Archives for 2025

Bureaucrats, Blood Sugar, and the Battle for Medicare’s Wallet

I’m back for Week 44 of my Mounjaro experiment—a strange week in which I unexpectedly shed some weight. While I’ve come a long way in taming my blood glucose and dealing with surplus flab, I’ve lately pivoted toward a new goal: clawing back some muscle mass lost during the early days of calorie-cutting. Yes, I’d still like to jettison the spare tire—but starving myself into a frail, wrinkled raisin of an old man doesn’t strike me as a smart trade.

As always, my goal here is to share the full range of what it’s like to use Mounjaro as a treatment for Type 2 diabetes. I throw in news, rants, and opinions to break up the play-by-play of what I ate, lifted, or avoided. I also encourage you, dear reader, to chime in with your own experiences—especially if you’ve got strong feelings or colorful language.

This week, we’re taking a detour into the foggy swampland of government price negotiations—specifically, Medicare’s recent decision to target some GLP-1 drugs for price negotiation while leaving others (notably Mounjaro) untouched. Yes, it’s time to point a crooked finger at Big Government. And as the old saying goes: “If you really want to screw something up, get the government involved.”

Administrivia

Before we get into the meat of the matter, here’s the usual legalistic eyewash: I’m not a doctor. I’m a 78-year-old Type 2 diabetic curmudgeon with strong opinions and a keyboard. That makes me dangerous, not qualified. So consult your own doctor before trying anything I mention here—especially if it sounds dumb or suspicious. If you disagree with my opinions, good. That just means you’re paying attention. Now on with the show.

Something Rotten in the State of Denmark?

Medicare recently published its inaugural list of drugs up for price negotiation, and wouldn’t you know it—Ozempic and Wegovy made the list. Missing in action? Eli Lilly’s Mounjaro and Zepbound. A bureaucratic oversight? Hardly. This looks a lot like a not-so-subtle tip of the cap to Lilly, the American pharmaceutical darling, while Denmark’s Novo Nordisk gets the shakedown.

Of course, the official explanation is that the IRA (Inflation Reduction Act—pause for laughter) only allows price negotiation for drugs that have been on the market for a set number of years: nine for pills, thirteen for biologics. Mounjaro and Zepbound are just too green. But hiding behind a rulebook is standard practice for bureaucrats doing something politically convenient. The result? Foreign-developed drugs get squeezed, while newer U.S.-made blockbusters skate.

Maybe They’ll Give Us a Better Deal on Greenland?

Here’s the kicker: by strong-arming Novo into offering Ozempic and Wegovy at Medicare-friendly discounts, the government may actually help the Danish firm—at least in the short term. Lower prices could make semaglutide the drug of choice for Medicare Part D plans, especially if Lilly insists on clinging to premium pricing. If that happens, Lilly might just cede the GLP-1 Medicare market to Novo Nordisk without firing a shot.

Yes, Mounjaro and Zepbound have outperformed semaglutide in most efficacy trials. But efficacy doesn’t help if the insurance gatekeepers make access a bureaucratic nightmare. Right now, insurers seem happy to steer folks toward the older, cheaper drug.

So what we may be witnessing is a slow-motion market share transfer, cloaked in the garb of populist price reform. Lilly will get its turn in the negotiation dunk tank eventually—but for now, Novo enjoys a politically manufactured edge. The irony? The haircut is being given to the foreign company while the American firm gets a fresh coat of hairspray.

In the meantime, Medicare patients looking to jump on the Mounjaro train may find themselves priced out. That’s not just market dynamics at play—it’s policy with side effects. While I hope to be off this stuff by the time all these moves take effect, you’ll certainly be the first to know if these political gyrations impact me!

In the News This Week

Regulatory and Legal Updates

• FDA Cracks Down on Compounding: With brand-name GLP-1 shortages resolved, the FDA is now telling compounding pharmacies to back off. Most compounded versions of tirzepatide and semaglutide are being shown the door.
• Court Ruling Upholds FDA Authority: A federal judge denied a compounding industry request to block the FDA’s directive. Translation: the FDA’s in charge, and compounded Mounjaro is out—at least for now.

Industry Moves

• Lilly Goes Global: Mounjaro has launched in India, adding a few billion more potential users to the GLP-1 pool.
• Novo Eyes the Future: Novo Nordisk just licensed a triple-agonist compound (GLP-1/GIP/glucagon) from The United Laboratories. Early-stage, but potentially a big deal.

