Especially if you have used them. Eugyppius, one of the geniuses on this platform, had a remarkable piece today about his personal experience with them.
I’m a full-time ER doc, and we are seeing increasing numbers of patients with severe vomiting and ileus/small-bowel obstruction associated with the GLP-1s. Add to that the nutritional malabsorption, muscle loss, and likely pancreas inflammation, and I’m a big thumbs-down on this medication.
The sad truth is that any primary care doc who refuses to give it to a mid-thirties woman trying to stuff into a bridesmaid gown next month will lose her business to a lesser-trained nurse practitioner down the street, and then the client will very possibly end up in the ER.
As an NP with more than 20 years of practice in Endocrinology, I'm very skeptical of the GLP1 class and actually, It's the doctors who seem to push them aggressively, without screening along the way for side effects, precautions, etc, just titrate, titrate, titrate. That's how patients end up in your ER. And why are we still arguing about how crappy NPs are, it's ridiculous. There's good docs and bad docs too.
I agree. For every benefit, there is a generally a downside. Calculate your daily caloric needs subtract 500 cal (kcals really) stick to it and exercise. It can be controlled without pharmaceutical intervention.
It does work...it always works. Pre-menopausal (and post menopausal) women need less calories. Eat less, move more. I'm a 63 yo post menopausal woman and my weight has never shifted more than 5 lbs here and there except when preggers. You have to adjust your habits.
I’ve never struggled with my weight either. That was until perimenopause. I guess you’re just one of the very lucky few because even numerous doctors will tell you that it is difficult for women because of the hormone shift. Metabolism slows down, not to mention, the cortisol increases due to what the body is going through with the numerous symptoms. To say it always works is an out of touch and frankly ignorant statement.
Though I do not take GLP-1s for weight loss, no it doesn't always work. You may be one of the lucky people, but I am not. Nutritionists, personal training, fasting, dieting, you name it, DID NOT WORK, and by the time I hit my late 60s, and still having intractable hot flashes mind you, it became apparent, that I was never going to be able maintain, an acceptable to me, weight. HRT gave me some relief, but my insurance decided that I should pay $400/month for a minimum dose. Please do not diminish those of us who have truly been struggling through no fault of our own.
GLP-1s slow down the passage of food through the digestive tract, so nasty gastrointestinal issues are hardly a surprise. Keep on the watch for an explosion of colon cancer cases in the next 10 or 15 years. They also suppress glucagon, which enables your liver to convert stored glycogen into glucose when your blood glucose is low. Humans evolved to go out hunting and gathering when food was scarce, and you need blood glucose for that. Somehow the suppression of glucagon runs counter to what we evolved to do. I regularly strenuously exercise when I haven’t eaten for 14 hours. I don’t get hungry and don’t lose energy. I am not on GLP-1s.
You're close. Not a less trained NP but to black market drugs. I have 25 lbs of post menopausal weight I need to lose because I can't fit any more workouts into my schedule. I'm guessing my dr. won't prescribe them but I've found a site that will...but don't worry, I'll at least visit with my GP first.
I just wish I could have had more patients with this attitude. If you really demand the compliant provider find one and just skip the unnecessary appointment and messages. Save us all from the resulting games, crying, temper tantrums and (of course) complaints/bad reviews after the denial.
Patients temper tantrums? I don't like my NPs tantrums and won't go to a doctor again. I turned septic after having the flu and wound up in the hospital. When I went for my follow up, she screamed at me that I didn't have the latest flu shot. I looked at my records and I'd had 11 flu shots over the previous decade. Never again. Y'all can shove it.
FWIW, you might ask a knowledgeable doc or np about hormones estradiol and progesterone supplementation. Luckily my gyn was up on research, my gp was not. Good luck finding a knowledgeable doc. I’m dreading when my gynecologist retires because he knows me.
Ouch. You probably wouldn't like my counsel either. Just sayin' you are fortunate you don't live in a medically underserved area or have family in skilled nursing or assisted living. Doctors love to practice in those environments, not. Choice/options are a wonderful thing. My observation is that heresy is not gender dependent, competency is not license related, and kindness and mutual respect is always correct.
I would like to see more unbiased analysis of this family of drugs. But the one thing we don't know is long term effects. We are running the experiment now....
For the record, I would not go within a 1,000 miles of a Covid vaccine, and I think a lot of the side effect critique/concern is misunderstanding the difference between a chain of amino acids (and their mechanism) and the many foreign chemicals that are prescribed out there that I would never put in my body.
Bad. Get in the gym, go for a walk, go for a run, eat clean whole food and stop with the drugs. You’ll live longer and feel better with zero side effects.
I generally agree with this and I have no desire to go on the drugs, but I walk 3 miles a day, I swim almost every day, I don't eat junk, I prepare almost all my own food, eat lots of protein and veggies and limit carbs and sugar, and lift light weights. Menopause hit me hard and I gained 50 pounds and trust me when I say it's been a struggle. But my blood work is good, my blood pressure is normal, my cholesterol is elevated but not high.
I'm there with you. I've recently switched up my exercise routine. A little improvement but think this will be the struggle until we die. At least we can still move! I'm going out kicking and screaming.
I've said to my doctor (a naturopathic MD) that I'm the healthiest fat person she knows and she laughed. There are some things we're working on slowly through supplements, and so far everything is going in the right direction, except the weight. I gave up all alcohol for Lent -- not one drop -- and didn't lose a pound. (I don't drink a lot, but I usually have one glass of wine or a "skinny" margarita after dinner.)
Bummer....I do know some women who are so fastidious with their diet, they work out and they just still gain weight. I shouldn't be so judgy (a comment I made above.) Perhaps I'm just lucky I have good metabolism. I never gain weight, I eat sugar (probably too much), I drink but I'm also VERY active. I'll be #1 on the Peloton leaderboard almost every time for my gender/age level (63 yo.)
This is where I am. I can't fit any more workouts into my schedule. We eat almost strictly plain roasted or baked meats with plenty of salads and fresh veggies. I'm so sick of this diet but we're sticking to it. I'm super healthy and strong...and now 25 lbs too heavy. Tirzepitide is looking better and better. So many of my friends and family have done amazing things on it. Oh and like you I don't eat junk food or drink soda but I've never really been a fan anyway so there was never anything to give up.
