completely healthy, came in for a shoulder arthroscopy — a simple outpatient procedure in a freestanding ambulatory surgery center. Surgery went fine. At the end of the procedure, she regurgitated gastric content and aspirated, and then had to be taken to the intensive care unit (ICU) and she spent 7 days in the ICU. Retrospectively, it was recognized that she was on GLP-1 therapy for weight loss, which was not disclosed. This was just before the ASA came up with the guidance, basically, so people didn't know that GLP-1 receptor agonists do increase the risk for aspiration. Jain: That's a really good point straight from your clinical practice. For our viewers who may not be familiar with the guidelines, could you tell us, in a nutshell, for people on GLP-1 therapy who are going in for an elective procedure that requires general anesthesia, what would be the recommendations for holding GLP-1s? Joshi: I have to first emphasize that currently, the evidence to provide any guidance is sparse, and whatever studies are available are basically questionable or of poor quality. 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I don't know whether you remember I had an algorithm I developed and presented at the American Diabetes Association (ADA) meeting, where I presented the potential risk factors. If the patients are at risk for regurgitation and aspiration, that's the patient population we've got to be extra careful with. Maybe start off withholding the drug if the patients are on, say, a weekly therapy, then 1 week before, though the evidence is minimal. Nevertheless, more importantly, avoid elective procedures during that escalation phase in this patient population. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/glp-1-guidance-reduce-regurgitation-and-aspiration-risk-2024a1000d35?src=soc_ytG6 Keto Acv Gummies Reviews Beware Form Scam Is It Real🥑⚖️ Dive into the world of the Keto diet with this #Shorts video! Discover the potential benefits and drawbacks of this low-carb, high-fat eating approach. 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However, please ensure that there isn’t any allergen or ingredients explicitly stated on the product which might not be right for your diet. vibez keto lets keto price rapid keto gummies apex keto plus keto slimming gummies Fast Weight Loss Pills Evaluating Quickacting Weight Management SolutionsWhat do you need to know to get the best results on a low-carb diet? Which foods to eat and which foods to avoid. In today's video, I'll share the low-carb foods to focus on, along with the number one mistake that may be slowing down your progress. Read the full guide at https://www.dietdoctor.com/low-carb 00:00 Introduction 00:38 Number 1: What is a low-carb diet? 01:51 Number 2: What to eat on a low-carb diet 03:24 Number 3: What are the benefits of a low-carb diet? 05:00 Main mistake when following a low-carb diet 06:04 How to get started Subscribe to our channel if you don't want to miss any of our videos: https://www.youtube.com/c/DietDoctorVideo?sub_confirmation=1 About us: DietDoctor.com is the world's number one low-carb site. Follow us for delicious recipes, meal plans and tools to make your low-carb and keto lifestyle simple. But this YouTube channel does not contain all our videos!Keto Diet 12 Week Update Weigh In Weight Loss Journey Ketogenic Dietbellies, beds, at least 60 kg women who gave birth are also suitable ❗️ Presence of cellulite and stretch marks is welcome ❗️ Age is not important ‼️ It’s time to start so as not to launch yourself❗️❗️❗️Exercise For Belly Fatarms Fatthai FatbellyfatarmsfatweightlossfitnessshortsmotivationfitThe Reasons You're Not Losing Weight on Carnivore Are you eating zero carbs… and still not losing weight? Or worse—gaining? In this video, Dr. Tony Hampton breaks down the Top 10 Reasons why your carnivore diet may be backfiring, from hidden insulin resistance to eating too frequently—even without carbs. You’ll walk away understanding the root causes that block fat loss on carnivore… and more importantly, how to fix them. 🔍 This is NOT just about calories. It’s about healing your metabolism, correcting hidden hormone imbalances, and optimizing your lifestyle—carnivore style. 🎯 Stick around for the practical tips and real-world strategies I use in my clinic. Let’s get you back on track. 👇 Drop a comment: Which reason hit home for you? 🎬 Watch next: https://www.youtube.com/@DrTonyHampton/playlists ⏱ Suggested Timeline / Chapters 00:00 Intro: Still Gaining on Zero Carbs? 01:27 Reason 1: You’re Eating Too Much Fat 02:05 Reason 2: Your Body Is Prioritizing Healing 02:32 Reason 3: You’re Not in a Caloric Deficit 03:03 Reason 4: Insulin Resistance Still Lingers 03:35 Reason 5: Poor Nutrient Absorption 04:00 Reason 6: Too Much Dairy or Eggs 04:30 Reason 7: Chronic Stress & Cortisol 05:00 Reason 8: Not Enough Sleep 05:25 Reason 9: You’re Eating Too Often 05:52 Reason 10: Hormonal Imbalance or Menopause 06:27 Reason 11 & 12 (Bonus): Too Low in Protein & Not Moving Enough 07:29 Action Plan: What to Do Starting Today 🔥 Hashtags #CarnivoreDiet #WeightLossTips #ZeroCarb #MetabolicHealth #Top10 #FatLoss #CarnivoreKeto #CarnivoreWeightLoss #HormoneHealth #DrTonyHampton #RootCauseHealing #InsulinResistance