Greetings, long-suffering Peptide Purgatory readers! Your favorite Mounjaro/Farxiga lab rat is here with another lengthy, boring issue for you. Self-disparagement aside, I hope some of you can benefit by reading my thoughts on the latest news about our GLP-1 RA medicated society.
And speaking of GLP-1s in the news, thanks to this miracle incretin, Eli Lilly now rivals the high-tech high-flyers as a trillion dollar corporation. During the week, Lilly’s market capitalization exceeded that magic, 13-digit threshold. How’s that for opportunistically converting the modern world’s deadly embrace of quick fat-loss cures to cash!
Who in the Mounjaro Am I?
In other notable news this past week, I turned 79 years-old. Yeah, this Nittany Turkey, pictured at left at my AI-enhanced best, is a foul old fowl, indeed, about to bunker in to avoid the Thanksgiving chopping block that will be the fate of so many of my relatives. Along that long life’s pathway I’ve accumulated my share of old bird afflictions, notably metabolic syndrome, Type 2 diabetes, chronic kidney disease, osteoarthritis, gout, erosive gastritis, and nine million other major and minor ailments. I’m taking Mounjaro for the diabetes, Farxiga for the CKD, and a couple of other drugs. While I believe I benefit from Big Pharma’s finest money-making drugs, I frequently use this space to disparage their profit-motivated market manipulation, spurred on by their government buddies and the willing collaboration of the captive medical associations.
In This Week’s Issue
This week, we look at current research that continues to hammer down the proven fact that GLP-1 drugs cause loss of beneficial muscle mass along with the desired fat loss. To combat the muscular attrition, we must diligently pursue strength training while taking these drugs or we wind up living the final years of our lives frail and helpless. I’ve taken this aspect of GLP-1 RA therapy very seriously: Since starting on Mounjaro in June 2024, I’ve been pumping iron like Arnold and crusading for others in my position to pay more attention to their muscles. Use ’em or lose ’em!
I typically include tidbits from my personal health story to further bore you all (but, hell, writing them is therapeutic for me). If your attention span permits, you’ll see my cognitive testing results from the SOMMA research study. I felt I screwed it up because I took the test by phone on a very busy morning. So, checking it our might confirm your suspicions about my mental acuity. On the other hand, despite the less-than-perfect score, you’ll see that I still can juggle a shitload of mentally taxing tasks in my daily life.
Also in this issue, Bullshit Corner takes a piss on RFK, Jr. and his captive CDC removing the research-based statement that no proven connection between vaccines and autism exists. This wreckless bungle opens the door for RFK’s plaintiff-bar buddies, as well as endangering our babies. Join us for a cynical look inside the YouTube influencer-run madness of the HHS clown car under RFK Jr.
So, sit back, grab a donut (which you can now pee out if you take some Jardiance), and enjoy!
Muscle Matters More Than the Scale
GLP-1s, Lean Mass, and How Not to Shrink Your Quads for Science
If you listen to the GLP-1 hype machine, you’d think the only number that matters is how many pounds fall off. TikTok: “Down 20% bodyweight!” Reality: “And 25–40% of that was lean mass, champ.”
A recent Healio piece made the point bluntly: yes, these drugs burn fat like a flamethrower — but some of what disappears isn’t fat. The question is whether you’re shedding acceptable “support structure,” or quietly trading diabetes for frailty.
Lean Mass: Not Just “Muscle,” Not Just Vanity
DXA doesn’t isolate muscle; it counts:
- skeletal muscle
- organs
- connective tissue
- and a whole lot of water
So when you hear that 25–40% of weight lost on semaglutide or tirzepatide is “lean,” part of that is simply shrinking fluid compartments as fat melts. But part of it is muscle and bone — the stuff you need to stay upright and avoid breaking like a breadstick.
How Much Are We Losing?
The trials say:
- Tirzepatide (SURMOUNT-1): ~25% of lost weight = lean
- Semaglutide 2.4 mg (STEP-1): ~39% = lean
If you drop 50 pounds on semaglutide, you might lose ~30 lb fat and ~20 lb lean. For someone going from 350 to 260, that might be fine. But for older adults, the frail, the osteopenic, or anyone who’s already wobbling on the edge of sarcopenia, that’s a real problem.
Kashyap notes unpublished data showing ~10% hip bone loss in 17 months on an incretin. That should make anyone over 60 sit up (carefully). [How long have I been on Mounjaro? Coincidentally, 17 months. –Ed.]
