Peptide Purgatory: Abandon All Protocol, Ye Who Enter Here

Such a Divine Comedy, Already!

A new title? Indeed. We now embark on Peptide Purgatory, a sacred holding pattern somewhere between Big Pharma’s hellish vision of eternal injections and the lean-muscled paradise of metabolic independence. Move over, Dante — there’s a new allegorist in town!

After 58 weeks treating my Type 2 diabetes with Mounjaro—or, if you prefer a more classical structure, seven cycles through the deadly sins of pharmacologic overreach—I’ve decided to stop counting. Weekly numbers were starting to feel like medieval penance: flagellate thyself with syringes, track thine macros, log thine glucose, and await absolution from the Endocrinologist-Inquisitor.

But unlike Dante’s weary soul climbing Mount Purgatorio, I do not seek cleansing by perpetual injection. I have reached the Terrace of Sloth (a.k.a. the drug pickup line at Publix), and I choose to climb out. Mounjaro has done its work—my A1c is down from 7.6% to 5.3%, and I’ve evicted 70 pounds of excess baggage—but the rest is up to me.

Big Pharma would prefer a different script, of course. They preach that obesity is a chronic, relapsing disease, with the sacrament of treatment being monthly copays and eternal syringes. This theological framing justifies lifelong pharmacotherapy while conveniently ignoring our debauched food system, sedentary lifestyles, and the collective national allergy to deadlifting anything heavier than a venti caramel macchiato while curling a chocolate frosted jelly doughnut.

In their gospel, there is no salvation outside of Novo Nordisk and Eli Lilly.

Well, I call blasphemy.

The real sin isn’t in the syringe—it’s in pretending it absolves you from doing the work. In my case, that meant ditching booze (although chronic, erosive gastritis provided the initial strong incentive), cleaning up my food, and embracing resistance training as if my post-arthroplasty hip depended on it—because it kinda does. Strength isn’t vanity. It’s survival. And at 78, I’m not chasing aesthetics; I’m chasing autonomy.

Make no mistake: I’m grateful for the GLP-1s. Mounjaro helped me reorient, recalibrate, and climb out of metabolic limbo. But it also deleted some muscle, delivered a few digestive curses, and dangled seductive lies about “easy weight loss” without consequences.

Now, I’m working toward the summit: discontinuation. I’m down to minimal meds, living leaner, lifting stronger, and eating like someone who reads ingredient labels (scary!). My goal is to be off Mounjaro by year’s end. Why? Because salvation doesn’t come in a box marked “dispense as written.” It comes from playing through pain, tracking your macros, lifting heavy, and keeping your muscle.

But before I descend into this week’s flatline progress report (hint: nothing dramatic, which is the point), let’s make a brief detour through the circles of GLP-1 delusion—where pharma angels promise salvation, but real-world data shows a less heavenly outcome.

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“Miracle Cure”, My Ass: Why the Real Work Still Matters!

You’ve seen the headlines by now. “Game-changing GLP-1s!” “Tirzepatide melts fat!” “Obesity cured!” Cue the violins, champagne, and IPOs. But two recent reports—the JAMA commentary by Lean and Batterham and the Healio real-world outcomes study—just threw some well-needed frigid water on the party. And I, your ever-contrarian Mounjaro user turned metabolic realist, have a few thoughts.

Let’s start with the JAMA piece. Lean and Batterham don’t question that GLP-1 RAs like tirzepatide can improve diabetes, weight, and cardiovascular risk. What they do question is the full-court marketing press to put half the adult population on lifelong injectable medications. Their key points: the long-term risks are still foggy, the trials aren’t designed to assess true disease modification, and the idea that everyone needs to stay on these drugs forever is—surprise!—largely pharma-driven fantasy.

Then there’s the Healio article, which delivers some much-needed real-world perspective. It followed nearly 8,000 adults who took semaglutide or tirzepatide for weight loss (not diabetes), and the results? A respectable 8.7% average weight loss at one year, but only 3.6% for those who bailed out before month three. Half quit before the year was out. The reality? If you don’t stick with it, the weight creeps back. And even if you do stick with it, most users aren’t getting the mega-doses used in the clinical trials—meaning many are seeing disappointing results.

Now, allow me to gently (or not) say: I told you so.

