The No-Namer Mounjaro Weekly

Nittany Turkey back atcha here to report my latest weekly results on Mounjaro and give you my latest opinions on where this whole thing is going. I track my progress and describe my experiences and observations. This week, I especially want to urge caution about trying to do too much, too fast.

On that latter note, I am pissing in the wind, but I want to give it my best shot. I know that the temptation exists out there to take Mounjaro or Zepbound like candy and derive wonderful, quick, instant gratification from reductions in A1c and weight. In our toxic, instant gratification-oriented society, we favor short-term pleasures over long-term results. Therein lies the crux of both how we arrived at where we are and why we think we can take magic pills to erase the damage in a hurry. But all this comes with many perils. Further down, I will describe a debilitating syndrome related to achieving control too rapidly.

Before I get to the week’s results and the week’s commentary, I’ll make the usual disclaimer. I’m not a doctor and I don’t even play one on TV. Neither am I a Mounjaro/Zepbound fanboy like the cheerleaders you’ll find on YouTube. Nope, I’m just an old fart with experiences to relate and — always! — an opinion. (And you know what “they” say about opinions!).

Results of the Week

The best characterization for this week is a “plateau”, for which I have no logical explanation. Diet and exercise levels were about the same as last week. Yet my average glucose increased to 104 mg/dL, up 4. Average morning fasting glucose was 106 mg/dL, up 9. If these readings continue their upward trend, this could suggest the need to adjust Mounjaro dosage upward. Recall that I had decided to remain on the starting dose of 2.5 mg for at least twelve weeks. But let’s not get ahead of ourselves here. As you will see below, I have good reasons not to want to accomplish too much, too fast.

Weight loss also stalled this week, with a one-pound gain. Here again, I do not want to reduce the fat too quickly, so I am not displeased. The thing is, though, I am eating between 1200 and 1600 kcal per day, getting adequate protein, and avoiding sugars. Being very carb sensitive, I watch the carbs, too, although not obsessively to the keto level. I typically consume between 60 and 100 grams per day. At this rate, weight loss should resume. After the initial reduction of seventeen pounds over five weeks, I hope to be able to shed 1.5 to 2 pounds per week.

Average blood pressure flat at 124/71.

Keepin’ it Slow

Although I originaly scheduled my next A1c measurement for September in conjunction with a follow-up with my doctor, I did an interim check. It had been 7.4 at the time I started on Mounjaro seven weeks ago, and as of Friday, it was 6.5. That’s a nice reduction of 0.9 in six weeks, but I want to go slower from this point. Below, I will relate a story by a YouTube Mounjaro user, which hammered home this point.

Counterintuitively, precipitous drops in HbA1c can cause worsen neuropathic pain dramatically. Before I tell you the related story, I must state that this is not just anecdotal bullshit from a layman, but it is supported in the medical literature. I will cite references below, or you can just do a Google search for “Therapy Induced Neuropathy of Diabetes”.

Now, the story of another Ben.

TIND: An Indirect Effect of Mounjaro Therapy

Despite my pissing and moaning about the crap I find on YouTube, I have been following my namesake, Ben, on his YouTube channel called “Bored to Death”. His posts remind me of talking with a friendly storyteller down at the corner saloon. He does not try to man-splain concepts like most of the Dunning-Krugerites on YouTube, where some of the women are worse man-splainers than the men. He merely relates his experiences with our subject drug, Mounjaro, and makes relevant observations. One particular revelation caught my full attention.

YouTube Ben’s Neuropathic Pain Story

Ben is a type two diabetic whose weight was around 230 pounds, HbA1c was at10.6, and blood glucose at 474 mg/dL before starting the therapy. Mounjaro controlled his diabetes quite well, bringing those numbers down quickly — too quickly — as you’ll soon see. Ben got his weight down below 155 and his HbA1c to 5.4. He now wants to put on a couple of pounds, because he thinks he might have overshot the weight at which he’s most comfortable. But his weight is not the problem.

A month or two ago, Ben complained that he thought Mounjaro might be causing some severe neuropathy in his feet. The pain was so bad it was waking him up at night and impeding his sleep, night after night. For sure, neuropathic pain is no stranger to diabetics. I have experienced similar episodes that kept me up all night. It felt like I was being stabbed in the foot at maddeningly random intervals. In my last such episode, the pain was a 9/10. It completely wiped me out for a few days. In Ben’s case, it has gone on for more than a few days.

One difference is that I had not yet started Mounjaro when my pain episodes struck me. On the other hand, Ben was well into his therapy, so it was natural to conclude that his new pain was associated with the drug. Seeking relief, he set up an appointment with a neurologist. There, after enduring much more pain, Ben would determine that he was partially right. His chosen neurologist knew exactly what was going on.

