The Nittany Turkey

Your health-conscious Nittany Turkey is back atcha with another week of medical frivolity, pharmaceutical love/hate, and whatever else crosses my mind. I’ve just passed the one-year mark both taking Mounjaro and writing these updates, which center on that GLP-1 receptor agonist drugs and more specifically, tirzepatide, whose trade names are Mounjaro and Zepbound.

Via Mounjaro therapy combined with lifestyle changes in diet and exercise, this 78-year-old Type 2 diabetic has controlled his blood sugar, most recently scoring a 5.3% HbA1c, which deliciously makes my doctor jealous. “It’s lower than mine!” he exclaimed at our last encounter. Mounjaro has allowed me to eliminate metformin and halve my dose of losartan, a blood pressure control drug. Along with Mounjaro, I credit my amazingly supportive wife, my friends, you readers, and from time-to-time, my healthcare team (when I’m not bitching about them).

Nevertheless, along with the positive strides, there exists an omnipresent background reality of a near-octogenarian body that has seen better days. While I might be accused of over-sharing some personal health information, I know many of my readers either have endured similar health travails or will do so at some point. I hope that by providing TMI (too much information), I’ll help someone, somewhere. Plus, I love to write, and my expository efforts here provide a safety valve that helps me deal with the stress of living inside an unpredictable, old body.

Weight Loss: The Good, the Bad, and the Ugly

Over the year on Mounjaro, I have lost about 72 pounds of excess body weight. However, the most recent eight or ten of those pounds were unplanned and undesirable. I wanted to stop losing weight while concentrating on retaining or even building skeletal muscle. Thus, I had increased my caloric intake, especially the protein component, and I have been doing copious strength training workouts The plan was working well, with my weight hovering in the low 180-pound area until last weekend, when I suddenly dropped eight pounds, inspiring my latest visit to the fabled Dr. DeLorean (not his real name). I’ll talk about that visit, its sequels, and my busy week ahead in healthcare after our featured article.

In This Week’s Issue…

Rapid weight loss causes not only fat loss but also loss of muscle tissue. Coupled with sarcopenia, the muscle loss associated with aging, the results can be catastrophic for older adults. Heretofore, the remedy was strength training and increasing protein in the diet. This is a big problem for a couple of reasons. First of all, primary care physicians obsessing on the weight loss aspects seldom stress the crucial need to preserve muscle mass. Patients, too, become enthralled by decreasing numbers on the scale, in their euphoria not considering the possibility of collateral damage. When that realization arrives for some of them, it could be too late.

Although I have reservations about prescription drugs addressing all our body issues better than natural methods, I found the subject we’ll cover this week exceedingly interesting, especially for those of us who focus all our attention on weight loss. What if we could lose fat and gain muscle? Is that even possible. Well, saddle up and let’s take a ride through the monkey jungle to the confluence of the Trevogrumab and the Garetosmab, which define the fertile crescent of astounding pharmacological research.

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This Week’s Feature: Of Monkeys, Muscles, and Multinational Mischief

If you’ve been paying attention to the rapidly mutating landscape of weight-loss medications, you might’ve noticed that the latest shiny objects aren’t injectables, but injectable combos. And now, courtesy of Regeneron Pharmaceuticals, Inc., of Tarrytown, NY—who incidentally just pulled off a genetic database coup by acquiring the remnants of 23andMe—we’ve got a new pair of biologics in the spotlight: trevogrumab and garetosmab.

These two monoclonal antibodies are being studied in tandem with semaglutide (yes, that semaglutide, the generic name for Ozempic and Wegovy) to address the elephant in the examination room: muscle loss during rapid weight loss. As I have mentioned ad nauseam, it is a huge problem especially with GLP-1 drugs, where dieters lose weight fast but unfortunately lose a decent chunk of lean muscle in the process. So, Regeneron’s idea? Inject something that blocks muscle breakdown and perhaps even builds muscle, while semaglutide peels off the fat.

Monkey See, Monkey Gain

The inspiration comes from preclinical studies on obese monkeys, where combining semaglutide with trevogrumab and garetosmab not only reduced body fat but also increased skeletal muscle mass. Yes, you read that right—those lucky macaques lost weight and gained muscle, a metabolic unicorn if there ever was one. Try pulling that off at your local Planet Fitness!

So, what exactly are these mystery drugs?

• Trevogrumab is a monoclonal antibody that blocks myostatin, a protein that acts like a brake on muscle growth. Inhibiting it gives muscle tissue the green light to grow. Think of it as the anti-sarcopenia serum we’ve all been waiting for.

• Garetosmab targets activin A, another protein that suppresses muscle growth and promotes inflammation. Blocking both pathways theoretically amplifies anabolic signaling while dialing down the catabolic stress signals that GLP-1s may unintentionally stir up.

Together, this tag team may not only protect muscle mass during semaglutide-induced weight loss—but potentially reverse the muscle decline altogether.

Big Pharma’s Duality Dance

Now, before we break out the syringes and protein powder, remember: this is Regeneron. The company that gave us pricey eye injections and COVID monoclonals—both highly effective, mind you, but also wallet-vaporizing. So it’s no surprise that this muscle-preserving magic cocktail is currently sitting in Phase 2 clinical trials, with human results likely a year or two away. If Phase 3 goes smoothly (and that’s a big “if”), expect FDA filings around 2027 or 2028.