Clinical Tidbits

• GLP-1s Not Linked to Suicide Risk: A meta-analysis of 27 trials found no increase in suicide-related events from GLP-1s. Score one for safety.
• T1 Diabetics Taking GLP-1s: A growing number of Type 1 diabetics are trying these meds for weight loss, but risks of hypoglycemia mean it’s not one-size-fits-all.

My Week on Mounjaro

A quiet week. Jenny was in Chicago for her dad’s 87th, so no Thursday cheat lunch. Between back and neck pain, I barely got to the gym—just a light session Tuesday and leg day Thursday. I redeemed myself Friday with a 6.2-mile (10 km) hike in the 90-degree Florida swamp oven. Summer’s here, and it’s not playing nice.

I’ve ramped up calories lately to support muscle gain—yes, even at 78, I’m still trying to stave off sarcopenia. If I gain a pound or two, I’m hoping it’s biceps, not belly. My sketchy Chinese body comp scale may not be gospel, but I’m watching for trends. This week, though, if it isn’t lying, I paradoxically lost weight.

The Mounjaro Numbers, Man!

I’m still at 7.5 mg per week and hoping to avoid going higher. This week, I somehow dropped four pounds (1.8 kg)—go figure—weighing in at a pseudo-svelte 182 lbs (82.6 kg). My fasting glucose averaged 102 mg/dL (5.67 mmol/L)—up slightly, while my flaky Dexcom Stelo CGM claims my weekly average was 90 mg/dL, which I view as fiction. Still, it’s great for tracking food responses and trends.

I Experimented with Sweeteners So You Needn’t Do So

Bonus experiment this week: I tested allulose and monk fruit/erythritol on an empty stomach to see if either spiked my glucose. Nada. Flatline. However, they did move the needle in the digestive department—if you catch my drift. Better than Miralax. You’re welcome.

So, now, that paradoxical weight loss might have a viable explanation, as it were.

Until next week—stay strong, stay salty, and don’t let Big Pharma or Big Government pick your pocket.

Until next week, stay healthy!

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

Greetings to my fellow Type 2s and anyone interested in the intersection of senior health, metabolic challenges, GLP-1 receptor agonists, and lifestyle reinventions. You’ve landed at the right spot if you appreciate candid insights delivered through the unfiltered lens of a cantankerous 78-year-old retired geek. Over the past ten months on Mounjaro (now cruising along at the 7.5 mg dose), I’ve wrestled my glucose levels into submission, dropped sixty-five pounds, and revitalized many aspects of my health and energy. By year’s end, my ambitious plan is to phase out Mounjaro completely, testing whether my lifestyle upgrades can hold the line. Through these weekly chronicles, I share my victories, setbacks, and quirky observations, hoping you’ll extract a useful nugget or two from my experiences.

The Usual Disclaimers (Obvious, But Necessary)

Before diving into this week’s juicy tidbits, let’s briefly cover the necessary disclaimers. Nobody compensates me for these musings—they’re purely my own take on things. I’m not a physician, nor do I impersonate one convincingly on TV, so nothing here should be mistaken for professional medical advice. While I habitually offer unsolicited advice (old habits die hard), the responsibility to heed or ignore my counsel rests entirely with you. If my suggestions flop, please spare me from any legal battles and instead seek guidance from qualified medical professionals, including those eager tele-health types lurking behind pricey compounding pharmacy websites—after all, they’ve got malpractice insurance precisely for such occasions. Now, let’s get on with the program.

What We’re Covering This Week

In this week’s update, before reporting my progress for the week, we’re covering two areas of special interest for those on GLP-1 receptor agonists (GLP-1 RAs) like Mounjaro. First, we’ll dive into muscle mass retention—crucial when undergoing rapid weight loss. As I’ve often noted, rapid weight loss can unfortunately lead to significant muscle loss—up to 40% of the lost weight may be lean mass, as concluded by the SCORES study. This loss exacerbates age-related muscle decline, known as sarcopenia. Many individuals excited by their weight-loss achievements often underestimate the necessity of resistance training to preserve valuable muscle. We first examine the role of power training as opposed to strength training in connection with sarcopenia. Then, interestingly, we discuss recent studies that suggest coffee could be a surprisingly beneficial adjunct to resistance exercise.

