I’m back with my oblique title so my Facebook friends can see my posts. I am not certain whether Facebook’s objection is to the word “Mounjaro” or the picture of the Mounjaro injector pen. But I’m tired of messing around trying to outwit their spam algorithm.

This week, before presenting my update, I’ll be looking at the perils of rapid weight loss. This is a topic all of us who take GLP-1 inhibitors must understand. Unfortunately, people who are seeking a miracle cure for obesity, who are sold a bill of goods by profit-oriented weight-loss spas and shady tele-health providers are rarely given the full picture. Also, people who do their research watching GLP-1 proselytizing cheerleaders on YouTube typically find cherry-picked, biased commentary. Those sources emphasize the benefits while either playing down or ignoring adverse effects.

I don’t claim to be a doctor or a medical researcher, and you should not base medical decisions on information or opinions you find here. I merely wish to share some thoughts based on my perusal of the subject. You can investigate further if you wish. Please satisfy yourself that you have examined these potentially harmful effects from all directions. After all, you are (or will be) injecting a foreign substance into your body, so you better know what it will do to you, now and into your future. No drug therapy is completely devoid of side-effects, and Mounjaro and other GLP-1 agonists are no exception. Some of the potential adverse short-term effects are quite serious, while the longer-term, insidious effects are not yet thoroughly studied.

Losing is Winning?

So, you want to lose weight and somehow you got hooked up with a GLP-1 agonist, be it Mounjaro, Zepbound, Ozempic, Wegovy, or generic tirzepatide or semaglutide. Your “medical advisor” told you that you will lose up to 25% of your weight. They started you on a low dose, at which you suffered a few side-effects you felt were tolerable impediments on the way to your goal. A little nausea, some constipation, a feeling of fullness–still worth it. Meanwhile, you are losing weight quickly, which is addictive. If you slow down, they put you on increasingly higher doses, eventually getting you up to the top dose.

All the while, as you fall into the addiction spiral, you acclimate to the side-effects. You compensate by taking fiber supplements for the constipation, and by eating even less. Drunk with the prospect of losing more weight, you starve yourself, lose muscle, and lower your metabolism, while risking some horrible short-term issues like pancreatitis, gall bladder disease, intestinal obstruction, and treatment induced neuropathy of diabetes (TIND). But it is sooooo worth it to shed those unwanted pounds so easily.

Until it isn’t.

I Can Quit!

Like an alcoholic, you indignantly exclaim, “I can quit at any time!” Can you? What happens then? Have you screwed up your metabolism so badly that you’ll gain back 50% of what you lost in a matter of months? Better not quit, then! Can’t risk porking up again! You must do whatever you can do to continue taking your Ozempic. Denmark’s citizens appreciate your support because you and your fat loss colleagues have made Novo Nordisk’s contribution to that small country’s economy greater than the aggregate of all other production of goods and services there. You’re hooked on expensive Ozempic or its GLP-1 cousins for the rest of your life, but you’ll be oh, oh, oh, so healthy!

Well, maybe. Long-term effects of these drugs have not been thoroughly studied. But over the years, certain consequences of rapid weight loss have become known. Some are controversial, and you’ll need to do your own research to decide which ones you need to be concerned about. I will focus on two long-term effects here, namely, muscle loss and decrease in metabolic rate.

Muscle Loss

Losing weight quickly causes muscle loss along with fat loss, at a far greater rate than losing excess weight slowly through controlled diet and exercise. This can be devastating in middle aged and older adults, who are already losing muscle mass due to aging. Poor nutrition can also result in bone loss, which in combination with muscle loss can result in frailty.

In one study, researchers put 25 people on a very low-calorie diet of 500 calories per day for 5 weeks. They also put 22 people on a low-calorie diet of 1,250 calories per day for 12 weeks. After the study, the researchers found that both groups had lost similar amounts of weight. But the people who followed the very low-calorie diet lost over six times as much muscle as those on the low-calorie diet.

