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Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

nautil.us

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Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#111

Post by amelius »

j-conn wrote: post #35
amelius wrote: post #34

Earlier quoted context omitted.

Did you try those zero-sugar candy bars (often labeled as protein bars)? They work quite well for me, no messing with GLP-1 necessary.

Which do you like? Barebells salty peanut and chocolate dough over here. Though the sugar alcohols certainly aren’t great for you either, I think they were recently linked to stroke risk

I'm a Barebells Coco Choco "fan", though I'm aware of the stories around sugar alcohols. I think those bars are way too sweet anyway. They could use far less sweeteners. Would love to hear about more responsible options.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#112

Post by ErroneousBosh »

cthalupa wrote: post #25
ErroneousBosh wrote: post #16

Earlier quoted context omitted.

It doesn't reduce heart attack and stroke. It reduces appetite, kind of, and gives you a sore stomach while making you shit yourself inside out. All this can, with care, help contribute to weight loss. Weight loss can reduce heart attack and stroke, but GLP-1 does not. You could also reduce heart attack and stroke risks by not eating crap and going for a walk every so often.

We see risk reduction for heart attack and stroke for people on GLP-1s even without weight loss, which belies the idea that the protection only comes from losing weight. Edit: In fact, from the study - BMI went from 35.86 (Continued) to 34.57 (Discontinued) to 35.48 (Interrupted), Heart failure percentage was 11.57% for continued use, 12.73% for discontinued, 11.92% for interrupted NICM went 3.10% for continued, 3.36…

Have you got a link to the study those figures are actually from? I'm not saying their wrong but I would like to read and understand them for myself before I change my mind.

> BMI went from 35.86 (Continued) to 34.57 (Discontinued) to 35.48 (Interrupted),

So, what, was 35.86 the BMI at the start, 34.57 the BMI when they stopped taking the drug, and 35.48 after some interval?

For someone of a fairly average height, say 1.86 metres (that's a little under how tall I am) a BMI of 35.86 would be 124kg which is ridiculously fat and 34.57 would be around 119.6kg so you're looking at a loss of around 4.5kg or so.

That's a good shit and a haircut, in the grand scheme of things. It's fairly normal for someone's weight to fluctuate by a kilo up or down (a range of 2kg over normal) and not utterly off the map for a range of four kilos on a day-to-day basis, especially in obese people. That's why you're not supposed to keep weighing yourself and obsessing over the weight.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#114

Post by ajam1507 »

esperent wrote: post #100
smallnix wrote: post #53

Earlier quoted context omitted.

It's not useless. It might be expected, but now it's more certain. This allows planning with it.

Scientifically it's valid, and good scientists and doctors would immediately pick up on the nuance. The issue is shameless "science" reporting like this which packages up the results for non experts, without explaining the nuance because they know the sensational headlines will get more attention, and they know non-expert readers will get scared and share the article on places like HN or Facebook. It's such an obviou…

The doctor using the word “whiplash” is one of the authors of the study.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#115

Post by techjamie »

gpt5 wrote: post #41
TaupeRanger wrote: post #3

Kind of a useless analysis if it doesn't compare the risk after stopping GLP-1s to the risk of NEVER taking GLP-1s in the first place. We probably don't know the numbers yet, but one can easily envision a scenario like: risk of CE without GLP-1 weight loss: 20%. Risk after taking GLP-1s for 2 years: 10%. Risk after stopping GLP-1s: 12%. "Your heart attack chance goes up 20% after stopping GLP-1s!!!"

Especially since every GLP-1 study shows almost complete regain to original weight after stopping. It’s like stopping a blood pressure medicine and then being surprised that people have more heart attacks afterwards.

A tale older than the use of GLP-1. People do X to lose weight, they hit a target weight, declare victory and continue the habits that got them in trouble in the first place. You can go a little bit heavier on the meals and loosen the exercise if you desire, but you still have to keep yourself within maintenance threshold or the weight comes back.

GLP-1 masks the problem and people don't realize their actions aren't ideal once the mask is removed.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#116

Post by ErroneousBosh »

cthalupa wrote: post #90
sublinear wrote: post #87

Earlier quoted context omitted.

