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

nautil.us

71–80 of 128 posts

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

#71

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 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").

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

#72
Isn't GLP-1 creating a "feel-good" starvation? Patching the receptors telling the brain one is not hungry and then just letting the body starve happily, leading to significant muscle loss and aged face? Contrary to e.g. water fast where the body switches to 100% ketosis that can run as long as there is any fat in the body and one supplements electrolytes (Mg/K/P/HCO3) and vitamins (predominantly B1/B2/B3), leading to a much more healthy appearance?

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

#73
post #32
post #21

Earlier quoted context omitted.

That isn’t what this says at all.

(off-topic, but since the thread already is..) HN felt like one of the last places on the internet I could have good-faith conversations with intelligent people who would form thoughtful, on-topic replies. And now it feels like the user base here has shifted enough that the voting system no longer consistently elevates the interesting comments, but the comments that reinforce people's worldviews.

Everyone feels this way about HN at some point, it is normal. It is probably true that the user base has grown and so you see more low-value comments in absolute numbers as time goes on, but I still think the overall quality is decent and the community moderation solid.

It is also a Friday afternoon, and HN's weekend (and to some extent overnight) 'personality' is noticeably different than during typical business hours. I enjoy coming here on weekends but it gets a bit more wacky.

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

#74

Earlier quoted context omitted.

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.

When I was on Ozempic in the US (Bay Area), it was a dial-a-dose Ozempic branded pen. Came with 4-6 single use needles you’d screw onto the end before use, and discard into a sharps bin after.

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

#75
post #72

Isn't GLP-1 creating a "feel-good" starvation? Patching the receptors telling the brain one is not hungry and then just letting the body starve happily, leading to significant muscle loss and aged face? Contrary to e.g. water fast where the body switches to 100% ketosis that can run as long as there is any fat in the body and one supplements electrolytes (Mg/K/P/HCO3) and vitamins (predominantly B1/B2/B3), leading to…

There is nothing inherent in your description that would support your implied claim about facial aging.

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

#76
post #72

Isn't GLP-1 creating a "feel-good" starvation? Patching the receptors telling the brain one is not hungry and then just letting the body starve happily, leading to significant muscle loss and aged face? Contrary to e.g. water fast where the body switches to 100% ketosis that can run as long as there is any fat in the body and one supplements electrolytes (Mg/K/P/HCO3) and vitamins (predominantly B1/B2/B3), leading to…

GLP1s do not themselves cause any worse muscle loss than you would experience if you lost the weight by watching calories the old fashioned way.

"Ozempic face" is almost certainly an artifact of people who spent their life significantly overweight having somewhat looser skin than they would if they had maintained a low weight throughout their life.

Also, not everyone gets the face effect, not by a long shot.

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

#77

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").

Thanks for the reply. Your perspective framing this as "willpower" is precisely what I'm concerned about.

I didn't need any willpower to do this and I'm not even humblebragging nor think of myself as a tough guy. I'm saying that healthy habits are simply a matter of understanding. If someone wants to take GLP-1 on top of that, it's their call. Many seem to be under the impression it's so vital for their specific situation to lose weight or avoid a heart attack and I think that's plainly false. We shouldn't be feeding fear, and humans aren't that unique.

I did not change my diet. If anything I just added more variety with a specific intent and it worked. Even just changing the order in which one eats things (fiber before sugary foods) can make a big difference. Once I got the blood glucose under control all the strong cravings and eating mistakes basically went away on their own without my conscious effort. The body is all connected and driven by hormones.

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

#78
post #72

Isn't GLP-1 creating a "feel-good" starvation? Patching the receptors telling the brain one is not hungry and then just letting the body starve happily, leading to significant muscle loss and aged face? Contrary to e.g. water fast where the body switches to 100% ketosis that can run as long as there is any fat in the body and one supplements electrolytes (Mg/K/P/HCO3) and vitamins (predominantly B1/B2/B3), leading to…

GLP1s do not themselves cause any worse muscle loss than you would experience if you lost the weight by watching calories the old fashioned way. "Ozempic face" is almost certainly an artifact of people who spent their life significantly overweight having somewhat looser skin than they would if they had maintained a low weight throughout their life. Also, not everyone gets the face effect, not by a long shot.