Second, we’ll revisit the critical topic of avoiding rebound weight gain and elevated blood glucose after stopping GLP-1 RA therapy. Research indicates that most people regain weight and experience metabolic setbacks once these medications are discontinued. To counteract this, I’m establishing lifestyle foundations now—exercise routines, nutritional habits, and sustainable daily practices—that I hope will maintain my progress post-Mounjaro. Excitingly, recent developments point toward a novel medical procedure that could help sustain long-term metabolic stability.

Power Training Benefits for Sarcopenia

In the relentless battle against sarcopenia—the age-related decline of muscle mass and strength—recent research underscores the superior benefits of power training over traditional strength training for older adults. A comprehensive meta-analysis published in European Review of Aging and Physical Activity evaluated 15 randomized controlled trials involving 583 participants. The findings revealed that power training significantly outperformed strength training in enhancing muscle power (standardized mean difference [SMD]: 0.99), performance on generic activity-based tests (SMD: 0.37), and tasks emphasizing movement speed (SMD: 0.43).

Power training focuses on executing resistance exercises with speed during the concentric phase, effectively improving the ability to perform daily activities that require quick and forceful movements, such as rising from a chair or climbing stairs. This approach not only enhances muscle power but also contributes to better overall physical functioning in older adults.

Complementing these findings, a systematic review and meta-analysis in JAMA Network Open analyzed 20 randomized clinical trials with 566 community-dwelling older adults. The study reported that power training was associated with modest improvements in physical function compared to traditional strength training, highlighting its potential as a valuable intervention to mitigate age-related functional decline.

Incorporating power training into exercise regimens for older adults appears to be a promising strategy to combat sarcopenia and maintain independence. However, it’s essential to tailor exercise programs to individual capabilities and consult with healthcare professionals before initiating new training routines.

Waking Up Your Muscles

Regular readers know coffee isn’t merely a beverage in my routine—it’s practically a food group. Imagine my delight when research published in Frontiers in Nutrition linked coffee drinking to potentially preventing sarcopenia.

Regular caffeinated coffee drinkers enjoyed approximately 11%-13% greater muscle mass compared to coffee abstainers. Decaf drinkers missed this muscle-enhancing perk (pun intended), though they likely sleep better.

Not for Everyone

Interestingly, this benefit vanished for individuals with a BMI over 30, suggesting coffee—much like my humor—doesn’t universally resonate.

Researchers speculate coffee’s anti-inflammatory properties might reduce muscle-damaging inflammation, while its stimulation of autophagy—cellular recycling—might refresh muscles like a shot of espresso rejuvenates your morning.

But Beware of the Starbucks Trap

Before trading your gym membership for a coffee shop loyalty card, note the study’s limitations: self-reporting coffee consumption risks exaggeration or forgetfulness among its participants. Still, pairing coffee with regular resistance training and balanced nutrition remains a delicious strategy to maintain muscle. Just avoid sugary traps—a 16-ounce Starbucks Caramel Frappuccino contains 54 grams of sugar, enough to spike my HbA1c just from reading the menu. Now, if you’ll excuse me, my next therapeutic espresso awaits.

Avoiding Weight Regain: Duodenal Mucosal Resurfacing

As I persist on Mounjaro, responsibly transitioning off remains my primary concern. Encouragingly, Duodenal Mucosal Resurfacing (DMR)—recently FDA-designated as a breakthrough therapy—offers promising potential.

The aptly named SURMOUNT-4 clinical trial, published in JAMA in December 2023, starkly illustrates the rebound challenges of stopping GLP-1 RAs. After impressive mean weight loss (20.9%) during 36 weeks on tirzepatide, participants switched to placebo regained an average of 14% weight within a year. Conversely, continued tirzepatide users not only maintained but further reduced weight by 5.5%, clearly demonstrating the chronic nature of obesity and need for ongoing intervention.

What DMR Does

DMR addresses structural and functional abnormalities of the duodenal lining, conditions closely tied to obesity and type 2 diabetes. According to recent insights published in Diabetes, Obesity, and Metabolism, this outpatient procedure uses hydrothermal ablation to regenerate healthier tissue, improving insulin sensitivity, glucose stabilization, and weight maintenance.

The FDA granted breakthrough device designation to Revita, a specific DMR treatment targeting those with significant weight loss (>15%) from medications like tirzepatide. The ongoing REMAIN-1 trial currently evaluates DMR’s efficacy post-tirzepatide.

Pairing lifestyle strategies with cutting-edge procedures like DMR might provide a viable long-term path, possibly eliminating indefinite medication dependence.

