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The No-Namer Mounjaro Weekly

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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.

Mi Viaje Mounjaro

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Week Six Recap and Other BS

Greetings, Mounjarinos and Mounjarettes, and welcome to my as yet unnamed Mounjaro column! Nope, I still do not have a catchy title for this sub-blog, and I didn’t want to spend a lot of time scratching my head. Although I despise the use of the word “journey” to describe a therapeutic process, it was the only thing that came to mind, albeit in Spanish. ¡Hola, amigos!

For a permanent title, in view of my Pittsburgh heritage, I seriously considered “Voyage of the MonJaggoff”, but quickly nixed that idea because I do not want to be offensive(r).

Mounjaro

If you are new here, this is a place where I describe my progress with the ridiculously expensive but nevertheless all the rage diabetes drug called Mounjaro, a product of Eli Lilly & Co. Each Monday, I pass along information that I think might be worthwhile to others who are either taking or contemplating taking the drug. As a bonus, I regularly make fun of the plethora of YouTube channels “monetizing” their videos describing their producers’ cosmetic weight loss trials and tribulations.

Today I after summarizing my progress, I will write about which equipment and software I use for tracking my progress. Further down, I will tell you about my “bad blood” follow-up lab testing, and I will wrap up with a few words about supply shortages and my path forward.

Week Six Summary on Mounjaro

My average glucose level for the week was 100 mg/dL, down from 103 last week. Serum glucose reduction is the main effect I seek, although I will take the weight loss as gravy on that roast. The morning fasting glucose average for the week was 97. My goal is to get that down to 82 to match my wife, but I do not know whether or not that is realistic. My next HbA1c test is scheduled for September, and I am anticipating great results!

Weight loss continued this past week, albeit at a reduced rate, a loss of 1.8 pounds for the week. This is a comfortable weight-loss rate for the reasons I have described before. Obviously, fifteen pounds in five weeks is not a sustainable rate. My weight reduction is attributable to calorie deficit, which is facilitated by the drug. Mounjaro signals to the brain to stop thinking about feeding my face all the time, plus it slows processing of stomach contents. What the drug does NOT tell my brain is to get a decent amount of exercise; I must motivate myself to do that. (Someday there will be a drug for that called Offyerazza. But I digress.).

Blood pressure continued its downward trend after last week’s blip, averaging 121/72. This is another important consideration for an old fart with chronic kidney disease (CKD), which I will cover in a later section.

How Do I Track My Mounjaro Progress?

Hey, it is all automation, man! No, I have not yet set up Alexa to recite my weekly numbers for me on Monday morning. Nevertheless, each of my measuring instruments communicates with my smartphone via Bluetooth, and the associated apps keep good track of the data.

Glucose

For glucose, I use the Contour Next One glucometer from Ascensia ($28.50 at Amazon.com). I have verified its readings with lab tests processed by Quest, finding the results remarkably close. For convenience, I have two Contour Next Ones. I keep one in the master bathroom upstairs. The other one is downstairs in the family room to facilitate recreational finger-pricking while watching TV.

A package of seventy Countour test strips costs about $27 on Amazon.com, and the meter does not require coding. (However, every new container of test strips should be indexed with the appropriate test solution for accuracy). The Contour app provides excellent tracking and reports I can share with my docs.

Why No CGM?

Why do I not use a continuous glucose monitor (CGM)? These wonderful high-tech devices have become very sophisticated and convenient in recent years. For example, the Freestyle Libre 3 by Abbott Labs is an amazing piece of machinery! However, aside from the fact that stabbing my fingers several times per day constitutes less bullshit that hanging a piece of plastic on my upper arm, CGMs are notably inaccurate. Additionally, the cost angle is a significant roadblock for me. My old fart Medicare will not defray the cost of a CGM unless I either am using insulin or I am prone to hypoglycemic episodes. Neither is the case here, so I would need to go out-of-pocket another couple hundred dollars a month for this inaccurate pain in the ass. (You can see that I really want one, can’t you?).

