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Baseline cardiovascular assessment should include detailed history of prior cardiovascular events, current symptoms, blood pressure measurement, lipid profile, renal function assessment, and calculation of 10-year atherosclerotic cardiovascular disease (ASCVD) risk using validated tools such as the Pooled Cohort Equations

Declining AMPK activity, accumulating visceral adiposity, deteriorating insulin sensitivity, weakening thermogenic capacity, reduced exercise-mimetic signaling, and dysregulated appetite hormones are separate but interconnected processes

Gastrointestinal tolerability may be challenging, as both ketogenic diets and GLP-1 agonists can cause nausea, constipation, and altered bowel habits

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