Treatment Induced Neuropathy of Diabetes (TIND)

The neurologist told Ben that he had encountered this syndrome before, describing it as Treatment Induced Neuropathy of Diabetes (TIND), which he has been diagnosing with increasing frequency. He indicated to Ben that the condition was treatable and sent him off for an electromyogram (EMG) to assess the extent of damaged neural function. That is where we left off with Ben. I’ll be watching with keen interest to see how his follow-up goes.

So, what precisely is TIND? First, I will give you the medical overview of the condition, lifted from an abstract of a medical paper, along with symptoms and treatments lifted from ClevelandClinic.com. TIND was first recognized in the early days of insulin therapy back in the 1930s and was then known as insulin neuritis. After the medical information, I will add some laymen’s language of my own and a caution to anyone who thinks that rapid weight loss and rapid decrease in HbA1c is a wonderful thing.

What is TIND?

TIND is associated with a decrease in the glycosylated hemoglobin A1C in individuals with longstanding hyperglycemia. TIND is more common in individuals with type 1 diabetes but can occur in anyone with diabetes using insulin, oral hypoglycemic medications, or diet control. An acute or subacute onset of neuropathy is linked to the change in glucose control. Although the primary clinical manifestation is neuropathic pain, there is a concurrent development of autonomic dysfunction, retinopathy, and nephropathy.

TIND is uncommon and often underreported, but it is important to consider in patients who rapidly correct their hyperglycemia.

Symptoms include:

• Length-dependent, burning, and stabbing pain in the distal limbs
• Autonomic symptoms
• Pain that begins 2–6 weeks after glycemic control improves

Management of TIND

Management focuses on controlling symptoms while they gradually improve over time. Pain medications that may help include:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin IB)
• Lidocaine skin patches

Other treatments for diabetic neuropathy include:

• Anti-seizure medications
• Antidepressants
• Topical creams
• Transcutaneous electronic nerve stimulation (TENS) therapy
• Hypnosis
• Relaxation training
• Biofeedback training
• Acupuncture

The current criteria for diagnosis include a drop in HbA1c of greater than or equal to 2.0 in three months, with larger drops producing more extensive neuropathy and collateral effects.

I promised references, so here they are:

Stainforth-Dubois M, McDonald EG. Treatment-induced neuropathy of diabetes related to abrupt glycemic control. CMAJ. 2021 Jul 19;193(28):E1085-E1088. doi: 10.1503/cmaj.202091. PMID: 34281965; PMCID: PMC8315201.

Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain. 2015 Jan;138(Pt 1):43-52. doi: 10.1093/brain/awu307. Epub 2014 Nov 11. PMID: 25392197; PMCID: PMC4285188.

Now, Some Plain Talk

Although TIND is more commonly associated with type 1 diabetes with its rapid, brittle swings, cases among type 2 diabetics are increasingly reported. Undoubtedly, due to GLP-1 drugs, with their associated rapid improvement in HbA1c, the number of reported cases will rise in the future.

Especially for those of you who are enamored of dropping numbers, achieving target HbA1c too rapidly puts you at risk for not only neuropathic pain but also you risk worsening diabetic retinopathy, autonomic nervous system dysfunction, and kidney issues, as mentioned above. It can come on slowly or suddenly. Thus, caution is appropriate.

From my perusal of the literature, I suspect that those diabetics with the most to gain from Mounjaro, Ozempic, and tirzepatide therapy are the prime candidates for TIND when they try to control their disease too abruptly. In Ben’s case, he started with glucose of 474 and an HbA1c of 10.6, He rapidly lost eighty pounds, and got his numbers in range within several months, effecting a reduction of 5.2 in A1c. For him, Mounjaro was effective — too effective.

Take it Slow!

We’re back to the TANSTAAFL Principle: There Ain’t No Such Thing As A Free Lunch. Senior citizenly old farts like I know that treating one thing can easily screw up another, but younger folks have not yet learned that lesson. Perhaps driven by Big Pharma’s Madison Avenue co-conspirators or in irresponsibly rosy portrayals on social media, they see only the positive side of what has become a vogue therapy. The promise of easy weight-loss and diabetes control impels them to dive headlong into Mounjaro therapy, pushing their docs to repeatedly increase the dose, thus sucking them into an addiction spiral. Damn the torpedoes! Those numbers keep decreasing, sending endorphins to the brain, and calling for more decreases, so the faster, the better, they think. But at what cost?

