Mounjaro Update: Week 43

Greetings to my fellow Type 2s and anyone interested in the intersection of senior health, metabolic challenges, GLP-1 receptor agonists, and lifestyle reinventions. You’ve landed at the right spot if you appreciate candid insights delivered through the unfiltered lens of a cantankerous 78-year-old retired geek. Over the past ten months on Mounjaro (now cruising along at the 7.5 mg dose), I’ve wrestled my glucose levels into submission, dropped sixty-five pounds, and revitalized many aspects of my health and energy. By year’s end, my ambitious plan is to phase out Mounjaro completely, testing whether my lifestyle upgrades can hold the line. Through these weekly chronicles, I share my victories, setbacks, and quirky observations, hoping you’ll extract a useful nugget or two from my experiences.

The Usual Disclaimers (Obvious, But Necessary)

Before diving into this week’s juicy tidbits, let’s briefly cover the necessary disclaimers. Nobody compensates me for these musings—they’re purely my own take on things. I’m not a physician, nor do I impersonate one convincingly on TV, so nothing here should be mistaken for professional medical advice. While I habitually offer unsolicited advice (old habits die hard), the responsibility to heed or ignore my counsel rests entirely with you. If my suggestions flop, please spare me from any legal battles and instead seek guidance from qualified medical professionals, including those eager tele-health types lurking behind pricey compounding pharmacy websites—after all, they’ve got malpractice insurance precisely for such occasions. Now, let’s get on with the program.

What We’re Covering This Week

In this week’s update, before reporting my progress for the week, we’re covering two areas of special interest for those on GLP-1 receptor agonists (GLP-1 RAs) like Mounjaro. First, we’ll dive into muscle mass retention—crucial when undergoing rapid weight loss. As I’ve often noted, rapid weight loss can unfortunately lead to significant muscle loss—up to 40% of the lost weight may be lean mass, as concluded by the SCORES study. This loss exacerbates age-related muscle decline, known as sarcopenia. Many individuals excited by their weight-loss achievements often underestimate the necessity of resistance training to preserve valuable muscle. We first examine the role of power training as opposed to strength training in connection with sarcopenia. Then, interestingly, we discuss recent studies that suggest coffee could be a surprisingly beneficial adjunct to resistance exercise.

Second, we’ll revisit the critical topic of avoiding rebound weight gain and elevated blood glucose after stopping GLP-1 RA therapy. Research indicates that most people regain weight and experience metabolic setbacks once these medications are discontinued. To counteract this, I’m establishing lifestyle foundations now—exercise routines, nutritional habits, and sustainable daily practices—that I hope will maintain my progress post-Mounjaro. Excitingly, recent developments point toward a novel medical procedure that could help sustain long-term metabolic stability.

Power Training Benefits for Sarcopenia

In the relentless battle against sarcopenia—the age-related decline of muscle mass and strength—recent research underscores the superior benefits of power training over traditional strength training for older adults. A comprehensive meta-analysis published in European Review of Aging and Physical Activity evaluated 15 randomized controlled trials involving 583 participants. The findings revealed that power training significantly outperformed strength training in enhancing muscle power (standardized mean difference [SMD]: 0.99), performance on generic activity-based tests (SMD: 0.37), and tasks emphasizing movement speed (SMD: 0.43).

Power training focuses on executing resistance exercises with speed during the concentric phase, effectively improving the ability to perform daily activities that require quick and forceful movements, such as rising from a chair or climbing stairs. This approach not only enhances muscle power but also contributes to better overall physical functioning in older adults.

Complementing these findings, a systematic review and meta-analysis in JAMA Network Open analyzed 20 randomized clinical trials with 566 community-dwelling older adults. The study reported that power training was associated with modest improvements in physical function compared to traditional strength training, highlighting its potential as a valuable intervention to mitigate age-related functional decline.

Incorporating power training into exercise regimens for older adults appears to be a promising strategy to combat sarcopenia and maintain independence. However, it’s essential to tailor exercise programs to individual capabilities and consult with healthcare professionals before initiating new training routines.

Waking Up Your Muscles

Regular readers know coffee isn’t merely a beverage in my routine—it’s practically a food group. Imagine my delight when research published in Frontiers in Nutrition linked coffee drinking to potentially preventing sarcopenia.

Regular caffeinated coffee drinkers enjoyed approximately 11%-13% greater muscle mass compared to coffee abstainers. Decaf drinkers missed this muscle-enhancing perk (pun intended), though they likely sleep better.

Not for Everyone

Interestingly, this benefit vanished for individuals with a BMI over 30, suggesting coffee—much like my humor—doesn’t universally resonate.

Researchers speculate coffee’s anti-inflammatory properties might reduce muscle-damaging inflammation, while its stimulation of autophagy—cellular recycling—might refresh muscles like a shot of espresso rejuvenates your morning.

