GLP-1 drugs: An economic disruptor? (2024)
wildfirelabs.substack.com
wildfirelabs.substack.com
- Extreme appetite suppression to the point where I've started calorie counting specifically to make sure that I'm eating enough. It's incredibly easy to forget to eat.
- No more feelings of hunger. At all. This is somewhat depressing. Eating is no longer enjoyable and feels like a chore. I woke up hungry for the first time in a while a couple days ago and was excited - jumped out of bed and ran to eat something just for the pure joy of it. I've only felt that a few times in the past few weeks, compared to every day off the drug.
- I completely stopped drinking. Have you ever been to a bar after eating a big meal at a restaurant, and had trouble drinking because you were too full from your meal? That's how I feel all the time. 1 or 2 beers and it becomes uncomfortable to have anymore.
- Normally I go grocery shopping and within 3-4 days, all the "good stuff" (snacks) I bought are eaten. Now, since I stopped snacking and eating much less, groceries simply last way longer. <-- $$ saved in groceries significantly offsets the monthly price of the medication
- My morning starbucks routine has changed from 2 food items to just 1, which alone saves me $200/mo (sorry starbucks).
- Haven't noticed anything regarding impulse control outside of food. No anecdata to share on that point...
After a few weeks on the drug, I'm 100% convinced that once this drug is widely available and cheap... being overweight will be a choice (choosing not to take the drug).
The most important aspect of the drug that makes it work so well is it forces you to change your habits, no will power required. It also punishes you for bad eating habits. (That late night trip to McDonalds will have you feeling like shit the next day).
I'm the kind of person that used to be able to order just about anything on a restaurant menu and clean my plate completely. Now I simply can't do that. It's actually kind of embarrassing being at a restaurant with friends and being completely uninterested in the food.
This is the largest of several reasons I hesitate to try it for myself. I am a very big guy (I would be about 184lbs if I had 0% bodyfat at my current musculature level). From the experiences I hear, I would not only struggle to have enough energy to do any kind of rigorous exercise, but struggle to consume the amount of protein I require to even maintain my current muscle mass.
I do have issues with overeating and the prospect of a drug that prevents me from consuming too many calories is attractive, but the side effects sound counterintuitive to any kind of natural fitness.
You really need to prioritize protein intake and make sure your calorie deficit isn’t extreme.
Losing too much weight too quickly, with or without the help of a drug, can be very unhealthy.
I drink 4 protein shakes a day (160g total) in addition to regular food. If it weren’t for the protein shakes I definitely would be protein deficient.
You’re 100% spot on with decreased energy at the gym. I’ve had to pull back 4x weekly cardio to 1-2x weekly. Then again, anyone who’s in a calorie deficit has lower energy. It’s not a unique phenomenon of the drug, just a side effect of weight loss.
Presumably if you're trying to lose weight, you have energy to burn you carry around with you. A calorie deficit doesn't imply lack of calories to burn. Presumably you're trying to trigger ketogenesis.
Granted, this is a lot less easy to access than simply eating simple carbs right before a workout and likely a lot less comfortable.
Only if you're actually on a keto diet; most weight loss routines run a calorie deficit without triggering ketogenesis.
Also there's this whole thing about set points - you probably got to your weight somehow, and if it wasn't through consistently making stupid choices over many years, chances are this is what the body learned to consider an equilibrium state. Which means that, if you start running a calorie deficit, it's going to fight you every step of the way. It will happily scale down performance to conserve energy instead of burning the accumulated fat, so you'll just be slow and groggy but not lose weight. There's been reported cases where people got mental illness-level obsessive thoughts about food, which appeared when they were hungry, and stopped when they ate enough.
The degree of this problem varies between people, but it's generally not that easy to effectively lose weight, and some people simply lost the genetic/environmental lottery on this.
Yea, I think your eating and food habits you learn as a child and teenager tend to shape you for life. I was malnourished as a child (I was considered a picky eater) but as an adult I've found it quite easy to keep within the caloric bounds a doctor told me to keep to. One thing I've noticed is that hunger just doesn't bother me the way it does with people who struggle to lose weight or with binge eating—mostly a pain in the ass (I need to remind and force myself to eat), but occasionally something I'm grateful for as I watch the people around me struggle on an existential level with their cravings and bodies.
I also don't have a sweet tooth, and I put that on not being allowed sweets as a child except under very exceptional circumstances. I'm also a (thankfully recovering) alcoholic, so don't mistake this for being generally good at avoiding cravings.
The idea of set points is controversial and not necessarily the accepted scientific consensus.
Is there evidence to back this up? It sounds reasonable, especially without a limit on "too quickly" but (anecdata incoming) I'm curious because:
- When I first tried a low-carb diet (for non-weight reasons) I lost about thirty pounds in under three months without really trying, and hit something like 12% bodyfat
- When I started intermittent fasting (mostly unrelated to weight) I again lost about thirty pounds, this time in a little over three months, and probably ended up around 15% bodyfat
- Since then I found that neither low-carb nor intermittent fasting had a significant effect on my weight, so:
- When my doctor suggested I lose some weight I pretty forcibly calorie restricted, and lost about thirty pounds over four months (only down to about 20-something % that time)
- And just recently, for cholesterol, I've done it again and lost 25 pounds so far in something under three months.
All of which to ask, what evidence do you have, and what's "too quickly"?
1. the loss of muscle mass
2. low energy
3. unnecessary suffering
4. high fatigue
4.1. inability to maintain the low calorie diet for long enough
4.2. relapse; jojo-dieting.
1, 4.1 and 4.2 are the biggest problems.
The interesting thing will be once I stop losing weight and start rowing again seriously, can I get back to a reasonable performance level. Fingers crossed...
It's generally recommended to:
- do heavy resistance training
- losing fat at the rate of 0.5-1% of a body weight a week
- do it for 8-12 weeks
- (critical) after which to have a maintenance phase with a duration of 2/3-1 length of the dieting phase
- after that can do another dieting phase again.
- repeat as many times as needed.
- if wishes to build muscle/bulk, should do it 4 times slower than dieting. So 250g-1kg weight gain a month.
Sure, I get that, and I responded in the context of my original "I'm going to throw out anecdata" note. In that spirit:
I've generally gone longer than 8-12 weeks, but not by much -- longest is probably 16 weeks?
I've definitely lost more than 1% per week. I don't graph it, but I think I'm hovering in the 1% - 1.5% range.
I'm curious about the maintenance phase and strength aspects -- I'm not interested in bulk, just strength.
So they are going to force you onto a higher dose?!
The brand name GLP’s you can’t control the dose. But when you get it in a vial from a compounding pharmacy you can inject however much or little you want.
Not looking forward to ever using the brand name version specifically for this reason
Basically it is a ratcheting mechanism where after ~10 clicks you get .25 mg dosage and 20 clicks gets you .50. Basically, no doctor is going to endorse it, but you can dial a dose to whatever amount you want.
No. California has not banned compounding pharmacies, nor is there a significant movement to do so in the legislature, among the people (who could do so by ballot measure), or a proposal by the governor to do so. California does require additional licensure for sterile compounding, but that is very much not a ban on sterile compounding or compounding more generally.
Relevant to GLP-1s, though, several state pharmacy boards (not California’s, as far as I know) have raised issues that compounded GLP-1 drugs that they have seen appear to be illegal, because they use a form other than the FDA-approved base form of semaglutide (which is only available from Novo Nordisk), and th3 form used is not itself approved for human use, and have taken steps to crack down on that. But that's also not banning compounding, but enforcing existing rules on compounding.
I was approved for semaglutide but now compounding pharmacies like Hims are stating their cheaper (<$200/month) compounded versions are out of stock.
https://www.barrons.com/articles/eli-lilly-zepbound-higher-d...
First, there's no legislation. What is happening is that the branded drug was in shortage so compounding pharmacies were legally allowed to step in under existing regulations.
The shortage status was first updated in the summer, and Novo went on a lawsuit spree. Suing everyone mentioning GLP on a website.
But, there have been more back and forths since, very recent.
TLDR what is restricted now is not the sale of the compound, but the manufacture of it. Therefore, you can keep selling inventory past the restriction, but of course that will either run out, expire, or be restricted as well. As of now, if everything stays the same, expect the last few compound pharmacies to run out of product at the end of Q3/25 .
However, I understand there's groundbreaking legislation being worked on that will dramatically change the status quo for the better, meaning more choice for end consumers and less profits for Novo.
Some doctors will go by the Lilly recommendations but I think more are allowing people to stay on the lowest dose providing benefits. That leaves your health insurance as the only other obstacle.
There is a chart at https://zepbound.lilly.com/hcp/dosage
I was one of the rare people that saw results with 2.5mg but by the end of that first month I had plateaued. After 3 months at 5.0mg I've plateaued again and will probably move up to 7.5mg in the near future and stay on it as long as I can.
Some people like to go back to 2.5mg as their maintence dose after reaching their weight loss goals.