Temper Your Hopes

However, I’m wary Big Pharma might downplay DMR to protect the GLP-1 RA market. Eli Lilly, marketer of Mounjaro, managed all phases of SURMOUNT, concluding patients should ideally remain on medication indefinitely. Additionally, with Medicare my insurer and policy shifts in Washington, coverage for innovative procedures like DMR may sadly remain elusive for me and others in the same position.

My Week on Mounjaro

Neck and back pain nudged me to scale back workouts, though, being stubborn, I managed one heavy leg day, a cardio day, an upper-body day, and a five-mile mini-hike.

Fitness Equipment Retail Therapy

Deadlifts strengthen the back but risk injury. To mitigate aggravating my already problematic back (described as “a total mess” by my favorite physical therapist), I bought a “trap bar,” gentler for deadlifts than a straight bar. I’m not chasing lifting records—just modest goals around 600 lbs (272 kg), significantly more than the mere 374 lbs (170 kg) the guy in the photo was hoisting. (Believe that, and you truly appreciate my humor.)

My local senior citizen gym lacks a trap bar, a deficiency I’ve now rectified at home, allegedly due to my wife Jenny’s insistence. Initially, I pooh-poohed her idea, complaining about space, but conveniently blame her now. Jenny promises she’ll use it too, ensuring domestic harmony. Happy back, happy wife—a perfect win-win.

Now, on with the numbers.

This Week’s Mounjaro Numbers

This week was full of contradictions—I reduced workouts but increased my caloric intake. Clearly, building muscle and losing weight don’t exactly see eye-to-eye, so I’m deliberately operating at a small caloric surplus, rather than a deficit aimed at weight loss. I’m also vigilantly keeping my protein intake between 1.6-2.0g/kg daily, as recommended for seniors deeply invested in resistance training. Add to that creatine monohydrate supplementation—known for packing on water weight—and it’s no surprise my weight loss pace has slowed.

No excuses left. Weight’s up two pounds (0.9 kg) this week, and fasting glucose rose notably from 93 mg/dL (5.17 mmol/L) to 100 mg/dL (5.56 mmol/L). Clearly, I might have let carbs slip in alongside protein increases. Still, with my schizophrenic Stelo reporting an average glucose of 105 mg/dL (5.83 mmol/L), I’m comfortably within the decent control zone.

Thanks for Being Here!

Writing a self-centered blog carries the inherent risk of boring readers senseless. Hopefully, by sprinkling in current medical research and opinions on healthcare trends, my aim is to broaden the appeal. Today, we tackled power training versus strength training for sarcopenia, coffee’s muscle-preserving magic, and duodenal mucosal resurfacing as a potential escape hatch from GLP-1 rebound. I’ll let you digest all that (pun fully intended) and call it a week.

Until next week, stay healthy!

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

Iron, Compounders, and Global Warming—NOT!

Greetings, fellow Type 2 diabetics and anyone else interested in senior health, metabolic disorders, GLP-1 receptor agonist drugs, and lifestyle modifications. We cover it all here from the non-sugar-coated perspective of a curmudgeonly 78-year-old retired geezer who has taken the Type 2 bull by the horns and spews a lot of bull of his own. We talk about Mounjaro and other GLP-1 RA drugs, doctors, healthcare in general, and especially making lifestyle changes to improve our outcomes.

I’ve been on Mounjaro for almost ten months, now at the 7.5 mg/0.5 ml dose. I’ve managed to get my glucose under control, shed sixty-five pounds, and improved virtually every aspect of my health and vitality. Before the year’s out, I aim to wean myself off Mounjaro. Together, we’ll discover if my upgraded lifestyle is strong enough to sustain those gains. Writing this weekly column is my way of sharing the highs and lows of my Mounjaro experience, hoping you’ll find a nugget or two of useful wisdom from my adventures.

Administrivia

Before we dive in to Mounjaro territory, the usual disclaimers are necessary. I get no compensation from anybody for writing this drivel. All opinions expressed here are just that. I own them and you don’t. I’m not a licensed physician—I don’t even play one on TV—so nothing here qualifies as official medical advice. Sure, I often tell you what to do (it’s just my nature), but you’re entirely responsible for deciding to listen. Please don’t sue me if something you read about here doesn’t pan out. Instead, seek professional advice from your local doctor or even one of those questionable telehealth operators with vague qualifications at overpriced compounding pharmacies. They have malpractice insurance specifically to cover their inevitable screw-ups. Now, on with the show.

