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Survey administration The survey was hosted on the Michigan State University server using Qualtrics (monthly product release version June 6, 2024, Qualtrics, Provo, UT [17,18])

GLP-1 stimulation in the microbiome Human intestinal cells show Akkermansias effect on GLP-1 production Akkermansia secretes p9 protein which stimulates GLP-1 production Clostridium butyricum increases GLP-1* Dose-dependent increase of GLP-1 by Clostridium butyricum in a cell-based assay *Based on internal Pendulum R&D data Breakthrough clinical research Were continually pushing the boundaries in scientific research, and were excited to conduct a human clinical trial on GLP-1 and the gut microbiome

The 95%CI of RORs exceeded 1 for all assessable subgroups of GLP-1 RAs and DPP-4 inhibitors, suggesting a potential statistical link to the risk of biliary disorders, aligning with the general signal strength for these conditions