The only way this can possibly be correct is if you think that the "correct" weight is whatever the population average happens to be which is just...wild to me.
If we assume commenter is male (a statistical likelihood), then 20% is the high end of normal, and could very safely be halved. In the less likely case that they are female, then it is right in the middle of the normal range, and could safely be reduced by 5-10% at least.
The medical definition of overweight is basically if you're some number of standard deviations above the average from whenever they ran the stats, so population average = correct weight seems like as reasonable a standard.
Why do you think this? I agree that people who have associated risk factors should be prioritized, but if there's enough for everyone why wouldn't we give it to anyone who wants it?
Those concerns have nothing to do with the fact that it's ok for people to choose to start or stop medications if they would prefer (supplies allowing).
This is being injected directly into your flesh, there cannot be any mistake, or shortcut.
And crowing about saving $200/mo not buying food at Starbucks, well now Novo Nordisk is getting that.
Toast a bagel at home for $0.50/day instead.
I do not agree that people who don't "need" to be chronically medicated should not be. I think you can decide to take whatever you want for your own reasons. I am not going to tell you what you can and and can't take - unless you're like...taking something that makes you destructive or generate externalities or whatever. But this seems like the opposite?
Lots of questions here around profit and the awful medical system in the US, but on a basic level I think people should be able to do what they prefer and is safe.
If they're like typical westerners, they already self-medicate with coffee every day, with alcohol occasionally, and a big fraction of them (though much less than couple decades ago) also treat themselves with tobacco smoke - and ironically, weight loss is one of the few benefits some people actually use to defend their smoking.
Do they need all that medication? Well, it's socially unfavorable to say so wrt. alcohol, but ask any of the daily coffee drinkers whether they need their morning coffee...
So, sure, we don't know the long term risks of semaglutide ("just" 30 years or so) — but I say let people try it if they want, we let them use things we explicitly know to be dangerous, so why should we stand in the way of something that only might be eventually?
I buy Thomas Everything bagels at the supermarket, FWIW.
It’s a very interesting feeling to feel like you’re in full control of what you eat, not influenced by random cravings or hunger.
In my case I’m planning to only stay on it another month or 2 to drop 10lbs. I can easily see people cycling on/off this drug throughout the year to keep weight in check while removing will power from the equation completely. It’s quite remarkable.
[0] https://www.sciencedirect.com/science/article/pii/S266736812...
https://www.gov.uk/drug-safety-update/glp-1-receptor-agonist...
Sidebar: Mounjaro changed my life. I'd been very diabetic (300 units of insulin a day) for years on end. Taking that much insulin, my normally large frame got very large indeed. A couple of months into the Mounjaro and I was off insulin; a year into it and I was down 75 lbs and healthier than I'd been in 20 years.
I consider it a likely lifelong medication now simply due to that night and day difference to my life. It’s extremely rare I have a day where I need to be within 5 minutes of a restroom now.
My primary care doctor mentioned this might be a side effect when I first started, and she ended up being more correct than even she expected to be.
I recommend that you listen to the most recent Peter Attia podcast, which is a 2+ hour interview with Ralph DeFronzo (diabetes expert) where he goes deep into the effects of GLP-1 agonists on insulin response and other metabolic pathways. I came away with the impression that we're being too casual with how these drugs are being used -- if you're overweight these impacts are probably all for the good, but if you're not, it's more questionable.
If there’s a specific part you remember talking about the negatives I’d be interested to hear.
I legitimately have a difficult time finding anything negative when researching the drug, other than tolerable side effects like GI upset.
I don't have a list of exact timestamps, but there are multiple places where he discusses the impacts of the GLP-1 agonists (of various generations) on insulin signaling, glucose transport etc., and the conversation is generally complex, nuanced, and wide-ranging. We don't understand everything these drugs are doing, but they're clearly banging around a complicated metabolic/hormonal system with a big, blunt hammer.
Are you just using average as weasel words here? I get my best pump and generally have the best workout sessions at ~10-12%, which is easily maintainable for me, but definitely not for most people, having a drug that makes it effortless for most people is a GOOD thing. People shouldn't have to suffer to get to <15% if they aren't born with good genetics?
And what about strength athletes who want to build up a large runway? Now literally all of them can get down to ~7% no problem, and have no problems on the way up either.
I can't speak to their choice of taking the drug, but it's wild how warped people's perceptions are now of what constitutes "healthy" and "fat" thanks to the obesity epidemic. People remark on how George Costanza on Seinfeld was once considered fat (because he was), or how Homer's scale-tipping 300 lbs. in the King-Size Homer episode of The Simpsons was considered comically obese (because it was). Never mind the fact that people almost always underestimate how fat they actually are and are almost always disappointed by their DEXA scans. Even if the OP's estimate is correct that they're just a little north of 20% BF (as a man), they're still overweight, and specifically overfat, and probably look soft and doughy.
Name brand Ozempic is $230 CAD or $160 from Costco up here
I have no idea what Americans overpaying for healthcare has to do with a Danish drug company participating in the Canadian Healthcare market.
I’d rather thank the Canadian government for having a drug pricing review process.
If these companies don’t want to sell their drugs here, no one is making them. They are still here, so I think it’s safe to assume that they are still making money.
It’s just basic addressable market vs. development cost math.
The kinds of drugs that routinely experience years of delayed availability in markets like Canada and the UK until the learning curve has kicked in via the US and other less constrained markets.
Canada doesn’t even have particularly low drug pricing compared to the rest of the world, the opposite in fact. Canada just had low drug prices compared to the most expensive market on the planet.
It’s possible that lower drug prices in one country would disincentivize a global industry that touches almost every human on earth. Or it could not.
Personally, I think that they would cut other cost centers before they cut the only department that ensures their long term success
The industry could save tens or of billions per year by not advertising (this is a US thing, drug ads are nonexistent in many places), and eliminating pricing games, cost rebate programs, coupons, drug reps, etc. These are all significant costs and friction that don’t exist in most other countries.
My personal feeling is that claiming that the worlds least cost efficient healthcare system with many layers of added complexity is the driver behind pharmaceutical budgets is marginal.
And of course you have to consider that a significant portion of drug research costs are paid by government and other institutional grants
Also what proportion of that $1,000 goes to the manufacturer? From what I understand various middlemen and such get a significant proportion of that without providing any value?
e.g. https://www.ftc.gov/news-events/news/press-releases/2024/09/...
So compounders can no longer legally sell tirzepatide and will soon (April-May) be unable to legally sell semaglutide.
I'm single, live alone, work a lot, and earn a lot. Food delivery apps are hella expensive... but I still pay it quite frequently. Yes, I am ashamed, thanks for asking.
A month ago I suffered through a norovirus infection, the first time for me. In three days I lost six pounds (my BMI is 21.2 now). At first I wasn't surprised or worried -- after all, I had emptied out my digestive tract and was dehydrated. But a month has gone by and my appetite has been AWOL. I've lost another pound (5'11" @ 152 lbs). I have an appointment next week with my doctor's PA to see if something else is going on.
The taste of food is the same, but the craving is lacking. When I eat, my guts are telling my brain it is time to stop eating, as if I had eaten a pound of mashed potatoes only an hour ago.
I've never had this reaction to fast food before. I only eat mcdonalds every few months and yea it's not the highest quality food, but I don't think there's anything in it to make you sick any more than other burger places have. I imagine you'd have to have restricted fast-food nutrition for quite some time before you feel a difference.
I'd like to see a study comparing people who ate mcdonalds who thought of it like slop vs those who saw it as a treat. I'm curious how much of this is psychosomatic, or how much of the craving for mcdonalds is rooted in feeling like crap in the first place.
(Granted, I've never had an issue with maintaining my appetite before, in fact I have issues keeping weight on, so I might have a fundamentally different relationship with food.)
> I've never had this reaction to fast food before.
I do. Because of it, I eat fastfood when I'm willing to pay that price, ~5x/decade.
> I'd like to see a study comparing people who ate mcs who thought of it like slop vs those who saw it as a treat. I'm curious how much of this is psychosomatic.
The notion that our psychology could be holding us back from fastfood completeness is one that never occurred to me. I like how novel it is.
Food sensitivities are primarily a lot of medical questions, for which we have few answers. For example many fresh breads will give me stomach cramps and Rosacea. I can eat those same ingredients+amounts in other foods and be fine.
Many fastfoods ramp my brainfog up to 11. I don't know why. I'm in a poor position to consider the issue while the brainfog is in play. I could consider it later but the best I can hope for is unsubstantiated guesses.
I have not lost my appreciation for good food, I just eat less of it. I used to be unable to leave any food on my plate regardless of how good or bad it was, now I’m perfectly happy to leave something uneaten if it isn’t to my taste.
Losing the pleasure of food was one of my main concerns starting it, and it hasn't been an issue whatsoever.
Meanwhile, I'm back down to my healthy weight range, which I haven't seen since 2021, which was about the third time I'd been at that weight and then ballooned up. I was just about at the top of that range after two months, down about 30 pounds, and it took no effort whatsoever.