Typically, responsible weight-loss clinics counsel their patients to consume enough protein and diligently pursue a resistance exercise program to thwart muscle loss. While these measures slow down muscle loss, the big question is whether they do enough. For older adults, who can not effectively rebuild muscle, the loss can be irreversible. Furthermore, it is difficult to consume enough protein when the appetite suppression effects of GLP-1 drugs kick in. For an obese person who weighs 220 lbs (100 kg), we’re looking at 100-120 grams of protein per day, which is equivalent to a 22-ounce (624 g) ribeye steak. If you’re fatter, you’ll need more.

Rationalization

Some sources rationalize that if you lose a lot of weight, you’ll have lots less to carry, so you’ll need less muscle to support your smaller size. This is equivalent to saying that if your business is losing money, you can fire some employees because you’ll need fewer workers. True, but the bottom line is compromised, and with fewer workers, it will be that much harder to get back to where you were. You’re looking at diminishing returns. Even if you get off the drugs, you’ll need to consume loads of protein for modest gains in muscle mass, and you’ll be looking at gaining lots of weight back in the form of fat.

Metabolic Rate Decreases

The effect of rapid weight loss on metabolic rate has been studied since well before GLP-1 agonist drugs were a gleam in Big Pharma’s eye. Yo-yo dieting has been shown to lower metabolism during each weight-loss cycle. This results in a cumulative effect, making it harder to lose the weight the next time. Your body burns fuel at a lower overall pace, so you must eat less and work harder to lose the same amount of weight.

Recalling the earlier section of this article, rapid weight loss can cause significant muscle loss. Less muscle mass will decrease metabolism. So, it’s a vicious circle.

This brings us to why we have never seen a reunion show of The Biggest Loser contestants, who have been studied by bariatric researchers. You will not see that reunion because most of the contestants have regained much of their former size. Some have even exceeded their starting weight. One study assessed sixteen participants on The Biggest Loser. They lost a mean of 128.5 lbs (58.3 kg) during the competition. But after six years, they regained around 90.4 lbs (41 kg). Additionally, those who maintained a greater weight loss over time also had greater metabolic slowing. So, their metabolism never rebounded after they lost weight.

Slower metabolism leads weight-loss addicts to want to eat even less, thus risking nutritional disorders and more muscle loss. Their aversion to proper nutrition during the down cycle is abetted by the appetite suppression effects of GLP-1 agonists like Mounjaro and Ozempic.

What to Do?

Once again, I’m not here to push advice, just to tell you to keep your mind and your options open. I want to emphasize that there’s no such thing as a free lunch (no pun intended). You might be on Mounjaro for diabetes, and it might be working for you. I do not wish to discourage that therapy, because as the drug insert mantra goes, “your doctor prescribed this drug because its benefits outweigh its side-effects.” Trust your own, local doctor.

But weight-loss drugs have created a cutthroat, competitive, money driven, pay-for-play, highly commercialized healthcare industry segment. I urge caution dealing with tele-health doctors contracted by self-interested compounding pharmacies and med spas to push their drugs. Their impetus is to sell drugs for weight loss, not to look after your overall health. Imagine how they will support you when you develop pancreatitis or cholecystitis, listed adverse effects of Mounjaro. Their lawyers might tell them to refer you to your local face-to-face physician but beyond doing that, keep their mouths shut.

You did consult with your local doctor before you started on your GLP-1 drug, right? At the very least, do you keep your local doctor in the loop while you deal with the tele-health prescriber? Again, you’re injecting a foreign substance into your body that has both positive and negative effects on your overall health. Your doctor needs to be informed and involved.

Be Careful!

In summation, be careful. Resist the temptation to accelerate the process, increasing med doses to sustain a high rate of weight loss. Bigger adverse side-effects kick in at higher doses. Take it slowly. After the initial water weight loss, don’t be disappointed if you lose just a pound or two a week or if you stall for a while on a weight “plateau”. Keep working at it, keep the protein intake up, and be seriously committed to exercise, both resistance and cardio. Make certain that your diet consists of real food, not ultra-processed crap. Eat well and make it count. Do not malnourish yourself in an insane quest to lose weight faster. Nothing good comes easily, and there ain’t no such thing as a free lunch.

