Straight Shot with Dr. Clete Barrick

Let Dr. Barrick know what you think of the episode and send any questions his way too!

Every GLP-1 carries a black box warning about thyroid cancer. Should it worry you? This episode covers the thyroid cancer data, why screening ultrasounds backfire, your thyroid pill, prediabetes, low blood sugar on insulin and other diabetes medicines, type 1 diabetes, ketoacidosis, bariatric surgery, your adrenal glands and genetic causes of obesity. Ending with a verdict, built from a full literature review.

Dr. Clete Barrick is board-certified in internal medicine and obesity medicine. Straight Shot Season 2 goes through the body one system at a time.

In this episode:

- The thyroid cancer warning comes from rodents; the human risk is very low and unproven

- Routine calcitonin tests and thyroid ultrasounds lead to biopsies and surgery without proven benefit

- Levothyroxine doses often need to come down as weight comes off

- Prediabetes reverses while you take a GLP-1, and much of that fades after stopping

- Sulfonylureas and insulin need adjusting at the start, carefully, to avoid both lows and ketoacidosis

My book, the GLP-1 Bible, is up for preorder: https://barrickhealth.com/glp1-bible

Your first visit at Barrick Health is free: https://barrickhealth.com

Chapters

0:00 The thyroid cancer warning

2:05 Where the black box warning comes from

4:04 The common thyroid cancers

6:08 Why you shouldn't get screened

7:39 Your thyroid pill

9:16 Prediabetes, on and off the shot

10:49 Low blood sugar on other diabetes medicines

12:52 Type 1 diabetes

14:16 When type 2 isn't really type 2

15:23 Ketoacidosis without diabetes

16:13 After bariatric surgery

17:19 Adrenals and pituitary

18:32 Brain and genetic causes of obesity

19:51 Where I land

Sources

The black box warning

Rodent and monkey C-cell studies: https://pubmed.ncbi.nlm.nih.gov/20203154/

LEADER calcitonin: https://pubmed.ncbi.nlm.nih.gov/29279300/

Scandinavian cohort: https://pubmed.ncbi.nlm.nih.gov/38683947/

French case-control: https://pubmed.ncbi.nlm.nih.gov/36356111/

Common thyroid cancers

Annals meta-analysis, Ko: https://pubmed.ncbi.nlm.nih.gov/41359966/

Trial meta-analysis, Silverii: https://pubmed.ncbi.nlm.nih.gov/38018310/

Multinational cohort, Baxter: https://pubmed.ncbi.nlm.nih.gov/39772758/

Screening

Overscreening study: https://pubmed.ncbi.nlm.nih.gov/41371825/

Your thyroid pill

Oral semaglutide and levothyroxine: https://pubmed.ncbi.nlm.nih.gov/34289755/

Levothyroxine after bariatric surgery: https://pubmed.ncbi.nlm.nih.gov/26895690/

Prediabetes

STEP 10: https://pubmed.ncbi.nlm.nih.gov/39089293/

SURMOUNT-1 three-year: https://pubmed.ncbi.nlm.nih.gov/39536238/

STEP 1 extension: https://pubmed.ncbi.nlm.nih.gov/35441470/

Remission definition: https://pubmed.ncbi.nlm.nih.gov/34462270/

Low blood sugar

GRADE hypoglycemia: https://pubmed.ncbi.nlm.nih.gov/39546502/

Zepbound label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b

Type 1 diabetes and LADA

ADJUST-T1D, semaglutide: https://pubmed.ncbi.nlm.nih.gov/40550013/

Tirzepatide in type 1: https://pubmed.ncbi.nlm.nih.gov/41264593/

C-peptide and response: https://pubmed.ncbi.nlm.nih.gov/26242184/

Ketoacidosis

Ketoacidosis without diabetes: https://pubmed.ncbi.nlm.nih.gov/39686534/

After bariatric surgery

GLP-1 in post-bypass lows: https://pubmed.ncbi.nlm.nih.gov/27975209/

Adrenals and pituitary

Hydrocortisone absorption case: https://pubmed.ncbi.nlm.nih.gov/23264309/

Craniopharyngioma cohort: https://pubmed.ncbi.nlm.nih.gov/41153084/

Brain and genetic obesity

Exenatide in hypothalamic obesity: https://pubmed.ncbi.nlm.nih.gov/33026160/

TRANSCEND, setmelanotide: https://pubmed.ncbi.nlm.nih.gov/42418774/

MC4R carriers on tirzepatide: https://pubmed.ncbi.nlm.nih.gov/40858971/

Everything in this episode is for educational purposes. It is not medical advice.

#GLP1 #Thyroid #Prediabetes #StraightShot

Let Dr. Barrick know what you think of the episode and send any questions his way too!

Zepbound is now FDA-approved for sleep apnea. Can you finally put the CPAP away? This episode covers what GLP-1s do for sleep apnea, why the sleep study should come before the shot, what happens if you stop, and the evidence on asthma, COPD, lung function, lung cancer and breathing side effects. Ending with a verdict, built from a full literature review.

Dr. Clete Barrick is board-certified in internal medicine and obesity medicine. Straight Shot Season 2 goes through the body one system at a time.

In this episode:

- Tirzepatide cut breathing interruptions in sleep apnea roughly in half, and about half of patients reached remission or mild sleep apnea

- Nobody has tested stopping CPAP on a GLP-1, and sleep apnea will likely return if the weight does

- Get the sleep study before the medication starts working

- Asthma and COPD flare-ups look lower in database studies, with no randomized proof yet

- No sign of more lung cancer; a reflux cough is the most common chest side effect

My book, the GLP-1 Bible, is up for preorder: https://barrickhealth.com/glp1-bible

Your first visit at Barrick Health is free: https://barrickhealth.com

Chapters

0:00 Can you ditch the CPAP?