Pharma Smells Opportunity
The minute someone whispers “muscle loss,” biotech startups come sprinting in:
- Bimagrumab + Semaglutide: 22% weight loss, minimal lean loss
- Trevogrumab + Semaglutide: lean loss cut in half
- Apitegromab + Tirzepatide: preserves ~4 lb of lean mass
Translation: “We fixed your weight loss; now we’ll sell you the muscle-protection DLC.”
Problem: we have absolutely no proof whatsoever that these combos improve function. Right now, it’s just prettier DXA scans and better p-values.
The Boring Stuff That Actually Works
The lifestyle advisory from obesity and lifestyle-medicine societies is the part everyone ignores because it’s not sexy:
- Protein: 1.2–1.6 g/kg/day
- Strength training: at least 3×/week
- Aerobic work: ~150 minutes/week
These work because drugs don’t decide what you lose — your behavior does. GLP-1s suppress appetite; they don’t send a memo to your quads saying, “Don’t worry, we’ll spare you.”
The Real-World Way to Not Become a Frail GLP-1 Success Story
1. Treat your muscle like critical infrastructure.
Goal is not “lighter at any cost.” It’s less fat, same or better strength.
2. Don’t inadvertently starve yourself.
GLP-1s make under-eating easy. Under-eating makes muscle loss inevitable.
3. Hit your protein like it’s medication.
Spread it across meals. Each one should trigger protein synthesis, not pity.
4. Lift heavy-ish things.
Push, pull, hinge, squat, carry. The compound load-bearing movements that keep you from becoming a fall statistic.
5. Watch function, not vibes.
If stairs get harder while weight drops, you’re losing the wrong stuff.
6. Be skeptical of expensive biologics until they prove functional benefit.
Saving 4 lbs of lean mass on paper means nothing if you still can’t get off the toilet without using momentum and prayer.
Bottom Line
GLP-1s are phenomenal for diabetes and obesity. But they’re agnostic about what you lose. You have to supply the stimulus that tells your body:
Keep the muscle. Keep the bone. Burn the fat.
Muscle isn’t vanity weight — it’s your glucose disposal system, your metabolic gearbox, your anti-fragility hardware. The drugs are the miracle; protein and barbells are the engineering that keeps the miracle from collapsing.
And around here? You know damn well which side I’m on.
Meanwhile, Back at SOMMA… (Now With 79 Years of Superiority)
While the rest of the SOMMA participants were shuffling into the cognitive testing dungeon like extras from a low-budget zombie flick, your soon-to-be-79-year-old correspondent sauntered in, casually posted a 27 out of 30 on the MoCA, and walked out without even breaking a synapse.
I had been concerned that I screwed up the test. I know I could have done better. When they asked if I was in a quiet place with no distractions, I lied. That morning had been a comedy of interruptions at inopportune times, and I was still mentally juggling the day’s priorities when the scheduled cognitive testing call came.
Well, apparently, I did better than I thought I did, which would be good enough for some old farts, but still disappointing to me. If you insist, though, I’ll gloat about it.
The Mind/Body Connection
I keep telling everyone strength training pays off, and now we have proof: somewhere between the deadlifts, the monster walks, and the leg presses that would make a 40-year-old rethink his life choices, my brain apparently decided it should try to keep up. Neuromuscular adaptation? Hell no — neurovascular domination. At this point, every barbell I lift probably generates enough BDNF to power a small research lab.
And it’s not like I’m strolling through life carefree, eating bonbons and solving Wordle.
I have cognitive load that would bring a lesser, 79 year-old mortal to his knees:
- Negotiating the ACA insurance labyrinth, where the reward for hours of navigating contradictory government websites is the privilege of paying a thousand bucks a month so my not-yet-Medicare-eligible wife can be assured of catastrophic coverage if she ever needs it (and maybe a “free” gym membership).
- Bracing for the inevitable “Medicare Solvency Plan,” which will raise eligibility to 85 — conveniently just after she turns 65.
- Performing my weekly duties as Awards Secretary of a national ham radio organization, herding directors, soothing officers, writing five-year plans that actually require five brain cells to read, and championing fee increases like some geriatric Alexander Hamilton.
- Coexisting with Big Pharma, the PBMs, Dr. DeLorean, Dr. Macallan, and all the other characters in the ongoing medical sitcom that is my life.
- Managing a workout schedule that would make an Olympic trainer say, “Sir, please sit down, you’re making us look bad.”
- Designing networks, running APRS experiments, patching Proxmox clusters, and keeping eight computers, multiple VLANs, and a FlexRadio behaving.
- Maintaining a dozen or so Geocaches involving serious bushwhacking that is far less of a strain than is dealing with inflexible bureaucrats in the Florida Department of Environmental protection.
- Writing a twice-weekly column about Penn State football, especially in a season everybody would prefer that we permanently erase from our memory banks.