Yeah -- menopause REALLY sucks and I don't think most men understand what happens to our bodies. I had 5 kids and lost most of the baby weight. But hit 50 and WHAM! But even if we're overweight, one of the best things to do is just keep doing light weights. Even if you don't see weight come off, we have to keep our muscles because once you lose them it's much harder to get back.
You write "we'. I think that is our American issue. We are social eaters. We no longer have to find or work so hard to get our sustenance. I grew up in a large extended family milieu. I left home for grad school, began to cook for myself. AS yrs went by, all my family members gained weight. Not hugely obese, just not TRIM. My weight is same as high school (I'm 70's). I realized as years passed, in all my going back for visits with family, that if I ate the way they do, I would be their size. I simply eat foods and less meals for what I feel I really NEED, for health w/enough enjoyment mixed in, with some special fun treats for special times. I am able to do that. For all sorts of emotional/social reasons, as a culture, we have big ATTACHMENTS to food - consider the advertising!!!!! It may sound trite or unsympathetic, but our relationship to food needs amending.
Great point. My dad was an athlete all his life and once he hit 70, really struggled with his weight. He "created" what he called the "not my day to eat" diet where he would only eat every other day( now called intermittent fasting I think). He described that it wasn't that hard to stick to other than it was very socially awkward for him. After 6 months though, he was back to his trim, athletic self. I would have to agree on the relationship with food. I do wonder how Italians do it. And French. Two cultures that tend to be family/food oriented. It's all very interesting.
I think you hit on something. As I'm watching some of the reels from the World Cup players who have been posting about how awesome America is, the theme that runs through most of them is the amazing food and the size of our portions. Yes, Americans need to adjust their relationship to food.
Just as illicit drugs were overtly pushed across the west post-WWII as agents of personal and social destruction, so too was processed food used on Americans (in particular) as an agent of health/social destruction. I think it was intentional and orchestrated.
This was me. Adding low dose retatrutide changed my life in all the ways noted. There has been no downside. Note that you have to be all in with excellent nutrition and exercise.
Cyclosporiasis...I live in Michigan which is the hardest hit and have (sadly) been avoiding most produce, especially lettuce where they think it is coming from. No salads for me for a while!
Walking does little. Sprint or do HIIT instead. Intense swimming intervals are good.
The rest: just fast. I’m no expert but I’ve seen what works in many. It does require one to be very disciplined and change his relationship with food. You do want caloric intake to drop under your basal rate. One can eat in the 8 hour windows only, and/or do regular 18-24 hour fasts. There are various options.
Grass fed / organic, and well-chosen supplements should dominate what is ingested. Once weight settles in 6-12 months, depending upon where the person is, he/she can reintroduce some things to comfort level.
Let’s see: a drug with noted side effects but a quick fix, or make a real lifestyle choice before it’s too late. Because once you go the GLP route, at some point you’ll need to stop, right? Then what? These drugs alter your body chemistry, hard pass.
I exercise daily more than you might imagine: walk 3-7 miles, daily, five gym classes/week, intermittent fasting 6 days/week…but I do like a sweet treat and/or a glass of wine and my metabolism is just very, very slow.
Many of us already do all of this and STILL cannot drop the post-menopausal weight. And some of us get injured when we add too much strength training or even yoga to our lives. I have chronic inflammation issues and even minimal excess fitness seems to aggravate it, sometimes sidelining me for a week at a time.
If you have chronic inflammation take a look at your eating and drinking habits. Read the ingredients on labels, GLP’s are a short term fix, you cannot stay on it forever, then what?
I’m old, and I do 4 days of cardio (65 min/day) and 3 days of strength training/wk. On a typical day I get 12,000 steps in. Losing weight comes from dietary changes mostly, and from exercise, a little (marathoners and distance runners are a different case). What I’ve read is that glp1s cause loss of muscle mass and fat equally, which is not a good thing.
The lost of muscle is what I've heard as well. The thing is ... there are so many things that can go into weight gain/loss. I know mine was caused mostly because of menopause which hit when I became an (almost) empty nester which cut my activity. I know that I could fast and it might work. I can't run anymore. I have arthritis in my knees (I was brutal to my body as a teenager/young adult from soccer). I walk for cardio and to keep my joints healthy. I take high-quality supplements based on what I need (according to extensive blood work) and I have a LOT of muscle under the fat. What works for some people doesn't work for others. I'm more concerned about health issues than how I look. ... I've cut out seed oils, I cook almost all my own food, I make my own dressings, I eat high protein meals ... but I also have a sedentary job and that's not going to change. The only thing that worked to actually take off weight was when I did strict KETO for 3 months ... but I couldn't eat enough fat to move the needle past a certain point because I don't have a gallbladder to help process the fat.
Yes, I am well aware of processed food excess and the boom in the pushing of it since post-WWII when the brave new world arrived with TV ads and supermarkets and food corporations selling tantalizing junk food. I think it was part of the intentional social-destruction agenda.
However, there are many people in situations not so cut and dried. I always roll my eyes a bit when I read these great pieces of "wisdom". You probably tell addicts (of various sorts) just to stop doing what they are doing, and figure this is all the advice it should require. As if there is nothing else behind the scenes driving this.
Prednisone is a notorious weight-gaining medication for instance, and is prescribed for a whole load of inflammatory conditions, including autoimmunity. So you might have to choose between your Lupus and your weight.
Same goes a for a large number of weight-gaining psychiatric drugs.
Radiation for brain tumours has been known to affect the metabolic HPA axis, leaving the patient (children included) with chronic metabolic difficulties.
There is PCOS. There are endocrinopathies. And no one walks around with a banner telling others that they have another medical issue rather than an eating compulsion.
Th self-righteousness of the "Just cut the calories and move!" crowd is what amazes me. It strikes me as a hierarchical tactic.....if the other guy is visibly fat, I can automatically claim moral superiority if I am not fat. It's an easy win for the morally lazy...especially if their own faults are not the visible sort.
I am not of the leftwing Woke persuasion. I think they shamelessly use obese persons in their Woke political posturing, in order to virtue-signal. Although I am not in favour of encouraging obese persons to become trapped in victimhood either, especially if the new GLP-1 drugs can help move them out of that.