Weight

My weight is recorded each morning by the sleek glass and metal pride of China, a Renpho Smart Scale. When I bought it several years ago it was dirt cheap, somewhere around $20. I see that now it is available at $23.99 before applying a $2 coupon at Amazon.com — still cheap for what it does. The scale also does a bio-impedance measurement to determine BMI and body composition, although it does not offer metabolic rate like some of its counterparts. (What do you want for $20, anyway?). Its associated phone app does an outstanding job of tracking weight and all those body composition measures over time, providing handy interactive graphs to show progress or lack of same.

Blood Pressure

Blood pressure tracking is via an Omron BPS5450 Platinum Series (currently $109.11 at Walmart.com). I have checked its accuracy against two of my doctors’ instruments, finding the results close. Once its Bluetooth link is set up with the smartphone, it automatically transfers each reading. The app does a great job of tracking and averaging blood pressure, plus identifying peaks and heart rate abnormalities.

Food Logging

Finally, for tracking what I stuff into my pie hole, the MyFitnessPal app with premium subscription ($79 per year) makes the food diary extremely easy. It has a barcode scanner and a robust database of food items. Many of the database entries have been vetted for nutritional component accuracy. This is way more than a calorie counter. Instead, it keeps me well informed of macro and micro nutritional intake in comparison with goals I have set. While logging each chunk of food I slurp up is a pain in the ass, this app assuages some of the butt ache. I have used it off and on for four years; had I stuck with it, I would not be so damned fat!

Bad Blood Follow-up

Recall that although neither I nor my doctor associated my abrupt decline in kidney function with the Mounjaro therapy, I was quite concerned about it as I reported last week. I did some re-testing and concluded that my dehydration prior to the previous test was the culprit. Although creatinine is still high at 1.36, it is down from 1.4. I felt relieved when the urinalysis results revealed no albumin and albumin/creatinine ratio (ACR) of 5. An ACR under 30 is normal and good. Back to the blood, my BUN/creatinine ratio was 16, still in the normal range. Sodium and potassium were all in range.

I also did a cystatin-c test to get a more accurate reading of my eGFR. While the eGFR calculated using the creatinine result gave me a 54, the cystatin c test resulted in a 46. The usual estimating procedure for eGFR is not only less accurate, but also has been subjected to some racial perturbation. Previously having different scales for black vs. white populations, in 2021, the woke movement in medicine decided to be racists and declare that there is no difference. The expected result is a compromise scale for all. But I digress.

Whether 54 or 46, this puts me in Stage 3A of CKD, and the absence of proteinuria puts me in subclass A1, which means I have been stable since about 2020. Kidney function declines with age, exacerbated by high blood pressure and diabetes. The previous test gave me an eGFR of 43, which would have classified me in Stage 3B, hence my panic reaction. Going forward, I must avoid dehydration to forestall a further decline. On Mounjaro, dehydration can present insidiously, so those of us taking the drug must hydrate diligently.

What about omeprazole?

I also reported that Prilosec (omeprazole) has been associated with kidney damage. Due to my alarmism in view of several lawsuits against its manufacturer, coupled with what I felt was a decline in kidney function, I discontinued it. However, long-term omeprazole is still recommended by gastroenterologists for avoiding progression of Barrett’s Esophagus (BE), so I will strongly consider resuming it, although I might do so at the minimum dose. Some GI docs have said that for long-term BE therapy it is just as effective at 10 mg per day for BE than 40 mg per day, and produces fewer side-effects at lower dosages.

Mounjaro Supply Shortages

In past weeks I have told you about the explosion of demand for the vogue drugs in the GLP-1 class such as Mounjaro and Zepbound causing supply shortages. These have been acknowledged publicly by the manufacturer, Eli Lilly & Co. Until I placed my order for next month’s supply, I had not been affected by these shortages. However, my pharmacy responded to my most recent on-line reorder by telling me that the drug was out-of-stock and they would order it. Of course, they did not say when to expect it, just that they would send me a text message when it arrives.

Having just injected my Week Seven dose last night, one more Mounjaro injector in the refrigerator for next week. Thus, I am not yet anxious about a potential discontinuity in the therapy. Stay tuned to next week’s column for an update, just in case I freak out then. The possibility exists that I can titrate up to 5 mg from 2.5, although shortages might exist at both of these lower dosages.

