Ozempic drug supresses desire to smoke, drink and more?
theatlantic.com
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Work also seems more interesting, but my untreated ADHD seems to be getting worse.
like thats not something I’m deriding its just news to me
makes me wonder what this drug actually does, flush gut bacteria? just the right ones?
To answer your question, yeah turns out it was never about will power. Some people just had hormone drive to be healthier than others and finally we can pharmacologically start to level the field.
I’m lean but dont do that and can recognize the benefits. It would be cool if we could pharmacologically make that appealing too.
What if we could just continually swap in states.
Executive work mode, ah it feels so good to think and focus.
Empath mode, ah it feels so good to build relationships.
Brolic mode, ah it feels so good to think about working out, and actually work out!
In the meantime I would like that choice from a purely self preservation interest in being good at other bodily health and resource appropriations
Shouldn't take more than a bit of caffeine to get you moving at that point.
As to empath mode, you've just described MDMA. But it'd be nice if there were something a little less intense. That you could take weekly without frying your brain & was mild enough for family/work social situations. (And no, alcohol doesn't fit the bill).
appreciate the perspective but I want to be like the people that feel pulled to "find" it at all.
The high can be way better than you'd believe possible before you try. Or if you don't believe personal anecdote.. /something/ must be keeping all those people coming back to it at considerable expense, hassle and time.
but its pretty clear what I'm asking I don't have to keep re-explaining that, for thanks for chiming in.
- aim to either meet or exceed the previous workout, and consider that a success
- count reps so you can increase them 1 at a time until you're ready to increase weight
- for cardio, increase difficulty (incline/speed) until you're ready to increase distance
- set a longer term goal, too, like a body weight bench press or a 10 minute mile
- after doing this for a while, you might notice some differences in your appearance, which can be its own motivator
What a completely silly take away. It's like nature vs nurture it's not 100% one thing only.
As a very young child, my family was probably on the upper end of poor. "Treats" were rare and food was not anything to be wasted at all. I'm almost 50 now, and it's virtually impossible for me to throw away food. I have to have an inner monologue conversation with myself about whether I really need to finish my portion and whether it's OK to discard it. Needless to say, despite being very physically active, my weight has challenged me my entire life.
As a parent, I'm irrationally proud of my child for being able to stop eating when they're full, even if it's ice cream or a treat. That's actually helped me get over throwing food away (a little bit, at least)
- GLP-1 (semaglutide)
- optionally, that and also GIP (tirzepatide)
- optionally, both of those and also glucagon receptor (retatrutide)
But these hormones directly make you not hungry, among other things. They are probably some of the things that your gut bacteria manipulate to commandeer your behavior.
This can lead to the body to break down muscle tissue to obtain protein for energy which could lead to a loss of lean muscle mass
However, maintaining regular exercise and consuming sufficient protein can help to minimize the impact of lean muscle mass loss
The problem is apparently that studies only use change in weight instead of body composition, so doctors have to be aware of that and get the patient measured themselves to make sure they're actually getting leaner instead of losing weight but getting "more obese".
Misinformation. Many of the studies track total fat, lean body mass, visceral fat, and literally dozens of other secondary outcomes/endpoints. See an example of such results here: https://clinicaltrials.gov/ct2/show/results/NCT03548935
This has already been covered yesterday in sibling comments about the NCT03548935 study and Peter Attia being in general a source of misinformation.
Here are some other semaglutide studies which track lean body mass specifically: https://clinicaltrials.gov/ct2/results?cond=Semaglutide&term...
Semaglutide users lost 16% bodyweight overall but only 3.4% of their lean mass.
This is study NCT03548935 if you’d like to look it up, there are other statistics of interest in it as well.
I used to lift and be real fit till about 40. Like bulky-lean looking, bench 400 10x with a 6pack. Had a lot to do with being on the road for work all over the world, and you sit at the gym at the hotel for an hour every night because of nothing else to do, and there are girls there also on business who you'll never see again. I drank A Lot, ate anything I wanted, and did lots of blo on weekends.
It was getting out of control, so I did months of google-foo, went to a pharmacy in eastern europe, got like a thousand 150mg disulfiram pills under the counter for fifty bucks, and took one pill every morning for 2 years. You don't drink, you can't drink or you die, you forget drinking exists and after a couple of months don't even think about it, yet still do all the same stuff you used to - like dancing and clubs if that's your thing. And it's even more fun. There were no side effects.
Then things changed with age, testosterone went to crap, joints hurt. I got married and settled down. Can't work out too much now - just a couple of hours per week, and no heavy weights. Within 2 years I couldn't fit into my clothes and had high blood pressure and high cholesterol.
I realized I don't eat because I'm hungry, but because it keeps away sadness. So I changed my diet so I could eat however much I want. I now have a 4-pack instead of 6, fit into my pants, and eat however much I want.
I cut out fat completely. No oil when I cook besides a light spray on the frying pan. No nuts. Tuna - not salmon. Real expensive lean filet if I want cow in my mouth. Only white meat from birds. All the pasta, rice, and potatoes I want, but zero sugar added to anything. Lots of splenda and sweet n low. Fat free fairlife milk (lactose filtered out = less sugar calories). I eat normal sized meals.
Then, I have fruit and berries, and I eat as much of that as I want. I'm stuffing my face the whole day. Today, I had a pint of blueberries, 5 medium apples, 2 mangoes, and a pound of grapes.
Speaking of gastrointestinal issues, my poo is now soft and gentle, and smells delicious.
With regards to cutting out fat, if you are advocating for a weight management plan for the general person, it is really too prescriptive and doesn't take into account that someone following your diet should not be accidentally increasing your carbohydrate intake (fruit sugars are still sugars!), resulting in the diet being a total wash. The gold standard for diet-based weight management is food journaling, and not cutting out an entire group of macronutrients without holistic consideration of your diet.
people who have to take last-measure medication usually don't stop eating when they are full. i know, it's weird to tell someone who doesn't stop eating when they're full, how to still maintain weight if they... don't stop eating when they're full. i'm a weird guy with ADD and get side-tracked easily. I got an appointment with the florist about that next week, hopefully he can recommend a medication.
yes, a doctor will not tell you diet tricks. if you are asking your doctor for diet tricks, we need to step back a minute. when you're done grocery shopping at jiffy lube, drive home, sit down, and carefully read this link.
this is what a doctor is. a doctor will give you general health guidelines, but knows very little about diets. https://en.wikipedia.org/wiki/Physician
And again, you are being far too presumptuous about OP’s interventions. And I certainly don’t know what this business about ADD appointments at the florist or grocery shopping at Jiffy Lube you’re talking about is.
but before one would do that, which may be an insurmountable long-term goal, someone should compare going to a florist for pills, to going to a doctor for making up diets.
so, would you say a solution to the problem that lets you eat as much as you want, so you don't have to use your willpower, be an appropriate solution to suggest? There is a difference between taking last-resort medication for the rest of your life, and eating apples.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ (2019)
Substantial weight loss is possible across a range of treatment modalities, but long-term sustenance of lost weight is much more challenging, and weight regain is typical1–3. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained (Figure 1)4. Indeed, previous failed attempts at achieving durable weight loss may have contributed to the recent decrease in the percentage of people with obesity who are trying to lose weight5 and many now believe that weight loss is a futile endeavor6.
I had to reconfigure my entire life around it. I kept barely enough food in the house to meet my calorie target for the week. I once fell asleep while driving home from work and ran off the road because my blood sugar was so low. I spent 9 hours a week doing intense exercise and pretty much any time I wasn't doing that or working I was just sleeping. I basically had to have no social life, because socialization around here pretty much mandates large quantities of food.
