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Elevated GH and IGF-1 drive the effects people seek, and the same elevation drives fluid retention, glucose changes, and the theoretical long-term concerns discussed below

Optimise your nutrition and hydration: Ensure you are consuming adequate calories despite reduced appetite, as severe calorie restriction can lead to fatigue Eat small, frequent, nutrient-dense meals throughout the day rather than large portions Maintain good hydration, aiming for 68 glasses of water daily (follow your clinician's advice if you have been advised to restrict fluids) Include complex carbohydrates, lean proteins, and healthy fats to sustain energy levels Consider keeping a food diary to identify if tiredness correlates with inadequate nutritional intake Address gastrointestinal side effects: Since nausea, vomiting, and diarrhoea are common with Rybelsus, these symptoms may indirectly contribute to fatigue by affecting your ability to eat properly or causing dehydration

C., Haas, B

Brinkman, M.A