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Around 30% of patients start with bulbar symptoms, which affect the muscles used for speaking and swallowing, leading to problems like slurred speech (dysarthria), trouble swallowing (dysphagia), and twitching of the tongue muscles (Chi et al., 2013)

doi:10.3390/nu9121286 38

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This approach isn't suitable for everyone, particularly those with diabetes on insulin or sulfonylureas, pregnant or breastfeeding women, people with a history of eating disorders, those with kidney disease, or frail individuals

0.4% with placebo and 1.1% with dulaglutide [24]