Mounjaro: Week Three

I write a lot, and I enjoy doing it. Recreational writing ventures include a regular column in my club newsletter, the Penn State football portion of this blog, and now, this weekly feature regarding my foray into the use of the diabetic control drug (and vogue weight-loss sensation), Mounjaro. Writing about it also provides a record of my experiences for personal reflection, a weekly diary, as it were. Having completed my third weekly injection, I am here to provide observations and some opinions about the drug and its popular culture.

Recapping the past two week’s posts, I told you about my frustrations with the on-line so-called support community and with the drug’s availability. Nine out of ten vlogs and blogs center on the weight-loss aspects of the drug, even though at this point, the Unites States FDA approved Mounjaro for diabetes control but not specifically for weight-loss. (The FDA approved a relabeled version of Mounjaro called Zepbound for weight loss only). Last week, I mentioned that some YouTubers have received monetary compensation from big pharma for their efforts in promoting sister drug Ozempic and I disdained the practice of dose-splitting.

Today, I will talk about my continuing Mounjaro experience, especially one nasty side-effect that we do not talk about at the dinner table: constipation. Another one that I will touch on is dehydration. But first, the good part.

Progress after Third Week on Mounjaro

Recall that my dose of 2.5 mg is the “starter” dose of Mounjaro. For most people, the minimum therapeutic dose is 5 mg. After the first month, many move up to that dose. However, I chose to remain at 2.5 mg for the second month. I am an old fart with several significant gastrointestinal co-morbidities, along with my diabetes. I am wary about the rush-to-market testing not being thoroughly predictive enough for geriatric use. This decision to remain at 2.5 was mine, not my doctor’s.

Tomorrow, I will discuss my thoughts with my doctor. I want him to order a set of blood tests—nothing too elaborate—a SMAC-25 as a baseline for repeat and follow-up in six months, which will coincide with my next annual physical exam. I want to make damn sure that this stuff is not doing anything bad to my liver, kidneys, my muscles, and my kishkas in general.

Weight Loss, or Lack of Same

My weight loss stabilized and was flat for the week, no major surprise due to a couple of things. For one, I had been taking hydrochlorothiazide (HCTZ) as an adjunct medication for control of high blood pressure. However, since starting Mounjaro and adjusting my diet, my average morning BP is less than 120/70. Therefore, I discontinued the HCTZ with my doctor’s concurrence. HCTZ is a diuretic; in view of my dehydration, I expected to gain a little rebound water weight. Thus, it is no surprise that my weight remained unchanged since last week. I’ll note, though, that dehydration and rehydration caused a two-pound drop and increase during the week.

Glucose Control

This is the area I am most interested in, as diabetes is a killer. Many of its symptoms are occult, and we do not discover the damage this disease has wrought until it is too late. Crappy diets and metabolic syndrome exacerbate the situation. My alarm over a recent A1c report impelled me to use Mounjaro, despite the possible negative side-effects.

I am happy to report improved glucose control. My morning fasting glucose readings had been over 140 mg/dL prior to Mounjaro. During the past week, I averaged 98. Today, for example, I measured 92 before and 98 an hour and forty-five minutes after the meal. Whether or not I can attribute this completely to Mounjaro is muddled by my associated dietary changes. I will describe those next.

Dietary Changes

A well published benefit of Mounjaro is appetite suppression, given its dual effects of slower digestion and increased satiety. These “features” make it easier to change one’s diet to lose weight. So, what did I change?

I am eating smaller meals, less junk, and more fiber and protein than previously. My insulin resistance makes it problematical to consume lots of carbs, which I had been doing before the Mounjaro excursion. Sneakily, I was eating lots of cereal to provide the fiber I needed to keep the kishkas running, and of course, this caused weight gain along with glucose spikes up the ass for the past year or so. Now, I have a protein breakfast accompanied by a glass of psyllium fiber supplement to provide the fiber. I anal retentively track my meals with an app called MyFitnessPal, which ensures that I stay on track.

My protein target is ninety grams per day. It is especially important while taking Mounjaro to ensure adequate protein in the diet, because especially among us old farts, weight loss attributable to the drug often involves loss of muscle mass. Protein in the diet and resistance exercise are necessary to avert this damaging consequence. Furthermore, muscle destruction, called myolysis, can cause kidney damage, to compound the felony. So, I do what is necessary to keep the protein up and I am increasing my exercise.

