Neerav Mullur

Incoming Internal Medicine PGY1 at McMaster University

All opinions are my own

[Neerav Mullur @NeeravMullur]

@ApoDudz With glp1s and sglt2is around the question of whether A1C lower = better won’t ever really be answered by RCTs, all we will have are cohort studies

[Neerav Mullur @NeeravMullur]

@ApoDudz This seems like an example of where torturing the data will reveal anything you want. I don’t think a single person is surprised that the mortality increased in those who had poorly controlled T2D and nowadays accord is but a good suggestion being from pre-CVOT days of diabetes

[Neerav Mullur @NeeravMullur]

@JCanNuSH @MichaelMindrum That said I guess the effect of the metformin is there as well. Not sure what would be expected in the way of A1C reduction in treatment naive patients vs those already on metformin but it’s interesting to see this table! Thank you!

[Neerav Mullur @NeeravMullur]

@JCanNuSH @MichaelMindrum Surpass 2 is what I found most striking, because all of the tirz doses exceeded A1C lowering of 2%, with 7-11% weight loss, while Retatrutide had 11-15% weight loss. I definitely see the floor effect but am surprised the floor is reached at 6.0% and not lower.

[Neerav Mullur @NeeravMullur]

@MWeintraubMD @DrDerekConnolly Surpass 2 compared sema and tirz, and found tirz max dose at -2.30% in charge from baseline. With greater weight loss seen with Retatrutide, GCG agonism could possibly explain why the A1C reduction stops at a similar point as tirzepatide.

[Neerav Mullur @NeeravMullur]

@MacroFour @DrHirschfield @LiveAncestral Poorly, the entire bodybuilding community exists because you’re wrong. Doesn’t work and doesn’t work long term are two very different things

[Neerav Mullur @NeeravMullur]

@MattCalkinsMD Super interesting study because of the attention paid to metabolism. Interesting also is the increase in protein ox in KD here. Either way tough for authors to highlight anything about long term liver health after 6 days of KD🤣🤣🤣

[Neerav Mullur @NeeravMullur]

@MattCalkinsMD @BradChilmeran @richcollins @ApoDudz This is hilarious LOL. Props to Terry for actually using a bot, I respect the hustle.

[Neerav Mullur @NeeravMullur]

@raphaels7 The steam is coming out of your ears LOL. I said sex vs gender is a well made distinction but you chose to ignore that. Phillips isn’t even debating reproductive phys, this is about exercise and you’re getting heated about pronouns.

[Neerav Mullur @NeeravMullur]

@raphaels7 Discrediting someone’s expertise in their field on the basis of your disagreement with a sort of political position is a bit strange. Also sex vs gender is a very well made distinction which I suspect no one will disagree with you on.

[Neerav Mullur @NeeravMullur]

@EricTopol What is the definition of microdosing anyway? data exist at 0.25mg Sema, 2.5mg Tirz, 0.1 daily sema. These are micro relative to clinical doses, but are we to believe they have no place other than initiation? Such blanket thinking sounds antithetical to individualized medicine.

[Neerav Mullur @NeeravMullur]

@mackinprof This was an absolutely insane read, very concise and detailed explanation of the two sides and a shining winner of this debate, all understandable to someone with minimal understanding of exercise phys. Thanks for the breakdown.

[Neerav Mullur @NeeravMullur]

@mackinprof It’s a great day when the GOAT pours cold water on the anti carb guys.

[Neerav Mullur @NeeravMullur]

@ZKForTre @drgarymcgowan @whitfieldlewis6 Alongside discounting fibre’s benefits in an organ system because it isn’t recommended in an acute illness of that organ system? AceI can’t be nephroprotective then, nor can SGLT2i’s, nor can lasix.

[Neerav Mullur @NeeravMullur]

@drgarymcgowan X isn’t beneficial it’s the effect of X on the body is such a strange take. By that logic exercise isn’t beneficial, it’s the effect of the exercise on our body🤣🤣🤣🤣🤣🤣

[Neerav Mullur @NeeravMullur]

@MichaelMindrum @cpgale3 @hmkyale Pangram seems to be quite sensitive but not specific. I’ve run some paragraphs from Drucker’s 2006-2007 reviews and pangram gives >75%

[Neerav Mullur @NeeravMullur]

@bschermd This is not a novel finding. Fibrate trials, ACCORD-Lipid, all show that artificial TG reductions don’t show reductions in events. What is more interesting is that despite ApoB lowering, there was no plaque reduction. This seems explainable by it not being a high risk group.

[Neerav Mullur @NeeravMullur]

@morellifit Almost everyone in the space who knows anything about incretin therapies knows they are more than weight loss drugs

[Neerav Mullur @NeeravMullur]

@MichaelMindrum @ScottAppliedSci Possibly alongside futile cycling there is increased peripheral FFA usage in B-ox with TBK1 inhibition, so less FFA to the liver for ketogenesis?