Is something physically wrong with me? Probably, but good luck getting an American doctor to give a flying fuck. My thyroid stopped working when I was a child and it went undiagnosed for two years because doctors just keep telling my mother I was lazy. Ultimately a toll booth attendant diagnosed it because her dog had similar symptoms and my mother had to go full Karen to get the simple blood test to happen. American physicians are fucking useless.
Even treated, to this day I have to eat well under the caloric requirement that I "should" be eating and constantly feel like shit in order to lose weight, which makes me perform worse at work and apparently require 3-4 hours extra sleep every day.
I can guarantee you "willpower" people aren't doing that. Your body isn't fucked up and constantly demanding more calories than you need, so it comes easy to you and you probably just take any excuse to feel like you are better than other people.
It is people like you who are the absolute worst to deal with. You take a specific example which probably does not not apply to your body, completely and completely twisted what was said so you can both be a victim and feel superior.
I specifically stated a diet that for a person who is working out a couple of hours per week, there is a way to constantly eat and minimize the caloric intake despite large amounts of food. I did not remotely suggest stuffing your face all day is a willpower-based solution to a thyroid problem.
I'm 5'11. In my early 30s, I was a 31 waist, 170lb, benched a full set of 400lb, ran cross country, and had 6% body fat. In my late 30s, I was a 34 waist with high blood pressure. I made the change in my diet, and a few years later, I'm a 31 waist, 170lb, normal blood pressure, and 10% bodyfat, and I eat as much as I feel like, just not whatever I feel like.
This is a solution for maintaining a healthy weight in an active lifestyle, that uses zero willpower, because my willpower is bad. This is not a solution for someone with a thyroid problem who needs to lose almost the weight of my whole body.
I don't know what it is with you and this other guy. You read very simple basic text, and you reply to something you've completely made up. It's like your brain paints a virtual world for yourself where you can feel constantly offended. No one's out to get you. No one's making fun of you. People are talking about something that clearly wasn't for you, so you inject yourself into the conversation so you can feel attacked. Stop that.
> In my early 30s, I was a 31 waist, 170lb, benched a full set of 400lb, ran cross country, and had 6% body fat.
> In my late 30s, I was a 34 waist with high blood pressure.
> I made the change in my diet, and a few years later, I'm a 31 waist, 170lb, normal blood pressure, and 10% bodyfat.
Your enormous transformation was gaining and losing 3 inches on your waist over the course of a decade or so? WOW! Thank you so much for taking the time to share your perspective. That's incredible. Honestly it's amazing to be inspired by someone like you who has been able to manifest such a huge change from exertion of willpower alone. Reminds me of this video: https://www.youtube.com/watch?v=lsSC2vx7zFQ Let me know what you think about it!
They talk about how if you want success, you need to treat it like the air you breathe, that once you want something as bad as you want to breathe, then you'll finally get there.
Huge respect for your personal transformation, and the insane willpower you channeled to lose 3 inches of your waistline over the course of a few years. Being able to drop one whole pant size is simply incredible.
I tried this a few years before going with my "apple diet." It works, but my bloodwork after a few years said I need to stop. There is a catch. The first year, you Cannot pass gas. That clumped oil that comes out, comes out very easily, and unfortunately Alli makes you gassy too. This side-effect goes away in about a year if you power through it.
Not a dietician or a doctor, but perhaps your mounjaro treatment can be cycled with Alli (cheap, OTC) every few years to save some cash. Invest in a large bottle of Dawn dishsoap. Put it in a spray bottle and spray the bowl after you do your stuff. You'll have to, just trust me.
Elsewhere in this thread it was stated that food journaling was the gold standard in weight loss, which also I’d expect to increase mindfulness around eating.
And then when you go off the diet (either intentionally, or more likely, by just slowly drifting back to the norm), you'll return to eating what you were before, and will return to your original weight. Which is why the only diet that works is one you can stick to indefinitely. So, if the parent can stick to a no fat, high complex carbs diet for life, it will probably work for them.
I don't do high carbs - fruit are not high in carbs you actually process. I eat normal portions of complex carbs like bread and pasta, normal sized meals. I eat a ridiculous amount of fruit, and that has some sugar in it, but it's actually not that much. What that does is increase my fiber intake to ridiculous levels - and that has many benefits.
My issue was that I use food as an anti-depressant, and to deal with stress. The solution had to involve eating a lot, but minimizing calories. That's why the fat had to go - I can eat twice as many carbs as fat for the same weight. When you look at things like fruit - a lot of those "carb" calories you don't even metabolize since it's fiber.
I don't think I have discovered some magical solution, but it works for people like myself, who have what I consider a minor mental illness called 'self-medication with food.' Mental problems are a lot harder to fix than just not using oil and replacing nuts and chips with fruit. My solution to win the war was not to fight it and learn to live w/ the fact that I'm not perfect, and adjust the lifestyle to that.
High carb diets are a bad idea. I eat normal balanced meals, just with no fat. Long-term high fat diets are for people who want liver damage, and stop eating when they're full. A little bit of fat makes you full, unlike carbs. But keto is terrible for your health if you do it for decades.
The tiny amount of fat I do get, is from things like red tuna and other low-fat fish. It's amazing how little good fat you actually need in your diet, if you look that up. Literally one can of chunk light canned tuna is all you need for the day.
Now here's something groundbreaking that's pretty good - thin and wide no sugar no fat pancakes: 1 cup flour, 3/4 cup fat free fairlife milk, 2 packets splenda, 1/2 cup Egg Beaters. mix real well so it's runny with no flour chunks. no need for baking powder. real short spray of oil to just get some drops on a teflon pan. no need to spray when you flip.
Now my diet is not high carbs, but let's address the "no fat+high carbs = bad." the reason that's everything you've read in the last 20 years, is because that's what you chose to read. there are different diets for different causes of fatness in people.
fat makes you full faster so helps you eat less calories. carbs make you work out harder, so you burn more calories. if you have an active lifestyle - carbs and no fat. if you sit on the couch after sitting at the office, you want fat and no carbs. dietary fiber isn't something you should count as carbs.
if the reason you're overweight is because you like to constantly eat, and it has zero to do with hunger - you don't want any fat. you want the most amount of food for the least calories, and fat is double of carbs per gram. you want lots of indigestible fiber a normal amount of carbs, and eating the potatoes with that thick rough skin, with the skin.
It's really strange how you and a few other people just keep making up weird scenarios, then attacking those to make yourself feel superior. I don't get it. It was 1/4 book page of simple text. How is it possible to read something that simple, that short, and then make up something completely different in your head. This explains a lot of politics, but I don't get what people with that mental illness are on HN. Please stop. You are not superior - you have reading comprehension problems.
Do you find other pleasures (non food and drink) as enjoyable? Interesting to hear if it’s selective or dampens everything.
I'd say that's a pretty huge deal. Did you report that?
> In a 2-year trial among patients with type 2 diabetes and high cardiovascular risk, patients treated with this drug experienced a great incidence of diabetic retinopathy complications (3% vs 1.8%). The absolute risk was greater in patients with a history of diabetic retinopathy at baseline (8.2%[drug] vs 5.2%[placebo]) than those without (0.7%[drug] vs 0.4%[placebo]).
https://www.drugs.com/sfx/semaglutide-side-effects.html
Would be very interested in knowing the commenter’s diabetes status.
The no apparent reason was a bit of hyperbole, since my vitreous was pulling away from the retina and brought some pieces with it during the process. But as to why that was happening at my current age is unknown. Second was likely related to stress in the eye from healing from the first surgery. But the point was I didn’t take any blows to the head or eye, or any other common cause of retinal detachments.