2:02 The sleep apnea trials

4:10 What it means for how you feel

6:49 Can you stop your CPAP?

8:52 Semaglutide, retatrutide and the rest

11:02 Get tested before you start

13:18 Obesity hypoventilation

14:26 Asthma and COPD

16:36 Lung function and rarer lung disease

17:40 Lung cancer

18:25 Cough, reflux and other side effects

20:08 Where I land

Sources

Sleep apnea trials

SURMOUNT-OSA (NEJM 2024): https://pubmed.ncbi.nlm.nih.gov/38912654/

Zepbound label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b

How you feel

SURMOUNT-OSA patient-reported outcomes: https://pubmed.ncbi.nlm.nih.gov/40774158/

Time course and weight: https://pubmed.ncbi.nlm.nih.gov/41135142/

SAVE CPAP trial: https://pubmed.ncbi.nlm.nih.gov/27571048/

Stopping CPAP and stopping the shot

SURMOUNT-4: https://pubmed.ncbi.nlm.nih.gov/38078870/

Diet-cured sleep apnea follow-up: https://pubmed.ncbi.nlm.nih.gov/9864013/

The other GLP-1s

TRIUMPH-1 retatrutide: https://pubmed.ncbi.nlm.nih.gov/42814954/

SCALE Sleep Apnea, liraglutide: https://pubmed.ncbi.nlm.nih.gov/27005405/

UK active-comparator cohort: https://pubmed.ncbi.nlm.nih.gov/42745463/

Getting tested

AASM diagnostic testing guideline: https://pubmed.ncbi.nlm.nih.gov/28162150/

Obesity hypoventilation

ATS guideline: https://pubmed.ncbi.nlm.nih.gov/31368798/

Bicarbonate on GLP-1s and SGLT2s: https://pubmed.ncbi.nlm.nih.gov/41014194/

Asthma and COPD

Asthma exacerbations, Wang: https://pubmed.ncbi.nlm.nih.gov/39012183/

GLP-1s in obese asthma, McCraw: https://pubmed.ncbi.nlm.nih.gov/42733229/

Weight loss and asthma control: https://pubmed.ncbi.nlm.nih.gov/39940116/

COPD target trial emulation, Ray: https://pubmed.ncbi.nlm.nih.gov/39928303/

Lung function and rarer disease

LIRALUNG: https://pubmed.ncbi.nlm.nih.gov/34737187/

Liraglutide in COPD: https://pubmed.ncbi.nlm.nih.gov/35237033/

GLP-1 before lung transplant (case): https://pubmed.ncbi.nlm.nih.gov/38594196/

Lung cancer

TriNetX respiratory outcomes, Ho: https://pubmed.ncbi.nlm.nih.gov/41083699/

Medicare cancer cohort, Lu: https://pubmed.ncbi.nlm.nih.gov/40841345/

Side effects

Infections meta-analysis, Han: https://pubmed.ncbi.nlm.nih.gov/41173399/

Chronic cough, Gallagher: https://pubmed.ncbi.nlm.nih.gov/41296333/

Silent aspiration case: https://pubmed.ncbi.nlm.nih.gov/40625884/

Wegovy label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b

Everything in this episode is for educational purposes. It is not medical advice.

#GLP1 #SleepApnea #Zepbound #StraightShot

Let Dr. Barrick know what you think of the episode and send any questions his way too!

What do GLP-1s do to your bones, muscles and joints? Today we cover muscle loss, bone density, fractures, knee arthritis, joint replacement, gout and tendons, plus a verdict, built from a full literature review. Dr. Clete Barrick, board-certified in internal medicine and obesity medicine, continues Season 2 of Straight Shot: every organ, one episode at a time. This one is your musculoskeletal system.

The GLP-1 Bible, preorder now: https://barrickhealth.com/glp1-bible
Free first visit with Dr. Barrick: https://barrickhealth.com

Chapters
0:00 Do GLP-1s melt muscle and thin bones?
2:17 Muscle: how much is really lean mass
5:53 Bone density: what happens at the hip
8:23 Fractures, the Wegovy label and falls
11:16 What protects you: lifting, protein, calcium, the bone scan
15:35 Knee and hip arthritis: the good news
17:56 Joint replacement and orthopedic surgery
20:13 Gout and uric acid
21:24 Shoulders, tendons and back pain
22:44 Teenagers and the growing skeleton
23:21 Where I land: the musculoskeletal verdict

Sources
Muscle
Eisa 2026, lean mass in 20 trials: https://pubmed.ncbi.nlm.nih.gov/41877354/
SURMOUNT-1 body composition: https://pubmed.ncbi.nlm.nih.gov/39996356/
SURPASS-3 MRI: https://pubmed.ncbi.nlm.nih.gov/40318682/
Batsis 2026, Annals review: https://pubmed.ncbi.nlm.nih.gov/41996180/
SEMALEAN: https://pubmed.ncbi.nlm.nih.gov/41068996/
Copenhagen fitness: https://pubmed.ncbi.nlm.nih.gov/41579235/
BELIEVE, bimagrumab: https://pubmed.ncbi.nlm.nih.gov/41772149/

Bone density
Hansen 2024, osteopenia: https://pubmed.ncbi.nlm.nih.gov/38737002/
Copenhagen bone: https://pubmed.ncbi.nlm.nih.gov/38916894/
Mesinovic 2021, diet and bone: https://pubmed.ncbi.nlm.nih.gov/34004388/

Fractures
Zhang 2025, 44 trials: https://pubmed.ncbi.nlm.nih.gov/39603373/
Hamad 2026: https://pubmed.ncbi.nlm.nih.gov/42496972/
Kasher Meron 2026: https://pubmed.ncbi.nlm.nih.gov/41665888/
SELECT: https://pubmed.ncbi.nlm.nih.gov/37952131/
Wegovy label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
Constantine 2026: https://pubmed.ncbi.nlm.nih.gov/41429015/

