Mt. Kilimounjaro Update

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!