>but my untreated ADHD seems to be getting worse.
I had very similar results after taking ketamine for treatment-resistant depression. It eliminated all my compulsive tendencies for getting cheap dopamine hits (food, doomscrolling, etc), reset my tolerance to everything (caffeine, ADHD meds, alcohol), and made my ADHD worse while improving throughput and ability to Get Shit Done.
I wonder if they affect the same parts of the brain in a roundabout way? Ketamine is also used to treat addiction (opioids, primarily).
Do you experience any anhedonia while using Mounjaro? Did your overall pleasure response get blunted?
don't make unsubstantiated leaps :-)
I’m not making unsubstantiated claims. Don’t accuse me of that, because you don’t like my answer.
So what? Ketamine is a treatment, not a cure.
Would you apply the same logic to insulin for T1 diabetes?
We don't know of any cure for depression, but with ketamine we have an effective rapid treatment.
Ketamine has a great therapeutic range, a well-understood side effect profile, and can bring a patient back from the brink of suicide in a matter of hours. It's also incredibly inexpensive to produce, on par with aspirin. Why shouldn't we use it?
Ketamine or suffering & death? Ketamine no question. I agree, but it’s not so black and white how you may perceive it. It might be ketamine or death for you, I don’t know. For me it was certainly. So sorry, if it is for you now. I’m not telling you it’s bad or that you shouldn’t do it. Do whatever you think is the best for you. I went through all of that and found other methods of treatment actually effective of solving the root causes of my suffering and not just the symptoms. Meditation, somatic experiencing and mdma therapy[1] are the main methods I found the most effective, in no particular order.
I’m not looking to argue about your choice of treatment. If you want to share your experience or hear mine, give me a way to contact you. Have a good night/day. [1]https://www.nature.com/articles/s41591-021-01336-3
In my case, MDMA would not have been the appropriate treatment.
All of the things we are discussing have value and a role in mental health care. It doesn't have to be a contest.
>Neurotoxicity
unclear. on the onehand, unpublished studies in gorillas show no lesions. on the other, retroactive studies of heavy polydrug abusers show lesions. not super high-quality evidence either way. there's also rat studies showing lesions, but rats are unusually sensitive to neurotoxicity from dissociatives. they get similar lesions from nitrous oxide while humans get no such thing. honestly the potential bladder toxicity is more concerning imo.
>relapse rate
still much better success rates than SSRIs.
not saying ketamine is perfect --- would be better to have a purpose-built drug, and a lot of the clinics are kind of scummy and charge exorbitant prices. but this + non-psychedelic 5ht2a plastinogens are the most promising things to come out of depression research in the past 45 years.
If anything, the after-effects of ketamine treatment alleviate my lifelong dissociation and other symptoms depression and PTSD. Something about the induced dissociation "wraps around" and snaps people back into fully being present.
Have you ever had ketamine treatment? Where are you getting these conclusions?
Ketamine didn’t heal me, my perspective just changed, which can be valuable though.
I thought that was the entire point of the treatment. Is that not the case?
> Weeks after the second treatment ... I stopped getting treatments
This sounds like an unusual, very sparse schedule. Most ketamine treatment routines have many more than two doses, and nothing resembling multi-week intervals between doses at the start.
My wife has undergone ketamine treatment, and as part of it, I read up on the literature. Typical ramp-up schedules (like hers was) would be one or twice per week for one or two months, and then less frequently until you stop or go into "as-needed" maintenance dosing.
I'm glad you found other things that worked for you, but what you describe doesn't sound like a normal course of ketamine treatment.
Possibly slightly, but not life impacting.
The person I know taking Ozempic has only lost weight (35 lbs) due to the fact that eating now makes her sick. She has been sapped of all energy and has developed issues with her bladder, circulatory system, joints, thyroid, and digestive system since starting Ozempic. I’m not saying it’s due to Ozempic, but I am saying all these issues have cropped up in the few months since she started taking it, and she never had any chronic health issues prior. At least she lost some weight, I guess.
Ended up getting acute cholecystitis and a dead gallbladder plus sepsis after. Not too pleasant of an experience.
I still have pretty big appetite suppression, and only minimal nausea sometimes if I eat too much, but what it's done to my blood glucose is AMAZING. And I lost some weight when I started which was a great bonus. It can be hard to start but it's truly worth it, just adjust the dose. I take 0.5mg as I can't handle the larger 1.0mg dose.
In a fair world that would be considered severe malpractice :-( It's nearly common knowledge. A huge number of people are suffering under these medications because of starting at a dose to high or raising doses too quickly / too much at a time.
LY3437943 looks even more promising, with fewer side effects. Semaglutide will probably have the most side effects because it only has one action (GLP-1 agonist). Tirzepatide has slightly lower side effects because it adds a dual action (GLP-1 agonist + GIP analogue) so it can act at a lower magnitude on the GLP-1 receptors to avoid strong side effects, while still having higher efficacy due to its additional, separate, GIP action.
LY3437943 retains both the actions of Tirzepatide but adds a third action, glucagon receptor agonist. So it should be able to have higher efficacy at a lower equivalent dose than the other two (less action on GLP-1 and GIP mechanisms, fewer side effects).
For those people who tolerate the drug well, it can be revolutionary in their lives, but it's unfortunately not a good fit for everyone.
I hope your family member gets better soon.
Reminds me of the first FDA approved weight loss drug, Alli, that basically just gastrointestinally punishes you if you eat more than a few grams of fat.
Christ. This is like Crohn's disease in pill form. One too many teaspoons of olive oil and you're in for an unpleasant evening...
Does the fda allow that?
In many cases the hell that is chemo is considered acceptable for even moderate increases in expected lifespan. That’s why people started talking healthy life expectancy vs just life expectancy.
I still can't eat too much salmon in one sitting though :-( I don't get diarrhea but I do get stuck on the toilet for ages after.
Better not tell that to all the cardiac patients on nitroglycerin.
Because it’s so wonderfully effective for the majority, there ends up being a ton of social and economic pressure for anyone even slightly overweight to take it, despite said 10% risk of death.
(Edited to add):
“The Pill,” by Meg Elison
https://escapepod.org/2022/11/03/escape-pod-861-the-pill-par...
https://escapepod.org/2022/11/10/escape-pod-862-the-pill-par...
10 years ago, I was reading about nootropics and ran across an interesting piece on the ethics of drugs (that has probably been lost to time). The question it was asking was "why can we take drugs to bring us to normal, but we can't take drugs that make us better than normal?"
The interesting consequence is that it de facto forces people who don't need drugs to take them or be at a disadvantage. (think adderall at a competitive college or testosterone for lifting).
Because ultimately drugs make you pay one way or another, eg dependency, liver toxicity, numbness of some other facet and so on. When none of those will be true it’s the day they become the new norm
Some drugs are a bargain. Caffeine. E-nicotine. Some are hellishly expensive. Solvents will destroy your health without even giving much in the way of a high.
Consider caffeine, which is probably entirely responsible by itself for a significant sliver of the world's total GDP.
We just don't have a lot of drugs like that because it's hard to find stuff that's performance-enhancing without serious side effects.
[0] https://www.hopkinsmedicine.org/news/media/releases/johns_ho...
[1] https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294388/
out of an n of >3000 patients getting medication, 34 ended up having some form of pancreatitis. At least 12 people on placebo got pancreatitis. That's a much higher rate, but the odds are still pretty low.
I'm sure I'd easily lose weight with Ozempic but I'd still be suffering health issues. Not because of Ozempic itself but just because I wouldn't be getting enough calories, despite still being above a healthy weight.
