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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

#81

Post by storus »

rootusrootus wrote: post #76
storus wrote: 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.

Not really, Ozempic face is the same face as one gets when starved of food for a longer period of time from low caloric diet that contains carbs. Ketosis on the other hand doesn't cause this unless one has almost no fat left as it doesn't switch body to the starvation mode.

There are two modes the human body operates normally - insulin-driven, active when carbs are in the food, and ketone-driven, active when there is a lot of fat storage and no food intake, or food has no carbs. Insulin-driven operation switches to starvation when food intake has caloric deficit but still enough carbs for insulin to be triggered; ketones on the other hand lead to zero insulin activity and pure fat burning; starvation is only activated when humans reach around 4% body fat while in ketosis.

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

#82

Post by gedy »

Teknoman117 wrote: post #62
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…

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.

I highly recommend Zepbound, you might try it.

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

#83

Post by rjurney »

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…

So try Mounjaro. It works better.

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

#84

Post by [deleted] »

gedy wrote: post #78
rootusrootus wrote: post #76

Earlier quoted context omitted.

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

[deleted]

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

#85

Post by shlant »

ErroneousBosh wrote: post #16
Robotbeat wrote: post #2

Kind of makes sense that stopping taking a drug that reduces heart attack and stroke risk leads to a return to the higher risk of before.

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.

> You could also reduce heart attack and stroke risks by not eating crap and going for a walk every so often.

Oh wow it's so simple! why has nobody thought of this before??

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

#86

Post by cthalupa »

sublinear wrote: post #77
rootusrootus wrote: post #71

Earlier quoted context omitted.

> 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 situ…

> I'm saying that healthy habits are simply a matter of understanding.

Plenty of people have heard everything there is to hear on this, understand it, and still fail to implement it.

> I did not change my diet.

You plainly did. You do not lose weight without your diet changing.

> If anything I just added more variety with a specific intent and it worked.

This is changing your diet.

> Even just changing the order in which one eats things (fiber before sugary foods) can make a big difference

Changing your diet to eat more filling foods is a very frequently recommended thing, yes.

> 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.

My blood glucose has always been excellent. It did not stop me from having food noise and cravings.

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

#87

Post by sublinear »

rootusrootus wrote: post #46
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.

What is it about GLP1s that bring out the kooks who suddenly think diet and exercise are the only valid medical treatment? Is it a moral issue?

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.

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

#88

Post by cthalupa »

storus wrote: 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…

Muscle loss is determined by your protein intake, muscle stimulus, and rate of weight loss. Plenty of people start lifting for the first time (or after having stopped for extended periods of time) when going on GLP-1s and actually put on muscle mass.

It might result in more loss of buccal fat than otherwise but even that is not definitive. Activating the receptors is not the same as burning fat - there are GLP-1 receptors all over your body in all sorts of organs. If you activate them in your brain you're not burning your brain for energy.

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

#89

Post by cthalupa »

storus wrote: post #81
rootusrootus wrote: post #76

Earlier quoted context omitted.

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.

Not really, Ozempic face is the same face as one gets when starved of food for a longer period of time from low caloric diet that contains carbs. Ketosis on the other hand doesn't cause this unless one has almost no fat left as it doesn't switch body to the starvation mode. There are two modes the human body operates normally - insulin-driven, active when carbs are in the food, and ketone-driven, active when there is…

This is a bunch of pseudoscience.

"Starvation mode" as people talk about it is generally nonsense - the exceedingly low bodyfat you mention for keto is the same place you would see it in a non-keto diet when we talk about actual starvation mode and not whatever you're talking about with a non-ketogenic diet.

The only real difference when it comes to the biology here is that fat mobilization into glucose is significantly slower and less efficient, which keeps your blood sugar levels more constant, which results in fewer post-meal food cravings. Which isn't nothing, but it's not muscle sparing in and of itself.

We have plenty of studies here. Keto diets are not better for sparing lbm.

https://pubmed.ncbi.nlm.nih.gov/38934469/

In fact, if you already have significant muscle mass, it might be worse. Glycogen is hugely important when doing resistance training, and keto significantly impacts your glycogen stores. People perform worse with their resistance training on keto than regular diets.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9244428/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8469041/

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

#90

Post by cthalupa »

sublinear wrote: post #87
rootusrootus wrote: post #46

Earlier quoted context omitted.

What is it about GLP1s that bring out the kooks who suddenly think diet and exercise are the only valid medical treatment? Is it a moral issue?

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"

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