Wrapping It Up and Putting a Bow on It

So, I would say that I am making progress on all fronts with the Mounjaro therapy, and I have assuaged my worst fears about a worsening kidney situation, so it is all good. I hope I have provided you with some useful information about tracking equipment and software if you are interested in keeping score for yourself. Finally, we will see where we are going with these supply shortages. Next week should be telling.

I will see you all next Monday with another action-packed post. Thanks for being here, and stay tuned!

Mounjaro: No Catchy Title Yet

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Five weeks into Mounjaro therapy, and still without a cool title for this sub-blog. The YouTube channel names for similar ventures suggest that I need a fancy moniker to match the likes of: A Little Less Lisa, Countess of Shopping, Downsized, Fit Fat Fun, On the Pen with Dave, Mounjarbro, etc., etc., ad nauseam. I will give you some more thoughts about YouTubers and then touch on my progress. Finally, I will relate a story that has me on the verge of going legal with the medical system.

Mounjaro

As for YouTubers, they talk about their “weight loss journey” and give tips to those who are too lazy to do their own research, hoping to impel them to follow them down the primrose path while earning a little YouTube scratch. As you will see later, some doctors are just as bad as the “influencers” when it comes to prescribing drugs without considering the context. But for now, I need to pick on the YouTubers.

Pushing Drugs

“Monetizing channels” is the way of YouTube, where you can pick a popular topic like Mounjaro, which is all the rage at fat salons and shady telehealth profiteers, make some videos, and get compensated for it based on the almighty YouTube algorithm. Why not cut in on the Mounjaro action while talking about yourself? Woo-hoo! And while you are at it, why not pass along dangerous tips about how to obtain the drugs from on-line sellers or telehealth operators and then divide doses? Loosing (sic) weight is a big money business. Everywhere you turn, someone is authoring a book, selling a diet plan, producing a video, or now more than ever, pushing drugs.

While Eli Lilly & Company, manufacturers of Mounjaro, might ordinarily be grateful for all the free publicity, they are not amused. Many of these YouTubers proselytize the use of compounding pharmacies to obtain generic, compounded versions of tirzepatide to an audience of people ill-equipped to vet them. I seriously doubt that any of them have investigated where the ingredients for the compounded tirzepatide come from. (I have seen one compounding pharmacy’s video which shows it being reconstituted from a powdered form; however, does anyone know who makes the powder? Is it made under tightly controlled conditions?). On June 20, Eli Lilly wrote an open letter to the public, published on their shareholder website and on social media decrying the use of potentially dangerous generic alternatives.

Naturally, the Internet weight-loss crowd ganged up on them, declaring rampant self-interest and accused Lilly of making too much money. We’re capitalists here, you know, fellas and fellatrixes. You are just mad that they are trying to take your cheap tirzepatide away so you will not loose wait (sic).

Are Compounding Pharmacies Safe?

Tough question. Many compounding pharmacies perform worthwhile services, but others are shady. While Lilly might have overstated its case, how do you ensure that you are getting a pure drug that stays pure? The FDA has spot-inspected compounding pharmacies who participated in their risk-based volunteer inspection program. Many came out clean, but some notable findings were a toaster oven being used as a sterilizer, a dog bed near a sterile workstation, and workers not wearing gloves while formulating medicines. Pet hair, dander, and human skin create dust, a transport mechanism for pathogens just waiting for a suitable medium to land in to multiply and mess you up. So, you better know a lot about the compounding pharmacy you choose and its sources of the medicine you will inject into your body.

The well-known case of a compounding facility in Massachusetts a decade ago underscores the need for scrutiny of sources. The lab supplied a contaminated methyl prednisolone compound to joint and back pain clinics around the country. Seven hundred fifty people in twenty U.S. states were affected and more than sixty people died. In Michigan alone, eleven people died. The lab and its principals were found guilty of falsifying inspection records, resulting in a fifteen-year jail sentence for the bigshot. That ex post facto resolution does nothing for the families of the those who perished from the fungal meningitis infections caused by the tainted drug, which was manufactured under unsanitary conditions. Read the synopsis from the CDC here.