Protection
LITOE, older adults: https://pubmed.ncbi.nlm.nih.gov/28514618/
Beavers 2025, weighted vest: https://pubmed.ncbi.nlm.nih.gov/40540267/
Nutrition advisory 2025: https://pubmed.ncbi.nlm.nih.gov/40445127/
Weaver 2026, protein: https://pubmed.ncbi.nlm.nih.gov/41553490/
Calcium case report: https://pubmed.ncbi.nlm.nih.gov/42226819/
Preventive Services Task Force screening: https://pubmed.ncbi.nlm.nih.gov/39808425/

Knees
STEP 9: https://pubmed.ncbi.nlm.nih.gov/39476339/
TRIUMPH-1: https://pubmed.ncbi.nlm.nih.gov/42814954/
LOSEIT: https://pubmed.ncbi.nlm.nih.gov/33471039/
Qin 2026, cartilage: https://pubmed.ncbi.nlm.nih.gov/41666927/

Surgery
Badhe 2026, waiting list: https://pubmed.ncbi.nlm.nih.gov/42558015/
Lee 2026, arthroplasty: https://pubmed.ncbi.nlm.nih.gov/41072556/
Pereira 2025, fracture fixation: https://pubmed.ncbi.nlm.nih.gov/40915058/
Yu 2026, neck fusion: https://pubmed.ncbi.nlm.nih.gov/42635669/
Preoperative pilot trial: https://clinicaltrials.gov/study/NCT07755085

Gout
SURMOUNT-1 uric acid: https://pubmed.ncbi.nlm.nih.gov/41198460/
Wang 2024, gout: https://pubmed.ncbi.nlm.nih.gov/38796335/

Shoulders, tendons, back
Bergstein 2025, frozen shoulder: https://pubmed.ncbi.nlm.nih.gov/39855332/
Stump 2026, carpal tunnel: https://pubmed.ncbi.nlm.nih.gov/41719026/
Benedict 2026, back pain: https://pubmed.ncbi.nlm.nih.gov/42238413/

Teenagers
Mitra 2024, teen surgery: https://pubmed.ncbi.nlm.nih.gov/38333369/
Bone study, ages 12 to 21: https://clinicaltrials.gov/study/NCT06903923

Also cited: Lilly's TRIUMPH-4 release (Dec 2025) and the 2026 American College of Rheumatology guideline coverage.

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Wegovy #BoneHealth #StraightShot

Let Dr. Barrick know what you think of the episode and send any questions his way too!

What do GLP-1s do to your reproductive health? Today we cover birth control, pregnancy, polycystic ovary syndrome (PCOS), menopause and testosterone, plus a verdict, built from a full literature review. Dr. Clete Barrick MD, board-certified in internal medicine and obesity medicine, continues Season 2 of Straight Shot: every organ, one episode at a time. This one is reproductive health, for women and men.

The GLP-1 Bible, preorder now: barrickhealth.com/glp1-bible
Free first visit with Dr. Barrick: barrickhealth.com

Chapters
0:00 Ozempic babies, and what's behind them
2:28 Birth control on tirzepatide, and why fertility comes back
5:42 Planning a pregnancy: the washout and the weight rebound
9:01 A positive test while you're on your shot
12:04 Breastfeeding on a GLP-1
13:06 Polycystic ovary syndrome (PCOS) and fertility
15:26 Menopause and hormone therapy
17:39 Breast and endometrial cancer
19:15 Men: testosterone, sperm and erections
22:48 Where I land: the reproductive verdict

Sources
Birth control
Zhou 2023 https://pubmed.ncbi.nlm.nih.gov/37940910/
Kapitza 2015 https://pubmed.ncbi.nlm.nih.gov/25475122/
Jordy 2021 https://pubmed.ncbi.nlm.nih.gov/33782832/
UK contraception guidance 2025 https://pubmed.ncbi.nlm.nih.gov/41136186/
Zepbound label https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
Foundayo label https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8ac446c5-feba-474f-a103-23facb9b5c62
UK regulator 2025 https://gov.uk/government/publications/glp-1-medicines-for-weight-loss-and-diabetes-what-you-need-to-know
Australian regulator 2025 https://www.tga.gov.au/news/safety-updates/updated-contraception-advice-mounjaro-tirzepatide
Planning a pregnancy
Wegovy label https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
Wyckoff 2025 https://pubmed.ncbi.nlm.nih.gov/40652453/
Maya 2025 https://pubmed.ncbi.nlm.nih.gov/41284263/
Yu 2026 https://pubmed.ncbi.nlm.nih.gov/42208070/
Imbroane 2025 https://pubmed.ncbi.nlm.nih.gov/39848396/
Hattler 2026 https://pubmed.ncbi.nlm.nih.gov/42391628/
Banerjee 2026 https://pubmed.ncbi.nlm.nih.gov/42098901/
A positive test
Cesta 2024 https://pubmed.ncbi.nlm.nih.gov/38079178/
Dao 2024 https://pubmed.ncbi.nlm.nih.gov/38663923/
Brown 2026 https://pubmed.ncbi.nlm.nih.gov/42258827/
Breastfeeding
Diab 2024 https://pubmed.ncbi.nlm.nih.gov/39275201/
PCOS and fertility
Lin 2026 https://pubmed.ncbi.nlm.nih.gov/41862977/
Chen 2025 https://pubmed.ncbi.nlm.nih.gov/40713699/
Legro 2022 https://pubmed.ncbi.nlm.nih.gov/35041662/
Wu 2026 https://pubmed.ncbi.nlm.nih.gov/42001071/
Jensterle 2026 https://pubmed.ncbi.nlm.nih.gov/42106472/
Ongoing trial https://clinicaltrials.gov/study/NCT06742710
Menopause
Bozick 2025 https://www.rand.org/pubs/research_reports/RRA4153-1.html
Tchang 2025 https://pubmed.ncbi.nlm.nih.gov/40074721/
Castaneda 2026 https://pubmed.ncbi.nlm.nih.gov/42290037/
Marassi 2025 https://pubmed.ncbi.nlm.nih.gov/40706779/
Hurtado 2024 https://pubmed.ncbi.nlm.nih.gov/38446869/
Viana 2026 https://pubmed.ncbi.nlm.nih.gov/42721915/
Cancer
Piccoli 2021 https://pubmed.ncbi.nlm.nih.gov/33248445/
Ko 2026 https://pubmed.ncbi.nlm.nih.gov/41359966/
Yen 2026 https://pubmed.ncbi.nlm.nih.gov/41665904/
Hsieh 2026 https://pubmed.ncbi.nlm.nih.gov/42000371/
Men
Salvio 2025 https://pubmed.ncbi.nlm.nih.gov/40105090/
Deameh 2026 https://pubmed.ncbi.nlm.nih.gov/41498523/
Orra 2025 https://pubmed.ncbi.nlm.nih.gov/41291666/
Jensterle 2019 https://pubmed.ncbi.nlm.nih.gov/30707677/
Gregorič 2025 https://pubmed.ncbi.nlm.nih.gov/39511836/
Able 2025 https://pubmed.ncbi.nlm.nih.gov/38778151/
Bajaj 2021 https://pubmed.ncbi.nlm.nih.gov/34153269/
Tang 2026 https://pubmed.ncbi.nlm.nih.gov/42005929/
Cowart 2025 https://pubmed.ncbi.nlm.nih.gov/40614622/