Does the same thing happen if you slowly wean yourself down? Are you cutting out essential nutrients that your body needs to function properly rather than the unnecessary carbs/junk? The reason I'm asking these things is that people I know who have reduced their caloric intake usually report feeling better, not worse.
Also, as a sibling comment alluded to, when you have fewer calories to eat, the micronutrients in the few foods you do eat matter that much more. The nutritional quality of food you need to stay healthy increases greatly when in a caloric deficit. Fruits and veggies are great for helping that, and multivitamins are cheap insurance policies to make sure you aren’t deficient in anything important, IMO. YMMV. Best of luck with your goals!
If anything, my energy levels actually went up immediately after starting it. Normally I was pretty sluggish but it felt like some extra firepower was unlocked.
Everything has risks and benefits, and might harm some people. I hope your family member gets better soon.
But, also doing CrossFit 3D/wk. and now have a CGM so I can easily track blood glucose.
- blood pressure
- lipids (HDL, LDL)
- insulin sensitivity
- blood glucose
- strokes
- cardiovascular events + deaths
- myocardial infarctions
- hemoglobin A1C,
- revascularization,
- etc, etc, etc
are literally all affected positively (to the benefit of the imaginary "mean" patient) in bulk.
Note though, that doesn't mean 100% of patients are have positive results, just that each of these are, in bulk, positive across the tested subjects when averaged together. There's little in the data to suggest that cases like your family member aren't happening or couldn't happen.
There's also evidence that GLP-1 agonists increase the rate of glucose use in the brain, accelerating learning rates. (The brain accounts for 2% of body weight but up to 25% of glucose consumption, it really is fueled by glucose)
https://clinicaltrials.gov/ct2/show/NCT00256256?term=stroke&...
About 6 months ago there was a posting about Ozempic and I had said something to the effect that it wasn't worth it watching some of the side effects my wife had from it. And then I went to the doctor for a check-up and lo and behold I had diabetes. Asymptomatic, but an A1C of 11. My doctor re-ran the test because he didn't believe it and it doesn't run in my family. My cholesterol had also jumped and he said he was going to put me on a statin after the initial 3 months of adjusting to the diabetes medication.
My Dr. puts me on Ozempic and I grumble about it but with that test results I had, I knew I had to do something. Fast forward 3 months, I dropped 20 pounds, and every other measurement is back in the green, including my A1C. Now, I made some serious lifestyle changes and ate a diabetic diet (limiting carbs, the types of carbs, etc), and have been keeping up with being more active but my entire relationship with food has changed because of Ozempic. Before I had a near compulsion to eat more than I should. Now, I don't because one, I feel fuller quicker and two, I know I'll feel horrible for hours if I over-eat. It only took one of those events to never want to do that again. I can't really explain why but I also don't have as strong of a desire to eat foods that are bad for me. I really thought I'd battle the cravings more after going cold turkey from "bad" foods. I can't say why it is but it's true. Side note, going to the grocery story was really difficult at first....there is so much sugar in the American food supply.
Energy wise I will say that I did struggle with low energy initially as my body adapted to lower calorie intake but I also learned that when I found the right balance of protein/complex carbs for me that my energy levels came back up and I now feel better than ever.
My doctor was shocked. I've never seen him that animated when I came back in for the 3 month follow-up. I didn't need to add any additional medications and they're slowly adjusting me back towards a single medication.
I'm kind of wondering if the people having a bad result don't drink enough water each day to clear out their systems? Yeah, that's a simplistic take... but still, curiosity. :)
Dehydration is not a confounder for an A1c test since the percentage is relative to the hemoglobin present. The primary confounder to A1c are blood disorders such as hemolytic anemias that lower the normal lifetime of RBCs or proportion of HbA. And this tends to falsely lower the A1c.
A person with an 11% A1c is also likely drinking quite a bit (whether they notice it or not) because at that point the chronically elevated glucose is elevating serum osmolality to increase urination.
I think the “fit” of the world get inherently uncomfortable that our relative social currency is being “devalued” if everyone can be like us with an “unearned” pill. And it comes out as hostility and skepticism.
I admit haven’t done much research on this particular topic. History should caution us that serious medication like this often has serious side effects which are not apparent early on. I get that. But unlike many others I don’t “hope” that happens like some kind of moral balancing. I get that reaction. In my gut I have that “I did it with willpower and lifestyle and sweat and these people shouldn’t just get it at CVS.” But that’s just the primate status brain talking.
Not that it impacts the outcome but I sincerely hope these drugs can improve people’s lives without significant negative problems. I can find my relative status elsewhere or better yet try to grow up past such impulses.
It's also downright laughable how the media/Youtube influencers/etc. treat everyone like idiots. Men's Health will run an article on Mr. Moviestar who was 5'11' and 150 pounds before his role as Superhero Character got to 200 pounds and veiny biceps in 6 months by eating eggs, oatmeal, and chicken breast and doing some situps.
*criminal
Not literally, but it's really, really awful for society to have no idea what physiques/transformations required AAS and which didn't. That type of misinformation should not be allowed, and it would be amazing if there were a reasonable way to ban mass media lying / misrepresentation. Unfortunately, any law like that would instantly get weaponized to obliterate any remaining first amendment protections.
It's crazy how many athletes I tried to keep up with at D2/D3 schools which I now realize were on heavy steroid cycles but at the time I just thought I wasn't eating enough / had bad genetics / whatever.
It's also interesting how the negative effects of light/moderate steroid use are really blown out of proportion, and how many men on "TRT" are getting their testosterone to twice the highest "normal" levels (e.g. reaching testosterone levels of 1500-2000) under a doctor's recommendation.
And men just blame themselves their whole life for simply not trying hard enough.
When I finally started TRT at the relatively very low dose of 120mg/week I laughed/cried for months at how insanely easy it was to build real muscle for the first time in my life. Training at 15-25% of the intensity that I used to over the past 20 years yielded 400% better results.
The drug probably helped.
Context: work at a big tech co.
From what I have heard, all of these issues come back as soon as someone comes off the drug. So either a person is committing to a lifetime of being dependent on this drug, or a person is committing to some period of time of ideal living, followed by a possible time of depression after reverting to the status quo.
Everyone's on something and/or coping in unhealthy ways.
I've been trying to understand what changed to create the obesity epidemic. Many things contribute, but it's hard to identify the smoking gun. My understanding is that one major lever seems to be the advent of snacks, refrigeration, and microwaves. Drastically reduced food prep overhead has radically alerted eating patterns.
Sure, people may go to the gym more... But they also take the lift or the escalator in stead of the stairs much more, and the car in stead of a bicycle or walking. Any source for your claim?
I am concerned that maybe there isn't a dose where you can stop taking more and keep the results. I am worried that everybody will need to keep taking more as they build up more tolerance to it. The study that showed how effective the drug is was 60 weeks long.
That is a long time, but it doesn't show what happens if somebody plans on staying on the drug for years.
Same as with drugs for hypertension, depression, hyperglycemia and many, many others. Not every drug is supposed to somehow permanently cure you.
"But you have to do it forever" shouldn't be a convincing dismissal after 10 seconds of thought.
If I stop going to the gym for a couple of months, I'm probably not going to gain any weight because I still eat healthy and stay active.
And for some people they will have to take this for life, which isn't so different from many other medications.
Similarly, if a person loses 30 pounds on this drug, then stops using the drug and reverts to normal habits, it will take a while to regain those 30 pounds. And the long term shift of maintaining the new body weight doesn't require any radical changes (unlike losing 30 pounds, which does require sustained radical changes).