Be Careful and Do Your Homework

Other incidents have occurred with compounded drugs since then, according to the FDA. I am not trying to steer you away from a cost-saving alternative to brand-name medicine, but I do want to scare you enough to impel you to protect yourself against potentially harmful suppliers and products, emphasizing once again that you are injecting this stuff into your body. Any microbial, fungal, or even inorganic contamination is dangerous. For the “damn the torpedoes, full speed ahead” weight loss crowd, please proceed cautiously. And if you don’t wish to heed my advice, fine. In the words of Davy Crockett to the people of Tennessee after losing his U.S. Senate bid, “You may all go to hell, and I’ll go to Texas.”

Not a Mounjaro ‘Journey’

But I digress. Back to the damn “journey” characterization. Well, sheeeit, this ain’t no journey. It is pharmacotherapy with side-effects, not a whoop-de-doo fun excursion on the Tirzepatide Highway. It comes with risks that are not to be minimized by sugar-coated commentary or videographic bubbling over someone’s weight loss. Still, for the hell of it, and to make some light of the crap that is out there, I am thinking of catchy names for my weekly blasts. How about “Tirzeppity Doo Dah”? Wait, that won’t work for some of you wokers, being a politically incorrect reference to Disney Studios’ much maligned “Song of the South”. So, how about “Constipatient”, honoring one notable, common side-effect of Mounjaro. Not catchy enough? Can I propose “The Snows of Kilimounjaro”? Sorry, Ernest. Hemingway is rolling over in his grave over that abuse of his 1936 short story title. Decisions, decisions!

If I was a YouTuber, I would exhort you to leave your own suggestions in the comments below, hit the “like” button, and make sure you subscribe to the channel. Those actions all play directly into their compensation algorithm. However, here, where I am not in it for the money, I will merely ask you to cough up any bright ideas. The author of the winning suggestion will receive — um… uhhh… nothing I can think of.

Before I leave this ridiculous subject, one more comes to mind: “Mounj Veneris”. OK, now that’s out of my system. On to some more serious subjects.

Week’s Progress on Mounjaro

I amped up the exercise during the week, which I believe might account for some of my 2.6-pound weight loss. That’s fourteen pounds in five weeks, an unsustainable rate I hope to slow down. I bought a set of 52.5-pound adjustable dumbbells, because my 25-pound set limited my workouts. Do not laugh and call me a lightweight, you anabolic steroid shooting bodybuilders out there! I’m an old fart not seeking to look like a gorilla, but just wanting to maintain the muscles I have, which are imperiled by rapid weight loss.

While this is a known issue, particularly for “seniors” (i.e., old farts), YouTubers either dismiss it with the generalization, “when you lose weight, you always lose muscle along with the fat”, or they say, “eat more protein”, but they rarely say anything about strength-building exercises. As for me, I hope to forestall the sarcopenia journey, even though even my doctor handwaves, “you lose muscle as you age, anyway.”

Glucose and BP

Moving right along, my glucose average for the week was 103 mg/dL, down from 108 last week. This is equivalent to an HbA1c value of 5.2 — very encouraging! For the past thirty days, the average has been 112, so I am very appreciative of the downward trend. Much of the improvement results from eliminating lots of crap from my diet, which is aided by the Mounjaro. I am no longer thinking of what I am going to eat next while I am eating something, and I no longer have sugar cravings. (Never have I craved sugar itself, just sneaky sugar-laden crap like cereal. However, I will admit to having a donut or two when provided at a meeting or function).

Blood pressure was up for the week. I can loosely relate it to some intestinal cramps that kept me awake on June 26, which I have been experiencing mildly since then. Before that episode, I was averaging 115/65. On the day after the Night of the Cramp it was 140/85. Since then, the average has been about 130/80. While it might be bullshit correlation, I am wondering whether the cramps in da kishkas were related to Mounjaro. We will see how this plays out.

Bad Blood Revisited

Last week, I told you about my abnormal blood test that revealed a steep decline in kidney function. I also told you that my doctor advised me not to panic, ordering a re-test in a month. I prefer the term “proactivity” over “panic”. If something is going wrong, I want to hop on it. I had mentioned that my dehydrating hike might be implicated in the kidney decline — causing acute kidney injury (AKI) — which might mean that it can improve if I maintain decent hydration. Or it might not. So, I went looking for other potential issues relating to drugs I am taking, including Mounjaro.