What We’re Covering This Week

This week, after an update on my seemingly eternal iron deficiency saga, we’ll delve into the controversial realm of compounding pharmacies and GLP-1 RA drugs. Next, we’ll lightly mock some “woke” physicians who’ve prioritized “saving the planet” at the possible expense of surgical patient safety. After that, we’ll share the success story of one brave soul who discontinued Mounjaro, thanks to sheer determination and disciplined lifestyle changes. Finally, as always, you’ll get an update on my personal progress. Buckle up and enjoy the ride!

Ironically…

Let’s kick things off with my ongoing iron chronicles featuring Dr. DeLorean (not his real name), whose enthusiasm for proactive medicine remains utterly nonexistent. My latest iron results arrived this week after three long months of dutifully choking down 65 mg of ferrous sulfate daily. How’d we do? Well, “meh” about covers it. Ferritin inched upward to a modest 38 ng/mL, total iron crept to a just-acceptable 59 ng/dL, and total iron binding capacity clocked in at 341 mcg/dL. Although technically hovering around the low end of normal, my iron saturation calculation stubbornly stayed subpar at 17%. Hemoglobin (13.9 g/dL) and hematocrit (43.1%) remain within the safe zone, though comfortably close to the lower boundary.

Naturally, Wednesday morning brought a call from Dr. DeLorean’s office, delivered with all the charm and warmth of an automated voicemail. “Your iron is low but improved,” droned the messenger. “Doctor says you can resume donating blood if you want—just keep taking the supplement.” No curiosity, no suggestions for further investigation, and certainly no enthusiasm for identifying an underlying cause. A stunning display of medical prowess.

Given the option between trusting Dr. DeLorean’s apathetic approach or trusting my instincts, I’m opting for caution. I’ll keep my rare blood type safely at home for now, despite genuinely missing the feel-good vibes of helping others. I’ll also transition to carbonyl iron (Feosol Complete) in hopes it yields faster improvements. And yes, I’ll take matters into my own hands and revisit my labs in three months—Dr. DeLorean or no Dr. DeLorean.

In fact, it’s looking increasingly likely that in three to six months, the DeLorean chapter will be behind me—a distant memory, fond or otherwise. Stay tuned.

Renewed Concerns over Compounding Pharmacies

In several past issues, I expressed concern over compounding pharmacies and telehealth organizations and their unregulated pandering of GLP-1 RA drugs as weight loss panaceas. In this connection, an article in The Wall Street Journal caught my eye. Reading this piece about the potential end of compounded knockoffs of Ozempic and Wegovy provided a peculiar sense of vindication—like seeing authorities finally crack down on questionable practices. These online telehealth operations, once known mainly for marketing ED medications, quickly pivoted to pushing knockoff weight-loss drugs to eager dieters. I’ve criticized them before for prioritizing profits over patient safety, and this article reinforces that these concerns remain justified.

Online influencers, particularly those on YouTube, compound this issue (pun intended). Many influencers not only profit from platform monetization but also get direct payments or sponsorships by telehealth/compounders like Hims & Hers or Ro. This dual revenue stream creates clear conflicts of interest, potentially misguiding desperate consumers who rely on their advice for serious health decisions.

Exploiting Regulatory Loopholes

The WSJ, recent coverage in JAMA, and now the New England Journal of Medicine (NEJM) highlight precisely why these telehealth/pharmacy operations are troubling. They exploit regulatory loopholes, framing their services as affordable alternatives and claiming to offer personalized treatments—though adding vitamins or other supplements to Ozempic and Mounjaro knockoff medications does not significantly alter their legitimacy or efficacy. According to JAMA, compounded GLP-1 medications like semaglutide and tirzepatide have rapidly expanded due to initial shortages and ongoing insurance coverage limitations. Last year alone, compounding pharmacies reportedly filled approximately 80 million compounded prescriptions for semaglutide, underscoring the scale of this market.

The NEJM further emphasizes significant ethical and legal concerns surrounding partnerships between pharmaceutical companies and telehealth platforms. These partnerships potentially violate the Anti-Kickback Statute (AKS), which prohibits financial incentives for patient referrals or prescriptions. Telehealth platforms increasingly use social media advertising—sometimes lacking proper disclosures of risks or contraindications—to drive demand. Pharmaceutical companies like Pfizer and Eli Lilly have developed consumer-facing websites linking patients directly to telehealth prescribers, raising concerns about inappropriate prescribing practices driven by financial rather than medical considerations.

