Nittany Turkey back atcha with another week of reporting Mounjaro progress, served alongside a 15 mg dose of opinionated diatribe. You know what they say about opinions? Well, I’ve gotta have one, and this is my platform for sharing it.

This is NOT a commercialized platform in any way, shape, or form. I don’t display ads or get click-through revenue. If I recommend products I use, it is because I use them and like them. Similarly, I do not offer medical advice, just a recap of my own experiences with Mounjaro for the treatment of Type 2 Diabetes.

I also write about Zepbound and compounded tirzepatide, which are all the same drug as Mounjaro. They are merely packaged differently. Mounjaro and Zepbound, both products of Eli Lilly & Co., are branded versions of tirzepatide. Mounjaro is approved for Type 2 Diabetes, while Zepbound is approved for weight loss. I have written lots about the social media influenced pop culture surrounding these drugs, fueled by direct-to-consumer advertising by big pharma and our societal penchant for hopping blindly onto the latest fad in can’t-fail weight loss treatments.

Today, I’ll recap my progress on Mounjaro therapy, which is neither a “journey” nor an “adventure”, I’ll introduce the concept of an exit strategy, and then I’ll serve up another editorial.

My Progress on Mounjaro

Having taken Mounjaro at the 2.5 mg loading dose for nine weeks, my progress stalled in both glucose and weight. Typically, you start on 2.5 and move up to 5 mg after the first four weeks. I, being an old fart who is wary about dangerous side-effects because of my long laundry list of comorbidities, stuck with the 2.5 dose for twice the typical time. While my numbers tell a subtle story of stalled progress, one thing stuck out like a sore thumb. The appetite suppression associated with Mounjaro evaporated.

Last Sunday night, Jenny and I went out to dinner for our anniversary. My unsuppressed appetite wanted everything on the menu, but I settled on a Caesar Salad, 14-ounce ribeye, asparagus drizzled with a balsamic reduction, and whatever the hell “smashed potatoes” are. I cleaned my plate like my mother always told me I should, which is why I got so fat in the first place. Thinking back to my first week on Mounjaro, I could not finish restaurant meals. So, I felt that this, coupled with the numbers, signaled time to up the dose.

My doctor agreed and I am proceeding cautiously, on the lookout for side-effects or anything unusual. I will certainly report anything out of the ordinary.

The numbers, already, Turkey!

OK, OK… who’s counting, already! Here you are with my progress for the week. Average blood glucose increased from 100 to 101, which still ain’t bad. Morning “dawn effect” readings averaged 101 as well. Weight dropped by one pound, which was due to a midweek lack of appetite caused by some bad heartburn. (On the whole, I blame my gigantic anniversary dinner transgression while Jenny focuses on the “smashed potatoes”). My blood pressure is trending nicely downward due to weight loss, averaging 125/71.

An encouraging sign is that this morning’s glucose reading was 89, the first sub-90 wake-up reading I can recall. Could be a coincidence, or it might be related to my having injected the first 5 mg dose of Mounjaro last night. So, let’s see where this 5 mg dose takes me. Thus far, I have experienced no noticeable side-effects. I’ll continue to report on my progress.

My Mounjaro Treatment Philosophy

I don’t want to be on Mounjaro for the rest of my life. It still amounts to injecting a foreign substance with many known and unknown side-effects into a well-aged body — a substantial risk for an old fart. No doubt, the big fooda/big pharma/big doctra/big governmenta conspiracy would love to view me as a guaranteed revenue stream, but I hope to avoid going down that rabbit hole. Thus, as I approach my goals, I intend to develop an exit plan.

That’s a tricky situation, because of the potential for reversing any positive accomplishments. I need some intelligent guidance (hint: it won’t come from social media) while I develop the plan. My doctor will be of limited value, because he is a member of the “prescribe, prescribe, prescribe” culture of this country’s current medical milieu. Like most modern docs, he is not comfortable with patient-driven care, and while I will accept input from him, I will make the decisions.

