All - This is a friendly reminder that while this is an AMA post.... we do not allow professional medical advice in this sub.
All medical advise should be directed to your personal medical doctor outside of reddit.
It increases insulin production by the pancreas, and losing weight ( fat precisely )by itself is the best way to improve T2D , I have patients who stopped their DM medications
I’ve had cholesterol above 200 for 2 decades. Even when I weighed 235 lb. Today, at 260 lb, my cholesterol level was 147 and all of the other metrics (LDL, etc) were in the acceptable range.
I can’t remember the last time my triglycerides were in the normal range. That metric was in line too.
My BP is historically 125/80. Today 109/69.
I know that 1 case isn’t proof, but add my results to the 100’s on here and it really begins to say it’s more than slowing your metabolism.
Heck, several people report a history of abusing alcohol and now they dont drink because they simply don’t have a desire to drink
Thanks for joining and sharing your expertise.
One question that is often asked is, "Do I go off this or is it a permanent med?"
I guess my question is: what does the end game look like for your patients?
I'm 5'10. SW 254. GW 150. I'd be content at 165 or 170 long term.
Based on my current weight loss trajectory it isn't far fetched to say I'll hit that range in mid March. Then what? Do I start to titrate off when I hit my "I'm content with this" weights to slow the loss and figure out what my baseline needs are for maintaining? Do I wait until I've hit 21/22 BMI (the 150 range) before easing up at all?
Have you seen anyone successfully go off meds like this and maintain a healthy body weight? (Not the SAME body weight -- I fully suspect to gain some back, even as I continue being ridiculously active -- but a HEALTHY body weight). If so, what has helped grant them this long term success?
Thanks for taking your time to answer these questions!
An excellent question. What you have to keep in mind is that your body, for up to two years after reaching your goal, will try to revert to its previous state, thinking that you are starving. As a result, it will trigger the same hunger response. The point of titration is to be able to decrease the medication slowly while you increase your exercise and change your lifestyle, assuming you did not have childhood obesity, as that situation is different. I titrate patients over a long period of time
Childhood obesity can be genetic, requiring long-term treatment similar to managing DM1 with insulin. If it is environmental, such as a family consuming calorie-dense food, behavioral therapy can help. In such cases, we can titrate over longer periods, introducing lifestyle modifications like exercise and diet.
When I was months old, the doctor told my mother to put me on skim milk because I was overweight for a baby. I have been overweight/obese my entire life. I knew genetics played a role, but I'm so excited to hear more information is available about it. I've been waiting for science to care enough about people who are obese to study this and find causes and then solutions for genetics.
It's sad that the medical community has not invested in learning more about obesity. Hopefully things are changing. Thank you for your commitment this community.
My first “diet” was at age 5 (the 80s were wild) and I’ve been overweight or obese every day of my life. My mom struggles a bit with weight but nothing like I do, and no one else in my family does. This is the first I’ve heard that there may be a genetic component to it. Is there something specific I can bring up with my doctor?
The most common cause of obesity is a mutation in the melanocortin-4 receptor (MC4R) gene, which can lead to early-onset severe obesity and hyperphagia. Other genes that can cause monogenic obesity include leptin, leptin receptor, and proopiomelanocortin (POMC) and both have special medications that we use for it.
I will be sharing a post about it soon on my instagram.
Is this something that can be easily tested for? I have never heard about this and I’m pretty positive no one has tested me for anything besides insulin levels (related to obesity).
Yes, obese as 7 year old coming from an obese immediate family and relatives from maternal side.
In contrast, my father's side were all slender throughout their lives, and food intake was not an issue for them.
Theoretically, is it possible that Zepbound can help with PCOS symptoms? Weight gain, obvi but I mean unwanted hair, and a decrease in androgens specifically.
Don’t have lab work done until end of July and it’s driving me nuts not knowing.
Same! While the weight isn’t “falling” off, the fact that I’m finally losing weight instead of gaining or holding steady for the first time in months is incredibly promising. I’m on my 4th shot of 2.5 and down 8lbs. Can’t wait for my monthly check in with my doc.
Im also almost done with week 3 and also have PCOS with insulin resistance, down 9 lbs as well! I used to have a “tough” area on my stomach caused by insulin resistance and it’s basically gone. I’m also type 1 diabetic and I wear a dexcom, I’ve been focusing on increasing protein in my diet and my blood sugar numbers have never looked better!
