GLP-1s came to my attention a few years ago, but because of the side effects, it made little sense to me from an athletic and general health perspective. This was mostly due to only semaglutide (Wegovy) being available, which binds itself very tightly to the GLP-1 receptors (which then causes issues).
With the advent of Tirzepatide (Mounjaro), the view from the athletic corner changed drastically given its pharmokinetics (less binding to the GLP-1s (less nausea) and some GIP cover (also less nausea)). Works way better for athletic and general health use.
I usually do a cutting phase to get leaner every year after winter, and I go from about 185-190lbs at 12% to 165lbs at 6% bodyfat. Takes me about 4-6 months and it usually gets increasingly harder once you enter single digit bodyfat % (also age does become a factor). Food noise towards the end can be loud.
I tested out micro-dosing Mounjaro over the last 3 months (under the 5mg clinical dose per week) and it has made the cutting phase much, much easier.
Went from 188lbs (12%) to 168lbs (6%) in 3 months with complete control of my hunger levels.
I have to admit that I am very impressed. My wife is now using it (micro-dosing under 5mg) and she also very happy with her ability to control food intake.
I seem to be a hyper-responder because people comment on being at 10-15mg/week, which just seems to be a really high dosage to me.
Mounjaro is approved/marketed only for Type II diabetes, while Zepbound is approved for weight loss and sleep apnea. You have to have good insurance and a supportive doctor to get approved for insurance on Zepbound (in the U.S.). And you better stay insured since the medication is for life.
I have almost exactly the same graph as you are showing above, I lost 20 pounds in 3 months (with the 4th month leveling off and now requiring titration) with very few changes to my dietary & exercise habits. The awkward thing about it is my nutritionist has made it clear that I have to eat more, not less, to achieve a healthy diet. Why was I even gaining weight in the first place, who knows. Whatever the reason - Zepbound clearly solved it. I really think they have found the answer to obesity.
Yes I created an account just to talk about Zepbound - it’s a life changer.
Yes. In the US that is true. They have separate brand names.
I am UK-based, so we only have Mounjaro available over here. You can get it prescribed privately (in the case of athletes its actually easy to get because they use BMI as the main factor).
Agree that it can be tough to get enough nutrients if you are restricting calories too much (this is where I see value in taking external supplements (Calcium, Magnesium, Zinc etc)
In the abstract sense, Tirzepatide works by altering your bodies set point when it comes to homeostasis via the GLP-1 receptors.
So if you take 5mg, your hunger might disappear, you will eat less, and the weight reduces. At that point you will plateau (this generally means that the 5mg dose is sufficient to keep you at that weight) and you will feel hungry if you try to lose more weight.
If you then go to to 7.5mg, the same logic applies. You will get reduced hunger, you eat less, and your weight reduces. Until it stops working (plateau), which would be your new set point at 7.5mg.
That dosage-response curve is highly individualised though, so you really have no idea how it will affect you until you try it.
Agree that these drugs are an impressive weapon against obesity. The main challenge now is what comes after (either maintenance at low dosages or you come off completely).
Some struggles that non-athletes like myself have with this medication are (1) it suppresses your thirst as well as your hunger, so if you’re not drinking enough water prior to taking it you’re certainly not going to be drinking enough now (welp). I’m getting to the point where the lack of hydration is making me feel faint on the daily.
And (2) the doctor is regularly scolding me to do strength training at least twice a week - muscle mass is apparently impacted equally to fat mass (although my scale does not yet indicate this… but I do not know if I should trust the scale on that).
Side effects outside of that I’ve found to be minor - like a day of continuous burping at the beginning of the week. Maybe some gut pain in the first few weeks. I do have a colleague that is absolutely destroyed every week she takes this - but apparently, it’s worth it.
And to be clear, I am not actually restricting calories right now or on a diet (and was not before medications this is just how I normally eat). I did commit to eating less bread and am trying to include more vegetables, but outside of that my habits are the same. That’s why it so freaking remarkable to me that I step on the scale every morning and without fail it’s going down. To have the same impact with only dieting/exercise I would have had to be consistently under 1200 calories a day and to do exercise every single day - results would be seen only over a much longer period.
Also of note, 8 of the 20 pounds lost was actually in the first week. I have gallstones now (I assume because of it). Still worth it.
I have noticed this as well. Got dry mouth for a bit and it got hard to chug water down. In hotter weather this might be a concern (even a 1% decrease in hydration can cause issues).
I got around this by drinking low sugar diluted fruit juice (the taste helped a lot to drink more) but agree it was very easy to kind of drift by the day not drinking enough water.
The published studies don’t really give a good view of how much muscle is actually lost, primarily because they didn’t really exercise and they also didn’t eat enough protein (double whammy effect really). If you keep protein intake high enough (say 1.5g or so per Kg of LBM) I don’t see you losing much LBM even with only a little exercise. Thats the key really as it can be tough to eat protein when your hunger is minimal (protein shakes can actually help a lot here).
Re: Gallstones
This is one of the main reasons why going slower is the way to go initially (less hydration and more bile due to reduced stomach content mobility = potential gallstones). Seen a few instances in athletes as well of this phenomenon.