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Wegovy #Fertility #StraightShot

Let Dr. Barrick know what you think of the episode and send any questions his way too!

What do GLP-1s do to your gut? Today we cover the everyday side effects, the rare ones, what helps, and a verdict, built from a full literature review. Dr. Clete Barrick MD, board-certified in internal medicine and obesity medicine, continues Season 2 of Straight Shot: every organ, one episode at a time. This one is the gut.

In this episode:
- The everyday side effects: nausea in 44% at 2.4 mg of Wegovy, vomiting or constipation in about 1 in 4, almost all mild and tied to dose increases
- The nausea is not the weight loss: under 1 percentage point of semaglutide's weight loss traces to GI side effects
- Tirzepatide against semaglutide: small day-to-day differences, and the same rate of serious GI events
- What helps: going slower is the only thing with randomized support, and the schedule on the box is a ceiling, not a requirement
- Emergency visits: about 24,500 for semaglutide in 2022 and 2023, almost 70% of them GI, 1 in 11 a medication error
- Stomach paralysis: a solid meal half-empties about 36 minutes slower, and a gastroparesis diagnosis is uncommon, up 60% from a low base
- Surgery, endoscopy and colonoscopy: retained food four to six times more likely, no rise in aspiration, and why the one-week hold was walked back
- Pancreatitis: 18 cases on liraglutide against 23 on placebo, no difference across 31 trials, about 1,300 British reports
- Bowel obstruction: up 70% in one British study, no increase in 300,000 Scandinavian patients
- Reflux roughly doubled across 55 trials, about 4 extra cases per 1,000 patients
- IBD: relapse 7.9% with or without a GLP-1. Colon cancer: no reduction across 90 randomized trials
- Birth control on tirzepatide needs 4 weeks of backup after every dose increase, and liraglutide beat colesevelam for bile acid diarrhea

The GLP-1 Bible, preorder now: barrickhealth.com/glp1-bible
Free first visit with Dr. Barrick: barrickhealth.com

Chapters
0:00 The side effects everyone gets, and the four fears
3:19 How common and how mild
5:04 The nausea is not the weight loss
7:08 What helps
10:38 The emergency room
12:34 Stomach paralysis
15:04 Before surgery, endoscopy or a colonoscopy
18:31 Pancreatitis
21:42 Bowel obstruction
23:16 Reflux and the burps
24:52 Crohn's and colitis
26:05 Colon cancer
27:02 Your other pills
28:18 Where I land: the gut verdict