I could find only positive information about Mounjaro forestalling the progression of chronic kidney disease (CKD), and I was not cherry picking. This concurs with my doctor’s knowledge of the subject. However, I did find two drugs I was taking that might have exacerbated the CKD. The first, hydrochlorothiazide, I had already discontinued. The second, omeprazole, used to control gastroesophageal reflux disorder (GERD), is a problem. My gastroenterologist prescribed the drug for long-term use at twice the OTC dose. I have been taking it for six months. Recently, I found an observational study in Pharmacology that implicated the drug (brand name Prilosec), in AKI, particularly among us over-65, over-medicated, over-the-hill senior old farts. Later, I found an overview of PPIs and CKD progression in a 2023 review in Cureus, via the NIH.

Prilosec Lawsuits

According to Drugwatch, AstraZeneca, manufacturer of Prilosec, agreed in October 2023, agreed to settle about 11,000 Prilosec and Nexium lawsuits for $425 million dollars. The lawsuits, along with similar kidney injury based Prevacid lawsuits, were combined into a multidistrict litigation in New Jersey federal court. Drugwatch’s legal partners are currently not accepting [any more] Prilosec lawsuits.

Suing the manufacturer is not something I could do, and it is not my style. In my case, I am was taking generic omeprazole, so who am I going to sue? Some lab in India? On the other hand, two doctors, my gastroenterologist, and my primary care physician, who prescribed this crap for long-term use need to do some ‘splaining. How much damage has been done and how it can be related to omeprazole will determine what I do from here.

Taking Action on My Own

Without discussing any of this with my primary care doctor, in whom my confidence regarding proactivity and attention to detail is decreasing, I discontinued the omeprazole. While I have scheduled the one-month re-test he wanted for the end of this month, I also scheduled some testing for today on my own. I want to stay on top of the kidney situation, setting up an appointment with a nephrologist sooner rather than later if things are going south. Do I sound like Chicken Little? In my mind, forewarned is forearmed. Permanent kidney damage is playing for keeps at the highest possible stakes.

Is it any wonder why I tell people to be seriously watchful and knowledgeable about what they are putting in their bodies when doctors cannot even be trusted to keep track of drug effects properly? Overmedication is a scourge, and failure to understand interactions between medications, other medications, still more medications, in combination with a patient’s chronic conditions is a genuine problem.

What about SGLT-2 Inhibitors?

My doctor says he currently has twenty to thirty patients on Mounjaro, his preferred drug for type two diabetes (T2D). However, another class of drugs, called SGLT-2 inhibitors, piqued my interest when I consulted him about doing something more for my worsening T2D. The SGLT-2 inhibitors are oral drugs such as Jardiance and Farxiga, which are well documented to have a positive effect on kidney and heart function while controlling glucose and promoting weight loss. However, one scary side-effect is Fournier Gangrene, a life-threatening necrotizing infection of the perineum (the area between the genitalia and the anus, or the “taint” in street vernacular). Gangrene in the feet is another rare risk. Unpleasant, to say the least.

Three of my friends are taking Jardiance. One has reported no issues. One is newly on the drug for congestive heart failure, an on-label use for non-diabetics. Too soon to get any good data. The third, however, has been taking Jardiance for diabetes for years. He was hospitalized earlier this year for a foot ulcer that became gangrenous. Amputation was a strong possibility, but he managed to avoid that awful fate and recovered completely.

When I mentioned SGLT-2 inhibitors to my doctor in the same conversation in which he promoted Mounjaro, he brushed me aside. Without touching on either the positive kidney effects or the potentially negative side-effects, we quickly moved back to Mounjaro. If this is merely closed-mindedness or lazy preference for a single drug, it is bad enough. I certainly do not want to think there is more to it than that.

Mounjaro Person or Jardiance Person?

In today’s hyperpolarized society, exacerbated by YouTube/Instagram/Facebook tribalism, one must either be a Mounjaro person or a Jardiance person. We cannot engage in constructive discourse to weigh the pros and cons of both. When doctors are subject to the same prejudices and biases as we patients, how does that help us get the best treatment for ourselves?

Having covered my progress, having bashed YouTubers and their drug pushing, and having exposed my doctors and their own brand of drug pushing, I will now terminate this post. I hope you are finding these weekly epistles interesting and worthwhile.

I have babbled long enough. See you here next week.