I feel amazing. Muscle mass is also doing fine, and I'm well into middle age so any protective properties of youth are largely gone, still having no problems there.
That being said side effects vary and lots of people mention it gives them nausea. I can easily imagine how that would interfere with taste.
I wonder if with time, you can learn from this drug, form the helpful habits/behaviors and then stop taking it.
> Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month
Uh, you're allowed to stay there as long as you want. I was on 2.5 for two months and asked my Dr to up the dose, as progression kind of stalled in the second month. I've been hanging out around 3.5-4.5mg/week since then losing ~5 lb/month steadily.
Sounds like you're pretty sensitive to it, which is nice. You can lower the dose even further if you think it's too strong at 2.5mg/week.
It is definitely a game changer.
It would be fascinating and almost too good to be true if we found a way to suppress only largely harmful (in our current environment) urges but leave the good ones intact.
Something like that becoming widely available could change the world, and mostly for the better. It would refocus our entire economy on much more constructive pursuits instead of gambling, addiction, and pandering to transient urges.
I did have some energy loss, especially at first, but I assume that was because my body was struggling to cope with a lack of carbs. However, after a couple of weeks that for the most part disappeared.
Starbucks food is especially calorie dense. I realized this when I lost a bunch of weight in 2018 and I noticed the calorie counts on the printed cards that some stores have. Even for junk food, Starbucks junk food is more calorific than average for the same items.
I started to consider that for a typical customer's consumption, McDonald's might actually be healthier than Starbucks. Which totally goes against the image people have of both places.
People think if they are "going for coffee", it's better for you than having a milkshake and following it with candy. But it's essentially what they're doing.
(I heard this somewhere on the internet, about the Frappucino.)
It seems like there is a lot of disagreement on this very basic point. Surely there must be data from the decade or so it was prescribed for diabetes.
I wonder how the body reacts after being on the drug for years at a time and then you cut it off, are the cravings stronger than before you started the drug?
I think the craving is primarily a function of how much your stomach expects food, ie the more food the more craving, but also you can get it used to a lower regime. And to external factors like stress, tiredness, cold, etc.
For decades I've struggled with diets but tirzepatide is the only thing that's made me stick with it. Will power alone wasn't enough, but with tirzepatide I'm very confident I'll get down to a under 100kg for the first time since I was a teenager, within a few months.
I've never had any psychological difficulty with losing weight. I don't care if I'm hungry.
But what happens when I eat less and lose weight is that I have trouble concentrating. The glucose my brain needs just isn't there. And if I do physical activity, forget about it -- my blood sugar is going to my muscles and I'm unproductive for hours afterwards as I just can't think. Also, if I go to the gym, my muscles take a week to recover instead of a couple of days, because they're just not getting the glucose they need to repair themselves.
I don't hear any of these complaints from GLP users though, which baffles me. Not eating enough affects us in lots of ways besides just being hungry. How has it been for you?
I get so confused because the small amounts of food that people talk about eating on GLP, don't seem like enough to sustain themselves long-term.
Are they exaggerating? Or do they talk about not eating dinner, but that's because they had 1,700 calorie lunch at the burger place? Or is that just during weight loss, and then once a target weight is hit, they're eating like a normal (healthy-weight) person again?
I just genuinely don't understand how people are surviving with the diets they describe.
They are probably losing muscle mass!
So you're still eating plenty, but the point is that you no longer have any desire to over-eat?
And so at a restaurant you still order and eat, but the food just doesn't mean "enjoyment" the way it used to?
That makes a lot more sense then. If food becomes more about removing a negative feeling of discomfort, than a positive feeling of deliciousness, right then overeating would never make any sense.
Thanks!
I went out to eat today, and enjoyed my food. I didn’t order a big burger, but a smaller sandwich. I had a bite of an appetizer, but not more than a bite. Still super enjoyable, but it might be even better now because I don’t feel like a fat pig afterwards due to reasonable portion size.
I am food motivated like a dog, for whatever that’s worth.
Because obese folks have stored energy reserves. The body is really good at adapting and using them.
I was attempting to be at a 1k/day calorie deficit during my peak weight loss phase. I typically met or beat this target, usually eating around 1200-1600 calories/day plus a lot of walking - 25k steps/day minimum as an absolute non-negotiable. I'd check my step counter before bed, and put pants back on and go for a "midnight" walk if I was under my count for the day.
The first few weeks were quite hard, but it was pretty smooth sailing after that. Lots of naps. After that I was tired some days, but not overly so. I peaked at about 30lbs/mo weight loss for ~3 months, then tapered off to 5-10lbs/mo for my final 30ish I had to lose.
I don't really suggest anyone else attempt to "crash" their program like I did - but it's how my brain operates. I need immediate and obvious results, and those turn into a feedback loop for me. Being a bit more tired each day was perfectly acceptable for the goals being achieved.
That said - I wish I had started resistance training when I started my dieting program. I took it up at the very end of my weight loss, and it took me about 9mo to get back to roughly the same lean muscle mass as I had before I lost weight. I'm still working on min/maxing body comp about 18mo later.
The best weight loss program is the one that works for you. Pretty much full stop. It's going to be highly individualized. Some folks will do much better with a small deficit for a few years, but I know from experience that would never work for me.
I think a lot of the stuff you see on-line about "forgetting to eat dinner" is exaggerated and folks starting off on the drugs being amazed at it. Very few people will post a "well, I'm a bit less hungry" type of result. Everyone I know on them eventually became somewhat habituated to this sort of effect, but everyone is highly different. For me, I considered Tirzepatide a performance enhancing drug for my diet. I still went to bed hungry most nights - it was just far easier to chain together days and weeks of doing so on the drug vs. off. It still took a lot of willpower and habit building for me to pull it off at that level.
My baseline was in the ballpark of 3000-4000 cal/day. I'm losing about 5 lb/month, or 1.25 lb/week; assuming it's all fat, that's a 4400 cal/week deficit or ~625/day. 600 cal a day less is kind of a lot! Some people starting fatter than I was take bigger doses and have bigger deficits.
> Are they exaggerating?
In my experience: I'm not hungry for breakfast at all. Lunch: I try to have it, definitely have it if I exercised. (But if I didn't exercise it's pretty easy to just ignore hunger signals and eat my first meal at dinner.) Dinner is like, smaller than it was when I wasn't on the drugs. And then some post-dinner snacking.
I'm on the low end of the Rx dose range (2.5-15mg/week); on a higher dose, eating even less is plausible.
> Or do they talk about not eating dinner, but that's because they had 1,700 calorie lunch at the burger place?
1700 cal meals are mostly out of the question for me on these drugs. Your gastric emptying is slowed down, so you just can't house big meals in the same way.
> Or is that just during weight loss, and then once a target weight is hit, they're eating like a normal (healthy-weight) person again?
Yes, I think this is a big piece of it. To actually lose weight, you need to eat less than the sustainable steady state.
This is crazy, I have the completely opposite effect. On keto + calorie restriction I feel much more alert and sharp.
And my genetics also showed this to be the case too!
- 45 mins before workout: small bowl of oatmeal with milk
- 30-0 mins before workout start: 1 liter of water pre-hydration
- During workout: 1/2 liter of water per half hour of intense cardio training, less so for resistance
- Straight after workout: double black espresso coffee (high caffeine)
- Hit sauna for extensive slow cool-down, drinking one sports drink (sugars and electrolytes)
- hour later: full meal of mainly lean protein
Never had issues with muscle pains or "fog".
If you go really deep beyond your usual sustain, feeling physically exhausted and needing rest afterwards is normal. Eating your way through it is not the way to go.
This is a common misconception.
Yes, muscles are made from protein, and so you need additional protein to provide new "building blocks".
But the process of muscle repair uses a far greater amount of glucose to actually do the work of assembly. Estimates are generally that you need something like 10x as many calories from carbs/fats to build muscle, compared to the actual protein required.
So no -- muscle repair actually comes primarily from glucose, if you're measuring calories. But the point is that you need both. If you eat plenty of protein but your blood sugar is low, the muscle growth/repair will be extremely slow, or just not happen at all.
Also, your protocol is entirely about the workout. I'm talking about the 48h afterwards, when the growth actually occurs in response to the stresses incurred during the workout.
My shits, however, have been glorious since starting the drug. Truly pleasant steamers that rocket right out.
I used to view eating as a chore and it was great. Then (no joke) I got into tech and everywhere I work they have fancy food or frequent team lunches or something of that nature.
I wish I could go back.
Personally, I love food. I can't live without stuffing candy in my mouth. But I also have a tendency to get fat, so I weight myself every day, and based on that I either have a diet day or a cheat day. Moreover, I do a lot of physical exercise every day. The idea of having to depend on a drug to live is scary to me.
Having said the above, I'm sure that one day we'll create a drug that makes life of majority of population better, and we'll be able to administer it to everyone without major consequences.
Keto + intermittent fasting are my magic pill right now and have been for some years.