Commenting as a subscriber--and prescriber. I think GLP1s are a holy grail: The safe and very effective weight loss prescriptions we have been waiting for. They are good for weight, diabetes, blood pressure, heart, and kidneys. What's more, it will soon be evident that they are preventing LOTS of cancers (while causing very few) as obesity is a risk factor for MANY cancers. Having said that, they DO have some effects on the body and brain that I'd rather they didn't.
You lose one pound of muscle for every two pounds of fat lost. Not a great outcome--but exercise can minimize the muscle loss (sarcopenia). The effect on the brain is a bit more concerning to me and not as well described--although Eugyppius attempted to. I think it's more accurate to say that GLP1s reduce cravings for EVERYTHING. So, if that's food, booze or drugs that's great. But what if it's sex with your spouse, travel, or socializing? That is my main concern, and we haven't really measured that well yet. I think dosage titration is important and weight loss is not the only metric we should be looking at.
Great Post Doc, I think the loss of positive desires may be overblown, but I am on a very small does (2.2mg weekly). Sex drive extremely high (at 69 yrs old), still love my cocktails and socializing.
First of all and most strongly, I remain - contra the AAP - very much against them in children.
Still skeptical of them in adults because there’s no such thing as a free lunch and because I view them as the pharma equivalent of The Picture of Dorian Gray - if your blood remains nothing but liquefied Cheetos dust, it doesn’t matter what the scale says, you’re rotting from the inside.
But I’ve had similar even stronger opposition to ADHD meds and SSRIs in kids for years and they’re just getting more and more widespread so I’m sure this will continue to spread like wildfire too, moral and long term consequences be damned.
GLP-1's - Excellent for weight loss, terrible for health.
Opiates - Excellent for pain control and for getting you addicted
Stimulants - great for improving attention, terrible for your adrenal glands.
I think we are asking the wrong question here: Do people want symptom relief or do they want improved health. Drugs are a great way to get symptom relief, but are terrible for health. Treating root causes of illnesses improves both symptoms and health.
Which do you prefer, symptom relief or health? If it was number one, you have been brainwashed and it is too late for you.
No drug, and no amount of exercise alone is going to result in a healthy body or healthy weight. Nutrition for the human body - It's firstly the food. Get educated: pcrm.org, nutritionstudies.org
But losing weight IS about health. It lowers your risk of many types of Cancer, it lowers your blood sugar levels and often normalizes cholesterol, it improves liver function, and many other health improvements.
You didn't know this?
GLP-1s are also being studied for the effects they have on lowering inflammation and on helping to correct blood vessel hyperpermeability found in Plasma disorders. These drugs may be useful for more than one purpose.
Your abundant self-righteousness is going to be your downfall, Mark. Silly comment. Takes all kinds, I suppose. You seem to live in an indulgent fantasy world, posturing as the great Hero. Come down to earth, my friend.
Pharmacist here with four decades in pharmaceutical sales. I have no personal experience with these products either as a practitioner or a patient. My read on this today is these products are probably best used right now in diabetics and morbidly obese people to reduce cravings, lose weight, and improve blood pressure and blood sugar control. I would not recommend they be used in mildly overweight people or normal weight people. WE HAVE NO IDEA WHAT THE LONG TERM EFFECTS OF THESE PRODUCTS ARE and if you stop taking them and return to your old habits you’ll regain your weight loss. Like other people have mentioned, I’m all for continued study where appropriate and looking for potential long term benefits/toxicities to get an idea of the risk/reward potential of these products. One must always be careful when messing with Mother Nature!
I'm skeptical of the GLP-1s. I know they work. But I've lost count of the things that seem too good to be true. Lose weight without self-denial? Looks like these drugs have made it possible. But without side effects? Count me skeptical until the people taking them have experienced nothing bad for ten years or more.
Liver damage? Your doctor needs to brush up on his literature, Reta shows more promise for treating fatty liver than any drug out there, bar none, especially with its safety profile. It's an amino acid chain. The liver improvement results are astounding in the clinical literature.
Sometimes, but fatty liver is very hard to get rid of, very hard. One of the things that attracted me to Reta was the incredible potential it shows for treating fatty liver. I have mildly elevated liver enzymes and mildly fatty liver (hasn't worsened in 20 years, but I'd love to get rid of it).
Zero long term studies. You’re the guinea pig. My motto is don’t be a guinea pig. They burn muscle for the weight loss. They can paralyze your digestive tract.
Reported side effects and general loss of desire alone are enough to counsel caution. There presumably are folks for whom the cost/benefit calculus favors taking GLP1s. But the known downsides and the unknown risks (remember Fen-Phen?) should weigh against broad long-term use.
Currently a lot of unknowns for sure, PNW. I think part of the issue is that they shouldn’t be treated and prescribed a standalone silver bullet but rather than, one part of a comprehensive treatment plan that includes prioritizing protein, a low and slow dose titration, weight training, and supplements to fill nutritional gaps. Sometimes use of digestive enzymes is indicated as well. There are other recommendations for which I encourage people look at information Dr. Tyna Moore has on her site. I’m not affiliated with her but have found her information to be thoughtful, thorough, and health promoting.
The primary problem is Americans and many in the West have generationally failed to pass on heritage wisdom and knowledge about eating and food preparation. They failed by trusting Uncle Der Stat to tell them what is healthy and what isn’t, ignoring the massive industry conflicts and all teaching from the founders’ political philosophy along the way.
So the children of these failures must build the wisdom back up. Fortunately, many individuals have rediscovered truths about fasting, organic/ancestral food preparation and cultivation, seasonal eating, and more human-compatible exercise such as sprinting and HIIT.
Drugs should generally have no part in this healing. It’s a fat and nutrition problem, and ultimately a willpower one once wisdom is received and internalized, and not something a chemical should be relied upon to do.
You might want to see my longer comment on this post. I generally agree although sometimes people need a leg up to get them started on the right path, and these meds can play a role in this, not as a mono therapy but as one piece of a comprehensive treatment plan that includes all that you mentioned above.
Michelle, I see too many comments on GLP-1 article forums where the commenters really, really want "the fatties" to suffer for their supposed sins. Only because those "sins" happen to be visible. The self-righteousness often turns to viciousness. Says more about the moral level of commenters of this nature than it does about "the fatties".