In the end, one way or another, I die. Between now and then, I will endeavor to do what is necessary to make life for me and those around me more enjoyable. One immense benefit of the Mounjaro, which seems to baffle my doctor but has been reported in studies, is a reduction in generalized inflammation. This could be a secondary effect, but it has been an obvious feature from the start of my therapy. It has enabled me to increase exercise, have more energy, and be less pissed off all the time. My pain levels are much lower now.

So, I will be gathering information from credible sources and working on the exit plan. I would like to be subjecting myself to the foreign intruder for no more than a total of fifteen to sixteen months, an arbitrary period based on what I think I can accomplish. Of course, at my age, shit happens, which will surely necessitate adjustments.

Mounjaro/Zepbound Shortages Lifted

Eli Lilly & Co. CEO David Ricks fired a shot across the bow of compounding pharmacies that dispense generic tirzepatide. Last Thursday in an interview with Bloomberg. Ricks declared that the shortages that enabled the compounders to legally sell the drug would soon be over. Once Mounjaro and Zepbound come off the FDA’s shortage list, US 503b compounding pharmacies can no longer legally sell the drug under the shortage exemption. They will have a sixty-day grace period to fill existing orders.

So sure enough, on Friday, the FDA shortage list reflected that both Mounjaro and Zepbound 10 mg and 15 mg doses, which previously had shown up as being in short supply, no longer had that designation.

This is the latest salvo from Lilly against those opportunists who are horning in on their territory. These operations exploit the massive, multi-billion-dollar weight-loss market for profit, benefiting from Lilly’s gigantic expenditure. Lilly invents a drug, ramps up manufacturing, develops a huge market through advertising, incurs huge development costs, and spends megabucks securing FDA approval, lobbying congressmen, and operating like big, bad, evil Big Pharma. Then, the vultures of telehealth operations and their compounding pharmacy partners swoop in to exploit the FDA loophole and as many desperate fat people as they can sign up.

Big Bad Pharma Wants to Protect Its Mounjaro Turf

I fully understand Eli Lilly wanting to protect its turf, and I have no problem with it. Meanwhile, vloggers are crying in their beer, which, by the way, some think they can drink while losing those twenty unwanted pounds. Their channels for cheap, compounded tirzepatide might be shut down soon. Then, my oh my, what will they do?

No legitimate doctor is going to prescribe a drug with potentially life-threatening adverse effects for cosmetic weight loss. (Along those lines, I recently saw one mid-twenties clown on TikTok saying how he was using compounded tirzepatide to get down to 155 lbs from 176; another on YouTube who I’ve mentioned in previous columns, was using it to reduce his body fat from 10% to 5%!). Well, boo-hoo! I hope Lilly succeeds in driving the cosmetic weight-loss industry back to herbal remedies, crash diets and other faddish pseudo-solutions.

The market fears that they and similar outfits might need to go back to concentrating on boner pills.

—TNT

Stock prices for Hims & Hers Health, Inc., one of the bigger suppliers of compounded tirzepatide along with generic Viagra with market cap of $3.78 billion, fell 16% in the wake of the Ricks interview. The market fears that they and similar outfits might need to go back to concentrating on boner pills. As of the publication time of this article, HIMS (NYSE) is trading about as low as $15.87, down from the August 1 high of $22.02, a 28% dive out the window.

Social Media Up in Arms

Social media wonks are outraged, displaying all the spoiled attributes of the entitlement society. Some of the more activist YouTubers exhibit signs of a messianic complex. Their self-appointed role as our savior impels them to think they can influence this multi-billion-dollar market by calling for a grass-roots effort to lobby the FDA and “prove” that shortages exist. But this is big-boy stuff, not influencer bullshit. They’re up against big pharma and big bucks. Will David take down Goliath? You answer that question.