Keto, fasting and also breaking the "foodie" culture that eating and going out to eat becomes a hobby.
I didn't order/dine in at all from a restaurant in 2024. It is much easier to not over eat the boring keto meals I make myself. My "cheating" is eating basmati or jasmine rice with a stir fry instead of cauliflower rice.
There is actually not enough known side effects for me to take GLP-1s. They are either complete miracle drugs or side effects we don't currently understand haven't come out in the wash yet.
We have a pretty good track record when a new powerful medication like this is introduces of doing things quite wrong. There are probably risk mitigation strategies we will learn in the coming decades that we simply can't know right now. Otherwise, these are basically free lunch miracle drugs. That seems an easy short.
I absolutely hate the way my appetite works. I have a genuine dysfunction with food. It goes back as far as I can remember. My cravings never stop, even after being satiated. It’s an endless cycle of weight gain then loss then gain as my willpower fluctuates for a variety of reasons.
My insurance only recently started to cover these weight loss drugs, and I have been looking into them over the last month because I think I’m an ideal candidate for it.
If it gives this kind of control over cravings and appetite I’m really looking forward to how this can genuinely make my life better
Control would mean I might still feel hungry. Ever. Or that I could decide to eat heavily at one meal, but I don't and as long as I take the drugs, I won't. That doesn't feel like control, it feels like I've had something removed. I guess it's a matter of perspective?
I don't know if its a common sentiment but this drug treatment is the hardest thing I've ever done for my health. I'm not sure I'll be able to continue though. It's like I've robbed myself of the one joy I had left and now I have none. Tread carefully.
It sounds to me like it brings you enjoyment you miss. I respect that.
Food for me isn’t that. The lack of cravings and appetite means I would be firmly in the drivers seat with it. It means I can eat exactly the amount I’m suppose to and not feel like I must have more
> [but] my dose is fine [because] I'm under the care of a physician
Get a second medical opinion from a doctor experienced with prescribing these drugs.
For me, hunger is misery, and so is feeling over-full. I’d do anything to take that away (well, short of sacrificing my financial security to pay the market rate for the drug.)
Your body has 2 separate engines that work completely differently
Here's my experience (n=1):
* Zepbound is better than Wegovy. Wegovy has more side effects than Zepbound. Also the Zepbound pen is better than Wegovy.
* If you're worried about needles, don't be. The injection feels more like a rubber band snapping at the skin. And you'll get used to it.
* I typically have moody days maybe 2 or 3 days after I inject. I attribute that to blood sugar changes.
* Food tastes differently to me now. Food I used to really like can sometimes now just be okay. I don't like french fries so much anymore like I used to (they're good, but not what I remember). The huge bowl of chips I got from the Mexican restaurants don't taste as good anymore. Potatoes aren't really as attractive anymore. I prefer protein.
* I had constipation, which is a side effect. There was a stool softener I took from costco that helped. Eventually that went away.
* I got a bike for exercise. It's nice in that I feel like I actually go places rather than sitting on a Peloton. I also get fresh air. I had to find something I wanted to do, and I hate walking frankly.
* As I lost weight my alcohol tolerance dropped, but it's to be expected but still surprising when one beer hits you harder than it used to.
Maybe some tips:
* Nausea might a be a side effect, more so with Wegovy than Zepbound according to my doctor. So I guess plan to take it easy if you can.
* Your relationship with food will change, so be prepared mentally for that. Food used to make you happy maybe, and now it won't. So figure out what activities and interests that make you happy which don't involve food.
* Sugar is the one thing that can still ruin your progress. So be careful with desserts/candies/sweets/sugared sodas/etc.
* There's some debate about whether diet sodas spike your insulin levels or not. I would recommend going to black coffee to get your caffeine if you haven't already, and black coffee will also help to stimulate your bowels as well. That said, diet sodas are still better than sugared sodas.
I’ve seen cases where these sites are 5x cheaper than insurance
So compounders can no longer legally sell tirzepatide and will soon (April-May) be unable to legally sell semaglutide.
That said, the lowest doses direct from Lilly without insurance are $350-500/mo. And if you can do math, you can pay for a higher dose and spread it out over time to achieve a lower average price.
Not everyone can take these drugs. Some people will have severe side effects. It's very common to have nausea, vomiting, etc., and some people will experience these frequently enough that the prescribing doctor will rescind the prescription.
The rate is over 1% which isn’t a lot nor is it nothing https://jamanetwork.com/journals/jama/fullarticle/2810542
My doctor said that she now titrates the dose up slower than the recommended monthly increments and the side effects are less frequent.
Another problem is that GLP-1 drugs seem to synergize with other drugs that can cause GI issues.
Would Zofran throughout the day help with the side effects until the body adjusted?
I'm curious if daily oral doses which are smaller will solve a bunch of these problems at once, while also mitigating the supply-chain problems.
https://time.com/7130456/ozempic-side-effects-wegovy-mounjar...
The drug keeps me from binge eating, which is huge, but if I take enough to actually lose weight then I have weekly bouts of food poisoning because the sugars in my gut start to ferment. An entire day sitting on the toilet while holding a bucket because it’s coming out both ends.
But the late night trip to McD's always makes you feel like shit the next day, it's just that we then forget and do it again. (Same with drinking).
This may be an ignorant take and if it is I apologize, but isn't it a choice anyway? A calorie deficit and minimal exercise will have you cutting body fat. Or am I missing something here?
Giving a GLP-1 to a heavy drinker/alcoholic results in a skinny alcoholic.
Given that the overwhelming majority of alcohol is consumed by heavy+ drinkers this isn't the gamechanger people think it is.
In just the two weeks at that low dose it's been quite effective.
In fact the only reason I'm replying to your comment is because instead of being a bottle deep in front of the TV at this point in the evening I got bored after one glass and decided to noddle around on the internets.
Ask any heavy drinker/alcoholic and they will tell you that one doesn't just have 'one' drink and then move on with something else. One is always too much, and never enough. Now it feels like enough.
Happy the share more if you like :)
1. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
Zepbound/Mounjaro on the other hand has been fantastic. I just noticed I was hurting my muscles a lot and realized it was because I was losing muscle mass. I started taking protein shakes and that seems to have fixed it. Wish I’d realize it sooner as I’ve hurt my hip joint and can’t ride my bike which was primarily how I was exercising, so I need to go to physical therapy. I’m on 10mg and frozen at 260, have an appointment to go to the next dosage on Monday. Hopeful I’ll keep losing weight and get down to around 200.
For those who do, it makes them have a normal appetite.
Additionally, it seems to make junk food taste less appealing and real food more appealing.
... what? Get a better medical provider, you can stay on 2.5mg as long as it's effective. Your hunger will come back. Going up every month is poor practice if you have hunger-suppressing effects, whatever the manufacturer says: speak to an endocrinologist who's experienced with prescribing it instead. The first couple of weeks I had no appetite, but I stayed on 2.5mg for three months and had a healthy appetite by the end, and continued to take it slow. Lost about 1kg a week, and enjoyed my food just fine.
Respectfully, you're in week 3, I think it's worth giving it a few months before you start sharing your experiences of it on the internet.
The much more common experience of this drug -- when you've been on it a little while and you've found a good dosage -- is you enjoy food, you have an appetite, you're just not ALWAYS thinking about food. There is enough anecdata in the many subreddits to constitute actual data about what a typical experience taking any of these things feels like.
I've never felt hungry in the morning. I've never eaten a lot. When I was younger, I often forced myself to eat more, because I felt bad about how I wasn't "big enough" (which feels silly now as a proper adult).
Impulse buying food and snacking is something I only do if I haven't eaten for a long time, i.e. if I'm actually very hungry.
If I go out drinking, I also make a point not to eat very much before or during the drinking, because otherwise I just feel sick after like one beer.
I am talking about being okay in 900-1000 while my normal need was ~2500 and nutritionist had suggested to target around 2000 for first few weeks then bring it down to 15-1600 and then slowly bring it up near normal as weight settled. But by the end of 2nd week or 3rd I was struggling to finish 900-1000. I used to kinda force eat.
There was no medication involved in any way (not for this purpose; not for anything else).
For an alternative approach for comparison: My wife and I eat low carb and fast every other day for a year now. Around the 2nd month mark we got the exactly same outcome: food became a chore. We sometimes dont eat for 2-3 days when travelling or busy. I dont remember feeling hungry in about a year. We do sports - I sure have less peak power, but can sustain moderate efforts for longer (I use a power meter and Hr strap - my vo2max dropped). I feel significantly sharper mentally and managed to learn a new language (Dutch, from zero to B2) in a year - while working a cto job. Not eating easily gives 3hr extra a day, incl. what I get from waking up early.
Saves us a ton on groceries and eating out. The only thing we do watch out is carbs - I can eat a kebab or two tacos but dont eat any sweets, eat bread or drink beer/soda. Weight stabilized at my high school level. Not sure if I can recommend it as it is a bit tricky to practice, especially while having a job that requires routine socializing, but - it does work. The only really difficult thing is to start and endure the first two weeks or so.
