Iron, Compounders, and Global Warming—NOT!

Greetings, fellow Type 2 diabetics and anyone else interested in senior health, metabolic disorders, GLP-1 receptor agonist drugs, and lifestyle modifications. We cover it all here from the non-sugar-coated perspective of a curmudgeonly 78-year-old retired geezer who has taken the Type 2 bull by the horns and spews a lot of bull of his own. We talk about Mounjaro and other GLP-1 RA drugs, doctors, healthcare in general, and especially making lifestyle changes to improve our outcomes.

I’ve been on Mounjaro for almost ten months, now at the 7.5 mg/0.5 ml dose. I’ve managed to get my glucose under control, shed sixty-five pounds, and improved virtually every aspect of my health and vitality. Before the year’s out, I aim to wean myself off Mounjaro. Together, we’ll discover if my upgraded lifestyle is strong enough to sustain those gains. Writing this weekly column is my way of sharing the highs and lows of my Mounjaro experience, hoping you’ll find a nugget or two of useful wisdom from my adventures.

Administrivia

Before we dive in to Mounjaro territory, the usual disclaimers are necessary. I get no compensation from anybody for writing this drivel. All opinions expressed here are just that. I own them and you don’t. I’m not a licensed physician—I don’t even play one on TV—so nothing here qualifies as official medical advice. Sure, I often tell you what to do (it’s just my nature), but you’re entirely responsible for deciding to listen. Please don’t sue me if something you read about here doesn’t pan out. Instead, seek professional advice from your local doctor or even one of those questionable telehealth operators with vague qualifications at overpriced compounding pharmacies. They have malpractice insurance specifically to cover their inevitable screw-ups. Now, on with the show.

What We’re Covering This Week

This week, after an update on my seemingly eternal iron deficiency saga, we’ll delve into the controversial realm of compounding pharmacies and GLP-1 RA drugs. Next, we’ll lightly mock some “woke” physicians who’ve prioritized “saving the planet” at the possible expense of surgical patient safety. After that, we’ll share the success story of one brave soul who discontinued Mounjaro, thanks to sheer determination and disciplined lifestyle changes. Finally, as always, you’ll get an update on my personal progress. Buckle up and enjoy the ride!

Ironically…

Let’s kick things off with my ongoing iron chronicles featuring Dr. DeLorean (not his real name), whose enthusiasm for proactive medicine remains utterly nonexistent. My latest iron results arrived this week after three long months of dutifully choking down 65 mg of ferrous sulfate daily. How’d we do? Well, “meh” about covers it. Ferritin inched upward to a modest 38 ng/mL, total iron crept to a just-acceptable 59 ng/dL, and total iron binding capacity clocked in at 341 mcg/dL. Although technically hovering around the low end of normal, my iron saturation calculation stubbornly stayed subpar at 17%. Hemoglobin (13.9 g/dL) and hematocrit (43.1%) remain within the safe zone, though comfortably close to the lower boundary.

Naturally, Wednesday morning brought a call from Dr. DeLorean’s office, delivered with all the charm and warmth of an automated voicemail. “Your iron is low but improved,” droned the messenger. “Doctor says you can resume donating blood if you want—just keep taking the supplement.” No curiosity, no suggestions for further investigation, and certainly no enthusiasm for identifying an underlying cause. A stunning display of medical prowess.

Given the option between trusting Dr. DeLorean’s apathetic approach or trusting my instincts, I’m opting for caution. I’ll keep my rare blood type safely at home for now, despite genuinely missing the feel-good vibes of helping others. I’ll also transition to carbonyl iron (Feosol Complete) in hopes it yields faster improvements. And yes, I’ll take matters into my own hands and revisit my labs in three months—Dr. DeLorean or no Dr. DeLorean.

In fact, it’s looking increasingly likely that in three to six months, the DeLorean chapter will be behind me—a distant memory, fond or otherwise. Stay tuned.

Renewed Concerns over Compounding Pharmacies

In several past issues, I expressed concern over compounding pharmacies and telehealth organizations and their unregulated pandering of GLP-1 RA drugs as weight loss panaceas. In this connection, an article in The Wall Street Journal caught my eye. Reading this piece about the potential end of compounded knockoffs of Ozempic and Wegovy provided a peculiar sense of vindication—like seeing authorities finally crack down on questionable practices. These online telehealth operations, once known mainly for marketing ED medications, quickly pivoted to pushing knockoff weight-loss drugs to eager dieters. I’ve criticized them before for prioritizing profits over patient safety, and this article reinforces that these concerns remain justified.

