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👋 Happy Friday. Y’know the old saying: Med-news a day, keeps industry-specific ignorance away... So it's too bad we only do one email a week. You're screwed, I'm sorry…

Here’s what we got:

• 🐆🐊💉How To Train Your GLP-1 Mimetic

• ⏰ Circadian Showdown: Which Sleep Pattern Endangers Your Heart?

• #TheMoreYouKnow: Other Top Stories of The Week

CLINICAL SUMMARY
How To Train Your GLP-1 Mimetic

Welcome… to Pharma Safari 🐆🐊💉 

Watch out now. Keep your distance. What you’re seeing in front of you is a wild GLP-1 mimetic. 

GLP-1 mimetics are curious creatures. In the wild, their sole focus is on diabetes. In recent years, we’ve managed to domesticate the beast. It can now focus on a much more generic goal — weight loss. 

Now, this shift has led to GLP-1s becoming more popular than Labubus. Pharmacies are overwhelmed. Cheaper, impure-breed GLPs are being sold on the grey market. And, when sold to the wrong owner, the consequences can be a disaster for both parties. 

As a healthcare provider, it’s your responsibility to ensure breeds like semaglutide and tirzepatide are paired with the right handlers. And more importantly, that they’re managed with care. Because these creatures aren’t plug-and-play. They need training. Monitoring. Structure.

Luckily, JAMA Internal Medicine has published the five cardinal rules of GLP-1 stewardship:

1. Track Weight, But Don’t Fixate:

I know our key performance indicator here is weight loss. You can expect a loss of 15–21%. But it’s a real goldilocks zone we’re trying to reach. 

Monitor weight monthly during dose titration. Once stable, check quarterly. But if your patients lost less than 5% by week 16, that’s a signal. Not of failure, necessarily, but of something. Maybe adherence. Maybe dose. Maybe the wrong mimetic entirely.

Also: beware the other extreme. If weight loss is too rapid, or dips below a BMI of 18.5, start investigating. Red flags include sub-800 kcal diets, hormonal disturbances, muscle loss, and “I swear I’m fine” energy levels that say otherwise.

Sometimes the mimetic is doing too good a job. At that point, it might be time to taper the dose or for a psychiatric assessment.

2. Preserve Muscle Like it’s Made of Gold

Fun fact: 40% of the weight lost on GLP-1s may be muscle. That’s not ideal, especially if your patient wants to, you know… stand up.

To avoid this, we need protein. More than the average “I had a yoghurt this morning” kind of protein. Think 1.0–1.5 g/kg/day, minimum. For older adults or post-bariatric patients? Push that to >1.5 g/kg. Shakes count, provided they’ve got 20g+ of protein and don’t taste like despair.

Exercise matters too. Encourage 150 minutes of moderate cardio per week, plus strength training two or three times. Done right, this can reduce muscle loss by 95%.

3. Micronutrients: Small But Mighty.

Reduced intake = higher risk of deficiency. Most patients already start low on vitamin D, B12, iron, magnesium, etc.

Do lab tests up front or at the first signs of deficiency. Refer to a dietitian if possible. If not, use a screening tool like the REAP-S.

Focus on nutrient-rich foods, not calorie cuts. Supplement as needed, but prioritise real nutrition first.

4. Handle Side Effects With Empathy and Ginger Tea

Nausea, constipation, reflux. They’re common, especially during dose increases. Don’t just reassure. Educate.

• Nausea? Small, low-fat meals. Avoid fried food. Ginger helps.

• Constipation? 2–3L water/day, fibre (real food), maybe short-term laxatives.

• Reflux? Smaller meals, sit upright, skip spicy or caffeinated drinks.

Most symptoms settle with time, but only if managed properly.

5. Prevent Relapse Like It’s Your Full-Time Job

After stopping GLP-1s, patients typically regain 7–12% of their lost weight within a year. Not because they’re weak-willed, but because obesity is chronic. Semaglutide didn’t fix it… it managed it.

So. manage the transition. Set realistic expectations. If stopping, do it slowly. Watch closely. And keep the healthy habits going: movement, food quality, mental health support.

If weight regain crosses 5%, it may be time to restart treatment or try another approach. But don’t leave your patient to fend for themselves. That’s how mimetics go feral.

A final note. Training GLP-1 mimetics isn’t about issuing commands and hoping for the best; it’s about stewardship. Clinical curiosity. All medicine should be like this. 

Now go forth, and train your mimetic. Responsibly.