I always wonder whether they stop to think for even a moment what it must be like to live as the new class of lepers. What continual social-shunning does to the soul. Yes, there are individuals who let themselves go and allow food-constraint to die, but there are just as many others who are not guilty of that. I have seen situations where a crisis in a person's life has added 50 lbs. The leg-up of a GLP-1 may be just what they need to support them at that time.
I am very skeptical of any drugs with "miraculous" results and no bad side effects. I have menopausal weight gain and it was truly depressing to gain 50+ pounds over 3 years while being pre-menopausal, and then not being able to lose it no matter how many miles I walk or cutting out sugar, limiting carbs, and eating whole foods. Now that I'm post-menopausal, I'm stalled completely. My blood work is good, I walk, I lift light weights, I cook 99% of my own food, but I have a sedentary job. So while I have never been interested in these drugs, I could be persuaded to if I can see real results from people I know (or trust from experience, like Alex), over time, with no long-term side effects.
Talk to an endocrinologist and see if getting your hormones in line will help. I did that, took a GLP1 for 2 months to hard reset my metabolism, worked with a dietician and have been able to get down to my ideal weight and keep it off.
My hormones seem to be fine. My Pregnolone was low so I've been taking that for the last year, and that has helped a bit. But I'll talk to my doc. I go to a naturopathic doctor and she's very good. IF she thinks I need a specialist, I'll do that.
I've been taking Mounjaro for a over a year, and my initial reaction was identical. It seemed like an absolute revelation. After 64 years, I finally experienced what it's like to not be completely obsessed by food.
Unsurprising, since it is supposed to aid in addictive behaviors of all types.
However, like a good drug, the effects fell off sharply--and quickly. The food thoughts returned and it took actual conscious effort.
Like a true junkie, I continued to increase the dosage monthly until I maxed out. I never matched that initial euphoria (high), but it has definitely been effective as I have lost roughly 57 pounds.
And of course I can never stop...
The side effects have been negligible, no worse than what I experienced when overeating or indulging in terrible food choices.
All of my metabolic numbers have improved significantly, another major benefit. A1c way down, liver, and especially kidney numbers are back solidly in healthy territory. I was particularly pleased with the kidney numbers that had plummeted after two Covid jabs...
The side effect profile emerging on these drugs is scary. I also recognize that the drugs may be beneficial for some but I believe they are over-prescribed and doctors are taking advantage of people desperate for them.
Here is my take after being on Reta for about 8 months. First, I would would ramp up the dose very slowly. At a body weight of about 202 (muscular, but too much visceral fat), I began at .5 mg and slowly titrated over about 5 weeks up to about 2.2 mg per week (once weekly, subq). Tolerated it great, no issues. I think if you start too high too quick, you are more likely to experience undesirable gastro-type side effects. Literally, almost exactly as the clinical literature suggests, I lost about 7% of my body weight (it projects greater weight loss as you increase the dose). I was very concerned about muscle loss, which will likely happen if you get too aggressive on your dosage, but I've maintained muscle (I have no idea how someone could eat at all on the maximum clinical trial dose of 12mg per week!).
At first, the appetite/food craving suppressant aspect is pretty significant, but after time the cravings will return in part, however, my food portions still remain at about 65% to 75% or so of my pre-Reta levels...you're just full on less.
It may sound crazy, but my biggest issue with Reta is your desire to drink water craters, and thus, I get constipated. I still like my alcohol, and please ignore the silly bodybuilder myth that is all over the Internet that because alcohol empties slower from your stomach when on Reta (true) it increases your hangover (utterly false - slower emptying would decrease your hangover). The obsessive bodybuilder crowd loves to figure out ways to deny themselves of any fun (I've been to many a "party" with my BB friends and once the protein has been devoured from the buffet table, they don't really what to do with themselves after that). Nonetheless, hangovers do seem more intense. My theory is that because alcohol and Reta both lower your blood sugar, and low blood sugar has some symptoms similar to a hangover (fatigue, anxiousness, jittery, etc.) you get a double whammy. I have found that drinking a sugary drink either very late at night after drinking or first thing in the morning returns the hangover effect back to what you experienced pre-Reta.
Then there is the lab results. Wow. My HgA1c was within normal range for the first time in years, and my cholesterol was down, with no change in eating habits. And because my dose isn't very high and I'm not losing muscles, I'm quite a bit leaner/harder, which makes sense as Reta supposedly levels out your insulin.
All in all, I think it is an extremely safe, extremely effective treatment and if you're obese the risk/ reward ratio is off the chart in favor of taking it....not even a close call.
I’m a full-time ER doc, and we are seeing increasing numbers of patients with severe vomiting and ileus/small-bowel obstruction associated with the GLP-1s. Add to that the nutritional malabsorption, muscle loss, and likely pancreas inflammation, and I’m a big thumbs-down on this medication.
The sad truth is that any primary care doc who refuses to give it to a mid-thirties woman trying to stuff into a bridesmaid gown next month will lose her business to a lesser-trained nurse practitioner down the street, and then the client will very possibly end up in the ER.
As an NP with more than 20 years of practice in Endocrinology, I'm very skeptical of the GLP1 class and actually, It's the doctors who seem to push them aggressively, without screening along the way for side effects, precautions, etc, just titrate, titrate, titrate. That's how patients end up in your ER. And why are we still arguing about how crappy NPs are, it's ridiculous. There's good docs and bad docs too.
100%
I agree. For every benefit, there is a generally a downside. Calculate your daily caloric needs subtract 500 cal (kcals really) stick to it and exercise. It can be controlled without pharmaceutical intervention.
Tell that to a pre-menopausal woman. This does not work for everyone.
It does work...it always works. Pre-menopausal (and post menopausal) women need less calories. Eat less, move more. I'm a 63 yo post menopausal woman and my weight has never shifted more than 5 lbs here and there except when preggers. You have to adjust your habits.
I’ve never struggled with my weight either. That was until perimenopause. I guess you’re just one of the very lucky few because even numerous doctors will tell you that it is difficult for women because of the hormone shift. Metabolism slows down, not to mention, the cortisol increases due to what the body is going through with the numerous symptoms. To say it always works is an out of touch and frankly ignorant statement.
