Archives for August 12, 2024

“Release the Vials!”

Entering Week Ten on the weirdly named type two diabetes drug Mounjaro, I present my personal experiences, and I comment on the popular culture associated with the vogue use of the drug and its GLP-1 counterparts. As an “older man,” I am a curmudgeonly cynic, the antithesis of the Mounjaro/Ozempic/Zepbound/Wegovy fanboy and fangirl you will find promoting these products for cosmetic weight loss.

“Older Man”, My Ass!

What the hell is an “older” man? Older’n dirt? Why have we become so obsessed with non-offensive language that we can’t say “old man”. I call myself an old fart because that is what I am. I am not even an “elder statesman” or a “senior citizen”, and I am not seventy-seven “years young.” Here, we call a spade a spade, but I digress,

I will report my progress on Mounjaro first before launching into the weekly rant so those of you who don’t care for my opinions can have something for your trouble before you bail out. For those who can stomach it, I’ll add my commentary on the great triumph of the gratuitous weight-loss crowd, who have been calling on Eli Lilly & Company, manufacturers of Zepbound, a weight-loss product identical to Mounjaro, to “release the vials”.

Weekly Progress on Mounjaro, and Week 10 Recap

After my first week on the 5 mg dose of Mounjaro, my average glucose was 100 mg/dL, down from 101 mg/dL last week. I employ consistent methodology for measurement times and conditions, taking three readings per day: first thing in the morning, pre-prandial at dinner time, and two hours post-prandial. My morning average was 93 for the week, down from 101 the prior week. Nice!

My weight was down 0.8 lbs for the week. This is fine in conjunction with my desire to not lose too much weight too fast. Along with too rapid control of glucose, it can lead to a painful exacerbation of peripheral neuropathy known as TIND (treatment induced neuropathy of diabetes — which I documented in a prior weekly column). I had my difficulties during the week, which included a Thursday noontime visit to a German Bäckerei, Delikatessen und Biergarten, throwing me a midweek curve. I resisted the bakery counter, which the cosmetic weight-loss crowd would call a NSV (non-scale victory). However, in enjoying a fine German lunch of bratwurst, sauerkraut, and German potato salad, the carbs and sodium conspired to cause a moderate glucose spike and two-pound weight blip. Consequently, I doubled up on my Friday workout routine to compensate.

Blood pressure NSV (LOL) is progressing nicely, at a stable average of 124/67, about the same as last week’s 125/71. I am happy if it stays right there.

Side-Effects of Mounjaro Therapy

I have not had any disastrous or extremely debilitating side-effects from Mounjaro since the start of my therapy, unless you count constipation, which is universally reported. However, medical science cannot guarantee the absence of long-term adverse effects, as these drugs are too new. I want to steer people away from thinking they can buy into a miracle weight-loss drug without any risks, so please take my absence of side-effects with a grain of salt (unless you’re sodium sensitive like I am).

One note about appetite suppression. This is an excellent feature for those who cannot otherwise motivate themselves to avoid excessive eating. I certainly noticed the effect more at the outset of my Mounjaro therapy than I do now. I do not want to chase doses upward to maintain what the vogue weight-lossers refer to as an absence of food noise, for a couple reasons. First, once I chase the dose up to 15 mg, described by one YouTube weenie as “The King”, I can chase no more. Second, I want to self-motivate (an elusive butterfly in the past), and I do not want to rely on this crutch forever.

Week Ten Progress

As I enter Week 10, the most significant effect has been the drop in average glucose from 166 to 100. How much of this results from Mounjaro itself is impossible to say, as I have significantly adjusted two lifestyle factors since the inception of my therapy — namely, diet and exercise. While I have no doubts that the appetite suppression “feature” of Mounjaro facilitated my dietary adjustments, I cannot conclude that I could not have accomplished the same thing without the drug, which I have done several times in the past. So, in the worst case, Mounjaro is an expensive placebo with potentially unknown adverse effects that impels me to toe the line on diet and exercise to control my type 2 diabetes. (I TOLD you I am a cynic).

Could I have controlled the glucose and lost twenty-three pounds over nine weeks without the Mounjaro? Yes, I could have. I can state that conclusively because back in 2020, I lost seventy pounds on a low-carb diet, reducing my A1c from 7.5 to 5.5. Most of us gained weight in that pandemic year. However a lab report in October 2019 shocked me over my A1c and a concomitant diagnosis of Stage 3 chronic kidney disease, which impelled me to take action with a low carb diet.

Unfortunately, I gave up my gym membership in the Covid-19 quasi-shutdown, so I did not get back into a healthy exercise routine. Then, in 2021, complacency and boredom set in, so I gained back forty pounds over three years, putting me once again behind the diabetes and CKD eight ball. I found myself once again lamenting over yet another cycle of weight loss followed by rebound weight gain. This time, I am using Mounjaro as a crutch.

And you wonder why I am a cynic?

Will It Stick?

“Keeping it off” — the scourge of yo-yo dieters — is the holy grail few can find. The GLP-1s are too novel to conclude that they are not just another crash-dieting technique that will produce temporarily dramatic results followed by equally dramatic failure. As with all vogue weight loss plans, social media fanboys will bully away reports of failures while blowing much more noise than signal about successes which are necessarily temporary. The point here is that big pharma has hooked them on what those proponents feel is a miracle cure, which they will go to any length to defend — until they cannot.

So, in my case, I remain a cynic, although I am too old for yet another yo-yo cycle. The main thing is keeping my glucose in check while maintaining a healthy diet, forestalling the progression of chronic kidney disease, avoiding eating crap, and getting a decent amount of exercise. However, all those can be had without drugs, so the jury is out on where this is going in the long term, which at my age is not all that long! I do not want to be injecting drugs into me forever, and my history suggests that I will be non-compliant at some point.