And for meeker colleagues, their “journeys” and “adventures” are about to blow up, with predictable consequences. The wealthier ones will always be able to get their drug candy, so no effect there. The ones who are merely solvent and who have feathered their nest with YouTube revenues and referral fees from opportunistic telehealth providers will find either foreign or black-market channels for the fixes they seek. Then, they will tell their peers how to do it, further stoking their video revenue machine. They might get even more kickbacks that way, too. However, a few who are truly in need — and I don’t mean for cosmetic weight loss — will suffer, and I feel bad for them. I’m talking about those who are morbidly obese, with BMI northward of 40 and A1c to match.

Think of it this way. If we can shake the frivolous, cosmetic users out of the system, will there still be shortages? The unprecedented demand for the latest fad in weight loss magic bullets, GLP-1 agonists, is caused by a veritable plethora of relatively healthy yo-yo dieters hopping on the bandwagon of the latest fad. “But, but, dieting never worked for me!” Yeah, that’s the bullshit line. Think of it this way: For the $500 to $1,200 per month they are paying for a magical cure, they could have a gym membership, a personal trainer, and a regular appointment with a cognitive behavioral counselor. Moreover, they would have enough scratch left over for a healthy food budget. They could eat healthily while incurring no adverse drug effects.

But, noooooooooooo, they want magic.

Influencer, influence thyself!

What I hope will now dry up is the proliferation of YouTube vlogs proselytizing tirzepatide, especially the sponsored ones. I imagine that they’ll flail around for a while before the eventual shake-out. The worst are the ones offering dangerous advice on how to split doses, increase dosing frequency, and eat whatever you want. They’ll help you find a compounding pharmacy with a teledoc who will rubber-stamp your Mounjaro requisition, with referral fees flowing back to them. They’ll evaporate along with the compounded drugs they push. Finally, I sure as hell do not need any more middle-aged women man-splaining how these drugs work, middle-aged men with backward baseball caps calling me “you guys” while reporting the recycled incretin news of the day, or other so-called “influencers” attempting to advise me with anecdotal crap they heard from other influencers. Influence THIS!

Coming Soon: Over-the-Counter Mounjaro!

Over-the-counter Mounjaro is not so far-fetched! These drugs might well be offered over-the-counter in the future, because they are just about that freely distributed now. After all, you go to an integrated telehealth facility with a staff doc who doesn’t know you from Adam, you talk with a nurse or some other extender, and they give you your drugs — for a fee. Given our instant gratification society and our irresponsible lawmakers, coupled with the greed of big pharma and the conspiratorial complicity of a food industry that is poisoning us, why bother with perfunctory consultations and rubber-stamped prescriptions? Just drop the pretenses, cut out the middle-man and go OTC! Get your private-label CVS-branded Mounjaro today!

After all, how many states legalized recreational marijuana? How far are we from legalizing recreational Mounjaro? Follow the money.

That will do it for another fun weekly rant. Thanks for making this non-influencer feel that his words are being read. Whether you agree or disagree, about the novel weight-loss drug market, I hope I gave you some food for thought. I further hope that reports of my progress have offered encouragement to other Type 2 diabetics who seek solutions.

I’ll be back next week with more progress reports and more drivel.

Welcome to this week’s discussion of Mounjaro, including tidbits from my personal experience with the therapy. I am now into my ninth week on Mounjaro for diabetes, with the secondary object of losing excess weight.

To reiterate my cynical allusion, I do not regard this serious therapy as a “journey”, or as some now are calling it, an “adventure”. Whoop de doo! This is a serious undertaking with an unknown endpoint. I’ll say a few words relating to my chosen title for this week’s column before I update you on my progress.

Many vlogs and blogs are cheerleaders for Mounjaro, Zepbound, Ozempic, Wegovy, or their generic equivalents. Some of them are paid for their promotional efforts while others just want to spread the word about something new and exciting. The latter category of town criers pops up every time a new, miracle cure for obesity emerges, be it diet, exercise, or drug. This speaks to the futility of prior efforts, which doesn’t portend well for their future performance on the latest and greatest. Lots of past “journeys” to temporary nirvana followed by a return to old habits, old pathology, and old tonnage, make them ripe targets for the latest “guaranteed” weight-loss product.