But Beware of the Starbucks Trap

Before trading your gym membership for a coffee shop loyalty card, note the study’s limitations: self-reporting coffee consumption risks exaggeration or forgetfulness among its participants. Still, pairing coffee with regular resistance training and balanced nutrition remains a delicious strategy to maintain muscle. Just avoid sugary traps—a 16-ounce Starbucks Caramel Frappuccino contains 54 grams of sugar, enough to spike my HbA1c just from reading the menu. Now, if you’ll excuse me, my next therapeutic espresso awaits.

Avoiding Weight Regain: Duodenal Mucosal Resurfacing

As I persist on Mounjaro, responsibly transitioning off remains my primary concern. Encouragingly, Duodenal Mucosal Resurfacing (DMR)—recently FDA-designated as a breakthrough therapy—offers promising potential.

The aptly named SURMOUNT-4 clinical trial, published in JAMA in December 2023, starkly illustrates the rebound challenges of stopping GLP-1 RAs. After impressive mean weight loss (20.9%) during 36 weeks on tirzepatide, participants switched to placebo regained an average of 14% weight within a year. Conversely, continued tirzepatide users not only maintained but further reduced weight by 5.5%, clearly demonstrating the chronic nature of obesity and need for ongoing intervention.

What DMR Does

DMR addresses structural and functional abnormalities of the duodenal lining, conditions closely tied to obesity and type 2 diabetes. According to recent insights published in Diabetes, Obesity, and Metabolism, this outpatient procedure uses hydrothermal ablation to regenerate healthier tissue, improving insulin sensitivity, glucose stabilization, and weight maintenance.

The FDA granted breakthrough device designation to Revita, a specific DMR treatment targeting those with significant weight loss (>15%) from medications like tirzepatide. The ongoing REMAIN-1 trial currently evaluates DMR’s efficacy post-tirzepatide.

Pairing lifestyle strategies with cutting-edge procedures like DMR might provide a viable long-term path, possibly eliminating indefinite medication dependence.

Temper Your Hopes

However, I’m wary Big Pharma might downplay DMR to protect the GLP-1 RA market. Eli Lilly, marketer of Mounjaro, managed all phases of SURMOUNT, concluding patients should ideally remain on medication indefinitely. Additionally, with Medicare my insurer and policy shifts in Washington, coverage for innovative procedures like DMR may sadly remain elusive for me and others in the same position.

My Week on Mounjaro

Neck and back pain nudged me to scale back workouts, though, being stubborn, I managed one heavy leg day, a cardio day, an upper-body day, and a five-mile mini-hike.

Fitness Equipment Retail Therapy

Deadlifts strengthen the back but risk injury. To mitigate aggravating my already problematic back (described as “a total mess” by my favorite physical therapist), I bought a “trap bar,” gentler for deadlifts than a straight bar. I’m not chasing lifting records—just modest goals around 600 lbs (272 kg), significantly more than the mere 374 lbs (170 kg) the guy in the photo was hoisting. (Believe that, and you truly appreciate my humor.)

My local senior citizen gym lacks a trap bar, a deficiency I’ve now rectified at home, allegedly due to my wife Jenny’s insistence. Initially, I pooh-poohed her idea, complaining about space, but conveniently blame her now. Jenny promises she’ll use it too, ensuring domestic harmony. Happy back, happy wife—a perfect win-win.

Now, on with the numbers.

This Week’s Mounjaro Numbers

This week was full of contradictions—I reduced workouts but increased my caloric intake. Clearly, building muscle and losing weight don’t exactly see eye-to-eye, so I’m deliberately operating at a small caloric surplus, rather than a deficit aimed at weight loss. I’m also vigilantly keeping my protein intake between 1.6-2.0g/kg daily, as recommended for seniors deeply invested in resistance training. Add to that creatine monohydrate supplementation—known for packing on water weight—and it’s no surprise my weight loss pace has slowed.

No excuses left. Weight’s up two pounds (0.9 kg) this week, and fasting glucose rose notably from 93 mg/dL (5.17 mmol/L) to 100 mg/dL (5.56 mmol/L). Clearly, I might have let carbs slip in alongside protein increases. Still, with my schizophrenic Stelo reporting an average glucose of 105 mg/dL (5.83 mmol/L), I’m comfortably within the decent control zone.

Thanks for Being Here!

Writing a self-centered blog carries the inherent risk of boring readers senseless. Hopefully, by sprinkling in current medical research and opinions on healthcare trends, my aim is to broaden the appeal. Today, we tackled power training versus strength training for sarcopenia, coffee’s muscle-preserving magic, and duodenal mucosal resurfacing as a potential escape hatch from GLP-1 rebound. I’ll let you digest all that (pun fully intended) and call it a week.

Until next week, stay healthy!

For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.