Online influencers, particularly those on YouTube, compound this issue (pun intended). Many influencers not only profit from platform monetization but also get direct payments or sponsorships by telehealth/compounders like Hims & Hers or Ro. This dual revenue stream creates clear conflicts of interest, potentially misguiding desperate consumers who rely on their advice for serious health decisions.

Exploiting Regulatory Loopholes

The WSJ, recent coverage in JAMA, and now the New England Journal of Medicine (NEJM) highlight precisely why these telehealth/pharmacy operations are troubling. They exploit regulatory loopholes, framing their services as affordable alternatives and claiming to offer personalized treatments—though adding vitamins or other supplements to Ozempic and Mounjaro knockoff medications does not significantly alter their legitimacy or efficacy. According to JAMA, compounded GLP-1 medications like semaglutide and tirzepatide have rapidly expanded due to initial shortages and ongoing insurance coverage limitations. Last year alone, compounding pharmacies reportedly filled approximately 80 million compounded prescriptions for semaglutide, underscoring the scale of this market.

The NEJM further emphasizes significant ethical and legal concerns surrounding partnerships between pharmaceutical companies and telehealth platforms. These partnerships potentially violate the Anti-Kickback Statute (AKS), which prohibits financial incentives for patient referrals or prescriptions. Telehealth platforms increasingly use social media advertising—sometimes lacking proper disclosures of risks or contraindications—to drive demand. Pharmaceutical companies like Pfizer and Eli Lilly have developed consumer-facing websites linking patients directly to telehealth prescribers, raising concerns about inappropriate prescribing practices driven by financial rather than medical considerations.

Serious Safety Concerns

All these sources emphasize serious safety concerns. Over 600 adverse event reports have been submitted to the FDA related to compounded versions, including hospitalizations resulting from dosing errors. Unlike branded medications, compounded versions typically use multi-dose vials and manual syringes instead of autoinjector pens, greatly increasing the risk of user error. Issues like overdoses and incorrect active ingredients further complicate the safety profile. Yet despite these risks, demand persists because compounded versions cost significantly less (around $200-$300 per month) compared to branded counterparts ($1000-$1300 monthly), driven primarily by uneven insurance coverage.

Dr. Taylor Kantor of Ivim Health mentions affordability as justification for compounded drugs, positioning his telehealth platform as an accessible alternative to expensive brand-name pharmaceuticals. While pharmaceutical giants like Novo Nordisk and Eli Lilly certainly price their medications at premium levels, at least they invest in comprehensive safety research and regulatory compliance, along with the long-term research and development costs that make the drugs possible. Conversely, telehealth firms offering copycat drugs often allocate significant budgets toward advertisements and lobbying—like hiring celebrity spokespersons—to protect their lucrative niche.

Cost Considerations

If cost is genuinely the barrier, it might be wiser and safer for consumers to invest their resources into sustainable solutions like working with a personal trainer, consulting with a nutritionist, maintaining a gym membership, and adopting healthier eating habits. Such an approach not only addresses weight loss but contributes positively to overall health—even saving gobs of money in the long run.

Still, human nature assigns a high value to “the easy way”. People will be people. So, you’ll find lots of whining in JAMA and NEJM about how we must supply these miracle drugs to the underserved community because they deserve them, too. We must addict them to GLP-1 RAs for life because they deserve it?

My primary concern remains that patients bypass traditional healthcare professionals in favor of convenient, but less accountable telehealth services. Although local doctors have their own faults—as my ongoing Dr. DeLorean and Dr. Scrooge experiences illustrate—they have the critical advantage of familiarity with patient history and face greater accountability than anonymous online prescribers. Desperate people wanting weight-loss drugs are more likely to lie to distant strangers than to their flesh-and-blood doctor who knows their medical history over time.

Pushback by Big Pharma and Their Allies

Pharmaceutical companies Eli Lilly (manufacturers of Mounjaro and Zepbound branded versions of tirzepatide) and Novo Nordisk (Ozempic and Wegovy versions of semaglutide) rightly challenge compounding pharmacies for skirting crucial safety measures and FDA oversight. Cannily, compounding operations position themselves as fulfilling an unmet demand, yet their vast prescription numbers suggest a profitable mass-market approach rather than genuine individualized patient care.

