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Sanaka M, Kuyama Y, Yamanaka M

British Medical Journal: Long term use of proton pump inhibitors and risk of stomach cancer: population based case-control study in five Nordic countries Serious Adverse Effects of PPIs While the connection of PPIs to dementia or cognitive decline has also been discounted, omeprazole has been linked to kidney injury

Since the incretin hormones, glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GIP), are major regulators of post-prandial insulin secretion, inhibition of DPP4 by the gliptin family of drugs has gained considerable interest for the therapy of type 2 diabetic patients

Cirincione B, LaCreta F, Sager P, Mager DE

Who Experiences More Side Effects: Higher Risk of Side Effects: Women (higher rates than men) Starting at higher doses Rapid dose escalation History of GI issues (GERD, IBS) Slower metabolism Older age Lower Risk of Side Effects: Men (lower rates than women) Gradual dose escalation Prior GLP-1 exposure Following dietary recommendations Managing Side Effects Successfully: Diet Modifications: Foods to Emphasize: Lean proteins (chicken, fish, eggs) Non-starchy vegetables Clear broths and soups Crackers, toast (for nausea) Ginger (natural anti-nausea) Peppermint tea Foods to Avoid: Fatty, greasy foods (worsen nausea) Spicy foods (irritate GI tract) Large portions (harder to digest) Carbonated drinks (increase bloating) Alcohol (worsens nausea, dehydration) High-sugar foods (blood sugar swings) Eating Strategies: Small, frequent meals (5-6 times daily) Eat slowly, chew thoroughly Stop when satisfied (dont push to full) Stay upright after eating (prevents reflux) Dont drink large amounts with meals When to Contact Your Provider: Urgent (Call Immediately): Severe abdominal pain Persistent vomiting (cant keep fluids down) Signs of dehydration (dark urine, dizziness, confusion) Severe allergic reaction Vision changes Symptoms of pancreatitis Non-Urgent (Schedule Appointment): Side effects not improving after 4 weeks Want to discuss slowing dose escalation Questions about managing side effects Considering anti-nausea medication Weight loss plateau concerns Discontinuation Rates: Due to Side Effects: Semaglutide: 6.9% discontinue Tirzepatide: 6.2% discontinue Over 93% of patients tolerate well enough to continue Long-Term Safety: Semaglutide: On market since 2017 (8 years) Extensive real-world safety data SELECT trial: Actually reduced cardiovascular events (20% reduction) No new safety concerns with longer use Tirzepatide: On market since 2022 (3 years) Growing real-world safety data Clinical trials show excellent safety profile Cardiovascular outcomes trial ongoing Both medications appear safe for long-term use based on available evidence

Despite important procedural differences from our present study, a closer look at their findings also reveals a strong initial anorectic effect of Ex in the first 1 to 3 h, and the food consumption reductions in the time period of 4 to 5 h post-administration were of comparable size to our present findings in S2