Serious Safety Concerns

All these sources emphasize serious safety concerns. Over 600 adverse event reports have been submitted to the FDA related to compounded versions, including hospitalizations resulting from dosing errors. Unlike branded medications, compounded versions typically use multi-dose vials and manual syringes instead of autoinjector pens, greatly increasing the risk of user error. Issues like overdoses and incorrect active ingredients further complicate the safety profile. Yet despite these risks, demand persists because compounded versions cost significantly less (around $200-$300 per month) compared to branded counterparts ($1000-$1300 monthly), driven primarily by uneven insurance coverage.

Dr. Taylor Kantor of Ivim Health mentions affordability as justification for compounded drugs, positioning his telehealth platform as an accessible alternative to expensive brand-name pharmaceuticals. While pharmaceutical giants like Novo Nordisk and Eli Lilly certainly price their medications at premium levels, at least they invest in comprehensive safety research and regulatory compliance, along with the long-term research and development costs that make the drugs possible. Conversely, telehealth firms offering copycat drugs often allocate significant budgets toward advertisements and lobbying—like hiring celebrity spokespersons—to protect their lucrative niche.

Cost Considerations

If cost is genuinely the barrier, it might be wiser and safer for consumers to invest their resources into sustainable solutions like working with a personal trainer, consulting with a nutritionist, maintaining a gym membership, and adopting healthier eating habits. Such an approach not only addresses weight loss but contributes positively to overall health—even saving gobs of money in the long run.

Still, human nature assigns a high value to “the easy way”. People will be people. So, you’ll find lots of whining in JAMA and NEJM about how we must supply these miracle drugs to the underserved community because they deserve them, too. We must addict them to GLP-1 RAs for life because they deserve it?

My primary concern remains that patients bypass traditional healthcare professionals in favor of convenient, but less accountable telehealth services. Although local doctors have their own faults—as my ongoing Dr. DeLorean and Dr. Scrooge experiences illustrate—they have the critical advantage of familiarity with patient history and face greater accountability than anonymous online prescribers. Desperate people wanting weight-loss drugs are more likely to lie to distant strangers than to their flesh-and-blood doctor who knows their medical history over time.

Pushback by Big Pharma and Their Allies

Pharmaceutical companies Eli Lilly (manufacturers of Mounjaro and Zepbound branded versions of tirzepatide) and Novo Nordisk (Ozempic and Wegovy versions of semaglutide) rightly challenge compounding pharmacies for skirting crucial safety measures and FDA oversight. Cannily, compounding operations position themselves as fulfilling an unmet demand, yet their vast prescription numbers suggest a profitable mass-market approach rather than genuine individualized patient care.

Meanwhile, the American Diabetes Association explicitly states it does not endorse compounded GLP-1 products, emphasizing the importance of FDA oversight and clinician supervision. Both JAMA and NEJM report growing confusion among consumers about the legitimacy and safety of compounded medications, underscoring the need for clearer information and stricter oversight.

Summing It Up

Certainly, inflated costs of medications like Ozempic and Mounjaro contribute significantly to this problem, creating opportunities for exploitative businesses. Yet embracing gray-market compounding is hardly a safe or responsible solution. Patients deserve affordable, effective medications with proper medical oversight—not questionable formulations prescribed by remote clinicians lacking comprehensive patient knowledge.

Ultimately, neither side emerges entirely virtuous—both show elements of opportunism. Nevertheless, the unchecked proliferation of telehealth-driven compounding clearly poses a significant health risk. As highlighted by the NEJM, stronger enforcement of existing laws and clearer regulatory guidelines on pharmaceutical–telehealth partnerships are urgently needed. Until then, consumers should exercise great caution and engage proactively with trusted healthcare professionals.

Opinion: Climate Change over Patient Safety?

Just when I thought medical journals couldn’t further divorce themselves from patient safety and practical medicine, along comes this latest gem from JAMA on reducing surgical carbon emissions. Yea, verily, because when I’m being wheeled into surgery, my primary worry isn’t surgical complications or infection rates—it’s whether the hospital is recycling its gloves and gowns properly. Let’s get our damn priorities straight, people!

According to these authors, surgeons and anesthesiologists should now become climate warriors, scrutinizing the carbon footprint of every scalpel and anesthesia mask. God forbid they focus on something mundane like patient outcomes, already. Never mind that surgical trays will now omit crucial tools in the name of “environmental stewardship,” ensuring my surgeon gets a fun scavenger hunt mid-procedure. I’m sure those missing forceps were rarely used anyway.