Though I do not take GLP-1s for weight loss, no it doesn't always work. You may be one of the lucky people, but I am not. Nutritionists, personal training, fasting, dieting, you name it, DID NOT WORK, and by the time I hit my late 60s, and still having intractable hot flashes mind you, it became apparent, that I was never going to be able maintain, an acceptable to me, weight. HRT gave me some relief, but my insurance decided that I should pay $400/month for a minimum dose. Please do not diminish those of us who have truly been struggling through no fault of our own.
GLP-1s slow down the passage of food through the digestive tract, so nasty gastrointestinal issues are hardly a surprise. Keep on the watch for an explosion of colon cancer cases in the next 10 or 15 years. They also suppress glucagon, which enables your liver to convert stored glycogen into glucose when your blood glucose is low. Humans evolved to go out hunting and gathering when food was scarce, and you need blood glucose for that. Somehow the suppression of glucagon runs counter to what we evolved to do. I regularly strenuously exercise when I haven’t eaten for 14 hours. I don’t get hungry and don’t lose energy. I am not on GLP-1s.
You're close. Not a less trained NP but to black market drugs. I have 25 lbs of post menopausal weight I need to lose because I can't fit any more workouts into my schedule. I'm guessing my dr. won't prescribe them but I've found a site that will...but don't worry, I'll at least visit with my GP first.
I just wish I could have had more patients with this attitude. If you really demand the compliant provider find one and just skip the unnecessary appointment and messages. Save us all from the resulting games, crying, temper tantrums and (of course) complaints/bad reviews after the denial.
Patients temper tantrums? I don't like my NPs tantrums and won't go to a doctor again. I turned septic after having the flu and wound up in the hospital. When I went for my follow up, she screamed at me that I didn't have the latest flu shot. I looked at my records and I'd had 11 flu shots over the previous decade. Never again. Y'all can shove it.
Much of that weight is due to hormonal changes.
FWIW, you might ask a knowledgeable doc or np about hormones estradiol and progesterone supplementation. Luckily my gyn was up on research, my gp was not. Good luck finding a knowledgeable doc. I’m dreading when my gynecologist retires because he knows me.
@Patrick- did you just diss NPs?
If he didn't. I will.
I'm sure there are good ones but as much as I like the ones I've been to see, I'm glad I never took their advice.
Ouch. You probably wouldn't like my counsel either. Just sayin' you are fortunate you don't live in a medically underserved area or have family in skilled nursing or assisted living. Doctors love to practice in those environments, not. Choice/options are a wonderful thing. My observation is that heresy is not gender dependent, competency is not license related, and kindness and mutual respect is always correct.
Exactly!
Hmm, one way to trim down the population? Shed those useless pounds of unnecessary flesh??
Your comment was like a very concise documentary
I would like to see more unbiased analysis of this family of drugs. But the one thing we don't know is long term effects. We are running the experiment now....
Precisely. The risks such as pancreatitis are significant and until they are truly evaluated caution is warranted.
For the record, I would not go within a 1,000 miles of a Covid vaccine, and I think a lot of the side effect critique/concern is misunderstanding the difference between a chain of amino acids (and their mechanism) and the many foreign chemicals that are prescribed out there that I would never put in my body.
See also fellow Substacker's article on the subject: https://victorfitfleet.substack.com/p/your-body-already-makes-the-hormone?utm_source=share&utm_medium=android&r=pntgz
Excellent article! Thanks!
See the research here:
https://www.midwesterndoctor.com/p/the-great-ozempic-scam-and-safer?utm_source=publication-search
Bad. Get in the gym, go for a walk, go for a run, eat clean whole food and stop with the drugs. You’ll live longer and feel better with zero side effects.
I generally agree with this and I have no desire to go on the drugs, but I walk 3 miles a day, I swim almost every day, I don't eat junk, I prepare almost all my own food, eat lots of protein and veggies and limit carbs and sugar, and lift light weights. Menopause hit me hard and I gained 50 pounds and trust me when I say it's been a struggle. But my blood work is good, my blood pressure is normal, my cholesterol is elevated but not high.
I'm there with you. I've recently switched up my exercise routine. A little improvement but think this will be the struggle until we die. At least we can still move! I'm going out kicking and screaming.
I've said to my doctor (a naturopathic MD) that I'm the healthiest fat person she knows and she laughed. There are some things we're working on slowly through supplements, and so far everything is going in the right direction, except the weight. I gave up all alcohol for Lent -- not one drop -- and didn't lose a pound. (I don't drink a lot, but I usually have one glass of wine or a "skinny" margarita after dinner.)
Bummer....I do know some women who are so fastidious with their diet, they work out and they just still gain weight. I shouldn't be so judgy (a comment I made above.) Perhaps I'm just lucky I have good metabolism. I never gain weight, I eat sugar (probably too much), I drink but I'm also VERY active. I'll be #1 on the Peloton leaderboard almost every time for my gender/age level (63 yo.)
Kicking and screaming is the best way to go!
This is where I am. I can't fit any more workouts into my schedule. We eat almost strictly plain roasted or baked meats with plenty of salads and fresh veggies. I'm so sick of this diet but we're sticking to it. I'm super healthy and strong...and now 25 lbs too heavy. Tirzepitide is looking better and better. So many of my friends and family have done amazing things on it. Oh and like you I don't eat junk food or drink soda but I've never really been a fan anyway so there was never anything to give up.
Yeah -- menopause REALLY sucks and I don't think most men understand what happens to our bodies. I had 5 kids and lost most of the baby weight. But hit 50 and WHAM! But even if we're overweight, one of the best things to do is just keep doing light weights. Even if you don't see weight come off, we have to keep our muscles because once you lose them it's much harder to get back.
Try a RESET, fast 3 days, then NO sugar and sugary carbs for 6 months, you will be back to being 18 years old.
You write "we'. I think that is our American issue. We are social eaters. We no longer have to find or work so hard to get our sustenance. I grew up in a large extended family milieu. I left home for grad school, began to cook for myself. AS yrs went by, all my family members gained weight. Not hugely obese, just not TRIM. My weight is same as high school (I'm 70's). I realized as years passed, in all my going back for visits with family, that if I ate the way they do, I would be their size. I simply eat foods and less meals for what I feel I really NEED, for health w/enough enjoyment mixed in, with some special fun treats for special times. I am able to do that. For all sorts of emotional/social reasons, as a culture, we have big ATTACHMENTS to food - consider the advertising!!!!! It may sound trite or unsympathetic, but our relationship to food needs amending.
