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Lactic acidosis is more likely in individuals with kidney or liver disease, acute or unstable congestive heart failure, or severe dehydration

FGF21 has originally been described as a fasting hormone that is upregulated in the liver via PPAR and partly regulates ketogenesis during starvation or KDs

Gene expression studies reveal modulation of 408 neuronal genes, including dramatic increases in OPRM1 (opioid receptor, up 1,294%), KCND1 (up 845%), and SLC8A2 (up 737%)

I keep seeing this study being posted - the important point being that the patients in this study were all diabetics and the comparison was between those on GLP1 or on SGLT2i drugs