Meanwhile, the American Diabetes Association explicitly states it does not endorse compounded GLP-1 products, emphasizing the importance of FDA oversight and clinician supervision. Both JAMA and NEJM report growing confusion among consumers about the legitimacy and safety of compounded medications, underscoring the need for clearer information and stricter oversight.

Summing It Up

Certainly, inflated costs of medications like Ozempic and Mounjaro contribute significantly to this problem, creating opportunities for exploitative businesses. Yet embracing gray-market compounding is hardly a safe or responsible solution. Patients deserve affordable, effective medications with proper medical oversight—not questionable formulations prescribed by remote clinicians lacking comprehensive patient knowledge.

Ultimately, neither side emerges entirely virtuous—both show elements of opportunism. Nevertheless, the unchecked proliferation of telehealth-driven compounding clearly poses a significant health risk. As highlighted by the NEJM, stronger enforcement of existing laws and clearer regulatory guidelines on pharmaceutical–telehealth partnerships are urgently needed. Until then, consumers should exercise great caution and engage proactively with trusted healthcare professionals.

Opinion: Climate Change over Patient Safety?

Just when I thought medical journals couldn’t further divorce themselves from patient safety and practical medicine, along comes this latest gem from JAMA on reducing surgical carbon emissions. Yea, verily, because when I’m being wheeled into surgery, my primary worry isn’t surgical complications or infection rates—it’s whether the hospital is recycling its gloves and gowns properly. Let’s get our damn priorities straight, people!

According to these authors, surgeons and anesthesiologists should now become climate warriors, scrutinizing the carbon footprint of every scalpel and anesthesia mask. God forbid they focus on something mundane like patient outcomes, already. Never mind that surgical trays will now omit crucial tools in the name of “environmental stewardship,” ensuring my surgeon gets a fun scavenger hunt mid-procedure. I’m sure those missing forceps were rarely used anyway.

And don’t use the autoclave! Damn thing uses too much electricity. Think of the ozone layer! Think greenhouse gases! Reverting to 18th century sterilization techniques (read none at all) makes consummate sense. We all want to enjoy the brighter new tomorrow, even if we’re dying from sepsis.

Remote Magic

The authors suggest that preoperative assessments shift to telemedicine to reduce travel-related carbon emissions. Great fucking idea—because remote evaluations over pixellated video calls have never led to oversights or misdiagnoses. It’s not a stretch to predict that my next surgery will be done virtually too, saving the planet one pixel at a time.

Adopting The Three Stooges Method—a Big Hammer to the Head

And let’s not overlook the anesthetic gases. Apparently, desflurane should be banned from operating rooms because its global warming potential is just too damn high. So, if a patient happens to need that specific anesthetic for medical reasons, tough shit. After all, reducing greenhouse gas emissions surely outweighs effective anesthesia management, right? I’m certain patients will appreciate their surgeon’s dedication to climate change while they’re waking up mid-surgery with their chests cracked open or their knees grotesquely dislocated.

Lastly, the article triumphantly concludes that “individual clinicians can implement small changes that can prevent harm to patients and ultimately…decrease environmental harm.” Small changes indeed—like compromising sterility standards or cutting corners in postoperative care. But hey, at least the hospital’s carbon footprint will look fabulous on paper. Who knew healthcare’s primary mission was to chase carbon neutrality over patient safety? Clearly, I missed that line in the Hippocratic Oath.

“Getting Off” Follow-Up

Back on March 10, I shared my thoughts on discontinuing GLP-1 receptor agonist (RA) drugs, emphasizing two key points:

1. Big Pharma’s Perpetual Prescription Plan: The pharmaceutical industry seems keen on patients remaining on GLP-1 drugs indefinitely, ensuring a continuous revenue stream.
2. The Uphill Battle of Discontinuation: While it’s challenging, individuals can successfully stop these medications with dedication to lifestyle changes.