I followed the same routine 4 years ago, then I stopped and when I started eating carbs my vo2max recovered overnight. I think one cant have it all - either you run on stored energy which caps the power to weight ratio - or on readily available glucose and glycogen. Its fine, I am not an athlete, I do sports to feel good. I dont see an impact on raw strength - just on anaerobic performance.
You will probably land on "not often hungry". The feeling of being full very quickly when you do eat will stay
It already is.
> 'A movie theater chain recently analyzed their user data and discovered that 72% of their profits came from concessions, primarily from impulse purchases made by people who swore they "wouldn't buy anything."'
This combination of non-descript source, precise numbers, and 'quotes' looks like the usual bullshit one reads in self-help books. I conducted a quick online search but couldn't find any direct source for this claim (although the number might be in the right ballpark).
I'm seeing papers claiming both increased and decreased impulse control.
> America's largest mall operator, Simon Property Group, is converting anchor stores into medical centers and wellness spaces.
Maybe that's because malls have been struggling for years and are trying new tactics in response to that?
> Whole Foods is shifting from endcap promotions to subscription services.
So many industries are shifting to subscription services, because it's so lucrative. What evidence do we have that this is triggered by Ozempic patients??
When will I get downvote privileges on this site...
I would also gently point out the evidence for tempering alcohol only seems to be evident with people who have high BMI https://www.pulsetoday.co.uk/news/clinical-areas/mental-heal...
So yes, its worth thinking about how our economy is organised.
But the thing that is going to kneecap the US economy in the short terms are one of the following:
o Tariffs
o Cutting government spending (especially welfare)
o a steep rise in unemployment caused by government firing of civil servants
o fucking with the structure of the monetary system
o AI eliminating whole classes of jobs (taxi driving, phone centers, clerical work, etc etc)
Then again, maybe everyone being a 10 would level that out a bit?
Kids these days
I certainly don’t think Simon is preparing for this massive economic shift; I think they’re reacting to an existing trend.
> America's largest mall operator, Simon Property Group, is converting anchor stores into medical centers and wellness spaces. They're doing this because they recognize the writing on the wall.
Malls have been dying for years, and COVID felt like the nail in the coffin.
One was completely shut down in 2022 after years of decline, another lost all but one anchor and was auctioned off for unpaid property taxes.
In general this was a correction. The US ranked first in 2018 for retail sq ft per capita at 23. To put this in context, the next highest country, Canada, had 16 sq ft per person, and most developed countries sit around 3-4 sq ft per person. https://www.statista.com/statistics/1058852/retail-space-per...
[0] https://web.archive.org/web/20231006122607/https://www.bnnbl...
[1] https://www.marketwatch.com/story/coca-cola-and-pepsicos-sto...
In my entire office, there's one overweight person that I know. Out of thousands of employees. There could be more, and other cities might be different, but you get the idea.
The author intentionally or mistakenly applies some numbers to whole populations.
Keep chaining impacts while eliminating small coefficients, your end result will be off by more than a few orders of magnitude.
EDIT: I need to be more clear about my point: My BigTech office does not represent my country stats: Canada has a 26% obesity and 36% overweight adult population. Just taking those numbers, applying them to all populations is wrong.
The analysis is wrong in other subtle but important ways as well. A 25% increase in performance of an allegedly low performing group of a company would not increase the overall company's efficency as much.
That seems incompatible with the numbers that show something like 3/4 of the US population being overweight.
(And yeah, BMI isn't great, but it works pretty well with an aggregate population of sedentary individuals, which the population at large is.)
The Netherlands today are fatter than Missisipi was in 1985.
[0] https://www.cdc.gov/obesity/data-and-statistics/adult-obesit...
Homer Simpson was meant to be a fat idiot barely hanging on.
In the 40 years since the first episode he's gone to being average weight and fitness.
Economically he's now wildly successful for being able to own a house on a single income with three kids. There are people making over $800,000 today who can't afford that.
Only because they are spending lavishly on other priorities.
Two kids today are a much bigger status symbol than a 5 million dollar house.
I’m married, living in suburban California raising two of them on a single income much lower than $800,000 (much lower than 2/3 of that, too, since the hypotherical was 3 kids and I don't want that go be a distraction), I don't need to look up anything about a 1980s comparison to know that that $800k claim is sheer insanity.
> Two kids today are a much bigger status symbol than a 5 million dollar house.
No, they aren't. I mean, don't get me wrong I’d rather have my kids than the $5M house, but they definitely are not more of a status symbol than the $5M house would be.
You're doing it far worse than they are. The obesity rate in the US is something like 30%, with some regional variation.
Though treating the symptom is undeniably good, it also lets the deeper problems that lead to it go unchecked, and my fear is that it will lead to novel problems down the line. How recreational drugs are being replaced by social media is a good example of this; less harm to the body, undeniably good, but still harmful to the mind, and enabling new industries to pop up and find new ways to exploit people.
To be clear my problems aren't with Ozempic, and I believe it should be researched further and, if safe (which seems to be the case), widely available. But the fact is that many nations are able to maintain healthy weight without drugs, and I think if we fail to continue asking why that is, the same societal patterns that led to self-destructive individual behavior in the first place will remain unaddressed.
The idea that medical treatment makes us weaker is genuinely harmful nonsense on the order of claiming vaccines make us sick, and you should seriously reconsider your position here.
Do you have any concern that it's an over correction and leads to significant undereating? Which is also terrible for you. Genuine question for the record.
The US is that but for obesity. Yes, absolutely some individuals have brain chemistry that predisposes them to this.
But also maybe it's related to the cheapest and easiest forms of food being McDonald's-tier shit and 64oz beverages that are literally so much sugar that it would be unpalatable were it not dissolved in acid and carbonated?
https://www.who.int/activities/controlling-the-global-obesit...
The US isn’t even the top 9. Obesity is a global epidemic of Western disease. The food isn’t the cause, it’s the symptom of the brain chemistry. If it isn’t available, yes, the disease may not present. But if available, due to hormones causing the drive, it presents. Like cigarettes (nicotine), like cocaine, like alcoholism. Same reward center.
https://recursiveadaptation.com/p/the-growing-scientific-cas...
Are we more likely to give GLP-1s to everyone? Or outlaw calorie dense, nutrition lacking products? I argue the former, based on all available evidence.
It can be manufactured inexpensively, scales up, and will be as common as insulin or Metformin.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
> Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity.
It's not like people are eating too many plates of vegetables.
Hypercaloric overprocessed food contributes heavily to obesity outcomes.
Sure, people eating smaller amounts (of hypercaloric overprocessed food) is a win. But we should aim higher.
In the US, though, I don't mean to be super pessimistic but the problems are now so ingrained that I don't really see them improving for at least several generations. Stuff like:
1. Basically everywhere except for a few notable cities are organized around the car. Even if you wanted to walk places in a lot of towns it's near impossible or dangerous due to the road architecture. Fixing this now that it's built is an enormous challenge. I'll be long dead and gone before even a dent is made in it.
2. For decades we've been going in the wrong direction, and I don't see that changing anytime soon. I'm often shocked and saddened by how, well, "thick" high schoolers are these days. Like when I was a kid, there were certainly "fat kids", but it really wasn't that common. And we had a joke that when people went to college they would gain the "freshman 15" due to the all-you-can-eat dining hall plans. To me it looks like the freshman 15 now starts for high school freshman. And while I don't have kids, I've also heard others say how childhood has drastically changed since I was a kid. So much "hanging out", which used to be a physical activity, is now just done on phones. Except for organized sports, kids these days get much less "ad hoc" physical activity. High school is usually the thinnest/most fit a lot of people will be in their lives, and so I think we've condemned a ton of kids to a lifetime of obesity and health problems.
I'm all for changing our structural issues, but I'll take an imperfect solution now over something I don't think will come to pass for decades.
https://data.worldobesity.org/country/united-states-227/#dat...
I have to ask, why? (I'm not in the US, I should add). Like, sure, is the average American overweight? Yes. Are 80% of the top 20% of earners? Seems pretty doubtful, plenty of the rich look to be in reasonable shape.
That statistic suggests that 80% of successful people have such poor impulse control that they end up seriously overweight or obese. And I say that as someone who likes a treat every couple of days, but exercises enough to maintain a fairly healthy weight.
Admittedly if there were a GLP1 for procrastination, I'd be on that stuff like a shot...
Osteoporosis: https://www.womenshealthmag.com/health/a62282449/ozempic-bon...
Blindness: https://www.medicalnewstoday.com/articles/review-3-potential...
Stomach paralysis: https://www.webmd.com/obesity/ozempic-and-stomach-paralysis
https://www.nbcnews.com/health/health-news/ozempic-wegovy-li...
Genital infections: https://www.fda.gov/drugs/drug-safety-and-availability/fda-w...
Pancreatitis: https://healthylifebariatrics.com/ozempic-pancreatitis-sympt...