My hypothesis is that it supressed my body's natural production of whatever chemical in my brain helps me not go overboard with food. With that supressed by the drug I had an uncontrollable desire for food and currently I am fatter than I was before taking the drug in the first place.
You also said it stopped working while you were taking it in another post; are you just talking about satiety or one of the other effects like insulin production or glucagon release? Are you diabetic or just overweight?
I'm taking Rybelsus (pill form of semaglutide) and there are 3, 7 and 14 mg versions. My plan is to take 14 mg for a couple more months, then switch to 7 mg for 1-2 months and then 3 mg for a month before stopping taking it completely.
This is consistent with hungry brain hypothesis. Your hypothalamus detects that you have less body fat than amount set on "lipostat" and it tries to get fat content back to this set amount.
I love(d) nicotine and it was the only substance that I ever was addicted to. I tried dozens of times to quit and the only thing that helped was getting treatment for my ADHD. Quitting nicotine was easy for me on methylphenidate. I only tried combining them and nearly went to the ER, so I quickly learnt that I can't take them both. But when I'm on methylphenidate I just don't crave nicotine that much. It took 2-3 years to completely not get any nicotine cravings at all.
Could you elaborate on that? I'm currently still a smoker (working on it...) and on Concerta. Your note alarms me :)
Ten years later I went through the exercise again, but sadly it didn't work nearly as well as it had the first time around.
I describe my adhd as being addicted to nicotine and stopping cold turkey. Except you're not addicted to nicotine, what you're addicted to is a stimulus that is inconsistent and changes constantly. Your cigarette is a constantly changing thing.
Methylphenidate really messed me up, I found Lisdexamfetamine much much more effective.
I still use nicotine, though in vape form these days.
It worked so well I didn't want to move up so for month 2 I stuck with 1/10th the amount. During that month the effects wore off so I had to take more to get the same impact. I chose to just quit.
2 months after quiting I am 7 pounds fatter than I was when I started with the drug. I suspect that most people will need to keep taking more and more of it to get the same benefits they got from the recommended dose. I am really concerned this is going to lead to a bigger health crises than the one it purported to solve.
A lot of diabetics taking it to regulate blood sugar (particular the feedback loop with insulin and hunger) have said it's changed their life... but for people who are merely overweight I think the benefits may not always be worth the side effects. IMO the correlation between weight and health is not as strong as people often assume.
Anecdotal, but if you looked at me and my partner, you'd probably assume I was the "healthier" one based on our respective body types. But they're strong, fit, and rarely get sick (knock on wood); meanwhile I'm a lifelong wimp with a host of autoimmune issues. I outsource all of the heavy lifting to them, literally—if the trash is too heavy for me to take to the dumpster, they get to do it instead :P
So to your point about health crises, yeah. It seems foolish to put my partner on a weight loss drug just so they could "look" healthier while nursing a bunch of unpleasant side effects that would make them far sicker than they were before.
Having been recently diagnosed with Crohn's I 100% agree. Getting skinnier during a bad flare makes people think I'm in better health, because I look a certain way that aligns with their expectations, but it really just means my gut isn't absorbing any nutrients. Turns out being at my lowest weight in years was a Very Bad Thing and not a sign I was doing anything right.
Which, again, is an interesting juxtaposition with my partner who weighs more than me but whose body functions correctly and whose biomarkers come back normal, unlike mine.
All of these diseases have significant input from bad diet and metabolic disorder. Alzheimer's is considered a variation of t2d in some circles.
EDIT: Also, to my previous anecdote, despite being the skinny one compared to my partner, I actually do have several heart problems! (Thank you inflammatory diseases.) But you wouldn't guess that by looking at me, because weight is not a 1:1 indicator of health.
What other desires does it lessen? Does it suppress every hedonistic impulse? What does it do to creativity? Impulsivity? Does it make you more susceptible to or resistant to persuasion? Feels like reporting ‘oh it has these other unintended psychological/behavioral responses. Neat!’ is ignoring a whole can of worms that that opens.
It does sound too good to be true. However, it's possible that the drug is working on all of these through the same mechanism: by altering the brain's reward system.
If that's true, the drug doesn't make you not want to eat, it makes you not want stuff, in general. That could potentially suppress a wide array of addictive behaviors. I also wonder if that suppression might look a lot like clinical depression, though.
No one's been reporting depression that I've seen. And these groups ('fitness enthusiasts') experiment with enough other things that do cause depression that they're quite sensitive to changes in "well-being", "outlook on life", "mood", and "energy levels". It would be more widely reported in these circles if it did resemble depression.
Tylenol might get rid of your headache, but that headache can come back tomorrow. Stop taking birth control and you might get pregnant. Stop taking Claritin and your allergies return. Stop taking insulin, and, as with these new peptides, you lose control over your blood sugar. Stop taking Adderall, and not only will your ADHD symptoms come back, you'll also experience withdrawal.
Almost no medications are "one and done", and I'm not sure why Ozempic or Mounjaro are being held to needing to be a cure when it's clear that they're effective, repeatable treatments for blood sugar control and (likely related) weight gain.
Also, yes, you can absolutely advocate for a low-carb/low-sugar diet for those with poor blood sugar control. The issue there is that virtually every medical professional has advocated for similar diets for diabetics or those with blood sugar control issues for centuries, or even millennia - there is evidence of recommended diets for those with diabetes since BCE. This does not mean that those diets are easy or pleasant to follow, whereas all evidence indicates that common issues with appetite and energy on a limited calorie or low-carb diet are less prevalent with these new peptides than those trying to go it alone.
So I guess if it takes me 10 more years to gain it back I can look into taking it again.
I went off for three months and kept losing weight throughout.
And the data from these drugs shows they gain it back at regular rate at most.
Then, earlier this spring, that prescription ran out. Being in the middle of changing my primary healthcare provider I couldn't immediately get it renewed. And to be honest I wasn't at first all that bothered; I thought now that I've lost so much weight, and kept it off for so long with the help of these drugs, maybe I've got into the habit of eating less, so I can stay constant without them? Nope – in just a few weeks, ballooned back up some 8-10 kg. Had to scramble a bit to get the pill prescription renewed, been on it again for a couple weeks, but still some 6-7 kg above where I was before they ran out. Sure hope I'll get back down the rest of the way.
TLDR: Anecdata (n=1) says yes, going off the drugs even for a rather short while puts the weight back on quite quickly.
Check this 24-month clinical trial with >3000 participants[0]. It showed improvements in rates of:
- Cardiovascular death
- Non-fatal Myocardial Infarction
- Non-fatal Stroke
- Revascularisation
- HbA1c
- Fasting Plasma Glucose
- Body Weight
- Lipid Profile ( total cholesterol, LDL cholesterol and triglycerides)
- Urinary Albumin to Creatinine Ratio
- Systolic blood pressure (mmHg)
- "overall health related quality of life namely bodily pain, general health, mental component summary, mental health, physical component summary, physical functioning, role-emotional, role-physical, social functioning and vitality." (each of these categories were "quantitatively" measured using a calibrated questionnaire - - and they all showed a dose-response relationship -- 1.0mg semaglutide made a bigger improvement than 0.5 mg, vs. two different placebos)
0: https://clinicaltrials.gov/ct2/show/results/NCT01720446?term...
It sounds like you're realizing what it's like to really depend on a medication.
The anxieties and risks you're describing are what people with diabetes, cancer, HIV, bipolar disorder, schizophrenia, depression, ADHD, etc. deal with on a daily basis for their entire life.
Yeah, it is frightening! Sometimes a guy like this[0] comes along and makes your life even worse!
So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic...
Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...
This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies.
There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US).
A quick Google search turned up a report[2] that suggests that
> This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population.
So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper).
Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings.
[1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m....
[2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...
American healthcare system has perverse incentivizes. Most unhealthy groups are generally least likely to be privately insured, so insurers are incentivized to prioritize health issues affecting working-age adults, while neglecting those which will be someone's else concern in future.
One month supply us about £135 which is about $170 at todays rate.
There is anecdotal evidence that eating less is, in itself, so much more healthy that it doesn't really matter what you eat. Nutrition professor Mark Haub ate nothing but "convenience store food" for 10 weeks at a caloric deficit and all of his health metrics improved while he lost 27lbs.
http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/...
What’s the cost/benefit of weight loss and diabetes control vs $12k/year? I would expect people with high obesity are very expensive to insure and insurance can’t drop people any more. It may be cheaper to pay for ozempic (especially at whatever negotiated rate insurance pays) than to pay for the alternative negative health outcomes.
That and ozempic goes generic in 2031 and mounjaro in 2027 so soon this won’t be a question of $1000/month but maybe $1000/year at which point insurers will probably force customers to take it or pay higher rates.
$12k is going to be less than the typical admission to a hospital (for injury, illness, heart disease, diabetes related incident.)
Medicine tried this. It's extremely hard to actually to do it in practice. Obviously, it's better solution, but we are living in real world, where we have to choose "good enough" solutions over those deemed "better, but infeasible for 90% of patients".
These drugs would have to be pretty bad to counteract the massive health benefits from losing weight (even if they don't have diabetes). I've heard a few eye-openers in the comments, but unless they're more prevalent than I've read, or there's some ticking time bomb, the drugs are probably still a net health benefit.
This is true of every weight loss intervention: Weight Watchers, low-carb, keto, Whole 30, etc. Once people stop complying with them, they gain the weight back.
Most people don't realize how dismal the stats on long-term weight loss are. Almost no one maintains a substantial amount of weight loss for many years by following "just eat healthy and exercise" advice. The only intervention that does reliably work is bariatric surgery. The jury is still out on the new GLP drugs.
My understanding is surgery only works reliably because failure to comply with life style changes post-op is easily fatal and ethical doctors only perform the operation after patients have demonstrated that ability. In all but the most extreme patients, about a fifth to a third of the target weight loss has to happen pre-op for doctors to even consider the procedure. The surgery is essentially a sword of Damocles hanging over patients, reminding them that they'll die much faster than normal if they over eat.
My understanding is naive but I always thought it was no longer possible to fail to comply after this intervention?
[1] https://www.researchgate.net/publication/332884264_Gambling_...
In the addiction literature, the development of gambling dependence after bariatric surgery is limited. Mitchel et al. reported that 2 cases presented with post-operative gambling addiction in their 3-year screening study in 201 post-op case (5). In our case, the presence of genetic background may be a risk factor for the develop-ment of gambling
2 out of 200 cases is not that common and close to baseline level
Bariatric surgery usually works for 3 reasons. First and most obvious is that it reduces your stomach size so you simply can't eat as much. Second, in most cases, reducing the surface area of the stomach reduces the amount of hunger hormones that get released thus making you less hungry all the time. And the third is malabsorption. Meaning that of the food you do eat, you absorb less of the calories than you did before. So if it were possible, you could potentially eat the same amount as before but still lose weight.
I consider myself a much wiser and stronger person in recovery than I was before addiction. Who would I be if I took a magic pill and was still the person that sought oblivion? What will humanity be if it doesn't need such self-knowledge and resilience? What impact will that make in say, our future politics?
The fear is that by removing symptoms, we no longer find it important to address the root cause. The symptoms should be treated as a warning signal. It sounds dystopian to make poor psychology and poor life-fulfilment a consequence free norm.
Next day after hitting your goal, the starvation is still there. The desire to eat is still there. Hating working out is still there. But now you have to do this herculean effort every day not to get better. Not to lose weight. Just to maintain. Your brain wants you to gain 80 lbs and will never stop nagging you. Not on a good day. Not on a bad day.
Then something really shitty happens in your life. Like it does for everyone. You slip. Eventually you start to gain back the weight. You just want to die. You feel like a failure. You hate yourself.
That's the trick. Hitting goal weight the first time or two is relatively "easy". But you've achieved nothing if you aren't able to maintain weight loss. That's the failure of all approaches prior to these GLP1 and similar drugs.
Having set the scene, now compare it to semaglutide. You have a drug that regulates your brain. Gets rid of the constant nagging to eat. You get normal brain. You lose weight.
Now you have to pick, take a once a week drug for life to maintain, or do a herculean effort to fight the brain urges and work out to maintain.
Which do you think will be more successful?
This is...mostly wrong. Like both normal wrong, and "x-y problem" wrong. There is definitely some truth in there, but the full explanation would require an actual lawyer, because there's a LOT of layers of complication.
Just so people don't have to simply take my word against yours, here's Jacob Sherkow, JD, a professor of law and medicine at the Illinois College of Medicine on the topic:
> semaglutide that's "made, used, sold, offered to be sold, or imported into the United States is possibly an act of infringement, if Novo were to sue them"
But this isn't just about patents -- that's the "x-y problem" that I was talking about. It may not be legal to import active ingredients of FDA-approved drugs. Most peptides (AOC-9604, BPC-157, Ibutamoren, Ipamorelin, etc) are "legal" because they're not considered drugs. Once they're FDA approved, they become not legal to import/re-sell unless you're a compounding pharmacy. It wouldn't generally be legal to import fexofenadine (OTC allergy medication), for example, even though it's not a controlled substance. Because importing non-FDA drugs is generally not legal unless you're a licensed part of the medical supply chain.
So yes, compounding pharmacies can provide it to you and you offload the legal gray areas onto them. But just saying "they can't be patented" kind of hides most of the legal quandaries. From a practical perspective, many organizations and individuals do import these things without worrying about legal consequences, because enforcement is very low. But I wouldn't formally pretend the legal issues don't exist at all levels.
https://www.medpagetoday.com/special-reports/exclusives/9962...
Look, I read a bunch of contradictory stuff on the internet about this and am close to a good number of people in healthcare who told me compound pharmacies are legit and that there's a lot of FUD on the internet.
But I'm not pretending to be an expert in law or medicine.
People need to research this and do what they feel comfortable with.
That said, I'd personally prefer if the prices came down, the supply remained highly available and it was covered by insurance and the companies like Novo who spent money to create these solutions got paid for it. It's a miracle and they deserve what money they make off it.
From what I've read, sites like the above are really dangerous, because people are ordering from them and like you said, are NOT for human consumption.
Compound pharmacies, from what I understand, are meant for human consumption. From the healthcare people I know personally, including my own doctor, they have been used for ages and are totally legit. But folks should just talk to their doctor before taking anything.
After having learned potentionally nothing about nutrition, exercise, and self-control, are you stuck on these meds for life out of fear of binge-eating back to your original weight?
FWIW I'm on a hundred-pound roller coaster ride from 300lbs to 200lbs; currently ~215. I've learned a lot about discipline and sustainable habits along the way.
I imagine Ozempic will help with this even if people don’t learn about nutrition per se. Though I think basically everybody knows nutrition, it’s more about self control IME.
Things to note are, along the way I stopped drinking alcohol which helped me tons. Before 2020 I was a huge drinker (not alcoholic, but every day heavy drinker). Initially, I started smoking weed. This helped a ton because I stopped drinking completely, but I wasn't getting very high every day and I thought THC helped quite a bit too. Eventually, in late 2022 I stopped using THC too. I'm completely drug free now. I believe that both Prozac and THC helped me significantly to get out of depression. In addition to drugs, CBT (cognitive behavioral therapy), therapy in general and getting a cat has been extremely helpful as well.