Re: Nutrient Partioning
One interesting effect of Mounjaro is that it will improve the partitioning effect of the food you eat. You can have the exact same diet, but on Mounjaro you will get more fat being used for fuel (via the GIP agonism), which when combined with the anorectic effect (from GLP-1 agonism) can improve your body composition over time even though your diet hasn’t changed.
What is the caloric impact of this change? Bread has a lot of calories and a high glycemic index that will trigger hunger and lead to additional calorie consumption to fend of food cravings.
I assume GLP-1 makes it easier to stay on the diet wagon. Without it, people will have cheat days and make other excuses to consume foods on occasion that will just derail progress that they have made, which is where I think a lot of the struggle really comes from. At least for me personally, I can go months without candy or sugary junk food, but the moment have it once, I’ll crave it again for several days following that. Our food is designed for diet failure, and I don’t think this is well accepted.
For me, semaglutide’s biggest benefit has been eliminating food noise. If you don’t have food noise, I can’t describe what a miracle it is.
It also cuts my appetite by about 3/4. I have been lucky that I’ve had almost no side effects other than the intended ones (delayed gastric emptying, for example).
Have been lifting weights for the last 4 months and that’s been so much easier to stick to now that my weight is in a healthy range.
I’m on Wegovy . . . and will say that the appetite suppression due to the initial “side effects” of the drug has helped me get to developing better food intake habits.
My doctor told me that the greatest danger (for those who respond to the drug like I did) is that protein intake also drops significantly and can create an unhealthy posture (dietary wise) and your muscle mass will subsequently suffer as a result.
Anyway, I’m pretty happy with my self-image and self-esteem. I work on weight control by changing my self-control without any help. It is a struggle, but it is my struggle.
I think i’ll write a book, but I need a catchy title…
I guess I would pull these comments together and suggest that the food noise mechanism that exists in people that struggle with maintaining a healthy diet is much the same as the mechanism that exists in people that struggle with alcohol, although there is a point where alcohol can and will become a real dependency that is definitely a differentiator.
I don’t think I have a strong food noise issue, but I do know there are certain foods that I will eat too much of if I buy them, and when they run out I want to go to the store so I have more around. Sounds familiar, right?
But we absolutely view treating excess food consumption differently from excess alcohol consumption. For food, we diet, we restrict, then we relax. With alcohol, the treatment is abstinence. It’s commonly accepted that any drink is a step back towards restarting bad habits. For food, we hit weight goals, and reward ourselves with a food treat. I think that is setting up failure long term. GLP-1 drugs suppress that desire to consume those bad foods, but I suspect a viable long term alternative could also be abstinence of those trigger foods. Over time, that craving subsides, and a healthy diet can be maintained. I suspect this will take months to a year to achieve, the same timeframe it takes to really move on from alcohol. Most diets never last that long.
The food noise I get (or used to get) always wants sugar. I can binge eat an entire bucket of ice cream or bag of candy or whatever, and I’m more likely to do so after moderate stress. This made up for all the calories I wasn’t getting from eating real food.
I have lost weight before from strictly monitoring calorie intake and exercising every single day, but it always felt like I was starving and the weight always went back up slowly over time. My doctor told me that losing weight with diet and exercise alone will fail 90% of the time. 90% hit me like a ton of bricks - like why even bother at that point? (Yes, I was an actuary, if you were wondering, and I still do like numbers).
Anyways, I was given the choice between a long list of older-to-newer drugs and while Zep was the most expensive, it was also said to be twice as effective as its Ozempic/Wegovy predecessor (like an average of 20% body weight lost over time versus 10%), so it wasn’t really the hardest decision I’ve ever made. I no longer feel like an overstuffed sausage in my own skin.
Right, the sugar will reintroduce the food noise and put you back into bad habits over night. Its the same failure rate for an approach to sobriety that would suggest going sober for 3 months and then easing back into alcohol.
It requires a commitment to a complete lifestyle change. But no one sells that because it’s hard and being overweight is not that big of a deal, and solving the actual problem cuts off the $ for the people doing the selling.
The drugs make that lifestyle change easier/possible and prevent the relapses from happening when someone slips up. I am not saying people should not take these drugs, but I do wish that we had better understanding and education on food and nutrition that at least put this in the proper perspective for people to make better decisions. It’s expensive, and comes with side effects.
Used to do powerlifting and serious sports but now focus more on the challenge of getting as lean as possible without putting too much stress on my joints (easier to be 165-180 at low BF% vs 180-200 at low BF%) while playing with our little one (sports and activities) over the summer.
I went up to 7.5 mg last Friday and immediately started going straight down in weight again (2 pounds in 3/4 days). I didn’t really have any side effects like I was expecting - until today… sort of.
I do generally get nauseous if I push rigorous activity too hard (presumably because my heart rate goes from resting to heart attack in 2.5 seconds). But, uh, I usually stop before I run into any real problems.
Today there were some problems. Like projectile vomit problems - with food that I ate at least 2 days ago.
