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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

#61

Post by conception »

kube-system wrote: post #9
IAmGraydon wrote: post #7

Earlier quoted context omitted.

>This is a very odd phrasing that makes it seem like heart attack and stroke risk are higher for those who stop taking the drug than those who never took the drug. That does appear to be the case, according to the study.

The conclusion of the study says: > This study showed that discontinuing and interrupting GLP-1RA treatment could erode and might reverse the cardiovascular benefits of the drug in a duration dependent manner, increasing the risk of cardiovascular events. emphasis mine

Could.

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

#62

Post by Teknoman117 »

rootusrootus wrote: post #43
Teknoman117 wrote: post #26

I’m always kind of envious of the people who were able to lose weight on GLP-1 drugs. I lost a bunch of weight a few years ago, and still need to lose a lot more (430 lb -> 330, goal 240), but I fell out of the good habits for, well, no good reasons… Decided to try Ozempic and was on it for about 6 months. Didn’t do a single thing for my appetite unfortunately, even on the max dose. Sample size of one here, but if yo…

You missed out on both of the weight suppression tricks, which really does suck. Appetite suppression (or reduction of food noise) is pretty useful, but GLP1s also tend to punish you mightily if you overeat. For me, even if I were hungry, overeating will make me hurt for hours. I could not gain weight on this even if I wanted to. There are some difference, too, between the various drugs. I never tried ozempic, I went…

Yeah I might just have to go get it out of plan. Kaiser covers Ozempic, but none of the Tirzepatide based medications. (Edit: looks like that might have changed)

I am a big guy (6’4, 330 lbs), but I was amazed that Ozempic just seemed to do nothing. I was having the gastric side effects, but I could still eat 3000 calories a day if I cheated without feeling anything.

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

#63

Post by cthalupa »

amazingamazing wrote: post #58
cthalupa wrote: post #57

Earlier quoted context omitted.

The ability to be disciplined about eating is also a talent. Or do you think that somehow genetics don't play one of the largest roles in your ability to be disciplined when it comes to food?

If you can be disciplined about taking a drug you can about food. How do you explain correlations in obesity across cultures? Genetic superiority? Again, imho just making excuses for laziness. The same logic you’re applying here also applies to even taking the drug and picking up refills from the mail… Also look at obesity rates across time within the same country. It’s clearly not an issue of discipline, it’s an iss…

Why in the world do you think that taking a once a week injection requires even remotely similar levels of discipline to dealing with daily hunger and food noise? There's like, a dozen orders of magnitude in between. This is a silly argument.

> How do you explain correlations in obesity across cultures? Genetic superiority?

Every developed nation in the world except Japan has been seeing obesity and overweight rates rising at significant rates, including countries that have fairly similar cultures, such as Korea. You also see people move to America and stay in relatively isolated pockets of their culture and still gain weight.

So no. It's a matter of access to hyper palatable calorie dense food. The more of it around, the more likely people are to get fat. The fatter you get, the more of a feedback loop you end up in for a wide variety of known and relatively well understood mechanisms. GLP-1s help short circuit that feedback loop.

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

#64

Post by cthalupa »

vladgur wrote: post #60
brap wrote: post #31

Earlier quoted context omitted.

Wegovy/Ozempic didn’t do anything for me for months. Then my doc put me on Tirzepatide+Phentermine combo and I forgot what being hungry even feels like.

Do you have to remind yourself to consume things like proteins, etc to prevent muscle loss?

I couldn't hit my macros on tirzepatide - couldn't get enough protein without feeling sick to my stomach. One of the reasons I swapped to reta.

(though as a general note for anyone reading, just getting enough protein isn't enough - you need muscle stimulus too. Getting enough protein will help reduce the amount lost but if you really want to stop it, you gotta do resistance training)

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

#65

Post by AussieWog93 »

amazingamazing wrote: post #37

Honestly don’t understand it. Feels like a lack of discipline. I was 250. Plugged in a bunch of numbers into an app and it gave me a calorie count per day. I brought a scale with me everywhere, used ChatGPT to guesstimate calories, I added 50% for good measure. A year later I’m 175. You can’t do this even with drugs you’re gonna get fat anyway. I’m most curious about someone like me vs someone who lost the same amoun…

I'll bite!

A decade or so ago, when I was still in uni, I managed to get similar results naturally too - ~100kg down to ~65kg in around 18-24 months just by eating healthy and exercising more.

I put back all of that weight and then some during the COVID pandemic (I'm in Melbourne, Australia - we had the worst lockdowns on planet Earth) and this time struggled for years to lose it until trying GLP-1 drugs a few months back.

For me, what made it harder the second time around wasn't so much of a difference in discipline skills (if anything, they've improved) but the fact that there was so much more going on in my life - young family constantly getting sick, small business that started struggling, relationship/social issues, health issues (sleep apnoea) etc. etc.

I'd get on the weight loss train, lose a couple of kilos, then the whole family would get sick with the flu and I'd put it all back on again while recovering. Or maybe I'd be forced to shift my focus to the business so that we could keep the lights on. Or any number of things.

I guess my point is that it's not difficult to lose weight naturally (or any self-improvement, really) in and on itself, but it's completely different ballgame when you're fighting a war on 6 different fronts. Having one of those problems simply just disappear through GLP-1 drugs genuinely feels like a miracle.

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

#66

Post by amazingamazing »

cthalupa wrote: post #63
amazingamazing wrote: post #58

Earlier quoted context omitted.