This is just an anecdote, every brain is different. Never self medicate, see a doctor and a therapist!
The side effects of chronic use don't appear to be that significant and would need to be weighed against the side effects of chronic obesity.
There is no data to suggest that those that don't engage in binge eating will suddenly begin doing so when ceasing this medication.
The wonderful Paul Ford has the best writeup I've seen that discusses these more meta levels, the post-human implications of a drug we can genuinely widescalely reprogram ourselves with. Paul's so great. https://www.wired.com/story/new-drug-switched-off-appetite-m... https://news.ycombinator.com/item?id=34660232
Small text underneath: "Mounjaro is not a weight loss drug."
Man, the US pharma industry/marketing is so weird.
https://www.mounjaro.com/#:~:text=mounjaro%20is%20not%20a%20....
Recent studies have very clearly shown it's effective for weight loss even in those without diabetes, but there's a lag as the FDA reviews those studies. Until then, Lilly simply can't advertise it as a treatment for obesity.
Drug companies can’t promote a drug for something it’s not FDA approved for (off-label promotion). Companies face multi-billion dollar penalties for doing so.
Mounjaro is approved for type 2 diabetes. And weight loss is a great way to help get your type 2 diabetes under control.
So highlighting that it helps type 2 patients lose weight, while having an FDA mandated disclosure that it’s not approved for weight loss alone, makes perfect sense.
Semaglutide will probably have the most side effects because it only has one action (GLP-1 agonist). Tirzepatide has slightly lower side effects because it adds a dual action (GLP-1 agonist + GIP analogue) so it can act at a lower magnitude on the GLP-1 receptors to avoid strong side effects, while still having higher efficacy due to its additional, separate, GIP action.
LY3437943 looks even more promising, with fewer side effects. LY3437943 retains both the actions of Tirzepatide but adds a third action, glucagon receptor agonist. So it should be able to have higher efficacy at a lower equivalent dose than the other two (less action on GLP-1 and GIP mechanisms, fewer side effects).
These new drugs are peptide analogs that affect your body's digestion and how it deals with sugar and fat production and insulin.
Whether they, for example, increase the rate of glial brain cancer ... they really haven't been out long enough to know.
there are some great papers on fat labradors that hint at how these different genotypes are linked to our desire to eat and how that shifts our behaiour. Guide dogs are highly selected for trainability, and positive reinforcement with food reward plays an important role in their training. I think it was Yeo, found 22% of pet Labradors and 80% of Labrador guide dogs sampled carried a 14 BP deletion in the POMC gene, which forms part of this pathway.
https://doi.org/10.1007/s00125-016-4187-x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873617/
It's 100% true the vast majority (including me) needs to put some discipline into eating and exercise: normal people can't just eat whatever they want whenever they feel hungry. But normal people don't get fat eating whole foods, working out, eating below their demographic's daily intake; and normal people don't suffer immense fatigue on tiny calorie deficits or even maintenance. People with thyroid and other metabolic issues do. Which IMO completely destroys the "moral" argument for weight.
(And it's also probably true that most overweight people don't eat whole foods and work out daily. That doesn't mean its right to call out some random fat person eating a mildly-unhealthy meal. You have no idea what else they've eaten that day, what else is going on around them, and you wouldn't call out a skinny person who eats the same.)
This can easily happen if you eat the wrong food and train your gut to prefer the wrong types of food.
And by "wrong food" I mean the typical American diet -- processed food and soda.
Normies have it so easy. They take one bite and feel full. My brain would scream at me continuously to try and make me eat and would never be satisfied.
As someone who's bounced around weight a lot and also had long periods where I had to basically control it (wrestling in college), the main difference I've seen with people who are in shape and people are overeat is that the former group understands that it's 'ok' to not feel full all the time. As in like learning the TRUE difference between appetite and hunger.
I've had periods where I gained 50lb in like 4 months (start of pandemic) and all I had to do to basically get back to baseline is remind myself that I'm not going to die just bc I'm not constantly full.
But i definitely don't get 'full' after a few bites. I can keep eating and eating for sure. It's more that being what we call traditionally "full" is actually just wayyyyy overeating.
I've noticed that stress causes me mild stomach pain, which can register as hunger. It also causes dry mouth which registers as thirst. If you're satisfying that thirst with sugary drinks long term, then you're going to be in trouble.
There is also so much novelty and more interesting stuff going on while on vacation that I don't find myself poking through the fridge out of boredom.
Im the opposite when it comes to stress. I lose my appetite when I'm stressed but get super super hungry when bored. The lockdowns really messed up my eating habits but thankfully I've shed all the weight now that I can actually do stuff again.
Trust me on this. I also thought it was a self-control thing. It's not at all. When you're normal you actually get full. I don't mean telling yourself you are full, actually full. You do not want to eat anymore. You don't want chocolate straight after eating dinner. You don't go to the fridge randomly to get snacks. You actually have no desire for food. You voluntarily stop eating during meals because you don't want to eat anymore.
It's something you can't really comprehend without experiencing it because you've experienced a lifetime of the hunger constantly telling you to eat. The idea that you could just... not want to eat is just absurd. But that's how it feels. When a normal person eats a small meal and says they are full, they are actually full. There's no self-control for them, no screaming voice or impulses.
I guess I understand what you mean that you'd think that every skinny person must actually be full after eating and that's why they're like that, but everyone I know who is in shape (like really in shape, either ex college athlete or lives the gym life now and would be considered top 5% of the population), they absolutely do not feel full every meal/day. I mean talking about planning cheat meals and fantasizing about certain foods is super common in the fitness lifestyle.
I've met maybe 3 people in my entire life who have what you're describing: they truly don't care about food and can forget to eat meals if distracted. All the others have some form of habit/routine and wish they could eat more and stay lean.
I'm not discounting that some people really struggle with eating habits and literally cannot stop thinking to eat more (I have family members like that) but I do heavily disagree that 'normal' people are always full quickly and that's why they are 'normal' weight.
If it was a simple normal/not normal appetite wiring then why do most major cities contain way more skinny people and places like Mississippi are almost 50% obese? Or the fact that obesity was pretty rare 100 years ago. I think there's a lot more going on than just 'normal people get full quicker'.
The results are exactly the same... you fill full eating less quantity, cravings disappear after 1-2 weeks, increased focus and enhanced mental state. But yeah, you need some self-discipline, tons of coffee/matcha and water.
I've concluded that semaglutide is not for me. Just like self-discipline in pills, with potential side effects. So better to give IF another go... I'm in the 4th week and dropped 10lbs already.
It also has a repressive effect on drinking and smoke, to my great surprise. And it also has had an effect on my addiction to video games.
Drugs companies get a lot of slack (most of the time deserving) but sometimes they create miracles pills.
https://www.usnews.com/news/best-states/articles/2018-11-01/...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523158/
https://www.cnn.com/2023/03/07/health/fda-drug-shipments-khn...
https://www.usatoday.com/story/news/health/2022/12/14/states...
Also, I expect CRISPR or gene therapy to be the long game wrt this and updating the body's GLP-1 regulation, versus maintenance doses of a pharma product. This is a shim.
https://benmay.uchicago.edu/crispr-gene-therapy
https://www.creative-biogene.com/crispr-cas9/solution/glp1r-...
Hopefully the price will come down more as it becomes more prevalent or as generics become available.
This is ignorant/uniformed, but, taking research chemical by ingestion feels like I have some natural barriers still. Where-as I feel like there's a much more raw exposure to risk with injection. Also there's dumb risks like infection, if I don't attend well enough to injections.