And don’t use the autoclave! Damn thing uses too much electricity. Think of the ozone layer! Think greenhouse gases! Reverting to 18th century sterilization techniques (read none at all) makes consummate sense. We all want to enjoy the brighter new tomorrow, even if we’re dying from sepsis.

Remote Magic

The authors suggest that preoperative assessments shift to telemedicine to reduce travel-related carbon emissions. Great fucking idea—because remote evaluations over pixellated video calls have never led to oversights or misdiagnoses. It’s not a stretch to predict that my next surgery will be done virtually too, saving the planet one pixel at a time.

Adopting The Three Stooges Method—a Big Hammer to the Head

And let’s not overlook the anesthetic gases. Apparently, desflurane should be banned from operating rooms because its global warming potential is just too damn high. So, if a patient happens to need that specific anesthetic for medical reasons, tough shit. After all, reducing greenhouse gas emissions surely outweighs effective anesthesia management, right? I’m certain patients will appreciate their surgeon’s dedication to climate change while they’re waking up mid-surgery with their chests cracked open or their knees grotesquely dislocated.

Lastly, the article triumphantly concludes that “individual clinicians can implement small changes that can prevent harm to patients and ultimately…decrease environmental harm.” Small changes indeed—like compromising sterility standards or cutting corners in postoperative care. But hey, at least the hospital’s carbon footprint will look fabulous on paper. Who knew healthcare’s primary mission was to chase carbon neutrality over patient safety? Clearly, I missed that line in the Hippocratic Oath.

“Getting Off” Follow-Up

Back on March 10, I shared my thoughts on discontinuing GLP-1 receptor agonist (RA) drugs, emphasizing two key points:

1. Big Pharma’s Perpetual Prescription Plan: The pharmaceutical industry seems keen on patients remaining on GLP-1 drugs indefinitely, ensuring a continuous revenue stream.
2. The Uphill Battle of Discontinuation: While it’s challenging, individuals can successfully stop these medications with dedication to lifestyle changes.

Bradley Olson’s recent essay in The Wall Street Journal echoes these sentiments. After shedding 40 pounds using Mounjaro, Olson chose to stop its use, primarily due to the prohibitive cost—approximately $1,000 per month. He then embarked on a rigorous exercise program and a structured nutrition plan, leading to an additional 20-pound weight loss over the following year. This sharply contrasts with the backsliding experienced by most who quit GLP-1 RA drugs, as we mentioned a couple of weeks ago.

You Can Do It!

Olson’s experience underscores that, despite the pharmaceutical industry’s preference for long-term medication use, individuals can achieve sustainable weight management through diligent lifestyle modifications. Notably, Olson does not mention having Type 2 diabetes. His discussions about glucose pertain to monitoring dietary impacts, suggesting his use of Mounjaro was for weight loss rather than diabetes management. While he mentions blood glucose, he does so in the context of checking the effectiveness of his low-carb diet, not long-term diabetic control. Nevertheless, diligently pursued low-carb diets and vigorous exercise are indeed significant steps toward controlling diabetes.

A Little Help from Dr. Phinney

Also, Olson mentions that he used a startup called Virta Health for a while to guide his nutritional ventures and to augment his self-monitoring. My minimal research reveals that Virta is in the business of non-pharmaceutical, monitored low-carb lifestyle approaches to Type 2 diabetes and weight loss. Dr. Stephen Phinney, co-author of The Art and Science of Low-Carbohydrate Living is a co-founder and formerly Chief Medical officer of Virta.

Virta’s retail cost is currently $299 per month after a $250 initiation fee. Interestingly, those fees are quite comparable to what you would pay for some of the compounded GLP-1 drugs through our friends, the telehealth-compounders. Virta’s website suggests that many health insurance plans will cover their fees, with no mention of traditional Medicare doing the same. This might exclude it as a choice for me, although self-funding is a possibility. I’ll give Virta a stronger look when the time comes, because even with insurance coverage, Mounjaro is costing me $250 per month up to the ridiculously titled Inflation Reduction Act annual limit of $2,000.

(Yeah, well, with the unpredictable state of politics in Washington these days, it’s hard to say what the future will hold. But I digress politically—I prefer to steer clear since extreme voices on both sides seem determined to widen the ideological gap, making constructive dialogue increasingly rare. Enough said!)

Yes, It Can Be Done!