Bradley Olson’s recent essay in The Wall Street Journal echoes these sentiments. After shedding 40 pounds using Mounjaro, Olson chose to stop its use, primarily due to the prohibitive cost—approximately $1,000 per month. He then embarked on a rigorous exercise program and a structured nutrition plan, leading to an additional 20-pound weight loss over the following year. This sharply contrasts with the backsliding experienced by most who quit GLP-1 RA drugs, as we mentioned a couple of weeks ago.

You Can Do It!

Olson’s experience underscores that, despite the pharmaceutical industry’s preference for long-term medication use, individuals can achieve sustainable weight management through diligent lifestyle modifications. Notably, Olson does not mention having Type 2 diabetes. His discussions about glucose pertain to monitoring dietary impacts, suggesting his use of Mounjaro was for weight loss rather than diabetes management. While he mentions blood glucose, he does so in the context of checking the effectiveness of his low-carb diet, not long-term diabetic control. Nevertheless, diligently pursued low-carb diets and vigorous exercise are indeed significant steps toward controlling diabetes.

A Little Help from Dr. Phinney

Also, Olson mentions that he used a startup called Virta Health for a while to guide his nutritional ventures and to augment his self-monitoring. My minimal research reveals that Virta is in the business of non-pharmaceutical, monitored low-carb lifestyle approaches to Type 2 diabetes and weight loss. Dr. Stephen Phinney, co-author of The Art and Science of Low-Carbohydrate Living is a co-founder and formerly Chief Medical officer of Virta.

Virta’s retail cost is currently $299 per month after a $250 initiation fee. Interestingly, those fees are quite comparable to what you would pay for some of the compounded GLP-1 drugs through our friends, the telehealth-compounders. Virta’s website suggests that many health insurance plans will cover their fees, with no mention of traditional Medicare doing the same. This might exclude it as a choice for me, although self-funding is a possibility. I’ll give Virta a stronger look when the time comes, because even with insurance coverage, Mounjaro is costing me $250 per month up to the ridiculously titled Inflation Reduction Act annual limit of $2,000.

(Yeah, well, with the unpredictable state of politics in Washington these days, it’s hard to say what the future will hold. But I digress politically—I prefer to steer clear since extreme voices on both sides seem determined to widen the ideological gap, making constructive dialogue increasingly rare. Enough said!)

Yes, It Can Be Done!

In summary, while Big Pharma advocates for indefinitely prolonged use of GLP-1 drugs, Olson’s story demonstrates that with commitment and effort, discontinuation is both possible and effective. As regular readers know, my approach is to ramp up my exercise and low-carb commitments while I am still taking Mounjaro so those habits are ingrained by the time I wean myself off it. Although my approach is not an absolute guarantee of success, it will soften the blow of withdrawal, giving me a decided advantage over quitting cold-Turkey [there he goes with the Turkey puns again, already].

Thus encouraged, I shall proceed to this week’s numerology, as it were.

The Week on Mounjaro: The Numbers

The week kicked off with a Great Damn Idea (GDI): corned beef and cabbage in honor of St. Patrick’s Day, when we all pretend to be Irish peasants. The meal was excellent—though a departure from my usual low-carb fare, it notably lacked the traditional potatoes. What wasn’t excellent, however, was the aftermath, which led to an emergency call to a plumber. You see, this Turkey, who should certainly know better, forced a raw cabbage core down the garbage disposal. Predictably, the mangled, fibrous core traveled through the drain, encountered a partial blockage, and promptly completed it, backing up the drains into a delightful little catastrophe.

After futile attempts at non-surgical intervention with a plunger, I went outside to open the drain cleanout for a more precise differential diagnosis. Fouled water enthusiastically shot out at me, draining the sinks and confirming the blockage was downstream, between the cleanout and the street sewer. My options were clear: rent a drain auger and undertake the dirty job myself, or wisely call a professional plumber. Given that I lack even amateur plumbing skills, opting for the pro was an easy choice. Luckily, I found a local company offering a $93 special for uncomplicated drain blockages—a steal compared to the $200-$300 estimates I was seeing. At that price, it was just a few bucks more than renting equipment and required a whole lot less effort from yours truly.

So, what does all this have to do with my numbers? Absolutely nothing. I just couldn’t resist adding another semi-humorous story to an already lengthy post. The corned beef and cabbage meal was delicious, and although high in sodium, it didn’t significantly impact my glucose numbers—which I shall finally get to now. (You hope.)

The Numbers, Already!

