Itchy Palms and Soles at Night? Could It Be Fatty Liver or Liver Disease (FIB-4 Explained) Dr. Kulmeet Kundlas explains how chronic itching lasting more than six weeks—especially on the palms and soles—can be linked to fatty liver disease, fibrosis, or cirrhosis when common causes like dry skin (xerosis), dehydration, medications/supplements, and stress have been addressed. He describes theories that impaired liver function allows bile salts and endorphins to accumulate in systemic circulation, irritating receptors and causing itching.

Diabetic Neuropathy or B12 Deficiency? Metformin, PPIs, and the Tests You Need The script explains that numbness, tingling, and burning pain in both feet in people with diabetes is often labeled diabetic neuropathy, but up to one-third may have coexisting vitamin B12 deficiency that can mimic neuropathy and may improve with treatment. It describes how metformin can reduce B12 absorption by blocking calcium-dependent uptake in the terminal ileum over years, and how proton pump inhibitors and H2 blockers can also impair B12 absorption by reducing stomach acid needed for intrinsic factor. It highlights distinguishing clues of B12 deficiency such as posterior column symptoms (balance, vibration, clumsiness, falls), mental fog, glossitis, fatigue, and anemia, and recommends not relying only on CBC, checking B12 (aiming 250, preferably 400), using methylmalonic acid (MMA) for borderline cases, and requesting detailed foot exams (monofilament and tuning fork) and doctor-guided B12 replacement.

Avoid GLP-1 Side Effects: Why Wegovy/Zepbound Titration Matters (Dr. Kulmeet Kundlas) Dr. Kulmeet Kundlas, a primary care physician of 30+ years, explains that many severe GLP-1 agonist side effects from Wegovy, Zepbound/Mounjaro (tirzepatide), and related medications are often due to titration errors, patient impatience, pharmacy/education gaps, or restarting at too high a dose after missed injections. He describes how GLP-1s disrupt GI motility, citing Wegovy trial rates of nausea (40%) and vomiting (26%), and outlines the rigid step-up schedules (Wegovy starting at 0.25 mg weekly for 4 weeks toward a 2.4 mg maintenance dose; tirzepatide starting at 2.5 mg with increases every 4 weeks). He warns against unsafe dose-jumping and using non–FDA-approved compounding sources, notes pancreatitis warning signs, and emphasizes physician/pharmacist training plus lifestyle measures like high-protein diet, exercise, sleep, and stress management. 00:00 GLP-1 Side Effects Explained 01:15 Why the First Dose Hits Hard 02:29 Real Results and Big Picture 03:30 Wegovy Titration and Stacking 05:35 Zepbound Dosing and Missed Shots 06:00 Pen Mistakes and Compounding Risks 07:31 Warning Signs and Safe Wrap-Up