Consider the potential autonomic nervous system dysfunction associated with TIND. Dysautonomia can cause wide-ranging effects one might never associate directly with Mounjaro, such as blood pressure dysregulation, fainting, mood swings, exercise intolerance, and constipation, to name a few. I observed one Mounjaro YouTuber freaking out with an anxiety attack on camera. (Addiction to producing YouTube videos for fun and profit is another neurosis I’ll write about another time). It was an annoyingly ridiculous, gratuitous production in which her dog offered sympathy. She said that mood swings are an expected adverse effect of Mounjaro therapy, a concept I scoffed at before I hit the <BACK> button. However, I now admit the possibility that she might have dropped her numbers too fast; consequently, she might be suffering some of the insidious effects of TIND-related dysautonomia.

Kidney and Stomach Issues

Another pathology associated with TIND is nephropathy. Translated to plain English, this means it compromises kidneys. As I mentioned in past posts, I am already at Stage 3A of chronic kidney disease, so I have enough worries about kidney function without adding to them.

Gastroparesis has been reported in patients with TIND, another major caution for GLP-1 users, which already slows emptying of stomach contents. Gastroparesis (stomach paralysis) is a listed potential adverse effect of Mounjaro. Putting two and two together, I would conclude that the more effective Mounjaro is in doing its intended job, the greater probability that negative effects will arise.

So, KEEP IT SLOW!

“But I Can’t Lose Weight!” — An Editorial Digression

If you are taking Mounjaro like candy and plunging blindly ahead into the “less is more” paradigm, get your head out of your ass! I have heard too many fanboys and fangirls on social media rationalizing that obesity is a disease they are combating with GLP-1 uptake agonists, and thus, they are doing the responsible thing. In many cases, that bullshit, and they know it. They’re looking for the elusive magic bullet to avoid taking the arduous weight loss path of diet, exercise, and behavioral counseling.

Folks, I have been there myself, and I have made that same damn excuse myself. Who was I kidding? No one, not even me. Our society seeks excuses first, then it backs into solutions later. We can justify the multi-billion-dollar weight-loss med market, then bitch about the prices we are unwittingly bidding up by increasing demand. O ye seekers of magic bullets, heal thyselves!

A small percentage of fat people got that way due to heredity, defective thyroid glands, or other pathology, and truly cannot lose weight, but the systematic fattening of western society is responsible for much of what I will call “elective corpulence”. Certainly, our western diet is causing increasing insulin resistance and correspondingly fatter bellies. People love to eat sugar!

A Toxic Food Environment

Our food industry is happy to oblige them with increasingly wonderful sugary treats to satisfy their sugar addiction. Their multi-media ads bombard us with delectable visual depictions that make us salivate. Moreover, they hide sugar in the damnedest places (see my picture of the label from good old Morton Iodized Salt (trusted quality since 1848). Obesity and metabolic syndrome are indeed modern manifestations of our penchant for highly processed foodlike substances. We won’t blame our porkiness on the piles of sugar we’re eating, so we call it a disease that is beyond our control, one for which we seek a miracle cure.

Government is complicit, too. The flawed food pyramid, a political creation to cotton to the whims of the big agricultural lobbies, encourages us to eat this crap. Even the American Diabetes Association dietary recommendations are ridiculous. (Look at some of the big funders behind the ADA for a clue). Our ubiquitous crap foods keep us in the dual addiction cycle: addicted to sugar and addicted to the drugs that provide an “easy” fix for the effects of that addiction. Now, we are addicted to the drug, and we want ever increasing doses. We complain when shortages or prohibitive costs make it harder to get. Sound familiar?

So, we think we have found a miracle cure in Mounjaro, Zepbound, tirzepatide, etc. Think again, o ye miracle seekers. I have said it before, and I will say it again: There Ain’t No Such Thing As A Free Lunch! (No pun intended).

A Pharmafooda Conspiracy?

If I were into conspiracy theories, I would say that Big Pharma and Big Fooda are conspiring with each other to addict us to sugar, then sell us fixes for our resulting metabolic issues, a profitable symbiosis indeed. The fatter we get, the more crap food we’re eating, and the more drugs we’ll need to fix ourselves. Two centuries ago, people ate real food. Because they died younger from causes other than the insidiously devastating effects of metabolic syndrome and all its related comorbidities, we modern western folks think we’re superior. Really? We try to kill ourselves slowly by ingesting garbage, then we try to buy our way out of illness and death with overhyped, overpriced wonder drugs.

Unfortunately, there ain’t no free lunches and there ain’t no magic pills. If you just need to shed a few cosmetic pounds, you should not be on Mounjaro, Zepbound, Ozempic, Wegovy, tirzepatide, semaglutide, or other GLP-1 agonists. The risks outweigh the meager reward. And especially if you’re the ridiculous thirty-something putz who produced the YouTube video about shooting up with compounded tirzepatide to get from 10% body fat to 5%, about whom I wrote about on July 1, you should think twice about your damn recreational use of GLP-1s, steroids, and amphetamines!