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RESEARCH UPDATE
⏰ Circadian Showdown: Which Sleep Pattern Endangers Your Heart?

Look at them all. The morning people. With their chirpy disposition. A Parkrun, morning affirmations and 3 chapters of Atomic Habits all before 8am. 

Those early birds that get the worm. They float through life powered by black coffee and pure self-satisfaction.
Flexing their “perfect sleep score” on their Whoop or Oura ring.
What’s their secret? And where's my worm?!

I know comparison is the thief of joy, but now research verifies what I secretly knew to be true: 

If your sleep habits involve staying up past midnight and daytime napping like a Mediterranean pensioner… You might be courting atrial fibrillation.

This was found in research published in the European Journal of Preventive Cardiology. The Spanish researchers set out to investigate the association between daytime napping, night sleeping time and incidence of AF. 

To do it, they ran a massive prospective cohort study. Over 20,000 university graduates who were AF-free at baseline filled out questionnaires about how long they sleep and whether they nap.

• Daytime naps were grouped into <30 mins/day, >=30mins/day, or no nap

• Nighttime sleep is categorised as adequate (6-8 hr/day) or inadequate (<6hr/day or >8hr/day) - because apparently too much sleep is also a problem. Who knew?

With the patience of a Rihanna fan, the researchers followed up for the next 15 years to see who’d develop AF. 

What they found was:

• Out of the 20,827 people followed, 163 developed confirmed AF

• Long naps (≥30 min/day) were associated with a 62% increased risk of AF compared to short naps (<30 min/day) (HR = 1.62; 95% CI: 1.10–2.39). 

• No real difference between short naps and no naps

• Inadequate sleep (<6 or >8 hours) raised AF risk too. 89% higher compared to the sweet spot of 6–8 hours (HR = 1.89; 95% CI: 1.10–3.23).

• The combination of long naps and inadequate nighttime sleep yielded the highest risk. A threefold increase in AF (HR = 3.19; 95% CI: 1.30–7.79)

Coffee, alcohol and now irregular sleep schedule and even siestas? Managing health has a way of sucking the fun out of life, doesn’t it. 

But like all studies, this one has its limitations. The overall incidence of AF was pretty low, affecting the statistical power. Sleep habits were self reported, and only baseline sleeping and napping patterns were assessed. People can change y’know. 

This study isn’t saying you have to ditch your personality and start doing sunrise yoga in matching activewear. 

But when looking at lifestyle factors with patients with cardiovascular risk, it’s worth asking what time they finished that K-drama last night…and just how romantically attached they are to their bed.

QUICK BITS: OTHER NEWS YOU SHOULD KNOW

• Huge Research Boost With New Life Sciences Sector Plan - Unlike our cousins across the pond, it seems our government still remembers research exists. Hoorah! The UK’s just launched a £2 billion plan to become the number one life sciences economy in Europe by 2030. Fingers crossed this means the end of grovelling for 6th author on a paper about yeast metabolism in mice 🙏 

• Big Win For SGLT2 Inhibitors - SGLT2 inhibitors: not just for diabetes anymore. Why should GLP-1 mimetics have all the fun? According to a new meta-analysis, the -gliflozins can hold their own in acute heart failure too. Plus a bonus of a pretty solid safety profile.Now all that’s left is to wedge them into UK guidelines. So… see you in 2035

• BMA Not Letting Up - Strikes Done. Protest Continue. The BMA calls for deal to actually tackle the training bottleneck after foundation year training. And rightly so! A survey of 4,400 resident doctors found that 34% had no role secured for next month. 30,000 doctors applying for 10,000 specialty places according to the union. This can’t continue.

• Once-a-Week Insulin  – A new study in The New England Journal of Medicine shows that once-weekly insulin efsitora is just as effective as daily glargine in people with type 2 diabetes new to insulin. Same HbA1c drop, fewer hypos, and a lot less diary faff. Might finally be time to bin the daily jab.

• Palantir’s NHS Pitch: From Battlefields to Bedside – The US tech giant best known for helping fight wars now wants to help manage your diabetes. Palantir, fresh off its £330 million NHS data deal, has accused UK doctors of putting ideology over patient care, which is rich coming from a company whose usual clientele includes the Pentagon and Mossad. Naturally, the BMA isn’t thrilled about a firm with military surveillance roots getting its hands on patient data. And they’re not alone. Critics warn it could erode trust in the NHS faster than you can say “AI-enabled triage drone.” What could possibly go wrong?

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