Whether these changes result from the power of suggestion or the drug itself is a subject for debate. I would hope that they are permanent for me, so I can discontinue the drug at some point. Recall that I am at the starter dose of Mounjaro, which is half the recommended minimum therapeutic dose.

Some Mounjaro Side-Effects

In Economics 101, we learned the “TANSTAAFL Principle”, which posits that There Is No Such Thing as a Free Lunch. With Mounjaro, too, you will not be able to have your cake and eat it, too. (Mixing food and sugar metaphors and puns is fun for this old fart, but I digress). Aside from the price you pay at the pharmacist, trade-offs exist in return for your diabetes control and weight loss. You should prepare for them and do what is necessary to minimize them.

Below, I describe two common and notable adverse effects, which are constipation and dehydration. Some users suffer nausea or vomiting, two quite common side-effects I have not experienced. The published information for Mounjaro describes many other potential effects, some unbelievably bad. Therefore, you should diligently read the package insert and consumer materials and discuss them with your doctor to understand what you are getting into here. And do not for a moment think that you can just play with Mounjaro as a cosmetic, no-consequence drug without potentially serious side-effects. If you’re just seeking to lose a few pounds, it is not worth the risk.

Constipation

Nobody likes to talk about it, but most of us have experienced this unpleasant condition, a notable and common side-effect of Mounjaro. Man, it sucks! I keep the fiber up, but things just do not move through there like they used to. I have also used Miralax and Senekot. My guess is that they worked a little, and that without them, I would really be up the shit creek without a paddle. (So to speak).

This cannot be good over the long term, and I must wonder about the increased potential for intestinal blockages. The on-line so-called support group solutions are ridiculous, including the exhortation to eat watermelon. Completely worthless! I will discuss this subject with my doctor tomorrow to see if he has any bright ideas.

Dehydration

You MUST maintain your hydration while taking Mounjaro, or else! Kidney damage is irreversible. You drink lots of water with Mounjaro to ensure that does not happen. The idiotic weight loss community justifies the personal inconvenience of diligently pursuing increased hydration with the moronic maxims, “water burns fat” and “water flushes fat”. OK, I’ll give them their fantasies. Any port in a storm! Employ whatever reasoning you choose, but just do it! DO NOT obsessively celebrating “loosing” on the scale by regarding dehydration as legitimate weight loss. Hydrate diligently and intelligently. Your kidneys will thank you.

Ants: “Your a idiot!”

As I mentioned, I was taking hydrochlorothiazide for blood pressure control. This, in combination with the Mounjaro, cause excessive dehydration. I can typically tell when my hydration is low by how prominent my veins are in my arms and legs, and during the past couple of weeks on Mounjaro, it has been low. Couple this with my decision to do a strenuous hike last Tuesday in “feels-like” temperatures of high 90s Fahrenheit, and you have a recipe for disaster. I had to lay down during the hike to rest for a while, as my heart was pounding due to hypovolemia and the heat. A few harvester ant stings added insult to injury. Perhaps they were driving home an oblique hymenopteran message: “dumbass!”.

I brought along two-and-a half liters of water for that hike, which was only three-and-a-half miles, but it involved some heavy bushwhacking. I drank all that water. Furthermore, in the days before the hike I drank lots of fluids. Still, I became seriously dehydrated and felt crappy for days. My doctor confirmed that dehydration can occur with sudden onset while taking Mounjaro. One reason for this is that the satiety effect suppresses thirst as well as hunger, so people forget to drink water. So, please heed my warning!

Summing Week Three on Mounjaro

This concludes my weekly observations. I am hoping that my observations regarding side-effects like constipation and dehydration, as well as my modest short-term successes on a low dose of Mounjaro, will help guide you in making your personal decision to collaborate with your physician in determining whether “Mounjaro is right for you”.

I want to add that while social media has its place, it does not replace your legitimate doctor. (I add the qualification “legitimate” because weight-loss boutiques and less than scrupulous teledocs are now prescribing terzepatide to anyone, just for the asking). Too many people who get most of their information on social media are too lazy to do the real research necessary to make their own decisions. Social media posts run the gamut from highly informative to complete misinformation, with some “influencers” dangerously verging on practicing medicine without a license. To avoid legal trouble, most will provide a disclaimer. Take it seriously! You must not rely on “influencers” to make your health decisions, which should be a collaboration between you and your physician(s). Watch the influencers’ posts for amusement, take note of any interesting tidbits, and then talk to your doctor.

That’s it for now. I will return next week with more observations and paths forward.