- Living in a toxic HOA environment with multiple warring factions clamoring to either depose the President or put him in jail. Yea, verily, a neighborhood where “Signgate” approached Watergate proportions in the annals of HOA history and where every YIELD sign is a comedy act.
And still:
Twenty-seven out of thirty.
The SOMMA team should be studying me as a confounding variable. Hell, the statisticians probably had to huddle afterward to determine whether to classify me as an outlier, a mutant, or a rounding error in God’s spreadsheet.
Let’s face it:
What I call “screwing up” is what most people would proudly frame on their refrigerator next to their kid’s participation trophy.
So when this piece hits Peptide Purgatory, your humble narrator will have officially completed 79 laps around the sun, each one apparently sharpening my cognitive edge while everyone else is losing their car keys inside their own pockets.
I’d say “I hope that reassures my readers,” but let’s be honest — most of them have already fled.
The remainder are here for the spectacle, and I’m just here to blow my own damn horn for a while.
And I aim to keep delivering.
Expanded Bullshit Corner
And now, the feature you’ve all been waiting for. Bullshit Corner takes a cynical stab at the latest Trump Administration unabated HHS circus, captained by the plaintiff bar’s favorite partner, Ringmaster RFK, Jr.
The CDC’s vaccine safety page didn’t just get “updated” — it got RFK Jr.-ified. Overnight, the agency pivoted from the clear and correct “Vaccines do not cause autism” to a mealy-mouthed mess suggesting we haven’t “ruled out” that infant vaccines cause autism. This is what happens when the Department of Health and Human Services is left home alone with Robert F. Kennedy Jr. and no adult supervision. He raids the liquor cabinet, rewrites settled science, and blames the hangover on aluminum.
The new CDC text even claims that studies showing a vaccine–autism link have been “ignored by health authorities.” No, champ — they weren’t ignored. They were examined, weighed, measured, and found to be about as scientifically credible as a horoscope written by a goat.
The CDC now highlights a study by a University of Colorado “environmental scientist” whose résumé includes writing for RFK Jr.’s own Children’s Health Defense newsletter. That’s like citing the Marlboro Employee of the Month for research on lung cancer.
The study’s main point? Correlation between aluminum adjuvants and rising autism rates in the ’80s and ’90s. But correlation proves causation in the same way that rain proves umbrellas cause thunderstorms.
Meanwhile, a Danish study of 1.2 million children — you know, actual population-scale science — found no link whatsoever between aluminum-containing vaccines and autism. But why let evidence get in the way of a perfectly good panic narrative?
The CDC’s page includes a hilarious footnote revealing exactly how this mutant wording came to be. RFK Jr. promised Senator Bill Cassidy — as part of his confirmation horse-trading — that he wouldn’t remove the phrase “Vaccines do not cause autism.”
So what does he do? Leaves the header up top, then spends the entire rest of the page undermining it. This is the public-health equivalent of agreeing not to remove your wedding ring while posting Tinder profile updates.
This is what happens when you elect someone whose moral compass is calibrated by litigation strategy. He technically keeps his word while shredding the underlying meaning like a hungry goat with a legal pad.
RFK Jr. also pledged he wouldn’t push childhood vaccines off the market. Naturally, he’s now teeing up his handpicked Advisory Committee on Immunization Practices to do exactly that by targeting aluminum adjuvants — which, if removed overnight, could force a dozen pediatric vaccines out of circulation.
Fun fact for the aluminum-phobic: infants ingest far more aluminum from breast milk or formula in their first six months than from every vaccine on the childhood schedule combined. This is basic toxicology, not mystical thinking.
But RFK Jr. isn’t guided by toxicology. He’s guided by ideology — and apparently by staffers like Calley Means, a supplement salesman who’s made a fortune selling unregulated nostrums that require zero proof of safety or efficacy. It’s like appointing a payday-loan CEO to run the Federal Reserve.
The new CDC logic essentially declares: “Because you can’t disprove a negative, vaccines might cause autism.” By that standard, we must also investigate whether cauliflower causes telekinesis or whether magnets turn kids into werewolves.
And now that the government itself is amplifying vaccine doubt, expect vaccination rates to wobble and preventable diseases to make encore appearances — all so RFK Jr. can settle personal scores with aluminum and please the narrative gods at Children’s Health Defense.
Bottom line: This isn’t science. It’s an ideological crusade wrapped in lawyer-speak and sprinkled with just enough pseudoscience to confuse the masses.
Vaccines aren’t the threat. Weaponized bullshit is.