And pricing? Take a guess. If semaglutide alone can run $1,000+/month and a single monoclonal antibody like garetosmab (once studied for fibrodysplasia ossificans progressiva) is priced in the $300,000/year neighborhood—well, you do the dystopian math. Pairing two such drugs with a GLP-1 will likely result in a monthly bill much larger than your Social Security income and your Tom Selleck-approved reverse mortgage combined.

The Muscle Mass Mirage

Still, for a subset of patients—think elderly, frail, or cancer-cachexia cases—this combo therapy could be revolutionary. For the rest of us trying to keep our biceps from dissolving into batwings while on semaglutide or tirzepatide, it may be the ultimate carrot-and-stick routine… assuming your insurance company doesn’t laugh you out of the pharmacy.

Of course, for those of us who don’t mind some hard work, there’s always a cheaper alternative: lift weights, eat your protein, and maybe toss in some creatine. No prescription required.

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My Week on Mounjaro

So, as I mentioned above, I visited Dr. DeLorean on Tuesday with my tale of rapid weight loss and feelings of malaise. He did some blood draws: a CMP, CBC, and iron, as well as a urinalysis, and ordered an abdominal/pelvic CT scan and a chest X-ray, which I have scheduled for tomorrow. The blood results revealed an elevated white cell count, especially monocytes, so something is going on in there.

I still feel like crap, although I have been trying to keep up with strength training, much to the chagrin of my lovely wife. (But like she often exhorts to me, I’m not a princess). So, we await results of the imaging for more clarity on what ails me. From my point of view, my damn digestive tract is the root of all bodily evils, so I firmly believe that the answer will be found there. It might be bad or ugly, but it likely will not be good.

However, there was some good news in my lab report. The potassium spike noted on my May 17 blood work proved to be an anomalous blip. Potassium is back to normal.

Stacking It Up

I started physical therapy for my bum knee last Wednesday. I’m supposed to do that twice per week, but I scheduled only through today for a couple of reason. For one, this morning, I’m seeing a general surgeon to evaluate my inguinal hernia. My intent is to have it surgically repaired before it becomes a medical emergency. However, my schedule is a mess. The CT scan and Chest X-Ray results will bear heavily on my decision. I will not speculate on anything until I have digested them. As I mentioned above, I might or might not be able to schedule the six weeks of physical therapy I was prescribed, given the recovery time for hernia surgery, which will also impinge on my planned August road trip. So, albeit with a foreboding sense about the CT scan, I look forward to attaining more clarity as the week progresses.

I covered Monday and Tuesday, but the medical bullshit does not end there. On Wednesday morning, I will have YAG laser surgery on my left eye. Three-and-a-half years after cataract surgery, I have developed some cloudiness of the rear surface of the lens capsule, which is a common sequel. The YAG laser is a specialty tool that zaps the film and cleans up the visual field, not that all my floaters will go away or anything, but the cloudiness will be gone. For how long, no one knows.

Whew! About time I get to the numbers for the week, which are anticlimactic in comparison to the excitement of chasing around from medical facility to medical facility while waiting for results, which I’ll share with you in next week’s exciting update.

The Mounjaro Numbers, Already!

Given my unexplained weight loss, abetted by my appetite suppressing malaise, I have been eating opportunistically, not watching carbs. Thus, the glucose is a bit higher than I would like, although the weight keeps dropping.

Body weight: 173.6 lbs (78.9 kg) —  down another two pounds (0.9 kg) with no explanation
Average fasting glucose: 104 mg/dl (5.8 mmol/L) — would like it to return to the 90s
Average overall glucose (Stelo biosensor): 108 (6.0 mmol/L) — steady, all things considered.

Bonus Info: It Wasn’t the Coffee!

Remember Week 51, when I described a glucose spike I attributed to my morning coffee? Well, friends, I found the true reason for the spike, and it wasn’t the cuppa joe. Coffee does produce what can be described more accurately as a slight hump, but as it turns out, the spike was from the damn supplements I take in the morning before my coffee. Because of the Mounjaro Effect, I take a fiber supplement. I also take probiotic and magnesium supplements. I’ve been buying gummies without paying attention to the carbs. Well, friends, it turns out that all three supplements contain significant amounts of sugar and pack a combined 20g carb punch every morning. They were the culprit, not the coffee.

Conclusion: Of Science, Supps, and Sarcopenia

So there you have it—another week of GLP-1 rumination, medical spelunking, and simian steroidal envy. We began our odyssey deep in the metabolic jungle, where macaques on miracle meds defied the laws of thermodynamics and gained muscle while shedding fat. Meanwhile, back in the human world, I’m losing weight whether I want to or not, fighting off sarcopenia like it’s a rogue AI, and booking more appointments than a celebrity dermatologist during Oscar season.

This week brought a sobering reminder: weight loss without muscle preservation is a fool’s bargain, especially as we inch toward our eighth decade (with or without dignity). Whether future drugs like trevogrumab and garetosmab will be the golden ticket—or just another pricey detour on the road to “better living through chemistry”—remains to be seen. In the meantime, I’ll stick to my current stack: sweat, protein, creatine, and sarcasm.

Next week, we’ll parse scan results, ponder potential surgery, and maybe even exorcise that cloudy lens ghost with a well-placed YAG. Until then, stay skeptical, stay strong, and please—check the damn carb count on your gummies.

For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.