Sources
Everyday side effects
Wharton 2022 https://pubmed.ncbi.nlm.nih.gov/34514682/
Kushner 2025 https://pubmed.ncbi.nlm.nih.gov/39948761/
Wharton 2025 https://pubmed.ncbi.nlm.nih.gov/40961952/
Nausea and weight loss
Rubino 2025 https://pubmed.ncbi.nlm.nih.gov/39789843/
Crisafulli 2026 https://pubmed.ncbi.nlm.nih.gov/41183330/
What helps
Jastreboff 2023 https://pubmed.ncbi.nlm.nih.gov/37366315/
Wegovy label https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
Emergency visits
Lovegrove 2025 https://pubmed.ncbi.nlm.nih.gov/40194288/
Lambson 2023 https://pubmed.ncbi.nlm.nih.gov/37392810/
Stomach paralysis
Hiramoto 2024 https://pubmed.ncbi.nlm.nih.gov/38634551/
Jensterle 2023 https://pubmed.ncbi.nlm.nih.gov/36511825/
Niu 2026 https://pubmed.ncbi.nlm.nih.gov/40900093/
Sodhi 2023 https://pubmed.ncbi.nlm.nih.gov/37796527/
Procedures
Baig 2025 https://pubmed.ncbi.nlm.nih.gov/39694296/
Sen 2024 https://pubmed.ncbi.nlm.nih.gov/38446466/
Alkabbani 2024 https://pubmed.ncbi.nlm.nih.gov/39438043/
ASA 2023 https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
Kindel 2025 https://pubmed.ncbi.nlm.nih.gov/39480373/
Yao 2024 https://pubmed.ncbi.nlm.nih.gov/37856247/
Pancreas
Steinberg 2017 https://pubmed.ncbi.nlm.nih.gov/28476871/
Bakker 2026, preprint https://www.medrxiv.org/content/10.64898/2026.03.19.26348844v1
Wen 2025 https://pubmed.ncbi.nlm.nih.gov/40988099/
Azoulay 2016 https://pubmed.ncbi.nlm.nih.gov/27479930/
MHRA 2026 https://www.gov.uk/drug-safety-update/glp-1-receptor-agonists-and-dual-glp-1-slash-gip-receptor-agonists-strengthened-warnings-on-acute-pancreatitis-including-necrotising-and-fatal-cases
Ko 2026 https://pubmed.ncbi.nlm.nih.gov/41359966/
Bowel obstruction
Faillie 2022 https://pubmed.ncbi.nlm.nih.gov/34587280/
Ueda 2024 https://pubmed.ncbi.nlm.nih.gov/37716613/
Reflux
Chiang 2025 https://pubmed.ncbi.nlm.nih.gov/40499738/
Liu 2024 https://pubmed.ncbi.nlm.nih.gov/37739778/
IBD and colon cancer
Yeh 2026 https://pubmed.ncbi.nlm.nih.gov/42309434/
Wang 2024 https://pubmed.ncbi.nlm.nih.gov/38060218/
Figlioli 2024 https://pubmed.ncbi.nlm.nih.gov/39251099/
Other pills
Calvarysky 2024 https://pubmed.ncbi.nlm.nih.gov/38273155/
Zepbound label https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
Kårhus 2022 https://pubmed.ncbi.nlm.nih.gov/35868334/

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Wegovy #GutHealth #StraightShot

Let Dr. Barrick know what you think of the episode and send any questions his way too!

What do GLP-1s do to your brain? Today we cover brain benefits, harms, and a verdict, built from a full literature review. Dr. Clete Barrick MD, board-certified in internal medicine and obesity medicine, continues Season 2 of Straight Shot: every organ, one episode at a time. This one is the brain.

In this episode:
- How a GLP-1 reaches your brain: semaglutide does not cross the blood-brain barrier, so its strongest effects are on appetite and reward and its weakest are on memory
- Stroke: 16% fewer across 13 randomized trials in type 2 diabetes, and why obesity without diabetes is less settled
- Dementia prevention: about 45% lower odds of a diagnosis in the randomized GLP-1 trials, on thin data, and database studies that disagree once the comparison is fair
- Alzheimer's treatment: in evoke and evoke+, two Phase 3 trials with just over 3,800 patients, oral semaglutide did not slow the disease
- Parkinson's: the exenatide benefit disappeared in its Phase 3 trial
- Alcohol: in 108 patients with alcohol use disorder and obesity, semaglutide cut heavy drinking days by about four a month more than placebo, with no data past six months
- Other substances and smoking: what the veterans data can and can't show, and why Trulicity did not change quit rates
- Depression and suicide: the FDA pooled 91 trials, reviewed more than 2.2 million patients, found no increase, and had the warning removed from the Wegovy and Zepbound labels
- The one real harm: semaglutide roughly doubles a rare optic nerve stroke, nonarteritic anterior ischemic optic neuropathy (NAION), about 1 extra case per 7,000 patients a year. Sudden painless vision loss in one eye means same-day care
- Brain pressure, seizures, brain fog, and what carries over to tirzepatide and retatrutide

The GLP-1 Bible, preorder now: barrickhealth.com/glp1-bible
Free first visit with Dr. Barrick: barrickhealth.com

Chapters
0:00 Saving your brain or wrecking it? Four headlines checked
3:08 How a GLP-1 reaches your brain
4:37 Stroke: the benefit with the strongest proof
6:40 Can a GLP-1 prevent dementia?
9:36 Alzheimer's treatment: the evoke trials
10:58 Parkinson's: why the early promise faded
12:01 Drinking less on a GLP-1: the alcohol trials
14:06 Other addictions and smoking
15:22 Depression and suicide: why the FDA removed the warning
18:14 Your eyesight: the rare optic nerve risk and the symptom to know
21:21 Brain pressure, seizures and brain fog
23:12 Tirzepatide and retatrutide: what carries over
24:10 Where I land: the brain verdict

Sources (author, year, PubMed identifier)
Reaching the brain: Gabery 2020, 32213703. Stroke: Stefanou 2024, 38400569; Gerstein 2020, 31924562; Lincoff 2023, 37952131. Dementia prevention: Seminer 2025, 40193122; Tang 2025, 40193118; Zhou 2026, 41424236; Wang 2025, 40552638; Younis 2026, 41544899. Alzheimer's treatment: Cummings 2026, 41865758. Parkinson's: Athauda 2017, 28781108; Vijiaratnam 2025, 39919773; Meissner 2024, 38598572. Alcohol: Klausen 2026, 42070571; Hendershot 2025, 39937469; Schacht 2026, 42522065; Klausen 2022, 36066977; ClinicalTrials.gov NCT07218354. Other substances and smoking: Cai 2026, 41781010; Lengsfeld 2023, 36874396. Depression and suicide: the FDA Drug Safety Communication, January 13 2026; Pierret 2025, 40366681; Kornelius 2024, 39424950; Ueda 2024, 39226030. Optic nerve: Hathaway 2024, 38958939; Grauslund 2024, 39696569; Simonsen 2025, 40098249; Cai 2025, 39976940; Chrzanowski 2026, 42166479; Dhivagaran 2026, 42060879; Liu 2026, 41475544; regulators in Safi 2026, 42078635. Pressure, seizures, brain fog: Mitchell 2023, 36907221; Sioutas 2025, 40658395; Eun 2026, 42308439; Cheng 2026, 41370744; Badulescu 2026, 41218611. Tirzepatide and retatrutide: Chen 2026, 42420795; ClinicalTrials.gov NCT06383390.