Great point. My dad was an athlete all his life and once he hit 70, really struggled with his weight. He "created" what he called the "not my day to eat" diet where he would only eat every other day( now called intermittent fasting I think). He described that it wasn't that hard to stick to other than it was very socially awkward for him. After 6 months though, he was back to his trim, athletic self. I would have to agree on the relationship with food. I do wonder how Italians do it. And French. Two cultures that tend to be family/food oriented. It's all very interesting.
I think you hit on something. As I'm watching some of the reels from the World Cup players who have been posting about how awesome America is, the theme that runs through most of them is the amazing food and the size of our portions. Yes, Americans need to adjust their relationship to food.
Just as illicit drugs were overtly pushed across the west post-WWII as agents of personal and social destruction, so too was processed food used on Americans (in particular) as an agent of health/social destruction. I think it was intentional and orchestrated.
I think all cultures are social eaters and we have been for millenia.
This was me. Adding low dose retatrutide changed my life in all the ways noted. There has been no downside. Note that you have to be all in with excellent nutrition and exercise.
I don't know how old you are but we got shut out of HRT. It was a no-no when I was going through menopause and now it's a huge no-no at age 63.
I eat a salad a day and now I freaked out due to the explosive diarrhea bug out there (can't remember what it's called.)
Cyclosporiasis...I live in Michigan which is the hardest hit and have (sadly) been avoiding most produce, especially lettuce where they think it is coming from. No salads for me for a while!
Read this Substack: https://victorfitfleet.substack.com/p/your-body-already-makes-the-hormone?r=nl3ud&utm_medium=ios
Walking does little. Sprint or do HIIT instead. Intense swimming intervals are good.
The rest: just fast. I’m no expert but I’ve seen what works in many. It does require one to be very disciplined and change his relationship with food. You do want caloric intake to drop under your basal rate. One can eat in the 8 hour windows only, and/or do regular 18-24 hour fasts. There are various options.
Grass fed / organic, and well-chosen supplements should dominate what is ingested. Once weight settles in 6-12 months, depending upon where the person is, he/she can reintroduce some things to comfort level.
I gave the short version of your message. I appreciate it
have you been through menopause? It ain't that easy...just sayin"
Let’s see: a drug with noted side effects but a quick fix, or make a real lifestyle choice before it’s too late. Because once you go the GLP route, at some point you’ll need to stop, right? Then what? These drugs alter your body chemistry, hard pass.
I exercise daily more than you might imagine: walk 3-7 miles, daily, five gym classes/week, intermittent fasting 6 days/week…but I do like a sweet treat and/or a glass of wine and my metabolism is just very, very slow.
This guy is worth reading: https://victorfitfleet.substack.com/p/you-were-told-to-stop-running-because?r=nl3ud&utm_medium=ios
Many of us already do all of this and STILL cannot drop the post-menopausal weight. And some of us get injured when we add too much strength training or even yoga to our lives. I have chronic inflammation issues and even minimal excess fitness seems to aggravate it, sometimes sidelining me for a week at a time.
If you have chronic inflammation take a look at your eating and drinking habits. Read the ingredients on labels, GLP’s are a short term fix, you cannot stay on it forever, then what?
Then what? There are some psychological processes which may help at least as much. EMDR, "Unlearn Your Pain" by Howard Schubiner, and so on.
See the Recovery Norway website.
I’m old, and I do 4 days of cardio (65 min/day) and 3 days of strength training/wk. On a typical day I get 12,000 steps in. Losing weight comes from dietary changes mostly, and from exercise, a little (marathoners and distance runners are a different case). What I’ve read is that glp1s cause loss of muscle mass and fat equally, which is not a good thing.
The lost of muscle is what I've heard as well. The thing is ... there are so many things that can go into weight gain/loss. I know mine was caused mostly because of menopause which hit when I became an (almost) empty nester which cut my activity. I know that I could fast and it might work. I can't run anymore. I have arthritis in my knees (I was brutal to my body as a teenager/young adult from soccer). I walk for cardio and to keep my joints healthy. I take high-quality supplements based on what I need (according to extensive blood work) and I have a LOT of muscle under the fat. What works for some people doesn't work for others. I'm more concerned about health issues than how I look. ... I've cut out seed oils, I cook almost all my own food, I make my own dressings, I eat high protein meals ... but I also have a sedentary job and that's not going to change. The only thing that worked to actually take off weight was when I did strict KETO for 3 months ... but I couldn't eat enough fat to move the needle past a certain point because I don't have a gallbladder to help process the fat.
Yes, I am well aware of processed food excess and the boom in the pushing of it since post-WWII when the brave new world arrived with TV ads and supermarkets and food corporations selling tantalizing junk food. I think it was part of the intentional social-destruction agenda.
However, there are many people in situations not so cut and dried. I always roll my eyes a bit when I read these great pieces of "wisdom". You probably tell addicts (of various sorts) just to stop doing what they are doing, and figure this is all the advice it should require. As if there is nothing else behind the scenes driving this.
Prednisone is a notorious weight-gaining medication for instance, and is prescribed for a whole load of inflammatory conditions, including autoimmunity. So you might have to choose between your Lupus and your weight.
Same goes a for a large number of weight-gaining psychiatric drugs.
Radiation for brain tumours has been known to affect the metabolic HPA axis, leaving the patient (children included) with chronic metabolic difficulties.
There is PCOS. There are endocrinopathies. And no one walks around with a banner telling others that they have another medical issue rather than an eating compulsion.
Th self-righteousness of the "Just cut the calories and move!" crowd is what amazes me. It strikes me as a hierarchical tactic.....if the other guy is visibly fat, I can automatically claim moral superiority if I am not fat. It's an easy win for the morally lazy...especially if their own faults are not the visible sort.
I am not of the leftwing Woke persuasion. I think they shamelessly use obese persons in their Woke political posturing, in order to virtue-signal. Although I am not in favour of encouraging obese persons to become trapped in victimhood either, especially if the new GLP-1 drugs can help move them out of that.