If you can be disciplined about taking a drug you can about food. How do you explain correlations in obesity across cultures? Genetic superiority? Again, imho just making excuses for laziness. The same logic you’re applying here also applies to even taking the drug and picking up refills from the mail… Also look at obesity rates across time within the same country. It’s clearly not an issue of discipline, it’s an iss…

Why in the world do you think that taking a once a week injection requires even remotely similar levels of discipline to dealing with daily hunger and food noise? There's like, a dozen orders of magnitude in between. This is a silly argument. > How do you explain correlations in obesity across cultures? Genetic superiority? Every developed nation in the world except Japan has been seeing obesity and overweight rates…

> It's a matter of access to hyper palatable calorie dense food. The more of it around, the more likely people are to get fat.

Now there’s something we agree on. If only we could agree that no one is stuffing cheeseburgers down people’s throat other than themselves. So close.

Once the shame around disgusting fattening food has reached a critical mass the problem will solve it self.

Ironically the excuses you make for them only worsen the issue. If fat people and the food they ate were appropriate shamed they both would cease.

FYI in Japan fat people are ruthlessly bullied. Fat people are rare. Food for thought, pun intended.

Stop tolerated junk.

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

#67

Post by AussieWog93 »

rootusrootus wrote: post #43
Teknoman117 wrote: post #26

I’m always kind of envious of the people who were able to lose weight on GLP-1 drugs. I lost a bunch of weight a few years ago, and still need to lose a lot more (430 lb -> 330, goal 240), but I fell out of the good habits for, well, no good reasons… Decided to try Ozempic and was on it for about 6 months. Didn’t do a single thing for my appetite unfortunately, even on the max dose. Sample size of one here, but if yo…

You missed out on both of the weight suppression tricks, which really does suck. Appetite suppression (or reduction of food noise) is pretty useful, but GLP1s also tend to punish you mightily if you overeat. For me, even if I were hungry, overeating will make me hurt for hours. I could not gain weight on this even if I wanted to. There are some difference, too, between the various drugs. I never tried ozempic, I went…

Similar experience here with Tirzepatide. Overeating is punished swiftly and painfully.

If it works for you, look into getting one of the 15mg pens and counting clicks in order to get more doses per vial. I've been on the one pen for 3 months now and it's still got plenty of juice left.

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

#68

Post by renewiltord »

amazingamazing wrote: post #48
renewiltord wrote: post #47

Earlier quoted context omitted.

Everything is discipline. If you just always do the thing you’re supposed to you will win at life. People can’t always do the thing they’re supposed to so they supplement with drugs that help them do it: caffeine, amphetamine, SSRIs, GLP-1RAs and related drugs. In fact, everything is discipline. If you were disciplined enough to always put the basketball in the net from anywhere on the court you’d be Steph Curry. The…

Some things require talent like your examples, weight loss does not imho. The disparities in obesity and culture within country says it all.

You just have to be disciplined to always shoot accurately at the basket. Most people send it one way or the other but if you are disciplined enough in your aim at the basket no matter the constraints you will be the best basketballer of all time.

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

#69

Post by sublinear »

Teknoman117 wrote: post #26

I’m always kind of envious of the people who were able to lose weight on GLP-1 drugs. I lost a bunch of weight a few years ago, and still need to lose a lot more (430 lb -> 330, goal 240), but I fell out of the good habits for, well, no good reasons… Decided to try Ozempic and was on it for about 6 months. Didn’t do a single thing for my appetite unfortunately, even on the max dose. Sample size of one here, but if yo…

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 probably unnecessary for the vast majority of patients. Better food and information is more available than ever before.

I would strongly advise to watch your A1C and get out of the diabetes danger zone if you are. Most people can drop a few percent in as little as 6 months and it makes a massive difference in mental health. Blood glucose has a direct impact on the brain and overall cardiovascular health. If you drink alcohol, you might want to take a break also to let your liver/kidneys/pancreas do their jobs properly and restore insulin sensitivity and other hormones. Look into the "fruit paradox", and more generally get a good salad in for lunch to address nutrient deficiencies. Not crappy salads either. You're not a rabbit. Treat them like the amazing sandwiches without bread that they are.

Sounds like old advice, because it is, but I find people aren't listening because they want to more deeply understand why to do it and what the effects are. Convenience and unintuitive pricing are false bargains that get in the way of healthier habits. Focus on nutrition and not quantity. Change your groceries, change your life.

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

#70

Post by rootusrootus »

AussieWog93 wrote: post #67
rootusrootus wrote: post #43

Earlier quoted context omitted.

You missed out on both of the weight suppression tricks, which really does suck. Appetite suppression (or reduction of food noise) is pretty useful, but GLP1s also tend to punish you mightily if you overeat. For me, even if I were hungry, overeating will make me hurt for hours. I could not gain weight on this even if I wanted to. There are some difference, too, between the various drugs. I never tried ozempic, I went…

Similar experience here with Tirzepatide. Overeating is punished swiftly and painfully. If it works for you, look into getting one of the 15mg pens and counting clicks in order to get more doses per vial. I've been on the one pen for 3 months now and it's still got plenty of juice left.

One of the quirks of buying brand name GLP1s in the US is that we don't get the dial-a-dose pens, every autopen is one-shot. Some people disassemble them to get multiple doses, but at that point you might as well get the cheaper brand name vials or go with compound or gray.
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