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Wegovy #BrainHealth #StraightShot

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What do GLP-1s do to your kidneys? Today we cover the benefits, harms, and a verdict, built from a full literature review. Dr. Clete Barrick MD, board-certified in internal medicine and obesity medicine, continues Season 2 of Straight Shot: every organ, one episode at a time. This one is the kidney.

In this episode:
- FLOW, the only trial in this class built to test the kidney: semaglutide cut kidney failure, 50% filtration loss, or kidney and heart death 24% in 3,533 people with type 2 diabetes and kidney disease, and it stopped early
- The two numbers that run the episode: estimated glomerular filtration rate (eGFR), and the urine albumin-to-creatinine ratio (UACR), the earliest signal kidney disease gives and the one most patients have never had checked
- A class effect, not a semaglutide effect: kidney events down 18% across 11 placebo-controlled trials and 85,000 participants, with kidney failure itself the least secure piece
- Already on Jardiance or Farxiga? The FLOW subgroup everyone quotes has 79 events and cannot answer the question either way. You add, you don't swap
- Obesity without diabetes: SELECT cut the kidney composite 22%, and SMART dropped urine albumin 52% in 24 weeks in nondiabetic kidney disease
- Mostly not the weight loss: blood sugar explained about a quarter of the benefit and weight almost nothing, and below an eGFR of 60 the blood sugar piece disappeared
- Semaglutide or tirzepatide: SURPASS-CVOT cut major kidney events 23% against dulaglutide, a drug that protects kidneys in its own right, but tirzepatide has no placebo-controlled kidney trial and no kidney indication
- The harm column is dehydration, not toxicity: no excess acute kidney injury across 12 trials and 36,000 participants, the sick-day rule, and why the American Diabetes Association (the ADA) says a creatinine bump under 30% is not a reason to stop
- Reading your own labs during rapid weight loss: creatinine tracks muscle, cystatin C tracks fat, and in one trial's patients creatinine overshot measured filtration by 15 points
- Dialysis and transplant: 165 people stayed on semaglutide after starting dialysis with no safety signal, and in 18,016 transplant recipients GLP-1 use tracked with half the graft loss, with one caveat about the eyes
- Retatrutide: urine albumin falls 28 to 37% in Phase 2 trials, the eGFR rises, and the trial that could tell protection from hyperfiltration finished last October and has not published

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Chapters
0:00 One trial built for the kidney, and one number that lies
1:05 Why kidney disease is silent, and the new fourth pillar
3:31 The two numbers: eGFR and urine albumin
5:22 FLOW: the only kidney outcome trial in the class
7:46 Already on an SGLT2 inhibitor: add or swap?
8:48 Semaglutide, or the whole class?
10:19 Obesity without diabetes: SELECT and SMART
13:05 Semaglutide or tirzepatide for the kidney
15:04 The harm column: dehydration, not toxicity
18:07 Dialysis, the transplant list, and after transplant
19:54 Reading your kidney labs while losing weight
22:30 Retatrutide: why a rising eGFR proves nothing
24:53 What I tell my patients: the kidney verdict

Sources (author, year, PubMed identifier)
Kidney outcome trial: Perkovic 2024, 38785209; Tuttle 2026, 41706532; Tuttle 2026, 42233552. Class effect: Badve 2025, 39608381; Sasaki 2026, 40982219; Lee 2025, 40156846. Individual agents: Mann 2017, 28854085; Gerstein 2019, 31189509; Gerstein 2021, 34215025; Bethel 2020, 31757838; Muskiet 2018, 30292589; McGuire 2025, 40162642. Layering with SGLT2 inhibitors: Mann 2024, 38914124; Neuen 2024, 39210781; Jansz 2026, 42109572. Without diabetes: Colhoun 2024, 38796653; Apperloo 2025, 39455729; Heerspink 2026, 42308057. Mechanism: Mann 2021, 34009708; Alicic 2021, 33219281. Tirzepatide: Zoungas 2026, 42114520; Nicholls 2025, 41406444; Heerspink 2025, 40512543; Heerspink 2022, 36152639; Apperloo 2025, 39746157. Safety, dosing, the early creatinine rise: Packer 2025, 40162940; Feghali 2024, 39298632; Marbury 2017, 28349386; Urva 2021, 33778934; Idorn 2016, 26283739. Measuring filtration during weight loss: Yahya 2026, 42397155; Heerspink 2026, 41160422. Dialysis and transplant: Klein 2026, 41893299; Wade 2025, 41075262; Orandi 2025, 40056927; Kanbay 2026, 42017027. Retatrutide: Heerspink 2025, 40630318; ClinicalTrials.gov NCT06383390. Guidelines and label: Ndumele 2026, 42263157; ADA Standards of Care 2026, 41358881; KDIGO 2026 guideline, public review draft; the FDA, Ozempic kidney indication, January 28 2025.

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Wegovy #KidneyHealth #StraightShot

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What do GLP-1s do to your heart? Today we cover cardiac benefits, harms, and a verdict, built from a full literature review. Dr. Clete Barrick MD, board-certified in internal medicine and obesity medicine, continues Season 2 of Straight Shot: every organ, one episode at a time. This one is the heart.