My fasting blood glucose averaged a steady 93 mg/dL (5.17 mmol/L). However, according to my Stelo biosensor, my average blood glucose crept up slightly to 108 mg/dL (6.00 mmol/L). As I’ve mentioned before, these non-prescription biosensors aren’t perfectly accurate in absolute terms, but they’re fantastic for tracking relative changes based on my dietary choices. For instance, Thursday’s lunch at Outback Steakhouse, featuring half a small loaf of their sugary bread, resulted in a notable spike. Still, these spikes now max out around 140 mg/dL (7.78 mmol/L)—a vast improvement over the 250-300 mg/dL (13.89-16.67 mmol/L) peaks from before I committed to a low-carb, high-protein lifestyle.

Fat-cell scientist and acclaimed alliterator Dr. Ben Bikman of Brigham Young University offers a catchy and effective dietary mantra: prioritize protein, control carbs, and don’t fear fats. I’ve wholeheartedly embraced this approach, and its success speaks for itself.

My weight held steady this week at 184 lbs (83.6 kg), bringing my total weight loss since starting Mounjaro to about 63 lbs (28.6 kg). As previously mentioned, my current priority has shifted toward preserving—and ideally building—muscle mass, flipping the bird at sarcopenia. While I would still like to lose another 20-30 lbs (9-13 kg), that goal clashes somewhat with muscle-building efforts. Operating at a caloric deficit isn’t viable right now, so I’ve boosted my daily calorie intake primarily by upping my protein. The theory is straightforward: increased muscle mass will elevate my metabolic rate, potentially allowing some gradual weight loss, albeit at a turtle’s pace rather than a hare’s.

See you next week!

That wraps up another seriously literary effort by this Turkey. This installment was jam-packed, covering relevant topics from compounding pharmacies and GLP-1 RA discontinuation to climate-change lunacy permeating medicine—not to mention my plumbing misadventure. I hope you’ve enjoyed the stories I’ve unearthed and the opinions shared (whether you agree or not), as you continue following my Mounjaro journey. And, as they love to say on YouTube, please feel free to share your own tidbits in the comments below. I’d be thrilled to hear from others navigating their paths with Type 2 diabetes, GLP-1 RA drugs, or anyone else who enjoys a bit of good-natured skepticism toward medical wokeness.

Until next week, stay healthy!

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

Allulose, Overtraining, and Another Week on Mounjaro 7.5mg

Hello, fellow Type 2 diabetics and anyone else interested in Mounjaro, GLP-1 receptor agonists and welcome to aging fitness freaks of all shapes and sizes. Happy St. Patrick’s Day! This weekly column chronicles my progress on Type 2 diabetes control with the prescription drug Mounjaro,. During the past forty weeks of Mounjaro therapy, I got off Metformin, reduced my blood pressure medicine to half its original dose, and lost around sixty pounds (27.3 kg). Concomitantly, my HbA1c dropped from 7.6% (60 mmol/mol) to 5.4% (36 mmol/mol). Yea, verily, at the ripe old age of seventy-eight, Mounjaro and my associated lifestyle improvements have done me well!

Apart from my personal progress, I like to intersperse subjects related to Mounjaro therapy and Type 2 diabetes here. For example, last week I discussed getting off Mounjaro at some point. As I discover current information I think will be of value to others, I write about it here, sometimes offering opinions on pet subjects like the pharmaceutical industry and their social media cheerleaders. Also, having transformed myself into a gym rat, I often touch on exercise philosophies and equipment with senior citizens like me in mind. Nutrition is an important consideration, too, when managing diabetes, so I often add information in that area, which brings us to this week’s topic: allulose.

Not a Medical Advice Column

But first, I must spout the usual disclaimers. Pictured at left on the way to the nineteenth hole at sunset, I am a 78-year-old pretend amateur metabolic scientist and geriatric gym rat, not a licensed physician, so I can’t legally dispense medical advice. Like, would you even buy a used car from this Turkey, let alone trust him with your health? Oh, hell no! I might tell you what to do because that’s the way I am, but you have only yourself to blame for listening to me. In other words, don’t sue me because something you read here doesn’t pan out for you. Instead, visit your local flesh and blood doctor, or even someone of indeterminate national origin in a white coat on a tele-health screen at a profiteering weight loss salon or compounding pharmacy. They will have the necessary malpractice insurance to protect them when they screw up.