I’ve been on Mounjaro (tirzepatide) for over a year. But unlike the “miracle cure” crowd, I didn’t just stop at the needle. I used it as a tool—an opener—to help recalibrate blood sugar and hunger while I rebuilt the real foundation: strength, muscle, and metabolic integrity. The notion that you can simply melt away weight while lying on the sofa watching old Jane Fonda exercise videos and sipping your protein shake through a straw is seductive, yes. But also, dangerous.

Because here’s the trap no one tells the miracle crowd about: muscle loss.

If you lose 30, 40, 50 pounds without resistance training, you’re not just shrinking your waistline—you’re cannibalizing the very tissue that keeps your metabolism humming. That’s not a win. That’s a deferred collapse. When you rebound—which you will—it will be blubber, not muscle you’re adding. Add in the age-related muscle loss known as sarcopenia and you’ve got some serious, life-threatening problems.

What excites me—and what we should be focusing on—is that GLP-1s may help spare muscle when paired with resistance training and adequate protein. That’s the part I’m genuinely optimistic about. In someone actively lifting, moving, and fueling wisely, these drugs can provide a unique opportunity: reduce visceral fat, preserve or even rebuild lean mass, and unburden the pancreas and kidneys—all without a hypocaloric death spiral.

So no, I’m not dumping on the meds. I’m dumping on the fantasy. The shortcut thinking. The “no effort required” marketing that’s setting up a generation for rebound and sarcopenia. Debilitation in old age is a burden to the individual and society at large.

My protocol? Ditch the protocol. Think critically. Train hard. Track meals. Monitor glucose. Use the drug, don’t become the drug. And above all—keep your muscle.

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My Week on Mounjaro

Our star of last week’s column, Princess Poona of Hyderabad, surprisingly came through for me. Who am I to doubt EnGuide’s polite, cheerful South Asian operative?

Last Monday, I felt the heat of Dante’s Inferno as I wended my way through the fire and brimstone of automated customer service to eventually be connected with Princess Poona in her Indian call center. I was on my last dose of Mounjaro, and after being informed that the next shipment would be delayed, I needed some answers. Well, you can read that saga in last week’s report, but I’m here to tell you now that Poona’s promise to escalate my case was not just a ploy to get me off the phone. I received the shipment on Wednesday. Thanks, Poona!

Today, I’ll finish up my left knee physiotherapy with a final visit with my tennis nut therapist. I can detect no change in the chronic pain just above the kneecap after six weeks of twice-per week sessions. My self-diagnosis is quadriceps tendinopathy, which manifests itself mainly while climbing or descending stairs, or while sitting down or getting up from a seated position. Sitting inactive for a while will cause it to flare up. However, I can tolerate stationary biking or treadmill walking for 45 minutes without significant pain. I have arranged a July 25 follow-up appointment with the sports med doc to see whether she can amplify on my self-diagnosis and suggest any brilliant, non-surgical interventions.

The Mounjaro Numbers, Already!

My numbers have stabilized. Fasting glucose is 10 mg/dL higher than my long-term target, which I attribute to dietary changes. My paradigm shift from weight loss to regaining lost skeletal muscle ditched the strict low carb, low calorie approach in favor of increased protein and a calorie surplus. I have continued to lose subcutaneous fat as is evidenced by the prominence of veins in my extremities — veins that were long buried under a blanket of lard. The phlebotomists at the blood bank and Quest Labs are grateful.

• Weight: 174.6 lbs — the nominal 175 plateau.
• Fasting Glucose: 105 mg/dL — up 5.
• Stelo Overall Average: 101 mg/dL — down 5.

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Thread Count: One Less Needle, One More Rep

So there you have it: the gospel according to Big Pharma, rebutted by real-world data, Dante, and one cranky 78-year-old who lifts more than most people half his age.

The miracle-cure crowd will keep preaching pharmacological salvation. Influencers will keep selling their soul (and discount codes) for GLP-1s. And the medical-industrial complex will keep whispering that you’re broken, chronic, and helpless without their weekly miracle.

But some of us will keep grinding—tracking meals, moving iron, growing glutes, and protecting every ounce of lean mass like it’s gold bullion. Because it is.

This week? No dramatic shifts. No weight swings. Just another notch in the belt of consistency. The kind that doesn’t make headlines—but does make independence possible.

Next week: any insights gleaned by my PT evaluation, and possibly more on Poona, EnGuide, and the fine art of international peptide procurement. Bring popcorn. And creatine.

Until then:
Lift. Eat. Track. Think. Don’t let the drug do all the talking.

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