Intestinal paralysis (generally): https://www.healthline.com/health-news/fda-updates-ozempic-l...
Same, leading to colon removal: https://people.com/woman-sues-ozempic-manufacturer-colon-rem...
Depression: https://www.healthline.com/health-news/why-some-people-are-c...
Furthermore, people who say GLP-1 drugs are commonly prescribed omit the fact that diabetics are the main consumers, and their bodies probably work very different from those of normal people.
Have to wonder if people really understood the consequences, would they still allow themselves to get in that state? Then again, used to be that smoking was something 1-in-3 did, so...
Anyway, seems pretty settled that fixing T2D with GLP-1's is a lot less harmful than not, but using them on healthy people is a different story.
Imagine saying that starches have extended more lives than they have cost, without breaking down the analysis any further. Clearly the health impact depends on the quantities and patterns of consumption. This is the kind of muddling that is now happening with GLP-1 drugs.
Me too! Maybe later... <kidding>
Adderall?
The analogy for a GLP-1 agonist for procrastination would be something safer yet possibly more effective.
This might be my biggest unknown with GLP1s, how does it affect people with reward system issues — it could dramatically worsen a procrastination problem if it dampen the will to reward seek.
Then again it has only seemed to do this for vices so far
The consequences are significant health issues like obesity, diabetes and cardiovascular diseases. Healthcare systems struggle with preventable conditions while millions experience declining health and shorter lifespans. These corporations employ questionable strategies: marketing to children, lobbying against regulations, funding misleading research, and shifting responsibility to consumers.
Medications like Ozempic represent a threat to this model by reducing appetite and interrupting compulsive eating. Recent industry concerns about declining sales show how these medications could undermine their business approach. If consumers regain control over their eating habits, corporations may finally face consequences for practices that have profited from health problems for decades.
I've just never bought this.
Does grandma manipulate you when she adds sugar to her cherry pie? Does she manipulate you when she adds salt to her mashed potatoes?
Foods -- "ultra-processed" or not -- don't "manipulate" you. They literally just either taste better or taste worse. Grandma, and her grandma before her, used sugar, fat, and salt, and thank goodness they did. These are normal ingredients. It's not like they're nicotine or heroin or something.
I mean, is a fig tree "manipulating" you when its figs ripen with sugar so they'll be eaten?
You're not being manipulated. You're just choosing to eat what you choose to eat based on what you like.
Similarly, fig trees don’t make Fig Newtons. They make figs.
And the things that are different -- emulsifiers, stabilizers, natural/artifical flavors, etc. -- aren't actually making the product unhealthy, at least not in any way that causes weight gain. Those aren't sugars, fats, or salt. They're just making it last longer on the shelf, and have more flavor. But it's not changing the nutrition, and it's not making us eat more of it.
You really think Chips Ahoy is making you fat in a way that grandma's chocolate chip cookies don't?
That's my point. It's got nothing to with supposed "manipulation" of ingredients.
It's about other stuff -- whether it's price or accessibility or someone telling you "that's enough".
Drop dough into frying oil and then roll it in powdered sugar.
Drop potato slices into frying oil and then salt them.
You don't need boogeyman R&D chemicals to make food that you can't stop eating. What changed is the accessibility of these things. You can go to 7-11 and buy thousands of calories of packaged donuts for dollars. Combined with there only being junk food in US quickmarts compared to, say, cheap bento boxes in Japanese 7-11.
Isn't this what you were just arguing it was not 10 minutes earlier?
Because people don't act rationally. The model of a human as a rational actor who deeply considers all of the potential impacts of their decisions is a fiction that has been proven flawed by countless studies. Those actions can have externalities and consequences for which the public bears the cost, not just the actor.
> why is it their fault that people cant control themselves
Nobody's ascribing fault here; rather, we're trying to understand the bigger picture.
I dont believe that people who eat unhealthy food have any doubts about the effect of the food. They just dont care that its unhealthy, that isnt an externality.
> Nobody's ascribing fault here; rather, we're trying to understand the bigger picture.
The bigger picture is that more products that people enjoy is a good thing, and if some people cant handle that its not societys fault.
There are other externalities as well; for example, we still haven’t really solved the problems created by all the plastic packaging used with processed foods.
Junk food definitely is designed to abuse our natural instincts and needs, from packaging to ingredients. Go one year without processed food, you won't physically be able to drink coke or eat fastfood
I hate to tell you how much sugar grandma put in her lemonade, and in her sweet tea...
> My wife bakes cakes for 10 people with less added sugar.
That's extremely unusual. Different types of cakes take different amounts of sugar, but it's generally somewhere between 150g and 300g for an average-sized cake that might give 10 slices. That's between 3/4 and 1.5 cups of sugar. And that's without frosting or anything extra.
A cake with less than 60 grams of sugar... I don't even know what you'd call that. I mean, you'd never make a sponge cake or chocolate cake with such little sugar. It wouldn't even taste like cake. It would be more like a slightly sweet... bread?
Because sugar also greatly affects the texture of cake -- it retains moisture, prevents gluten formation, incorporates air... reducing sugar by 75% is going to make for a very dry, tough, and dense cake.
I can't even imagine how you're going to make a cake recipe work with 75% less sugar. And it's not an American thing -- it's not like European cakes are any different. Also, cakes don't work with 4x sugar either. Americans aren't overloading sugar that you need to compensate for, because that doesn't work for cakes either.
Are you sure you haven't confused it with just simply less frosting or something? Because a 10-slice cake with less than 60 grams of sugar just isn't really going to work, with everything I know about baking.
I can't eat cakes from coffee shops &co because they taste waaaaay too sweet.
You're just extremely sensitive to sugar. The average person is not.
But also, that's not necessarily an adaptation. I went for an entire year once without sugar. Once I went back (after finishing losing weight), nothing tasted overly sweet. It still tasted exactly as I remembered. I could (and can) still drink a Coke and it tastes great.
I mean, especially when I work out, I wind up ingesting a lot of glucose. It's just what my body needs to fuel itself, to keep my blood sugar from getting too low.
Then I must be extremely sensitive to sugar, too.
Manipulation implies a purpose, so I’d say no. Does grandma have an ulterior motive? She adds sugar to express herself through the art of baking or does she need a favor?
> I mean, is a fig tree "manipulating" you when its figs ripen with sugar so they'll be eaten?
..Yes?
Is plain old sugar, animal fat, and salt unhealthy in large quantities? Of course, but eating grandma's mashed potatoes and cherry pie once a week will not materially affect your health. Meanwhile you pass 8 taco bells on your way home from her house, not to mention the 3 fast food ads you heard on youtube or the radio. Come on.
It's not the food itself. The food isn't being "manipulated" in some sinister, unnatural way. It's not about supposedly addictive "dopamine pathways".
It's other things, whether convenience or advertising or whatever.
> > Big food corporations profit from ultra-processed foods that manipulate our natural systems.
> I've just never bought this
Yours is a rather strange reading if you truly mean to absolve the food of sinister intent. Clearly it has none.
Nor must the corporate entity producing it. That's the nature of moloch. You get bad outcomes even without outright villainy on anyone's part.
The food is being "manipulated" in the same way Grandma manipulates it, sure. Grandma bakes a pie from whole ingredients, sourced perhaps from an area farm or maybe even her backyard, with her bare hands. Show me how a Twinkie is made. The naturalistic fallacy is irrelevant.
It is simply wrong, not to mention naive, to think companies do not optimize their products to maximize impulse/repeat consumption. They are most certainly aware of dopamine pathways. This is one, and indeed a big one, of those
> other things
you mention. Convenience and advertising are big ones too. Why do we need so much convenience, and see so much advertising? Perhaps it has to do with the ordering of our lives around the very sort of institutions that sell us ultra-processed foods.
Manufacturers design foods to taste good, not for some secondary effect of sugar in the stomach.
The idea that the sweetness would be "unbearable in your mouth" is just plain silly. People suck on lollipops which are pure sugar -- are those "unbearably" sweet? What you're saying doesn't hold up to even the slightest scrutiny.
Manufacturers aren't going to waste money on additional sugar and then try to undo the taste with other ingredients. That's not a thing.
It details many Concrete examples of exactly how the companies are manipulating everything about food for profit.
Kessler, further FDA head has written about this topic extensively as well.
People are having fewer children.
Fewer miles are driven to fewer offices for fewer trips in cars.
Fewer impulse buys are being made and fewer dollars will be made by advertisements (according to the ops conjecture).
This is not inflationary. It is the opposite.
We live in a deeply deflationary world and we should not be confused by the local, transitory inflation that we may be experiencing at this moment.
Also we are having fewer children, does this drug reduce also the impulse of having sexual desires? In that case that would be even worst.
But who do you give it to? Well, obviously, you give it to billionaires because they are the best at managing money because they're billionaires. They can then spend it on wages, without having to produce anything useful because they are just getting free printed money.