Cast of Characters: The HHS YouTube Circus
- RFK Jr. — Secretary of HHS, part-time toxicologist of the imagination, full-time disruptor of settled science. Runs HHS like it’s a Reddit mod panel for r/AntiVax.
- Calley Means — Former Coke consultant turned “I’ve seen inside the Death Star” wellness crusader. Made a fortune selling supplements and now whispers in federal nutrition policy’s ear. The fox now writes the henhouse safety manual.
- Casey Means — Former surgeon, current influencer, glucose-graph evangelist. Nominated as Surgeon General because apparently we select our public-health leadership from the Explore page on Instagram now.
- Marty Makary — Now at FDA. Twitter-famous, YouTube-popular, cable-ready critic of the medical establishment. Spends half his time roasting agencies he now nominally helps run.
- Vinay Prasad — Makary’s spiritual cousin: academic by day, algorithm-optimized contrarian by night. Known for multi-hour rants that begin with “I’m just asking questions…” and end with “subscribe to my Substack.”
- Children’s Health Defense Orbit — The hyperventilating content mill formerly run by RFK Jr. The “studies” the CDC just cited were apparently workshopped here between crystal-healing posts.
- Calley & Casey Means’ YouTube Ecosystem — A shared cinematic universe of ancestral eating, glucose micro-dosing, anti-pesticide crusades, and earnest head-nodding on Rogan. Now inexplicably influencing real federal policy.
- The Supplement Industrial Complex — Hovering behind all of this like a Marvel villain, thrilled to see credentialed skeptics kneecapped while powder-filled capsules requiring no proof of efficacy are sold with medical fervor.
In short: It’s the first time in U.S. history that federal health policy has been shaped by a cast that looks like the guest lineup for a three-hour “wellness truth bomb” podcast.
Wrapping It Up: Smaller, Weaker, Dumber Is Not the Goal
So that’s this week in our brave new incretin world:
Wall Street is throwing confetti at Eli Lilly for turning GLP-1s into a trillion-dollar cash printer, the medical-industrial complex is still pretending muscle is optional hardware, and RFK Jr. is busy converting the CDC into a content partner for his antivax fan club.
Meanwhile, in the real world, the trade you’re being quietly offered is simple:
- We’ll shrink your waistline.
- In exchange, we’d like some of your muscle, a chunk of your bone density, and maybe a little bit of your common sense if you start taking YouTube medicine seriously.
If you’ve made it this far into the issue, you probably already suspect that’s a bad deal.
The gist is not complicated:
- GLP-1s and tirzepatide can be incredibly useful tools for diabetes and obesity.
- They do not care what you lose — fat, muscle, or bone.
- Your muscles, bones, and brain are your responsibility. That means protein, iron, barbells, walking speed, and occasionally saying “no” when the scale looks great but your legs feel like overcooked pasta.
I’m 79, allegedly cognitively intact, and still annoying enough to write all this instead of quietly fading into Medicare brochures. If there’s a point to this whole Peptide Purgatory enterprise, it’s this:
Use the drugs if they help you — but don’t abdicate the parts of your health that Big Pharma, RFK, or TikTok are never going to fix for you.
Muscle matters. Balance matters. Brains matter. The rest is just billing codes and stock charts.
Thanksgiving Send-Off: Congratulations, You’re an Endangered Species
If you’re still reading, congratulations: you are now part of a critically endangered subspecies — the Adult Human With an Attention Span Longer Than a Reels Clip.
You’ve survived:
- A lecture on lean mass and GLP-1s,
- An old man flexing his 27/30 MoCA like it’s a Super Bowl ring, and
- A full tour of RFK Jr.’s Department of Health and Harm Services, featuring a supporting cast of YouTube grifters and supplement peddlers.
For this, you earn my deepest respect and absolutely no tangible reward.
Here’s your homework until the next issue:
- Lift something heavier than your phone.
- Eat enough protein to keep your quads from entering hospice.
- Treat any federal website that suddenly sounds like a podcast guest with the suspicion it deserves.
- And if you’re on a GLP-1, remember: the drug can curb your appetite, but it doesn’t get to decide what kind of old person you become. You do.
Thanks for slogging through another overlong installment of Peptide Purgatory.
Now get out of your chair, go move something, and try not to let the CDC, RFK Jr., or Eli Lilly make you both smaller and weaker.
Until next time,
— Your foul old fowl, still lifting, still bitching, still here.
HAPPY THANKSGIVING TO ALL MY TURKEY READERS AND MY FALLEN HOKIE COMRADES!
Peptide Purgatory chronicles one man’s ongoing experiment with Mounjaro, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers. So, ask your doctor whether Peptide Purgatory is right for you!
For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.