My Progress on Mounjaro

With all the caveats I presented above, you would think that I was on the outside looking in, but noooooo, I’ve been taking Mounjaro for twenty-two weeks now for type two diabetes. My doctor prescribed it on June 5. Along with dietary changes and exercise, it has enabled me to achieve decent glucose control. I have also lost about 19% of my body weight.

Average glucose for the week was 99 mg/dL (5.5 mmol/L). This is excellent, and I’m hoping that it stays there or lower. One metabolic keto diet doc whose videos I have been watching likes to use a CGM to measure blood glucose twenty minutes before waking. She categorizes ranges 70-79, 80-89, 90-99 (mg/dL) in descending order of desirabililty. Mind you, she is dealing with non-diabetic or pre-diabetic people. Using the Clarity app, I find that my mean glucose between 6 am and 7 am is 90 mg/dL with a standard deviation of 7. This tells me that if the diet doc–who, by the way, disdains Mounjaro and other GLP-1 drugs–is correct, I still have some work to do.

I lost 1.6 pounds (0.7 kg) this past week, a desirable and sustainable rate. I’m now at 199 lbs (90.5 kg). I am working hard on preserving as much muscle as I can. Right now, physical therapy is helping with that. I’m hoping that the PT torturers will “fix mah back!” so I can resume resistance exercises at home. But I digress. Keeping the muscle mass intact is a priority. Muscle mass weighs more than lard, so if weight loss stalls due to me rocking up, so be it. So, weight loss is relegated to third on the priority list after glucose control and avoiding muscle loss.

Wrapping It Up for Y’all

In the south, the second person singular pronoun is “y’all”, while the second person plural or collective pronoun is “all y’all”. I moved to Florida with my family in 1961, then went away to school, went to work, lived a few places, then moved back to Florida for good in 1976. So, I’m allowed to say y’all.

I hope I have provided some useful information about rapid weight loss, muscle loss, and metabolic slowdown due to losing too much, too fast. I can not hope to even scratch the surface in a weekly blog post, so please do explore these subjects in greater depth. Your curiosity led you here because you care about your health and what a drug like Mounjaro can do. Taking it a step farther to glean more information elsewhere will serve you well.

See you next week!

…in my Mounjaroville

Yep, as I predicted last week, Facebook removed my Mounjaro update once again because they think I’m spamming the six people who read the updates. Sure, that’s what I’m all about, right? So I’ll obfuscate the name of the drug and I’ll post an innocuous parrot head picture once again. Screw Facebook and their dumbass spam algorithm.

I’ll remind you that you can subscribe to this blog via the tool on the right. You’ll get a notification when I post something, but otherwise, you won’t be spammed or harangued. This is a non-commercial blog, written for my own amusement, not for money.

But I am not here to write about Facebook. Mounjaro therapy–mine, specifically–is the topic at hand in this corner of The Nittany Turkey blog. It is mostly about me, but I also cover other subjects related to the vogue drug my doctor prescribed for my type two diabetes. Each week, I share an update of my progress getting my blood glucose under control. Boring, I know. So, I throw in frequent editorial rants to spice things up.

Just view this as a curmudgeonly old fart kvetching about his ailments and dishing out some impertinent opinions about human behavior, healthcare, and social media warriors. Take some TUMS and read on. Today, after a couple of irascible, stream-of-consciousness, somewhat redundant pontification, I get around to telling you how I am doing.

Don’t Stop Believin’ (in YouTube)

The pop musical group Journey recorded the song “Don’t Stop Believin'” in 1981. Since then, Forbes rewarded Journey by declaring it “The Biggest Song of All Time.” That’s all I want to say about “Journey” here, before my weak segue to the spurious topic at hand. I abhor using the word journey to describe drug therapy or other medical treatment. Tune into YouTube sometime. You’ll hear lots of wanking about Mounjaro journeys. Hell, if I wanted to know about frigging journeys, I’d watch travel videos instead. Characterizing serious medical therapy as something akin to a pleasure cruise is simply bullshit that I lack the patience to process, especially when that pleasure cruise is most often like The Poseidon Adventure.