Allulose: A Sugar That Sweetens but Does Not Fatten?

This week, I take a closer look at allulose, especially as it relates to managing Type 2 diabetes and weight loss. If you must sweeten foods, allulose might be a way to do so with minimal impact on your metabolic health. My wife Jenny, a microbiologist and an inveterate ketophile, some of whose distant ancestors were an inbred Irish tribe of Neolithic Era potato farmers and who sometimes identifies herself here as “Artificially Sweetened”, has joined me in sweetening things with allulose. We’ll see where all this leads us.

Allulose, classified as a rare sugar, naturally occurs in small amounts in foods like figs, raisins, and maple syrup. Unlike regular table sugar, it provides just about 0.2-0.4 calories per gram and minimally impacts blood glucose levels. This minimal glycemic response makes allulose particularly attractive for those managing diabetes or pursuing weight loss. Additionally, some studies suggest that allulose may improve insulin sensitivity and promote body fat reduction, both valuable benefits in diabetes management and weight control.

Is It Safe? Is It Better?

Like any sugar substitute, allulose isn’t free of controversies or potential drawbacks. Although generally recognized as safe (GRAS) by the FDA, some individuals experience gastrointestinal issues, like bloating, gas, or discomfort, when consuming large amounts. As allulose is relatively new to widespread use, there’s also limited long-term data available about its continuous safety and effectiveness.

Compared to other popular sugar alternatives, like monk fruit extract and erythritol, allulose is often praised for a more natural taste and superior baking performance. Monk fruit extract is calorie-free and has no glycemic impact, but can impart a noticeable aftertaste. Erythritol similarly provides minimal calories and glycemic response but often produces a cooling sensation that some find unpleasant. Each sweetener thus has distinct pros and cons, influencing their suitability based on individual preferences and health goals.

One potential drawback of allulose is its cost. For example, a three-pound (1.36 kg) bag of Truvia-branded allulose costs $25 at Amazon.com. But the good news is that it is SNAP EBT eligible. For those you outside the U.S. welfare state, this means that low-income families on government assistance can have their allulose, too, courtesy of the taxpayers who currently fund their Coca-Cola and Froot Loops!

Banned in Europe?

Notably, allulose remains banned in the European Union due to concerns raised by a study suggesting possible carcinogenicity at very high dosages. These findings, nevertheless, are controversial and have not been replicated in human studies. Consequently, while the U.S. FDA maintains that allulose is safe, European regulators continue to await more definitive research.

So, Why Do We Crave Sweets, Already?

Exploring the rise of sugar alternatives naturally leads to questions about our inherent craving for sweetness. Historically, humans evolved a strong preference for sweet foods, a survival adaptation that helped find calorie-rich sources during periods of scarcity. In modern societies of dietary abundance, this evolutionary trait contributes significantly to overconsumption, obesity, and metabolic diseases like Type 2 diabetes.

Has our societal sweet tooth intensified in recent decades? The evidence suggests yes. Over the past 50 years, global sugar consumption has skyrocketed, driven by the relentless marketing and ubiquity of ultra-processed foods, sugary beverages, and convenience foods engineered by a profit-hungry food industry. The relentless addition of sugar to everyday products—from breads and sauces to seemingly “healthy” snacks—creates an environment where sugar is virtually unavoidable. This calculated saturation of sugar by the food industry hijacks our brains’ reward centers, reinforcing cravings, perpetuating cycles of craving and dependence, and fueling epidemics of obesity and chronic metabolic diseases.

Our heightened demand for sweetness highlights the importance of finding suitable sugar substitutes like allulose. Understanding the biology behind sweet cravings underscores the value—and necessity—of alternatives that help mitigate adverse health outcomes while satisfying our innate preference for sweetness.

Kinda Like Methadone

But in my mind, a better approach is to wind down those primordial sugar cravings. Our ancient ancestors surely did not breakfast on Cocoa Puffs and Lucky Charms. The modern food industry, with its overwhelming abundance of hyper-palatable, chemically enhanced foods, is the true villain behind the sugar addiction epidemic—a genuine addiction deliberately fostered for corporate profit. Quitting cold Turkey (pun intended) may not be realistic, but each of us can take deliberate steps to reduce reliance on sugar and its substitutes, slowly reconditioning our palates towards healthier, less artificially sweetened foods.

