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Comment by robotnikman | Hacker News Reader

I've been thinking of trying GLP-1's since I have not been able to put off the extra weight I've gained since covid. I'm in my 30's now and I feel like around this age I am starting to feel the effects of this extra weight on my body.

What is HN's experience with using GLP-1 inhibitors, for those who have used them? I've heard of side effects like bone density loss, but I've heard those side effects are caused by taking too large of a dose.

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Bone density loss is a side-effect of losing weight. GLP-1s cause you to lose weight. You counteract that the same way you counteract it during all weight loss: Each day, eat 0.36 grams of protein for each pound (lbs) of healthy or lean body weight (i.e. you don't need additional protein for your excess body-fat, so use lean/or hypothetically healthy weight). Exercise inc. resistance training. For example if you would be 180 lbs at a healthy weight for your height, eat minimum 65 grams of protein.

Both of the two available GLP-1 have similar side effects, with Tirzepatide being lower at an equivalent effect dose. Their common side-effects are: Nausea, vomiting, diarrhea, and indigestion. With rare serious side-effects being: Pancreatitis, allergic reaction. thyroid cancer, and acute kidney injury.

Generally speaking the common side-effects are dose-dependent. If you suffer too much, you back off the medication until the side-effects are at a level you can manage. This is common.

So basically eat a high protein diet and do some weight lifting, that doesn't sound too. Thanks for the insight.

I've been on a low dose for a year. I've lost 25kg (60 lbs) without much effort. Yes, it definitely dulls my appetite, and if I want to have a nice meal, I need to plan ahead for several weeks so that I have it _just_ before my next injection. There's also the fact that I didn't realise how important snacking was to my mental health. Since I don't have that, I've had to find other ways to boost my mood.

As a brief summary, it absolutely delivers what it says it does. I've lost weight as it claimed due to appetite suppression and feeling fuller longer. However, it's more complex than that, and the battle to ensure I get enough protein has been tough.

> I didn't realise how important snacking was to my mental health

Could you expand on this?

Not OP but eating is often used to distract or alleviate uncomfortable feelings like boredom, anxiety, etc.

> Since I don't have that, I've had to find other ways to boost my mood

I have a similar issue, what did you come up with?

The bone density and muscle wasting are a product of a calorie deficit without protein or weight training. You'll see the same effects without GLP-1s if you just diet and don't actually lift.

As confirmed by DEXA scans, I maintained my (very high) bone density and actually put on about 3lb of muscle over a 2-month period on low-dose GLP-1 + a GHRH, while losing about 16lb of my most stubborn fat, including visceral fat that I hadn't been able to crack. I'm in my 40s, and my routine includes weight training, a high-protein diet, and Brazilian jiujitsu.

My approach is minimum effective dose as an amplifier to a good diet and active lifestyle, and it's been pretty damn effective. Primary effects are an effortless relationship with food - the "itch" I used to feel to eat constantly is pretty much gone, and the psychological pain of not eating things is more or less nonexistent. I did a 36 hour fast just to push it a bit, and it was trivially easy.

Side effects include an elevated heart rate (~5-8bpm, in my case taking me into the low 60s at rest) and sweating all the time, both of which are almost certainly due to the glucagon agonist's thermogenesis effect. No problems with constipation, though stools are harder (comparable to those on a keto diet, in my experience). No particular ill effects otherwise. n=1, YMMV.

Constipation and nausea.

You won't want to eat much, and if you do try to eat a full meal (if for example you went out to eat) you'll feel like crap for a few days.

But yes, otherwise it works as advertised.

To be clear, that is the advertised effects, not the side effects. The idea is that if you over eat you feel terrible, but also you won't want to overeat since you'll be full.

> I have not been able to put off the extra weight I've gained since covid.

What have you tried ?

Intermittent fasting, lifting, calorie counting. The problem is that I am only able to stick to those maybe for a few weeks at a time before I get off track and end up back where I started. Except with weightlifting, I was able to stick with that for a few years, but unfortunately you can't outlift a bad diet. My relationship with food has never been a healthy one, and it's been that way ever since I wad a kid.

I highly recommend trying CBT. In particular the app Noom was excellent at (permanently) reframing my relationship with food.

I've never heard of that app before, I'll take a look at it.

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