Commenting as a subscriber--and prescriber. I think GLP1s are a holy grail: The safe and very effective weight loss prescriptions we have been waiting for. They are good for weight, diabetes, blood pressure, heart, and kidneys. What's more, it will soon be evident that they are preventing LOTS of cancers (while causing very few) as obesity is a risk factor for MANY cancers. Having said that, they DO have some effects on the body and brain that I'd rather they didn't.
You lose one pound of muscle for every two pounds of fat lost. Not a great outcome--but exercise can minimize the muscle loss (sarcopenia). The effect on the brain is a bit more concerning to me and not as well described--although Eugyppius attempted to. I think it's more accurate to say that GLP1s reduce cravings for EVERYTHING. So, if that's food, booze or drugs that's great. But what if it's sex with your spouse, travel, or socializing? That is my main concern, and we haven't really measured that well yet. I think dosage titration is important and weight loss is not the only metric we should be looking at.
Great Post Doc, I think the loss of positive desires may be overblown, but I am on a very small does (2.2mg weekly). Sex drive extremely high (at 69 yrs old), still love my cocktails and socializing.
Wow. Should I put my disinterested husband on this stuff??
GLP-1s also haven’t affected my “desires” either. Still enjoy everything!
Not to worry about people losing their cravings to do pretty much everything. Isn't that the goal of post-modern society?
First of all and most strongly, I remain - contra the AAP - very much against them in children.
Still skeptical of them in adults because there’s no such thing as a free lunch and because I view them as the pharma equivalent of The Picture of Dorian Gray - if your blood remains nothing but liquefied Cheetos dust, it doesn’t matter what the scale says, you’re rotting from the inside.
https://gaty.substack.com/p/the-picture-of-dorian-gray-is-not
But I’ve had similar even stronger opposition to ADHD meds and SSRIs in kids for years and they’re just getting more and more widespread so I’m sure this will continue to spread like wildfire too, moral and long term consequences be damned.
The AAP are basically legally-protected child abusers. No one should listen to those awful people.
GLP-1's - Excellent for weight loss, terrible for health.
Opiates - Excellent for pain control and for getting you addicted
Stimulants - great for improving attention, terrible for your adrenal glands.
I think we are asking the wrong question here: Do people want symptom relief or do they want improved health. Drugs are a great way to get symptom relief, but are terrible for health. Treating root causes of illnesses improves both symptoms and health.
Which do you prefer, symptom relief or health? If it was number one, you have been brainwashed and it is too late for you.
Very good analysis
This post deserves more likes. Spot-on!
You are absolutely right on ...
No drug, and no amount of exercise alone is going to result in a healthy body or healthy weight. Nutrition for the human body - It's firstly the food. Get educated: pcrm.org, nutritionstudies.org
But losing weight IS about health. It lowers your risk of many types of Cancer, it lowers your blood sugar levels and often normalizes cholesterol, it improves liver function, and many other health improvements.
You didn't know this?
GLP-1s are also being studied for the effects they have on lowering inflammation and on helping to correct blood vessel hyperpermeability found in Plasma disorders. These drugs may be useful for more than one purpose.
I see a bright future for you working for Big Pharma. Just be clear about the spiritual adverse effects.
Your abundant self-righteousness is going to be your downfall, Mark. Silly comment. Takes all kinds, I suppose. You seem to live in an indulgent fantasy world, posturing as the great Hero. Come down to earth, my friend.
Pharmacist here with four decades in pharmaceutical sales. I have no personal experience with these products either as a practitioner or a patient. My read on this today is these products are probably best used right now in diabetics and morbidly obese people to reduce cravings, lose weight, and improve blood pressure and blood sugar control. I would not recommend they be used in mildly overweight people or normal weight people. WE HAVE NO IDEA WHAT THE LONG TERM EFFECTS OF THESE PRODUCTS ARE and if you stop taking them and return to your old habits you’ll regain your weight loss. Like other people have mentioned, I’m all for continued study where appropriate and looking for potential long term benefits/toxicities to get an idea of the risk/reward potential of these products. One must always be careful when messing with Mother Nature!
I'm skeptical of the GLP-1s. I know they work. But I've lost count of the things that seem too good to be true. Lose weight without self-denial? Looks like these drugs have made it possible. But without side effects? Count me skeptical until the people taking them have experienced nothing bad for ten years or more.
You are missing an option in your poll: I’m interested, but my doctor won’t prescribe them due to concerns about liver damage.
You have a wise doctor.
She has a very misinformed doctor.
Hope so.
Liver damage? Your doctor needs to brush up on his literature, Reta shows more promise for treating fatty liver than any drug out there, bar none, especially with its safety profile. It's an amino acid chain. The liver improvement results are astounding in the clinical literature.
@Jim- losing weight will also help wth a fatty liver. It's a vicious cycle.
Sometimes, but fatty liver is very hard to get rid of, very hard. One of the things that attracted me to Reta was the incredible potential it shows for treating fatty liver. I have mildly elevated liver enzymes and mildly fatty liver (hasn't worsened in 20 years, but I'd love to get rid of it).
Don’t even have a fat liver!!! Or fatty liver disease….just 5 lbs that won’t come off my belly!!!😁
Zero long term studies. You’re the guinea pig. My motto is don’t be a guinea pig. They burn muscle for the weight loss. They can paralyze your digestive tract.
Reported side effects and general loss of desire alone are enough to counsel caution. There presumably are folks for whom the cost/benefit calculus favors taking GLP1s. But the known downsides and the unknown risks (remember Fen-Phen?) should weigh against broad long-term use.
After the Covid debacle, I cannot bring myself to even consider the GLPs.
Everyone loves them and they are hyped for curing almost all maladies known to man. Step on up folks get your bottle before we run out.
Way too much hype, way too much money to be made to be believable. I am sure there are benefits. Just not sure they out weigh the long term cost.
Remember folks once upon a time your doctor recommended smoking to help relieve stress!
Currently a lot of unknowns for sure, PNW. I think part of the issue is that they shouldn’t be treated and prescribed a standalone silver bullet but rather than, one part of a comprehensive treatment plan that includes prioritizing protein, a low and slow dose titration, weight training, and supplements to fill nutritional gaps. Sometimes use of digestive enzymes is indicated as well. There are other recommendations for which I encourage people look at information Dr. Tyna Moore has on her site. I’m not affiliated with her but have found her information to be thoughtful, thorough, and health promoting.