Unless we're talking about emergency care, most pharmaceuticals are completely unnecessary and carry serious risks. There's not a single qualified doctor out there that would promote drugs before preventative measures.

Pretty much every adult fat person has attempted diet and exercise to resolve their weight issue. Saying they should try this first at this point in the game is like having your support case escalated 5 times already and them saying "have you tried turning it off and on again"

> Pretty much every adult fat person has attempted diet and exercise to resolve their weight issue.

If it's not working for you, it may be because you haven't sorted the "diet" bit.

Are you eating "low fat" or "low calorie" things? Because those are not food and they will make you fat.

Eat food, just a bit less of it than you do now.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#117

Post by camillomiller »

We built a world where food is so processed and toxic that it makes you easily fat, but instead of fixing that we invented a drug that makes you eat less. Why not invent a drug that makes you less thirsty for those whose water is contaminated by fracking?

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#118

Post by jakevoytko »

rootusrootus wrote: post #71
sublinear wrote: post #69

Earlier quoted context omitted.

I went down from 390lbs to 240lbs gradually over 5 years. I have maintained a weight of 240lbs since then (6'1" tall). The first year was the most dramatic loss of 100lbs. I was miserable and didn't know what I was doing other than counting calories. The rest of it was more considerate of total nutrition, and that's what made my good eating habits stick. I say this because while I'm not a doctor I think GLP-1 is prob…

> I say this because while I'm not a doctor I think GLP-1 is probably unnecessary for the vast majority of patients. We have mountains of evidence that willpower fails for something like 99% of everyone, which is far from a vast majority. I applaud anyone's efforts to become healthier, however (though 240 at 6'1" is still obese, I would still explore medicine if I could not get any lower "naturally").

My doctor, who is on the older side, told me that he went through his records when GLP-1s started being prescribed for weight loss. He wanted to calculate what percentage of his patients (a) he had advised to lose weight, (b) reduced their weight to healthy levels, (c) and kept it off.

From the starting population of overweight people, only 3% of people dropped down to, and stayed, a healthy weight.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#119

Post by actuallyalys »

46493168 wrote: post #6

In veterans with T2 diabetes: > To find out what happens when people stop taking GLP-1s, Al-Aly’s team of researchers tracked the health of more than 333,000 United States veterans with type 2 diabetes for three years.

The same thing happened when the same researcher did studies on Covid using similar datasets. There’s likely some generalizability but part of the reason the absolute risk is so high is because VA patients are a group already at high risk. It’s partly a failure of science journalism this caveat gets missed but seems like it is also one Al-Aly is happy to allow.

Re: Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists

#120

Post by storus »

cthalupa wrote: post #96
storus wrote: post #93

Earlier quoted context omitted.

I suspect you have no idea that your body has two independent energetic circuits - one driven by insulin and glucose, the other driver by ketones. Just please dump this to any decent LLm to give you ELI5. Muscles obviously need glucose for their best performance which is why strength training is not recommended during ketosis; OTOH ketosis is naturally muscle-sparing.

> I suspect you have no idea that your body has two independent energetic circuits - one driven by insulin and glucose, the other driver by ketones. I am fully aware - I have spent several years of my life following a ketogenic diet. None of that is relevant for "starvation mode" and insulin within that context. I was replying to your specific points - not providing an explanation on how ketosis works from end to end…

You keep mixing normal carbohydrate metabolism with functional starvation mode when in low caloric high carb diet, i.e. elevated insulin in a low-energy/tired mode with increased cortisol, ramping up gluconeogenesis from muscle tissue, catabolic state from elevated stress hormones, T3 thyroid hormone underproduction, adrenaline spikes leading to insulin resistance beta-andregenic sensitivity downregulation, none of which is present in ketosis from e.g. water fasting.

As for ketosis sparing muscles that comes from a wide range of effects like low insulin, preserved/increased GH/IGF-1, BHB-inhibited muscle proteolysis and low leucine oxidation.

https://pubmed.ncbi.nlm.nih.gov/41035089/

Your super confident attitude is likely going to lead nowhere for any people following your advice and when they confront you about not reaching any fat loss goals, your response will be likely "it's you", instead of understanding the gaps in your own knowledge.

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