We’re where we are because we are victims of the toxic food environment that surrounds us, but we cannot deny our complicity in the metabolic mess. No one held a gun to our heads to shove all that pizza, cereal, unnatural bread, cake, ice cream, and beer down our gullets. We have yo-yo dieted and screwed up our metabolism. Now, we throw our hands up in the air and say we need Mounjaro. Fine. It is what it is. I’m there, too. However, if you are seriously overweight and diabetic, and your doctor feels that “Mounjaro is right for you”, please resist the temptation to push forward too quickly.

A New One on Me

Being a career hypochondriac (but with real conditions to worry about), I try to read both popular and technical literature regarding my chronic conditions. I don’t have a medical background, but I have enough education to be able to read medical literature. I just want to know what’s going on inside me. This syndrome called TIND took me by surprise, completely out of left field. Rapid decreases in weight and glucose come with associated perils of which I was unaware. Who would think that too much control is a terrible thing? Thanks to Ben sharing his experience, I now have more data points to inform my own therapy.

If you’re on Mounjaro, Zepbound, or tirzepatide, you should learn about TIND as well as all the other notable potential adverse effects. Discuss with your doctor whether you might be better off with lower doses or slower upward titration. (Here, I’ll add my suspicion that many primary care docs are ignorant about TIND, and many will respond dismissively if a patient brings it up. You’re on your own with your doc, but if you have any suspicion that you might be entering TIND territory and your doc pooh-poohs the notion, SEE A NEUROLOGIST!). Slow, sustained weight loss to effect improvement to your metabolic syndrome is the goal, not fitting into that size 0 wedding dress in eight weeks.

Shooting up Mounjaro with wild abandon…

Are you saying, “I can’t worry about all those side-effects, because I’m having such fun slimming my ass down!”? That damn wedding dress? So, what’s up? Are you planning to be on Mounjaro for the rest of your life or do you plan to get off the drug, fix your crap-eating habits, and stop hiding behind that denial mantra of “I can’t lose weight”? Do you have a taper-off plan? Does your doctor? Do you care? Do you know what you’ll be eating once you get off Mounjaro? Or is not having your weekly subcutaneous fix unthinkable? I’m deliberately using harsh, junkie street language to make you think beyond the euphoria.

It’s all up to you. I can’t tell you what to do, other than to say, BE SMART. As a multiple-time yo-yo dieter, I know all the self-deluding bullshit rationale. I speak as one who is guilty of much rationalization about weight loss through many years successes followed by failure. All that experience has provided me is a hefty case of metabolic syndrome and a hefty gut. And, of course, I worry that once I get my numbers in line (slowly), I’ll get off Mounjaro and I will rebound right back to where I came from. Time will tell, and as an old fart, I don’t have the luxury of much more of that precious quantum entity.

Be Your OWN Healthcare Advocate

So, I hope I have at least opened your eyes to some potential trade-offs, whether you choose to think about them right away or not. Please try to approach the diabetes and weight control issue with moderation. Understand that you must be the driving force behind any decisions that affect your health. You must be especially mindful of this when accepting directions from weight-loss salons and telehealth operations with questionable motives. Even if you are dealing with your primary care doc, he or she does not know everything, and in today’s rush-rush world of factory medicine, they do not have much time for research. So, please be vigilant with your own health!

Later, you might be thankful that you read here that any drug therapy is not all sunshine and flowers, not even Mounjaro. Knowledge is power. Amen.

Wrapping It Up

We have seen how an obscure side-effect called TIND can arise out of what most of us would think is a good thing — controlling the metabolic issues too fast. This should impel us to exercise caution. Instead of the myopic view seen on YouTube, where decreasing numbers create a groundswell of interest in increasing doses to achieve maximal results instantly, we should be seeking moderations. Furthermore, we should do research on our own to unearth potentially damaging negative effects of Mounjaro and its sister drugs. This class of peptides has not been around long enough to predict long-term effects with certainty. We must guide our own care intelligently and responsibly.

Now, Back to My Own Mounjaro Trip

From the sublime to the ridiculous… Thinking about my blog title again, how about “Trippin’ on ‘Jaro” as a Summer of Love throwback name for all you fellow senior baby-boomer old farts out there? Does it suggest Jimi Hendrix, Janis Joplin, and Jefferson Airplane? Jimi, Joplin, Jefferson, and ‘Jaro! A trip is not a journey, and a journey is not a trip. Pass the acid and light up the bong!

And if you haven’t seen my wife’s hilarious lyrics to our theme song, to the tune of “Tomorrow” from the Broadway musical “Annie,” be sure to check last week’s comments.

That’s it for this week! See you here next week.