We’re in uncharted territory here, so the best thing I can do is be honest with you in my observations. I am not one of those obnoxious YouTube cheerleading fanboys who backs into justifications and ignores the downside. That ain’t me. I’m just generally obnoxious!

Time to segue to the opinion section of my weekly column, and you know what “they” say about opinions!

Release the vials!

The outcry by the Mounjaro/Zepbound fanboys (aka “influencers”) on YouTube and TikTok has long been, “Release the vials!” What this means to the lay person is that they want Eli Lilly & Co, manufacturers of the vogue weight-loss sensational crash diet drug, Zepbound, to supply their favorite elixir in single-dose vials instead of dosing injector pens. They figure that it will be cheaper than the dosing pen and that it will give them flexibility to play with doses, as they would be drawing up their shots into insulin syringes. “Release the vials!” they shout.

Their fervent wishes have come true, but I doubt whether the fanboys who get their fixes from compounding pharmacies will ever be satisfied until Lilly gives them one hundred per cent subsidies. Nevertheless, Eli Lilly has released the vials. Hip, hip, hooray! I think. Lilly will sell initial doses of 2.5 mg and 5 mg in vials, which they can produce in greater quantities than the injector pen with less manufacturing complexity. This is, of course, an excellent move by big pharma to convince more people that they need this magical potion, broaden its distribution, and bring more potential addicts into the fold.

Just like the schoolyard pushers.

This parallels the neighborhood schoolyard drug pusher, doesn’t it? Addictive drugsare offered by big pharma as “helping” those in need. They’re striving to meet the burgeoning demand — which they created with their direct-to-consumer advertising, their sponsorship of “unbiased” YouTubers, and concerted efforts through funded research studies that conclude that obesity is a disease. They sure have convinced lots of people of that! You go to YouTube and all you hear is “obesity is a disease.” Lots of victims out there. Lilly to the rescue! Release the vials!

The World Health Organization, a politically motivated funding sponge that promotes redistribution of wealth and medical resources, agrees that obesity is a disease. Of COURSE they do. Not only do they suck up to big pharma because it enhances their funding position, but they can suck money out of the U.S. government, their favorite target. And the fanboys can use their logically fallacious appeal to authority by name-dropping the WHO liberally (pun intended) throughout their specious defense of the “obesity is a disease” dogma.

Go ahead and watch a few of those YouTubers with newfound cynicism. You’ll hear that obesity is a disease that this wonderful drug treats, so we need more of it, sooner rather than later. If obesity is not a disease, how come we can cure it with a drug? You think that groundswell drummed itself up without big pharma churning the seas? All these people on their Mounjaro or Zepbound “journeys” — they need increasingly higher doses. Release the vials, already, so Lilly can make more of the higher doses we crave.

Release the vials!

Speaking of Journeys

Why the hell do we need cutesy characterizations of serious things? Watching YouTube, you’ll see it all over the place. We do not have fat guts; instead, we have “tummies”. Hell, I haven’t had a “tummy” since I was six. “Does wittle Benny have a wittle tummy ache?” Similarly, now we must put up with smarmy, obnoxious “weight loss journeys”. Why the hell do they characterize it as a journey? Should I buy trip insurance just to be safe?

The 1980s rock band, Journey, sang, “Don’t Stop Believin'”, so maybe that should be the fanboys’ theme song: Don’t stop believin’ that Mounjaro will save humankind from the scourge of involuntary obesity.

Contrarily, one of the most down-to-earth Mounjaro vloggers I follow, another Ben, whose channel is called “Bored to Death”, is seriously diabetic. He is not using Mounjaro to treat the diabetes, not just to lose a few pounds. Ben, who does not accept sponsorship offers, shares his firsthand experiences without pontificating about the mystical wonders of Mounjaro. His words resonated with me the other day. He said he had unwittingly called his Mounjaro therapy a “journey” once and felt so dirty that he wanted to wash his mouth out with soap. That immediatly cracked me up with recognition laughter, as I obviously feel the same way. People calling this serious therapy a “journey” or an “adventure” are making it sound like they’re having fun, not making a strong and arduous commitment to treating their diabetes.

Journey to hell in a handbasket.

And those who are just in it for cosmetic weight loss already know what I think of their latest, expensive crash dieting technique. These are weight-loss junkies who might not even exceed the obesity threshold of a 30 BMI. They might need to characterize it as a “journey” as they take a cruise on the turbulently turbid seas of yo-yo dieting yet again, a roller-coaster ride to financial ruin along with yet another unproven long-term weight loss fad.

In the words of a gone but not forgotten comedienne, Pearl Williams, a trip around the world is not a cruise.

Yea, verily, it is not a pleasure cruise and it is not a damn journey. Fat people must change the habits that made them diabetic in the first place. That ain’t easy. In the aggregate sense, our country and the western world are taking a “journey” to bankruptcy caused by the vicious cycle a self-created societal problem where we ingest ultraprocessed crap which we need drugs to counteract. Don’t blame the drug companies for wanting to make profits on what the food industry created, with whom they conspired along with government to effectively channel our choices to a lifetime of eating crap and paying the price. It is a vicious cycle.

So, don’t give me “journey”. Well, if you insist, it is a one-way journey to hell in a handbasket.

And that’s a Mounjaro rantwrap!

So, here I am, another week into the Mounjaro therapeutic process. I believe I have made considerable progress, but the jury is still out regarding whether the progress is directly related to the Mounjaro. Is terzepatide merely a useful adjunct to the classic three keys to management of metabolic syndrome: diet, exercise, and behavioral changes? Too soon to tell.

What will happen now that Lilly has released the vials? No one knows. It is a “journey” into the unknown.

I’ll be back next week with another recap and rant. Who knows what will set me off!?!?