In summary, while Big Pharma advocates for indefinitely prolonged use of GLP-1 drugs, Olson’s story demonstrates that with commitment and effort, discontinuation is both possible and effective. As regular readers know, my approach is to ramp up my exercise and low-carb commitments while I am still taking Mounjaro so those habits are ingrained by the time I wean myself off it. Although my approach is not an absolute guarantee of success, it will soften the blow of withdrawal, giving me a decided advantage over quitting cold-Turkey [there he goes with the Turkey puns again, already].

Thus encouraged, I shall proceed to this week’s numerology, as it were.

The Week on Mounjaro: The Numbers

The week kicked off with a Great Damn Idea (GDI): corned beef and cabbage in honor of St. Patrick’s Day, when we all pretend to be Irish peasants. The meal was excellent—though a departure from my usual low-carb fare, it notably lacked the traditional potatoes. What wasn’t excellent, however, was the aftermath, which led to an emergency call to a plumber. You see, this Turkey, who should certainly know better, forced a raw cabbage core down the garbage disposal. Predictably, the mangled, fibrous core traveled through the drain, encountered a partial blockage, and promptly completed it, backing up the drains into a delightful little catastrophe.

After futile attempts at non-surgical intervention with a plunger, I went outside to open the drain cleanout for a more precise differential diagnosis. Fouled water enthusiastically shot out at me, draining the sinks and confirming the blockage was downstream, between the cleanout and the street sewer. My options were clear: rent a drain auger and undertake the dirty job myself, or wisely call a professional plumber. Given that I lack even amateur plumbing skills, opting for the pro was an easy choice. Luckily, I found a local company offering a $93 special for uncomplicated drain blockages—a steal compared to the $200-$300 estimates I was seeing. At that price, it was just a few bucks more than renting equipment and required a whole lot less effort from yours truly.

So, what does all this have to do with my numbers? Absolutely nothing. I just couldn’t resist adding another semi-humorous story to an already lengthy post. The corned beef and cabbage meal was delicious, and although high in sodium, it didn’t significantly impact my glucose numbers—which I shall finally get to now. (You hope.)

The Numbers, Already!

My fasting blood glucose averaged a steady 93 mg/dL (5.17 mmol/L). However, according to my Stelo biosensor, my average blood glucose crept up slightly to 108 mg/dL (6.00 mmol/L). As I’ve mentioned before, these non-prescription biosensors aren’t perfectly accurate in absolute terms, but they’re fantastic for tracking relative changes based on my dietary choices. For instance, Thursday’s lunch at Outback Steakhouse, featuring half a small loaf of their sugary bread, resulted in a notable spike. Still, these spikes now max out around 140 mg/dL (7.78 mmol/L)—a vast improvement over the 250-300 mg/dL (13.89-16.67 mmol/L) peaks from before I committed to a low-carb, high-protein lifestyle.

Fat-cell scientist and acclaimed alliterator Dr. Ben Bikman of Brigham Young University offers a catchy and effective dietary mantra: prioritize protein, control carbs, and don’t fear fats. I’ve wholeheartedly embraced this approach, and its success speaks for itself.

My weight held steady this week at 184 lbs (83.6 kg), bringing my total weight loss since starting Mounjaro to about 63 lbs (28.6 kg). As previously mentioned, my current priority has shifted toward preserving—and ideally building—muscle mass, flipping the bird at sarcopenia. While I would still like to lose another 20-30 lbs (9-13 kg), that goal clashes somewhat with muscle-building efforts. Operating at a caloric deficit isn’t viable right now, so I’ve boosted my daily calorie intake primarily by upping my protein. The theory is straightforward: increased muscle mass will elevate my metabolic rate, potentially allowing some gradual weight loss, albeit at a turtle’s pace rather than a hare’s.

See you next week!

That wraps up another seriously literary effort by this Turkey. This installment was jam-packed, covering relevant topics from compounding pharmacies and GLP-1 RA discontinuation to climate-change lunacy permeating medicine—not to mention my plumbing misadventure. I hope you’ve enjoyed the stories I’ve unearthed and the opinions shared (whether you agree or not), as you continue following my Mounjaro journey. And, as they love to say on YouTube, please feel free to share your own tidbits in the comments below. I’d be thrilled to hear from others navigating their paths with Type 2 diabetes, GLP-1 RA drugs, or anyone else who enjoys a bit of good-natured skepticism toward medical wokeness.

Until next week, stay healthy!

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