“Learn to Eat!”

And, hey, I won’t tell you what to eat while dealing with Mounjaro therapy, either, like some YouTubers. Recently, I saw a disgusting video by one of the YouTube “influencers” chronicling her “journey”. She was showing what she ate on a particular day. I nearly vomited, watching her add processed crap like mayonnaise and bottled ranch dressing to her indulgences, with the happy approval of her canine meal companion. She not only wants to preserve her shitty eating habits, but wants to tell us all how to do it. Some “influencer”!

As a lifelong friend’s now dearly departed mother used to say, “Learn to eat!!!”

Abominations abound in the YouTube milieu. Watch those videos with a jaundiced eye. (My ocular bilirubin count increases every time I fire one up). Be a cynic. Most of these people are repackaging readily available information to get click counts, likes, thumbs-up, subscriptions, etc., to feed YouTube’s monetization algorithm. They have links to sponsoring organizations to further augment their coffers. Some even ask outright for donations! How the hell would you expect to get unbiased information from them?

Fortunately, a few unsponsored YouTube channels provide good, non-opinionated, firsthand individual experiences with Mounjaro. They are not obsessed with weight loss but with getting diabetes under control. Seek them out and appreciate them for their honesty and sincerity. As for the others, I’ll tune into them for brief entertainment, then throw up and leave.

Let them eat cake!

Soapbox Time — a Non-Mounjaro Odyssey

Not being a doctor, I do not presume to offer medical advice here. But I will tell people who need to lose a few pounds for aesthetic reasons to fix their diet and go to the gym. They should not look for miracle drug cures to fix their laziness and their unabated desire to stuff their face with ultra-processed crap. To them I say save your money and spend it on a dietitian and personal trainer. That’s my layman’s prescription for you! Vanity of vanities. All is vanity.

I saw one bodybuilder/body-worshipper type guy on YouTube reporting that he uses GLP-1 drugs when he wants to go from 10% body fat to 5% after his primordial winter hibernation. Give me a break, nut case!

As you can glean, I’m neither a doctor nor a great motivational speaker.

I disdain people buying into Big Pharma’s government supported position that obesity is a chronic disease we can conquer only with their highly profitable drugs. Obesity is a societal disease, alright! With the complicity of government, those of us who have been around long enough have seen our Western societies fatten up increasingly during the past half-century. Encouraged by “trusted” sources, we opt to eat crap that makes us sick. So, we buy into Big Pharma’s logic we can easily cure our behavioral problems with expensive drugs. Then, being human, we bitch that the drugs are too expensive.

We Want Our Mounjaro!

So, what do we want? Will our happiness eventually depend on our increasingly socialistic government providing free tirzepatide (the generic drug in Mounjaro and Zepbound) to every man, woman, and child who destroyed their health eating the food they prescribed in their flawed food pyramid? They designed those corrupt nutritional guidelines while succumbing to the lobbying power of Big Agra. Thus, the fox is guarding the hen house.

They vilified fats and lionized sugar, creating a high-carb, inflammatory lifestyle that is anything but healthy. Even the American Diabetes Association buys into that bunch of bunk. Of course, that association is also corrupt, taking major ongoing funding grants from major self-interested pharmaceutical sponsors like Eli Lilly and Novo Nordisk, who among others are Banting Circle Elite supporters at over $1 million per year. Food industry National Sponsors who provide at least $150,000 per year include Splenda and the Idaho Potato Commission. Nothing spikes your blood sugar quite as effectively as the lowly potato!

Who can we trust nowadays?

Compounding the felony, the food industry hired scientists who were about to become unemployed due to the collapse of the tobacco industry to research how to addict people to their ultra-processed, sugary food abominations. These top minds in addiction science have figured out how to put sugar in just about everything, with the happy collaboration of Big Sugar. Lobbyists from the food industry swing considerable weight with our corrupt government (pun intended), which is complicit in promoting the obesity causing foods. And that will cost us all, one way or the other.