Oh, but this is different. Yeah, right!

Do Your Own Research

The jungle of misinformation should impel you to avert the cheerleaders and do your own research on Mounjaro. Reading medical research papers can be tedious, and one must be careful to understand who funds the studies they describe. However, they are much better sources of information than the filtered, crowd-sourced, anecdotal crap you will find on YouTube. Even better, you don’t need to watch some moody woman babbling about how she transgressed by eating some Doritos the other day in the course of a boring, poorly edited video production. These “influencers” are funding their drug purchases and in some cases earning a living through YouTube’s funding algorithm by developing large audiences where they can preach to the choir. YouTubers thrive on lazy people who want their pablum spoon-fed to them in palatable dollops.

Sure, I sound like a broken record, but I urge caution for good reason. Many of those YouTubers are pushing telehealth operations and compounding pharmacies, and some receive valuable consideration for doing so. Be cynical about such recommendations and be careful about whose comments you take seriously. Magical cures bring subscibers; healthy diet, exercise, and cognitive behavior training are dull topics in comparison. So, watch these non-doctors for entertainment, but remember to take their medical advice and counsel with a grain of salt.

It’s A Jungle Out There

Don’t listen to bullshit. Listen to your doctor — a REAL doctor with whom you have a face-to-face relationship and who has an interest in your long-term outcome, not some PA working for a weight-loss specific telehealth operation where you pay $99 per month for access to the compounded version of Mounjaro, which costs another $350 or so per month. These mills are capitalizing on the current craze. Be assured that a market shake-out somewhere down the road will eliminate the weaker competition.

Many desperate dieters are hopping on that telehealth/compounding train, so there’s plenty of money to be made and lots of greedy start-ups willing to capitalize on the trend under the guise of helping people through their “journey.” Once you express interest somewhere — anywhere — in losing weight, you’ll soon see glitzy adds pandering their services and their wares. Do you know anything at all about these companies? Or do you just take their word for their legitimacy, sign up, and send them your money? How long will their business be viable? Be smart! Do your research!

My Weekly Mounjaro Recap

Once again, please recall that after eight weeks I am still taking the loading dose of Mounjaro, which is 2.5 mg injected subcutaneously once per week. Based on flattening of my numbers, it might be appropriate to titrate upward to the minimum therapeutic dose of 5 mg. I will discuss that with my doctor this week taking many other factors into account.

All that having been said, my glucose was flat from the prior week, averaging about 102 mg/dL, as was morning fasting glucose at 106 mg/dL.My weight was down 1.4 lbs for the week, but I had gained one pound during the previous week. Thus, the net weight loss over two weeks was only 0.4 lbs.

I will offer an interesting observation in connection with appeitite. Jenny and I went to a local steakhouse for a wedding anniversary celebration dinner last night, which screwed with my numbers somewhat. The notable thing about that meal was the return of my appetite. I devoured a 14-ounce ribeye, which I would not have been able to do a couple of weeks ago. To me, this is a strong indication that my body is getting acclimated to Mounjaro and might need a boost in dosage to achieve consistent effects going forward.

One of the most appealing things about Mounjaro and other GLP-1 agonsists for the weight-loss crowd is the associated appetite suppression. Fat people tend to think about food all the time, to the extreme of thinking about what we’ll have for our next meal before finishing the one in front of us. So, the ability of a silver bullet drug to turn off that part of our brain is a big thing. YouTubers call this “food chatter” or “food noise”. Mounjaro puts the food chatter under the Cone of Silence.

Wrapping it Up and Putting a Mounjaro Bow on It

I don’t have a lot for you this week, but I want to reiterate that regardless of your chosen method, please do not try to do too much, too fast. Last week I mentioned a painful neuropathic condition arising from too rapid a drop in HbA1c. This subject is certainly an appropriate thing to discuss with your doctor.

I’ll wrap up this week by wishing you well in your metabolic progress and thanking you for taking the time to read this.

I’ll be back next week with more observations and opinions.

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).

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!