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Growing evidence suggest that the elevation of GLP-1 is also critically involved in the effects of metformin, gut microbiota, and bariatric surgery on metabolic homeostasis 3,4,5,6

The biology is still visible

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GLP-1s, used to treat obesity, diabetes and heart problems, delay gastric emptying, and residual food or liquid in the stomach at the time of surgery with general anesthesia, may increase the risk for serious complications including aspiration

These approaches typically involve: Lower maintenance doses (200-300mcg daily) Monthly assessment checkpoints Flexible adjustment windows Extended rest periods (4-6 weeks minimum) Research Note: Extended protocols should only be undertaken with comprehensive monitoring and documentation