In spite of these protests, I think you are probably much closer to the truth here. Thanks for writing. These reactions I have are, I suspect, not really significant.
You reconstitute it with Bacteriostatic Water which is available without a prescription in the USA and contains 0.9% benzyl alcohol to inhibit bacterial growth.
If you're particularly concerned you buy a 0.22 micrometer PVDF "syringe filter" and pump it through that to another, fresh/sealed sterile vial which you can get for like $2.00 from a medical supply company (the syringe, filter, and vials are gamma-irradiated to destroy any remnants of RNA/DNA). That size filtration will filter out any lifeforms (fungal, bacterial, viral) while allowing the peptide/drug itself to pass through. So you get a guaranteed sterile solution out of the filter.
The same distributor sells legal things to import like L-Carnitine, Epitalon, Berberine, NAD+, NACET, and vitamins at great prices so I was saying I use them for things like that.
But others use them for GLP-1 agonists and many do their own independent testing.
0.22 won't filter out viruses, but time will inactivate enveloped viruses (which are usually the ones you want to avoid injecting), and source control/proper handling should take care of the rest.
Semaglutide is very, very cheap in the gray market. It's somewhat less effective than Tirzepatide and has slightly more side effects if you ramp up the dosage too quickly.
If an annual amount is purchased on the gray market, this brings the monthly cost down to:
- Semaglutide: $10/month
- Tirzepatide: $60/month
- Liraglutide: $87/month
- LY3437943: I have not yet seen this available, but it looks like distributors are notifying manufacturers of latent demand and are working to build up a supply chain.
Note that in the USA, it is legal to import certain amounts of FDA-approved drugs if you have a prescription for them. However, just because something is the exact same chemical as an FDA-approved drug does not make it an FDA-approved drug. It must be manufactured in an FDA certified facility and be the same brand/manufacturer/packaging/labeling/etc as the approved drug.
e.g. importing generic Sildenafil/Viagra is legal if you can find the Teva(tm) brand generic sildenafil in, say, Mexico or Canada for a better price. But it must be the pills manufactured by Teva in the appropriate facility with NDC #0093-5342-56[0].
If you import generic sildenafil "Cenforce" from the (very legitimate but not FDA-approved) Indian pharmaceutical manufacturer "Centurion Laboratories"...
...that would still be potentially criminal smuggling. Even if the pills you import show via laboratory test that they precisely match your medical prescription, they are not "FDA approved" and therefore not legal to import.
A lot of people do though!
to whit, (like botox), all the initial promises of the stuff have been waaaay overshadowed by...cosmetic value.
(I'm oversimplifying a bit...for those who are morbidly obese, yes, the weight loss really helps, but then they also have diabetes most likely which is the primary indication of the drug)
Ozempic costs money and its side effects include cancer, kidney failure, and ruining your eyes.
https://www.ozempic.com/faqs.html
edit: many point out calorie intake is the real problem, it's true: buy a kitchen scale, weigh your food, count your calories, and you will lose weight. Exercise is optional compared to that. Still, both are free and have more benefits.
Calories can still be a useful metric as a proxy but low calorie (“diet”) foods tend to compensate with more carbs. At least the ones I see regularly at my grocery store.
As a side note: It’s actually difficult to find pre-packaged low carb food at regular grocery stores sadly. It requires effort to make yourself, just like going to the gym. Like most good things in life.
And people wildly underestimate how many calories they need. Just by limiting the one portion to 50g of pasta, instead of my preferred 150+g, I can go under 100kg in less than a week. My 'how much should I cook' habits formed when I was young and spent at least a couple of hours commuting, but nowadays I'm quite literally just sit on my ass all day. It's bothersome and isn't fulfilling to use scales cut down on the food (especially if it's tasty) but...
It only takes ten or twelve hours of high-output exercise per day. Everyone's got that time to spare, right?
While aerobic exercise is more for a healthy circulatory system, anaerobic exercise has proven effective in weight loss.
Meanwhile GLP-1 protects and even improves the function of brain, lungs, heart, muscles, bones, and kidneys, it improves sleep quality and reduces sleep duration, it definitely decreases addictive behavior, and even seems to help with some immune issues (anecdotally, but the effect is so strong it’s remarkable).
https://en.m.wikipedia.org/wiki/Glucagon-like_peptide-1#/med...
This feels like saying chocking is a side effect of eating vegetables.
Most negative side effects from exercise come in a few camps.
* The exercise of choice comes with a risk of accidents. Accidents happen everywhere, but they happen to skiers more frequently than mall power walkers.
* The exercise of choice is well known to put strain on certain body parts. Usually this is a joint or tendon. Pitchers and arms. Power lifting and knees.
* The exerciser did not prepare well for exercise. Do they have proper equipment? Did they stretch? Did they warm up? Did they drink enough fluid? Are they attempting a goal they aren't ready for? Are they over training? Did they get training to establish proper technique? Are they distracted when they should have been focused?
That’s actually my point. HN not getting anything that isn’t straightforward though is expected.
The side effect profile of these modern drugs is actually shockingly minimal so I felt the GP post was doing much the same as people who would claim exercise has side effects - missing the forest for the trees. Everything has side effects but if something has an overwhelmingly positive effect profile with seemingly minor side effects the discussion shouldn’t be misdirected like they were trying to do.
And that works for what, 3% of the people that try it?
Exercise is medicine!
Far too few people understand that unfortunately. Something is wrong with our culture when the majority have the attitude that exercise isn't worth doing.
And every other culture on earth? You might as well "humanity", except it's a fairly new phenomena, so "humanity in last 100 years"
People who are addicted will repeat the behaviour even without the neurochemical response. Consider the ritual of the addiction as a form of self-soothing.
You have to treat the patterns we've trod in our own minds, as well as removing that biological reinforcement.
Is this faster-than-light-like impossible daydream or is there any plausible path to it?
A vomitorium is simply the large exit pathway in stadia for rapid egress of many people. The idea that ancient Romans had facilities dedicated to vomiting has been debunked.
Those people that tell you they can eat anything and not put on weight have a very different idea of what "anything" is than fat people, with probably an actual exception here and there (along with teenagers).
Reminds me of Olestra, the zero calorie oil substitute that failed because of similar sounding side effects. Olestra wasn't consumed/absorbed in the gut so you'd just shit out oil and your half digested food would glide out with it since it didn't block stomach emptying like real food.
Does gas, painful cramping and diarrhea sound like a good approach?
https://peterattiamd.com/the-downside-of-glp-1-receptor-agon...
lean loss does not mean muscle loss
https://twitter.com/MichaelAlbertMD/status/16470364172503040...
In 2021, a major trial of semaglutide’s weight loss potency examined the body composition of a minority of participants. These patients did not have diabetes, and they took a much larger dose of the drug. The 95 participants to undergo a body scan lost an average of 18 pounds of fat — and 12 pounds of lean mass.
If you simply eat at a calorie deficit and aren’t taking specific steps to preserve muscle (resistance training and high protein), a lot of the weight you lose will be muscle mass.
And if you can get them to take those steps, the need for the drug decreases.
So it doesn't dull all pleasure just almost all so it's not technically anhedonia...
I dunno, still seem pretty fucking bleak to me.
Obviously there are people who like the pleasure given to them by food a bit too much and they consistently overindulge, it can be that way for many things as well. I'm not saying that the cause is always related but for many it may be
If anything the opposite is far more bleak. Imagine if there was a drug that meant you're less easily satisfied, who on earth would want that?
That sounds like stimulants. You wouldn't be motivated to do things if you were satisfied, so any drugs that motivate people would seem to need to have to have such an effect.
That is not what that quote says.