Yeah exactly, what people call Ozempic Face is often just wrinkles. I look a bit older now that I lost 40 lbs, but much healthier shape. Fat does fill in your face some

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

#79
post #72

Isn't GLP-1 creating a "feel-good" starvation? Patching the receptors telling the brain one is not hungry and then just letting the body starve happily, leading to significant muscle loss and aged face? Contrary to e.g. water fast where the body switches to 100% ketosis that can run as long as there is any fat in the body and one supplements electrolytes (Mg/K/P/HCO3) and vitamins (predominantly B1/B2/B3), leading to…

There is nothing inherent in your description that would support your implied claim about facial aging.

"Emerging research suggests GLP‑1 receptors are present on adipocytes and fibroblasts. Some animal studies indicate that GLP‑1 agonism may promote lipolysis in subcutaneous fat more aggressively than in visceral fat, leading to disproportionate loss of facial fat. It also may affect collagen synthesis or skin architecture, though human data are still evolving."

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

#80

Earlier quoted context omitted.

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…

> 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.

No one is saying that it is forced. What I am saying is that your sense of moral superiority for the fact you aren't is misplaced.

Let's give you an anecdote: Up until 18 or so, I was a stick. I went from being a stick to getting into powerlifting. I spent the first chunk of my 20s with a pretty great physique. Then as I had more and more responsibilities in life, I had less and less bandwidth to apply to things like cooking, exercise, etc. I slowly lost muscle mass. I slowly gained fat. I had never had food noise when I was skinny - I had never compulsively felt the need to eat, regardless of hunger. I had never had food just constantly occupy my brain. After my slow descent into obesity, something fundamental about my relationship with food had changed. When my stress was lower and I was skinny or later fit, staying that way was easy. It didn't require great mental fortitude, massive discipline, any of that. And when I got fat, it wasn't because I was craving food - it was because I had shit to do and couldn't take the time to cook. Or because I was going outwith friends or my SO and eating out was a huge part of my social life.

When I looked at myself and decided I had to change, I though I just needed to stop doing those things. Stop going out, force myself to take the time to cook and let other things fall on the backburner, etc. Except now I thought about and craved food in a way I never had before. I went from thinking exactly the same as you to realizing 'Oh shit. This wasn't as simple as I thought it was.'

I lost weight plenty of times. Significant weight - not just a few lb, but 30+. Multiple times. And then I'd get busy at work, I'd have family members going through problems and need help, I'd have a rough patch with an SO - as soon as my mental bandwidth got divided, the weight loss stopped and regain started.

Even if an individual is just always able to resist, it's almost entirely based on their genetics. If you want to feel superior because of something you had no control over, I guess that's your perogative.

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

I think shame is a useful human emotion. We evolved it for a reason. But we also know that it has limits and that once those are reached more shame on top, it becomes counter productive.

> 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.

No. Fat people experience plenty of shame, and for a huge amount of them, it only worsens the problem. Once you shame a person too much - once you make it about them and not about the action - they start to feel that they are unable to make a change because they have less worth than those people that can, and often end up losing even more control in their relationship with food or whatever else they are being shamed about.

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

This is not universally true - it is highly regional, though the most populated portion of Japan is definitely an area where this is largely the case. But even in areas where this is not the case, they still have significantly lower obesity rates. Osaka and Hokkaido are significantly more laid back about it than the Tokyo area, for example, but they still have relatively flat obesity rates.

Basically every fat person in the developed world receives more than the maximum effective dose of shame over their body and it hasn't made them stop being fat.

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