In this episode:
- Heart-safety trials the Food and Drug Administration (the FDA) required showed protection instead: heart attacks, strokes, and cardiovascular deaths down 14% across ten trials in type 2 diabetes
- SELECT: semaglutide 2.4 mg cut major heart events 20% and death 19% in 17,604 people with obesity and heart disease but no diabetes
- Mostly not the weight loss: same protection at every starting weight, and C-reactive protein down 38% before the weight came off
- Tirzepatide: SURPASS-CVOT against dulaglutide, and the Mounjaro heart indication the FDA added on August 28, 2026
- Heart failure with preserved ejection fraction (HFpEF): tirzepatide cut cardiovascular death or worsening heart failure 38% in SUMMIT, semaglutide improved symptoms and cut events, and both made the 2026 European guideline
- Heart failure with reduced ejection fraction (HFrEF), the weak-pump kind: two neutral trials, one harm signal, and the rule that follows
- Heart rate, rhythm, and blood pressure: the class effect, when to get checked, and 18% fewer new cases of atrial fibrillation
- Semaglutide vs tirzepatide: four database studies, three answers, and what the randomized data support
- Who the proof covers: nothing yet for retatrutide, and nothing for people without heart disease until SURMOUNT-MMO reads out in October 2027


The GLP-1 Bible, preorder now: barrickhealth.com/glp1-bible
Free first visit with Dr. Barrick: barrickhealth.com

Chapters
0:00 Same drug class, two heart stories
0:52 Why the heart has real outcome trials
3:37 Type 2 diabetes: events and deaths down 12 to 14%
5:54 Obesity without diabetes: the SELECT trial
7:12 Why it's mostly not the weight loss
9:45 Tirzepatide and the new Mounjaro heart indication
11:39 Stiff-heart failure (HFpEF): SUMMIT and STEP-HFpEF
14:25 Weak-pump heart failure: where the drugs stay out
16:14 Heart rate, rhythm, and blood pressure
18:00 Semaglutide or tirzepatide for the heart
19:48 Who the proof covers: retatrutide and primary prevention
21:41 What I tell my patients: the heart verdict

Sources (author, year, PubMed identifier)
Class effect: Lee 2025, 40156846; Galli 2025, 40892610; Sattar 2021, 34425083; Badve 2025, 39608381; Neuen 2024, 39210781. Neutral trials: Pfeffer 2015, 26630143; Holman 2017, 28910237. Dulaglutide: Gerstein 2019, 31189511. Oral semaglutide: McGuire 2025, 40162642. Stroke: Gerstein 2020, 31924562; Strain 2022, 35582947. Kidney disease: Perkovic 2024, 38785209. SELECT: Lincoff 2023, 37952131; Deanfield 2025, 41138739; Plutzky 2026, 42610271; Lingvay 2024, 38907684; Deanfield 2024, 39181597. Tirzepatide: Sattar 2026, 42233927; de Lemos 2024, 38314555. SURPASS-CVOT: Nicholls 2025, 41406444; Nissen 2026, 41903177; Zoungas 2026, 42114520. Heart failure: Packer 2025, 39555826; Kramer 2025, 39566869; Kosiborod 2023, 37622681; Kosiborod 2024, 38587233; Kosiborod 2024, 39222642; Verma 2024, 39217565; Jorsal 2017, 27790809; Margulies 2016, 27483064. Heart rate: Jastreboff 2023, 37366315; Wu 2022, 36572913; Karakasis 2026, 41349790. Head to head: Wilson 2026, 41491349; Krüger 2026, 41207920; Katsura 2026, 41891334. Pipeline: Lam 2025, 40545827; ClinicalTrials.gov NCT05556512, NCT06383390. Guideline, label: Køber 2026, 42661420; Lilly press release, Aug 28 2026.

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Zepbound #HeartHealth #StraightShot

Let Dr. Barrick know what you think of the episode and send any questions his way too!

What do GLP-1s do to your liver? We cover the benefits, harms, and a verdict, all built from a 94-source literature review. 

Dr. Clete Barrick MD, board-certified in internal medicine and obesity medicine, founder of Barrick Health, 5,000+ GLP-1 patients, 95 lbs lost on tirzepatide, opens Season 2 of Straight Shot: every organ, one episode at a time, starting with the liver.

In this episode:
- Fatty liver by its new names, metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH), and why 70 to 80% of people with obesity have it
- Liver fat: retatrutide cleared 82% at 24 weeks, with 86% of patients back to a normal liver (placebo 0%)
- ESSENCE: semaglutide 2.4 mg resolved steatohepatitis in 63% vs 34% and improved scar in 37% vs 22%; the Food and Drug Administration (the FDA) approval in August 2025; why earlier treatment reverses more scar
- Tirzepatide in SYNERGY-NASH, and the honest read on fibrosis
- Alcohol: fewer alcohol-related liver events in cohorts, no change in drinking or cirrhosis in the largest study
- Cirrhosis: the one randomized trial where placebo did better on scar
- Liver cancer: why the data point both ways
- Rare liver injury: LiverTox now rates tirzepatide "probable rare cause," plus the four symptoms in the first four months that need a liver panel
- The gallbladder: the organ most likely to send a GLP-1 patient to the emergency room
- Muscle loss, what happens when you stop, and compounded product safety

Verdict: net positive for the liver, with two asterisks.