I’ll continue monitoring the latest research and sharing personal insights into my experiences with these sweeteners, aiming to maintain a balanced view of their benefits and potential risks. And, of course, I will continue to openly disparage the food industry, which spends even more money on lobbyists than the defense industry, for the harm it continues to inflict upon public health.

My Week on Mounjaro

As usual, I’ll close out this week’s column by recapping the highlights, lowlights, and numbers of metabolic significance, because what would life be without quantification?

Overtraining? (Or Maybe Just Over-Weeding)

I dialed back my workout routine this past week, but not for any admirable athletic reason—my back decided to protest vigorously after an ambitious weed-pulling session. Who knew gardening was an extreme sport? Despite this grievous horticultural injury, I managed five workouts, though admittedly on the gentler side.

The internal debate was familiar: pamper the injury and languish on the couch, or soldier on and pretend everything’s fine. Choosing the wiser path of “lightly soldiering on,” I cautiously maintained both cardio and resistance exercises, albeit at lower intensity. By Sunday, feeling reasonably recovered, I performed a full, hour-and-a-half routine of stretching and resistance training, prudently easing off on lower-back exercises. Upper-body exercises saw a modest weight increase—because, clearly, moderation is overrated. Today, it’s back to the gym in my lucky green t-shirt to work legs. What could go wrong?

Weight Loss Considerations (The Brief Version)

My primary motivation for starting Mounjaro was glucose control, but let’s be honest—shedding pounds was a welcome side-effect. To satisfy curiosity (and my ego), here’s the quick-and-dirty summary:

Last June, I tipped the scale at roughly 245-250 pounds (111.4-113.6 kg), sporting an impressive BMI of about 36.3 and visceral fat (the really nasty stuff) of 18 unidentified units reported by my cheap Chinese smart scale. This morning, I clock in at a svelte 183.8 lbs (83.5 kg), with my BMI down to 27.9 and visceral fat reduced to 11 pork units—still not marathon material, but decidedly less crappy fat around the internal organs. Alas, I still have a residual, deflated spare tire around the middle, which would likely require surgery to fix.

I’ve gone from squeezing into 2XL shirts and 42″ waist pants to comfortably sporting larges and the occasional optimistic medium, with pants sizes ranging from 34″-38″ depending on the generosity of the manufacturer’s vanity sizing and “cheater” fabrics.

Mounjaro kick-started this weight-loss escapade, but at this point, lifestyle changes are carrying the baton. With another 25 pounds (11.4 kg) still stubbornly hanging around, my primary focus is preserving muscle mass (not easy on fewer calories) and maintaining glucose control. I’ll take weight loss as it comes, if it comes.

Da Mounjaro Numbers, Already!

This week’s metabolic scoreboard remains stable. My fasting glucose averaged a consistent 94 mg/dL (5.2 mmol/L), identical to last week’s performance. Dexcom’s trusty Stelo biosensor reports an overall weekly average glucose of 100 mg/dL (5.6 mmol/L), so no wild excitement there.

Wrapping It Up

Thanks for tuning into another thrilling episode of my Mounjaro chronicles. Hopefully, you’ve learned something useful—or at least entertained yourself briefly. If you hadn’t heard of allulose before now, consider yourself enlightened. Until next week, stay healthy (and watch out for aggressive weeds).

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

First Week on 7.5 mg Dose

Greetings, fellow diabetics, pre-diabetics, and any other interested parties! If you are interested in the effects of GLP-1 receptor agonist drugs like Mounjaro and Ozempic, welcome! Here, we follow my progress on Mounjaro, which as this post’s title declares, I have been taking for forty weeks. This week is my first on a higher dose, 7.5 mg/0.5 ml, after dosing at 5.0 mg for the past few months.

If you’re new here, I’m a seventy-eight-year-old self-described curmudgeonly old fart. I was assigned male at birth and I identify as male. As I reported last week, I have the testosterone level to prove it! I remember when there were two genders. Back then, one “identified” as what one was, whether one liked it or not. But I digress, nostalgically pining for a bygone era.