The primary problem is Americans and many in the West have generationally failed to pass on heritage wisdom and knowledge about eating and food preparation. They failed by trusting Uncle Der Stat to tell them what is healthy and what isn’t, ignoring the massive industry conflicts and all teaching from the founders’ political philosophy along the way.
So the children of these failures must build the wisdom back up. Fortunately, many individuals have rediscovered truths about fasting, organic/ancestral food preparation and cultivation, seasonal eating, and more human-compatible exercise such as sprinting and HIIT.
Drugs should generally have no part in this healing. It’s a fat and nutrition problem, and ultimately a willpower one once wisdom is received and internalized, and not something a chemical should be relied upon to do.
You might want to see my longer comment on this post. I generally agree although sometimes people need a leg up to get them started on the right path, and these meds can play a role in this, not as a mono therapy but as one piece of a comprehensive treatment plan that includes all that you mentioned above.
Michelle, I see too many comments on GLP-1 article forums where the commenters really, really want "the fatties" to suffer for their supposed sins. Only because those "sins" happen to be visible. The self-righteousness often turns to viciousness. Says more about the moral level of commenters of this nature than it does about "the fatties".
I always wonder whether they stop to think for even a moment what it must be like to live as the new class of lepers. What continual social-shunning does to the soul. Yes, there are individuals who let themselves go and allow food-constraint to die, but there are just as many others who are not guilty of that. I have seen situations where a crisis in a person's life has added 50 lbs. The leg-up of a GLP-1 may be just what they need to support them at that time.
I am very skeptical of any drugs with "miraculous" results and no bad side effects. I have menopausal weight gain and it was truly depressing to gain 50+ pounds over 3 years while being pre-menopausal, and then not being able to lose it no matter how many miles I walk or cutting out sugar, limiting carbs, and eating whole foods. Now that I'm post-menopausal, I'm stalled completely. My blood work is good, I walk, I lift light weights, I cook 99% of my own food, but I have a sedentary job. So while I have never been interested in these drugs, I could be persuaded to if I can see real results from people I know (or trust from experience, like Alex), over time, with no long-term side effects.
Talk to an endocrinologist and see if getting your hormones in line will help. I did that, took a GLP1 for 2 months to hard reset my metabolism, worked with a dietician and have been able to get down to my ideal weight and keep it off.
My hormones seem to be fine. My Pregnolone was low so I've been taking that for the last year, and that has helped a bit. But I'll talk to my doc. I go to a naturopathic doctor and she's very good. IF she thinks I need a specialist, I'll do that.
estradiol and Synthroid really help. Synthroid, not the generic. Everyone I know who took the generic gained a lot of weight on it.
...to a point.
I've been taking Mounjaro for a over a year, and my initial reaction was identical. It seemed like an absolute revelation. After 64 years, I finally experienced what it's like to not be completely obsessed by food.
Unsurprising, since it is supposed to aid in addictive behaviors of all types.
However, like a good drug, the effects fell off sharply--and quickly. The food thoughts returned and it took actual conscious effort.
Like a true junkie, I continued to increase the dosage monthly until I maxed out. I never matched that initial euphoria (high), but it has definitely been effective as I have lost roughly 57 pounds.
And of course I can never stop...
The side effects have been negligible, no worse than what I experienced when overeating or indulging in terrible food choices.
All of my metabolic numbers have improved significantly, another major benefit. A1c way down, liver, and especially kidney numbers are back solidly in healthy territory. I was particularly pleased with the kidney numbers that had plummeted after two Covid jabs...
The side effect profile emerging on these drugs is scary. I also recognize that the drugs may be beneficial for some but I believe they are over-prescribed and doctors are taking advantage of people desperate for them.
I imagine that the risk benefit ratio is better for the obese, since obesity is so dangerous.
Unfortunately, now people are using it to shed a pound or two...
This is how the wealthy will also become the unhealthy.
Here is my take after being on Reta for about 8 months. First, I would would ramp up the dose very slowly. At a body weight of about 202 (muscular, but too much visceral fat), I began at .5 mg and slowly titrated over about 5 weeks up to about 2.2 mg per week (once weekly, subq). Tolerated it great, no issues. I think if you start too high too quick, you are more likely to experience undesirable gastro-type side effects. Literally, almost exactly as the clinical literature suggests, I lost about 7% of my body weight (it projects greater weight loss as you increase the dose). I was very concerned about muscle loss, which will likely happen if you get too aggressive on your dosage, but I've maintained muscle (I have no idea how someone could eat at all on the maximum clinical trial dose of 12mg per week!).
At first, the appetite/food craving suppressant aspect is pretty significant, but after time the cravings will return in part, however, my food portions still remain at about 65% to 75% or so of my pre-Reta levels...you're just full on less.
It may sound crazy, but my biggest issue with Reta is your desire to drink water craters, and thus, I get constipated. I still like my alcohol, and please ignore the silly bodybuilder myth that is all over the Internet that because alcohol empties slower from your stomach when on Reta (true) it increases your hangover (utterly false - slower emptying would decrease your hangover). The obsessive bodybuilder crowd loves to figure out ways to deny themselves of any fun (I've been to many a "party" with my BB friends and once the protein has been devoured from the buffet table, they don't really what to do with themselves after that). Nonetheless, hangovers do seem more intense. My theory is that because alcohol and Reta both lower your blood sugar, and low blood sugar has some symptoms similar to a hangover (fatigue, anxiousness, jittery, etc.) you get a double whammy. I have found that drinking a sugary drink either very late at night after drinking or first thing in the morning returns the hangover effect back to what you experienced pre-Reta.
Then there is the lab results. Wow. My HgA1c was within normal range for the first time in years, and my cholesterol was down, with no change in eating habits. And because my dose isn't very high and I'm not losing muscles, I'm quite a bit leaner/harder, which makes sense as Reta supposedly levels out your insulin.
All in all, I think it is an extremely safe, extremely effective treatment and if you're obese the risk/ reward ratio is off the chart in favor of taking it....not even a close call.
If you drink sugary drink late at night on the regular, aren't you wrecking the overnight glymphatic process and risking brain problems in future?