>- Retail spaces becoming venues to "try before you subscribe"
>- Restaurants becoming "social nutrition centers"
>- Shopping malls converting to "wellness districts"
Except for resturants, all of these have had problems for a long time. People have been talking about the death of shopping malls since the 90s.
Feels like other factors are in play here.
> Nike is shifting from "Just Do It" impulse messaging to long-term wellness partnerships
My read of "just do it" is actually the opposite. It's a message to dedicated athletes about not making excuses end executing.
Wouldn’t be easier just to look what happens in countries with low obesity rates? Certainly its good but doesn’t appear to be 100T good.
The constant access to unlimited tasty food we have now is completely unprecedented in human history.
Other animals will also overeat if you give them unlimited access to tasty high calorie food.
This is absolutely a situation we did not evolve to be able to handle unfortunately. Lack of sufficient food was the norm for most of our history, so it's not surprising that we evolved to want to eat a calorie surplus if possible.
In any case, I hope they're directionally correct. A class of widely-available drugs that lets us switch off impulses that don't suit our environment and wellbeing any more would be incredible and world-changing. I'm very curious to try GLP-1 agonists myself.
This sounds a lot like numbing "bad" feelings to me; there's no way to selectively numb, it's all or nothing.
Impulsivity isn't all bad.
But is it worth giving up your impulses? I mean all of them.
I have no proof that's how it works long term, but I do feel the question should be asked before we dive in head first.
I can still get a wild idea at 9 pm and lose myself in code. I still see flowers and buy them form my wife without planning. I still have a bowl of ice cream before bed sometimes.
The best way to describe it is that you still have the impulse, but you are able to rationally consider it.
If that's where your most powerful impulses are, that's where you're going to notice the difference.
Of course, with the shortage of geriatricians, most seniors are unlikely to find this out.
Are we just a bunch of NPCs waiting for the orders? One day it's McDonald's selling you the disease the next it's Novo Nordisk selling you the cure, and you apparently have to clap at that "miracle"?
But it's definitely done something to my non-food behaviour, albeit I'm not sure what exactly. It may well be that I was previously trying to satiate my constant desperate hunger for food with other forms of harmful addictive behaviour, and without the hunger, I just don't need that as much. The concept of satisfying one craving with another isn't new, after all.
The effects don't have to be dramatic to be harmful, subtle over time is arguably worse.
I just hope people keep their eyes open, that's all.
There are a lot of people who are sitting in front of a computer or a phone playing Roblox/Fortnite and watching TikTok and so on all day and night.
The economy evolves and will work around them…
I suspect his projections on the impacts these drugs will have on crime rates and alcohol consumption are probably also overblown. I could be wrong, but I would think that the sorts of people who seek out prescription drugs for impulse control aren't likely to overlap with people who drive drunk in the first place.
The anecdote about the lost muffin revenue was still quite interesting.
> I don't see why you would assume there's little overlap between people who desperately want to lose weight and people who drive drunk.
This is only a hunch, but I would guess that drunk driving is associated with low conscientiousness and that the sorts of people who are going to go through the trouble of getting medicated to lose weight are unlikely to be the sorts of people who drive drunk in the first place.
Maybe I was misinterpreting the point he was trying to make.
Drunk driving is associated with low impulse control due to being drunk. Being drunk might be associated with the kind of lack of impulse control that ozempic targets.
Don't worry there will be tons of complementary businesses like overpriced healthy food megastores and countless gyms that will absorb unemployed workforce and all that 'suddenly available' cash. Junk food is cheap, quality tasty healthy one not so much.
This is in the vein of “we eliminated a massive category of accidental deaths? But… but then what about the organ waitlist?”
The pride associated with having a body shape that a well trained Ai would classify as Manatee rather than Human is rapidly changing and _eventually_ society will be better off for it.
Also everyone is getting fatter. America is just 30 years ahead of most of the rest of the world in terms of obesity.
Take whatever country you care to name and the population of that country 30 years ago would call the population today lard-asses.
https://ec.europa.eu/eurostat/statistics-explained/index.php...
- Semaglutide just came off the shortage list [0], companies won’t be able to compound it for long
- generic Liraglutide exists, and is about half as effective
- patent expiries vary[1]
[0]: https://glp1.guide/content/semaglutide-removed-from-shortage...
[1]: https://glp1.guide/content/another-generic-liraglutide-launc...
https://glp1.guide/content/patent-expirations-for-glp1-recep...
The current retail cost in Canada is ~$160 USD per syringe for Ozempic.
That's $277-$425 in USD
Perhaps in non-US locations it will be that cheap for sure.
If Jerry is a body builder he can get to whatever body fat % he wants.
If Jerry wants to save money or doesn't want to wake up early hungry he can do that too.
If Jerry has religious beliefs about impulses coming from shaitan, he can get rid of them.
Besides, 75% of Americans are overweight/obese that's pretty much everyone.
> Imagine two employees. One can afford these medications, the other cannot. One has regulated impulses, higher energy, better focus, and lower healthcare costs. The other doesn't. In a few years, data shows the first is three times more likely to be promoted.
> Scale that across society.
I'm not sure this is a reasonable worry. Ozempic is going out of patent in less than a year's time. There will be cheap generics all over the place. Purportedly the drug has a very low unit cost and uncomplicated manufacturing process, and every potential generic manufacturer knows it'll be a huge hit. That means we should expect it to rapidly become a commodity that's quite available.
If it really does cut food, alcohol, and cigarette costs so dramatically then I suspect a decent amount of poorer people would budget for the drug even if it didn't become cheap. It's not like poor people don't buy food, alcohol, or cigarettes today -- if it's a net savings and health/life improvement, it's even more worth buying than the alternative.
Literally, the only reason any compounder today (that is brave enough) can produce Tirzepatide or Semaglutide is because the FDA has promised to not pursue legal action for a short period to enable people to find other solutions.
Prices are about to go back up/a bunch of options are about to leave the market. See: Novo Nordisk's share price/related news.
https://glp1.guide/content/patent-expirations-for-glp1-recep...
Again this is not great news but if you zoom out it’s amazing that obesity might be a solved problem basically completely in like 10 years.
Obviously GLP1s don’t work for everyone but they work for a lot of people, maybe we can focus the remaining resources on a smaller group of people with greater struggles
It seems that with food, I often don't like the taste or texture, or the sensation associated with eating. I also tend to feel full relatively quickly.
My solution was to make a shake - in this shake, I put a large amount of olive oil, mixed in with other ingredients which cancelled out the taste. Easy to consume over the day.
Over several years of having the shake, I got to a weight I'm happy with. I'm now in total control and can regulate my weight simply by adding or removing the olive oil in my shake. Over the past year I've started weight training 5 days a week and adding protein to the shake with good results.
When I go on holidays and don't have access to my blender, I reliably loose a bit of weight - probably the opposite problem most have when they go on holidays.
I'm also non drinker. Never really got on board with alcohol, didn't like the sensations of the effects.
I still eat normal meals much the same as before, just a smaller serving than what most others have.
(Lost ~35 lbs before tirzepatide, ~50 more lbs on it)
Drugs are not like a smartphone. There is no reason to believe you can improve on them (except on price)
So by definition, if they ever consider a "new generation" of GLP1-agonists, they will be better by definition.
Drug companies are trying to improve on Ozelympic.[1] The big win will be when somebody comes up with a pill form rather than an injectable.
[1] https://qz.com/novo-nordisk-eli-lilly-ozempic-wegovy-weight-...
Some of Silicon Valley's excess productivity over the rest of the world is driven by ADHD medication. Curious what happens when they also start taking GLP-1 medication.
as another person mentioned in this thread about people already combining glp's with other drugs, i can see scenarios in which some people abuse glps with adderall or even pain killers to become literal zombies - foregoing breakfast/lunch breaks, working longer hours... imo it could establish an even greater work demand from companies (implicitly) where if you're not on it, you're not "trying" hard enough.
Is there any data to show they have an effect on other addictive behaviours, like drug addiction, social media addiction, caffeine addiction?
Then I got sick…
I couldn’t eat anything with fat. Just the thought of it made me physically ill. I ended up dropping half my body weight in 18 months.
What I learned is that it is possible to break your body in many ways.
I didn't need a drug to reject having breakfast at Starbucks. I bake my own bread. I wake up early to have time to eat it in peace. I take enough time to roast my own coffee beans. I commute by bike.
It's about having some standards. A concept of a lifestyle and person that isn't just a corpo drone.
Saxenda + a calorie restricted diet is pretty much the best combo. Can't complain, never felt any better.
What on Earth are Americans doing to themselves?
I understand that ic certain cases these drugs may be useful, but as a replacement for proper food and health care?
Eat better, move more, it sounds like a full blown systemic health crisis
That said, these are definitely serious drugs and I wouldn't be taking one if my quality and length of life weren't threatened by metabolic syndrome, and if I hadn't been trying for decades to solve the problem without medication.