My foremost goal is to control blood glucose, which is paramount for any diabetic. Next, I want to preserve muscle mass. The rapid weight loss linked with these GLP-1 drugs is up to about 40% muscle. At my age, sarcopenia has already caused significant muscle loss. Thus, I do not need to further jeopardize my golden years with frailty due to irresponsible promotion of weight loss. My ultimate goal is to get off Mounjaro when I am stable and my lifestyle adjustments have been set in concrete.

Patient, Treat Thyself!

Before I talk about lifestyle changes, I’ll interject that I am not a doctor. My admonishments here represent my experiences, which I hope will benefit others. Even though I tell you to “do it my way” below, I am not recommending that anyone adopt my approach without consulting their own healthcare team. Much of what I offer here is my personal, cynical opinion. Yet, if what I say makes sense, talk to your doctor and ask whether The Turkey’s advice is right for you!

My lifestyle improvements are the old, familiar diet and exercise. Boring stuff, I know. First, I adopted a low-carbohydrate diet. This dietary approach is essential for diabetics, no matter what bullshit the American Diabetes Association is spewing. They, after all, get funds from Big Pharma, who prefer to keep us diabetic so they can sell us drugs. Next, I exercise six days per week, both resistance and cardio, to keep the muscles and cardiovascular system going. I have increased the protein in my diet to make certain I can build muscle mass. In short, I do not regard Mounjaro as a magic pill. I can’t hope for long-term success in controlling diabetes without making proper lifestyle adjustments while I’m on it, and continuing with them when I’m done with the drug.

So, Who’s Getting Off?

I firmly believe that if I can stick with a proper diet and a rigorous exercise schedule, I can eventually ditch the Mounjaro. But my cynical side tells me that Big Pharma will not appreciate that! At retail prices, they’re getting about $1,200 per month for the drug. The global GLP-1 analogues market was valued at approximately $37.4 billion and is projected to grow at a compound annual growth rate (CAGR) of 33.2%. The biggest impediment to continued explosive growth the pharmaceutical industry faces is “early” discontinuation, which translates to unwanted disruptions to the ever-increasing revenue stream. They want us to make a lifelong commitment to their GLP-1 RA drugs.

For whatever reasons—and cost is certainly one of them—many patients discontinue GLP-1 RA drugs in their first year of therapy. In many cases, such patients experience rebound effects, namely worsening glucose control and weight regain. Both are undesirable for me. I want to make sure that my lifestyle adjustments can sustain me when I ditch the Mounjaro. I will not be lazily compliant, staying on this crap for life even if I can afford the cost. I am not one to use crutches when their need has passed.

Keep ‘Em Hooked

Estimates that 50% to 75% of patients stop the drugs within a year confound Big Pharma and the doctors they influence. But to their delight, a recent Journal of the American Medical Association (JAMA) Viewpoint implores that physicians must redouble their efforts toward educating patients about compliance. They declare those non-compliant patients as susceptible to weight regain and loss of other benefits of the drugs. These notions, of course, are partially true, but they are also thinly veiled threats to keep us dependent on the drugs for life—or else!

Do It My Way!

I state unabashedly, sophomorically, and naively that doctors should be encouraging my approach instead of prescribing magic pills and considering that a done deal. Put your patients on these drugs if they have useful short-term effects but eschew the open-ended approach. Reorient people to living well and taking control of their chronic conditions. Encourage them to be active participants in their treatment, so they can get off the drugs. After all, in most Type 2 diabetes cases, it is a crappy lifestyle and crappy habits that got them there in the first place.

If you want to read more about patient non-compliance with GLP-1 drugs, this article in TCTMD provides highlights and comments on the JAMA Viewpoint. Read it with a keen awareness of the “one hand washes the other” nature of the industry.

I’ll finish this discussion with my observation that the medical community is paying much more attention to keeping people on the drugs than assessing potential issues that would suggest discontinuation. I rarely see any passionate healthcare articles imploring doctors to regularly monitor side effects of GLP-1 RA drugs with the intent of stopping them if things go awry.

Now, I’ll move on to my numbers for the week and my overall progress.

Numbers for the Week on Mounjaro

This was my first week on the amped-up Mounjaro dose of 7.5 mg. My average fasting glucose was 94 mg/dL (5.2 mmol/L), about the same as last week. My weight has been nominally stable, with a 0.6 lb loss for the week. Nothing exciting here, so that will do it for another week.

I hope to return next week with more useful information. In the meanwhile, stay healthy!

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