Follow the Money

Just keep following the money. You see the theme here. Ultimately, we will demand that government pay for the drugs, because we “need” them but we can not afford them, which is not “fair”. Government has no money of its own. It can either tax us, borrow money, or print money. Government-supported drug addiction would lighten each citizen’s wallet, either in the form of increased taxation or rampant inflation. There ain’t no such thing as a free lunch

So, from Big Farm-a to Big Pharma, the vicious circle is all about money, which they cleverly shroud in a cloak of altruism. “We The People” are being fed a bunch of sweetened, highly processed crap. Then, thanks to big business, we can buy an expensive drug to erase the fat created by ingesting this manufactured garbage. And it works so fast! We can further satisfy the same need for instant gratification that got us there, while suppressing any evidence of harmful adverse effects. Thus, they addict us to the expensive drug for life with unknown long-term consequences, because if we stop, we’ll be that fat person we don’t want to be. Big Pharma shakes hands with Big Fooda, and they live happily ever after.

The Latest Travesty: The Chillllldren

Big Pharma, namely Novo Nordisk, makers of Saxenda, Ozempic, and Wegovy, and Eli Lilly, makers of Mounjaro and Zepbound, have been testing its drugs for use by children. They have sought regulatory clearance for prescribing GLP-1 drugs for kids as young as six years old. Holy moly! Let’s prey on our children to expand their drug market!

Using that familiar guise of altruism, which the self-interested YouTube “influencers” have swallowed hook, line, and sinker, Big Pharma aims to save these unfortunate, disenfranchised fat kids from the abuse and humiliation that the fat “influencers” suffered on the playgrounds of their youth. Yeah, maybe, but today, fat kids don’t bother with the playgrounds. Instead, they stay inside playing video games. From the family room sofa and the game console, the only bullies they will confront can be switched off. Game over!

Fix the Parents, Fix the Child

Any parent who would give a chubby six-year-old a weekly injection of Mounjaro or similar GLP-1 drugs with that ridiculous justification needs to undergo a parental competency exam. They would be creating lifelong drug dependency in a helpless child under their control, parentally promoted addiction to an expensive substance whose long-term adverse effects are not yet thoroughly studied. They would be playing into the position advocated by Big Pharma, who fund studies to influence Big Doctra, filtering down to their grass roots pediatricians who pervade the parental sphere of influence with trusted, albeit misguided, advice. I can almost hear the direct-to-consumer ads: “Ask your pediatrician whether Wegovy is right for your toddler.”

Let us all pray that we can return to a saner situation where parents can once again control their children’s eating and exercise habits, promoting healthy diet and activity. Alas, by stuffing their faces with oversize portions of highly processed, sugary, inflammation promoting junk foods throughout the day and allowing them to sit on their fat asses playing video games while drinking Mountain Dew and Dr. Pepper instead of playing outside, parents and guardians have enabled a nation of fat kids. The CDC tells us that 22.2% of U.S. adolescents and 20.7% of children from six to eleven years old are obese. Lifestyle factors and poor parenting account for most of those cases, which we can not fix with weekly injections, unless it is an injection of common-sense responsibility in parents, teachers, doctors, and the screwed-up government on which our society is becoming increasingly dependent.

My Weekly Mounjaro Update

Now that my highly opinionated rant has driven away four of my remaining six readers, I’ll favor the remaining stalwarts with my weekly progress on Mounjaro. Oh, all right! Given the significant possibility that I have chased even the other two away, I’ll just amuse myself with my health update.

Aches and Pains

At the risk of becoming my hypochondriac grandmother of blessed memory, my self-diagnosed ailment of the week is meralgia paresthetica. In other words, weird numbness, burning, and pain caused by an inflamed nerve in my thigh. The nerve in question is a sensory nerve called the lateral cutaneous femoral nerve. It runs over the hip to the outside of the thigh. The causes can be clothing, like a belt, that is too tight, but pressure on the nerve can come from elsewhere, like my lumbar stenosis. This started before I got my physical therapy evaluation, which exonerates PT as the cause. We’ll see how the nerve acts through the remaining PT sessions.