GLP-1 Agonists, Senolytics, NMDA Modulators, Hormones and Peptides, NAD+ and mTOR Modulation, Nootropics and Adaptogens…
Forget weight loss. These people are going for immortality.
Does anything else you mentioned?
RCT-Proven: GLP-1 Agonists, mTOR Modulation (Rapamycin), NMDA Modulators (Ketamine), Metformin.
Speculative/Limited Data: Senolytics, Hormones and Peptides, NAD+, Nootropics and Adaptogens.
Keep in mind that the absence of published RCTs does not mean an intervention is ineffective; it may just be proprietary knowledge. Plenty of rich, private labs out there doing that kind of work today.
You order out you just order healthier. Healthier food is more expensive than junk food.
You buy an expensive bike. More clothes.
Healthcare is still expensive because people get older and older people need more care.
You've replaced one drug with another. Freud would be proud.
> If you told someone in 1850 that air conditioning would reshape the global economy, they'd think you were crazy.
This is incredibly misinformed. You've lived /with/ refrigeration and /without/ malaria for so long you have no Earthly idea how people in the opposite state lived their lives or saw the world around them.
> We're discussing the first medication that effectively regulates human impulse control. Think about that.
It has side effects. Think about that.
> The significant economic impact occurs in the second and third-order effects.
Yes and many of them will be negative. This is hyper futurism with zero grounding in the past. This is extremely lazy writing.
"you replaced this drug with hundreds of known downsides with one that has none"
Nice nonargument for the rest of your post. It's somehow misinformed to state the fact that the southern manufacturing industry simply cannot exist before air conditioning
Frankly your attitude is evil and you are a proponent of evil.
I can't understand this type of thinking. Of course it has downsides. You are being extremely disingenuous to say this. Let alone not acknowledging that different people experience different side effects. Plus you're completely ignoring the /reasons/ why people drink in the first place and abandoning any effort to impact those. Do you work for the company producing this drug or are you genuinely this gullible?
> your attitude is evil and you are a proponent of evil.
So you label things you don't understand as evil? What is this meant to accomplish?
If you really believe what you say then why aren't you pressing for the drug to be free? For free consultations to be given out? If it's truly this magical then it's very irresponsible to let a for profit company own it, sell it, and market it. Isn't it? Wouldn't that actually be evil? To champion this cause merely to make money for a patent holder?
You diminish these terms in your careless use of them.
First, those in power rebased the diet of the masses to carbs. Consequence: an eternal epidemic of obesity, with the many known complications and illnesses as a result.
Then, they now try to remedy the problem by fucking with the human body's mechanisms. 100% guaranteed to cause terrible side effects, in the long term. It's always more complex than you think. The more coveted a "medication" for a societal problem is -- with the problem being the pigswill that is fed to the masses, and our absolutely terrible sedentary, movement-less lifestyle --, the more quickly it will be greenlit, and the greater damage it will do over time (those pesky "unknown unknowns"). The hubris of human industry is unlimited; here's one example:
https://en.wikipedia.org/wiki/Thomas_Midgley_Jr.#Leaded_gaso...
> On October 30, 1924, Midgley participated in a press conference to demonstrate the apparent safety of TEL, in which he poured TEL over his hands, placed a bottle of the chemical under his nose, and inhaled its vapor for sixty seconds, declaring that he could do this every day without succumbing to any problems.
Here's another:
https://en.wikipedia.org/wiki/Thalidomide_scandal
And the list goes on and on.
The obvious solution to the obesity epidemic is to dismantle the food industry and the 8 hours workday. Our eating and movement/exercise habits need to revert to not just pre-industrial, but pre-agricultural standards. Move a lot every week (at least on 4 days per week), welcome hunger back into our lives (hunger allows you to appreciate and enjoy simple food -- intermittent fasting is amazing), and eat food with high volume, but low calorie content, and/or with low glycemic index. Our stomach volume and our blood sugar control had evolved for those types of foodstuffs, yet due to said rebasing of the diet of the masses to carbs, we've been filling our bellies with artificial food that's hyper-charged on calories and that get absorbed immediately. That's the recipe for growing fat tissue.
Two wrongs don't make a right.
And a final comment:
> Analysts predict that by 2030, 30% of American adults will be on these medications
Why doesn't that prediction make everyone shit their pants, from fear? Do you really want to make all those people dependent on Big Pharma just so they can eat healthily? How more basic do our bodily needs get than that?
This meds are pure evil, they're a non-answer, they're a cop-out, they only transfer power from Big Food to Big Pharma.
This is the same shit as trying to "cure" society-wide depression and anxiety with drugs. It only suppresses (or replaces) the symptoms, without fixing the root cause. We're depressed because our engineered societies make our lives meaningless. The struggle for survival is real, and the universe is unfair and indifferent, so we certainly need society, to cope with that. Just not this way.
> tetraethyl lead was known to be acutely toxic by those involved in the development of leaded gasoline. This included Midgley, who publicly insisted that there was nonetheless no health hazard posed
W.r.t. making people dependent on big pharma:
I have multiple allergies and although the drugs I take have side effects, I would not function without them ~8-10 months of the year (where I live, the pollen season is expanding with global warming).
I am somewhat dependent on big pharma for quality of life, but the alternative is strictly much worse for me.
I know it is a more mature type of drug, but the automatic kneejerk reactions against “Big Pharma” is unwarranted IMO.
There are rotten apples everywhere..
Is this another numbing zombie drug, like over-prescribed anti-depressants -- that some people genuinely need, but that make some other people accept a situation that they would otherwise be up to challenging and improving?
Also, are there side effects than can make it backfire for any patients? https://en.wikipedia.org/wiki/Reaver_(Firefly)#Origin
The hyperbole is just painful to listen to
Apparently in most muslim households this drops to 100% or zero consumption, you don't need freaking drugs for that
> 8.5 million jobs at risk
And it's a problem: 8.5 million working diligently to make the world less efficient, less healthy - generally less up-to-speed - is NOT a good thing. It's not something to long for. It's not something to protect through ... what? forced impulse buying? or other subsidies. It's something to change urgently - or at least get ready for. (And some of the businesses mentioned do think about it.)
Still it would be nice if society - in particular the US - put some effort into succeding at these transitions. These transitions do not need to be "one day you have a job, the next you don't and good luck". For one thing these transitions are never sudden - they have 5-10 years thereabout. For another there are options, "illegal to fire" (France, insane), "work or train" (Denmark is it?, admirable idea), "ease of starting and running new businesses" (various countries, the US not in the lead). By contrast, we regularly see indefinite term subsidies, and minimal education / training planning.
https://john.kozubik.com/pub/IcebergArticle/tip.html
... which is intended to present detailed, long-form treatments of a subject yet, at the same time, provide something interesting and actionable in a brief moment.
Because it's so thin, anything longer than 12 words becomes a paragraph which "slows" the reader, so there are a lot of punchy short sentences. This style would look silly if it was written on a wider left-aligned blog.
Alternatively, when I see the old-school blogs that fill the entire page-width, I get the instant feeling I'm about to read something opinionated and quixotic.
Sure enough, the last HN article with that style hit it-- let's rescue the web by sending around WASM-blobs to be rendered to a common Wayland-like compositing surface. Thanks again, default CSS!
A lot of catchy one liner hook sentences ("they're literally removing concession stands from NFL stadiums!") that sort of add up to make the author's point.
I'm pretty sure fact checking line by line will make the whole thing less impressive.
Everything has to be distilled down to ~200 char chunks that can be understood on their own as well as within the wider context.
EDIT: under the assumption of an average person who is not under any medical condition that may result in lack of willpower
Despite having a prescription, CVS told me that my insurance wouldn't cover it and it would cost $1500 for 30 pills. I walked away and then went back to buy it. If I could just get 30 additional minutes of billable time per day per pill it would be worth it.
I took about 5 over a week and destroyed the rest. It wasn't good for anything but keep me awake in a semi-zombie low-creative state. This very expensive drug/lesson was effective and making me realize I need to seriously work on my impulse control.
The point being that we all have different brain configurations which cause our behavior. Some we call tumors. Others are "normal". Your definition of "medical needs" is where the interesting meta-discussion takes place.
Food can evoke the same neurochemical response as hard drugs or sex for some people. It is even more readily available than either of those things, and it is advertised and produced by multinational conglomerates with huge advertising budgets. They have the resources to maximise the attractiveness of their products and optimise the way they taste to be as pleasurable to eat as possible. Usually that means filling them with terrible ingredients.
It's not much different than social media. People get addicted to social media because they don't stand a chance against social media companies that employ an army of people to optimise every facet of their product for addictiveness.
Modern lifestyles are more sendentary than they used to be, and that plays a part in the explosion of obesity, but so do the conglomerates that produce the junk food.
100% free and he doesn't have to rely on a magic pill now that he understands what's going on.
When people are educated and motivated you can bring them wherever you want. Nutrition has to fit in the greater picture, if you're obese and addicted to shit food you most likely have much bigger problems in life, usually fixing the root causes unlocks the rest.