The GLP-1 Bible, preorder now: barrickhealth.com/glp1-bible
Free first visit with Dr. Barrick: barrickhealth.com
YouTube: youtube.com/@BarrickHealth

Chapters
0:00 Same drug class, two liver verdicts
0:59 Who this is for, and the stages of fatty liver
3:43 Liver fat: retatrutide, tirzepatide, semaglutide
6:12 Steatohepatitis and scar: ESSENCE and SYNERGY-NASH
10:58 Liver failure and death in the cohort data
11:58 Alcohol and the liver on GLP-1s
14:55 Drug effect or weight effect? The mouse study
16:05 Cirrhosis: where the benefit stops
19:07 Liver cancer: data pointing both ways
20:20 Rare liver injury and four symptoms to watch
23:23 The gallbladder risk
24:51 Stopping the drug, and compounded product safety
27:29 What I tell my patients: the liver verdict

Sources (author, year, PubMed identifier)
Prevalence: Tilg 2026, 41212550. Liver fat: Sanyal 2024, 38858523; Gastaldelli 2022, 35468325; Flint 2021, 34570916. Enzymes: Wang 2025, 40489581; Newsome 2019, 31246368. ESSENCE: Sanyal 2025, 40305708. Semaglutide phase 2 trial: Newsome 2021, 33185364; Ratziu 2024, 38112484. SYNERGY-NASH: Loomba 2024, 38856224; Caussy 2025, 41066427. Meta-analyses: Mantovani 2025, 40736113; Dos Santos Borges 2026, 41810433; Wood 2026, 41365848. Liver society guidance: Bansal 2026, 41201884. Liver outcomes: Celsa 2025, 40015951; Engström 2024, 38085855. Alcohol: Kuo 2025, 39891379; Al-Moussally 2025, 40223043; de Faria Moraes 2025, 40845737; Subhani 2024, 39764544. Mechanism: Gonzalez-Rellan 2026, 41985454. Cirrhosis: Loomba 2023, 36934740; Yen 2024, 37331413; Elsaid 2024, 38538967; Hanai 2015, 25441595; Bhandarkar 2025, 41076575. Liver cancer: Dalbeni 2025, 41388641; Titus 2025, 40587039; Aburumman 2026, 42348118; Yen 2024, 38172833. Liver injury: LiverTox tirzepatide 35780672, semaglutide 31643889, GLP-1 class 31643819; Huang 2025, 40667509; Wharton 2026, 42338042; Amin 2025, 39415344. Gallbladder: He 2022, 35344001. Stopping: Tzang 2025, 41399474; Budini 2026, 41938838. Compounded: McCall 2026, 40285721.

Educational content, not medical advice. Talk with your clinician before changing any medication.

#GLP1 #Ozempic #Wegovy #Zepbound #Mounjaro #Semaglutide #Tirzepatide #Retatrutide #FattyLiver #MASLD #MASH #LiverHealth #Cirrhosis #WeightLoss #StraightShot #BarrickHealth

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Twelve thousand researchers. Hundreds of presentations. Five studies that matter.

Dr. Clete Barrick breaks down the most important GLP-1 research presented at the European Congress on Obesity 2026 in Istanbul, and what each finding means for patients on Ozempic, Wegovy, Mounjaro, and Zepbound right now.

He covers the new higher-dose Wegovy data (7.2 mg), the maintenance dosing trial Zepbound patients have been waiting for, what happens when you switch from an injection to an oral pill, the real-world data showing half of patients quit before they get the benefit, and the Viking Therapeutics oral pill that may compete with injectable tirzepatide by 2028.

Each study gets the same three-beat treatment: what happened, why you should care, and what you should do about it.

In this episode:

• STEP UP: Wegovy 7.2 mg delivers 20.7% weight loss, with responders hitting 27.7%
• Medicare BRIDGE program adding Wegovy 7.2 on July 1
• SURMOUNT-MAINTAIN: 5 mg tirzepatide as a legitimate maintenance dose
• Why the dose ladder mental model is wrong
• ATTAIN-MAINTAIN: Switching from Wegovy to oral orforglipron (Foundayo) vs. switching from Zepbound
• Why the GIP receptor matters when you change medications
• Wilding real-world data: 50% discontinuation, dose-dependent metabolic benefits
• The most important variable in GLP-1 treatment (it's not which drug)
• Viking VK2735: 12.2% loss in 13 weeks from an oral dual agonist
• What the pill landscape looks like in 2028

New episodes weekly. Subscribe and visit barrickhealth.com for physician-led GLP-1 care.

Everything discussed in this episode is education, not medical advice for your specific situation. Talk to your prescriber before making changes to your treatment.

LINKS

barrickhealth.com https://www.youtube.com/@BarrickHealth

TAGS/KEYWORDS

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ECO 2026, European Congress on Obesity, STEP UP trial, Wegovy 7.2, SURMOUNT-MAINTAIN, tirzepatide maintenance dose, Zepbound maintenance, ATTAIN-MAINTAIN, orforglipron, Foundayo, Viking VK2735, VENTURE-2, Wilding real-world data, GLP-1 discontinuation, GLP-1 news, oral GLP-1 pill, Medicare BRIDGE program, semaglutide vs tirzepatide, dual agonist, GIP receptor, obesity medicine, Dr. Clete Barrick, Straight Shot podcast

REFERENCES CITED

• STEP UP trial. Higher-dose semaglutide 7.2 mg for obesity. Presented at European Congress on Obesity (ECO) 2026, Istanbul. Novo Nordisk.
• Wadden TA, et al. Tirzepatide for maintenance of weight reduction (SURMOUNT-MAINTAIN). The Lancet. 2026.
• ATTAIN-MAINTAIN trial. Transition from injectable semaglutide or tirzepatide to oral orforglipron. Presented at ECO 2026, Istanbul. Eli Lilly.
• Wilding JPH, et al. Real-world discontinuation and metabolic outcomes of GLP-1 receptor agonists in 90,000 patients (UK/EU). Presented at ECO 2026, Istanbul.
• VENTURE-2 trial. Phase 2 results for oral dual GLP-1/GIP agonist VK2735. Presented at ECO 2026, Istanbul. Viking Therapeutics.
• Medicare BRIDGE Program formulary update, effective July 1, 2026.