Physical therapy is otherwise going well, although I can not gauge how it will help my screwed-up back. I am doing a total of twelve forty-five minute directed sessions at the rehab, including five minutes on the traction table. I visit the rehab twice a week and do prescribed exercises every day at home for fifteen minutes. The object of the PT is to reduce back and leg pain and numbness to a level that will allow me to resume my normal exercise program with minimal pain. In the meantime, I can do cardio, but no heavy weights.

Ironically Speaking…

Another investigation result during the week concerns low iron. Being blessed with a rare blood type, I donate blood as often as the blood bank allows. They measure iron using a non-invasive machine called Orsense, which typically shows my iron as slightly low. Yet they allow me to donate, so it is not dangerously low. On the other hand, being an old fart, I want to exclude anemia due to internal bleeds or whatever. So, I got blood tests for iron, iron uptake, and ferritin. I have shared the results with my doctor and will discuss with him whether supplementation would help.

He recommended good old Feosol to supplement my iron, with a follow-up in two months. He said it was strange that I wasn’t anemic, given the low iron. I’ll get a CBC before my annual physical exam at the end of November. It is my hope that it will confirm the strangeness of my non-anemia.

HIPAA, HIPAA, Hooray!

I’m a HIPAA disaster! From this platform, I tell you the world (all six of you) all about my ailments while the rest of the paranoid patients in the U.S. are worried about their insurance companies finding out they have AIDS or something. HIPAA, the Health Information Portability and Accountability Act, is a pain in the ass that, contrary to its title, effectively gets in the way of portability. (Government has a habit of misnaming legislation, the most recent example of which is the Inflation Reduction Act. But I digress.). Big Brother must do what it must do to secure the votes of various otherwise disenfranchised potential voters, the reasoning behind HIPAA. Wouldn’t it be nice if we did not need to fill out the same damn questionnaire each time we went to a doctor’s office? What a ridiculously inefficient waste of time! Don’t get me started!

The Mounjaro Numbers, Already!

Yeah, I know. I am so full of myself that I can’t focus. Let’s get down to business. As of twenty-two weeks on Mounjaro, I can report that my glucose progress is good. Starting this week, I’ll make it easier for non-U.S. readers to follow my progress by reporting SI units along with the conventional measurement system most familiar to us backward Americans.

Morning fasting blood glucose is down slightly, at 94.3 mg/dL (5.2 mmol/L), and my Stelo glucose biosensor tells me my average for the week was 102 (5.7), down from the prior week’s 114 (6.3). My next HbA1c lab test is coming up in a couple of weeks. However, if I can continue that 102 average, I will be right at my target A1c of 5.2% (33.3 mmol/mol).

I observed one glucose spike that took me out of range. At Thursday’s lunch at a local lobster joint, I had a cup of lobster bisque, which precipitated a spike to about 145 (8.0). Other than that, I stayed well within my target range of 70-140 mg/dL (3.9 – 7.8).

My weight was nominally stable, with a minuscule gain of 0.4 lb (0.2 kg) for the week. My absolute weight loss since the start of Mounjaro therapy on June 3 is still about 45 lbs (20.4 kg). I now weight 200.6 lbs (91 kg) buck nekkid.

So, That’s It

I’ll be back next week with more of the same. Other than my progress, a topic worth following is the ongoing court battles between Big Pharma and Little Pharma, the latter being the moniker I hung on the compounding pharmacy industry that bet big on the fatso drug market and is now clinging to it by the skin of their teeth. I find the legal machinations a rather interesting market case study featuring Big Pharma’s use of its financial muscle to exert control.

Some of the other topics I will cover in subsequent weeks are increased muscle loss during rapid weight loss episodes and the effects of serial crash dieting on one’s metabolism. The rebound effect after significant reduction after discontinuation of drugs like Mounjaro is another topic worthy of examination.

See you next week!