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CrossRef Letter: Association between Non-Alcoholic Steatohepatitis and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus (Diabetes Metab J2020;44:26776) Sung Hoon Yu Diabetes & Metabolism Journal.2020

This article explores tirzepatide's effects on appetite, reasons for paradoxical hunger responses, and evidence-based strategies to optimize your therapy

I discussed the roles of the three dietary components of Metabolic Engineering (i.e., Zone diet, omega-3 fatty acids, and polyphenols) in increasing AMPK activity in two of my most recent books, The Mediterranean Zone and The Resolution Zone (4,5)

Be alert to dizziness when changing positions Monitor blood pressure if possible, as dehydration can cause drops Note frequency and colour of urination throughout the day Medical considerations Adjust medication timing to minimise side effects that contribute to dehydration Consider temporary dose adjustment in consultation with your healthcare provider Discuss anti-nausea or anti-diarrhoeal medications if these symptoms are contributing to fluid loss Consider IV fluids for severe cases (requires medical intervention) When to seek medical advice Contact your healthcare provider immediately if you experience: Severe thirst that cannot be satisfied by drinking Little or no urination for 8 hours or more Dizziness or lightheadedness that impairs functioning Confusion, disorientation, or extreme fatigue Rapid heart rate or breathing Fainting or severe weakness Inability to keep fluids down due to vomiting Long-term outlook With proper management, most patients can maintain adequate hydration whilst on GLP-1 treatments

Immunohistochemical analysis has revealed GLP-1 R expression in the acinar and ductal epithelium of the lacrimal gland, although this expression is significantly downregulated in diabetic models