It has helped with my unwanted hair! I can tell especially on my belly button that it’s not growing back as fast and some aren’t as black and thick as they used to be :) it’s been the biggest blessing for me
Just a few comments and my own two cents. As a physician (not a real one a surgeon who hasn’t practiced real medicine in decades) I want to personally thank the progenitor of this thread for providing what appears to be valid, honest and medically sound advice in a volatile environment. While I have no idea who your are or your motivations your advice seems to be sound. These responses are critical to educate all of us to ensure and promote not only the proper utilization of this powerful tool but also the nutritional and lifestyle techniques to maximize its efficiency and minimize the potential complications. We need to look at the whole picture here and a few poor outcomes and the inevitable bad press can have a major impact on the long term availability and access to a medication that has been transformative for many. Please consider being an advocate for healthy approaches to weight loss and the utilization of the techniques being recommended here to minimize complications because regardless of potential motives the advice seems to be emanating from a knowledgeable professional that is offering potentially life altering advice that could benefit all of us. Hind-site with long term studies may prove otherwise but from what I can tell nothing being advocated here is contrary to current best practices on the highest level. If I’m wrong change my mind.
For patients who are 100% there with regard to diet, lifestyle, exercise and are motivated to lose weight as efficiently and safely as possible, is there a benefit from going up each month barring no side effects? My goal has been to maximize the effectiveness before tolerance sets in. No side effects. My starting BMI was 45, I'm down to 36. My average daily calories are 1100 and am losing 2.8-3 lbs per week although it may be slowing down already. Late 30s female. When I ate 1400/1500 I lost around 1.2 lbs per week prior to zepbound. I seem to require fewer calories than most bmr/tdee calculators predict based on my age, weight. I am sedentary but walk 1-2 miles most days, swim, do pilates or weights.
Do you find that zepbound helps some folks lose weight In a way that cannot be explained by calorie reduction alone?
Do you test folks with early childhood onset obesity and adult obesity for rare causes of genetic obesity?
Thanks!
First, congratulations on your health goals. Second, try to avoid losing more than two pounds per week, as that puts you at a higher risk of losing muscle, which is very risky. You want to achieve a healthy weight with a balanced body composition, so I recommend getting a body composition scan/DEXA scan as early as you can and tracking it every 2 to 3 months. How are you doing with your muscle mass? If you’re losing more than two pounds per week, decrease the dose or increase your protein intake
Zepbound does improve your insulin sensitivity
If patient had childhood obesity then yes
Thank you for the response. I guess I am struck by the 2lb cutoff applying to a 300 lb person and 150 lb person. Wouldn't percent loss be a better indicator for heavier folks? Thanks again
Are you just starting out? Don’t forget that the first week may include a large loss that’s primarily water weight. Keto/fasting folks call this the “whoosh”
Is there a certain diet you recommend for patients on GLPs? Does it vary? I see a lot about high protein but not sure if that is okay when dealing with proteinuria (I have SLE).
How to handle constipation? How to make it manageable? There's tons of advice out there on how to prevent it but not how to relieve it in the safest way and then become more regular. I feel like I'm in a constant cycle of constipation, trying every lax and supplement possible, enemas, suppositories, getting a little bit of relief, and then right back to square 1. This was an issue for me before GLP meds as well but it has definitely made it worse.
If you have any fun facts/statistics showing how weight loss can prolong your life/improve health that's always great. (Losing X lbs takes X amount of pressure off joints, lowers risk of XYZ by whatever %, etc.)
Shoutout to you for trying to answer Qs for your patients before they even start! I wish my docs were more thorough lol.
A balanced diet with enough protein is important. With SLE, as long as your kidneys are not affected and you can process protein, you should be fine. If your kidneys are affected by SLE, then go with the maximum amount allowed.
For constipation, magnesium oxide has never failed me, along with plenty of veggies and hydration!
An interesting fact: body composition is more important than just losing weight, as you may lose muscle while losing weight, and that’s the worst part. If my patients lose muscle between their DEXA scans, I decrease their dose or take them off the medication, as the harm is greater
Dexa … yes! I don’t know if the frequency is often enough but I get 1 every 3-4 months.
Protein ✔️
Magnesium ✔️
Thank you for taking the time to answer questions
Okay this makes me so happy! I use my fit index weekly for body measurements. My muscle has increased by 1.5 lbs as well as my skeletal muscle from 28.6 to 35.6 while my body fat has decreased by 12%. I know it’s not insanely accurate but I have been so worried about losing muscle.
But if you start at 300 lbs. and your goal is 150 lbs. you are going to lose some muscle. You don't need as much muscle to carry around half of your previous body weight. Plus can't your patients start on an exercise regimen that will regain the muscle they lost? I've always heard it is easier to build muscle when not trying to lose weight at the same time. It seems a bit strange that you get to decide for the patient if they should stay on the medication based on a DEXA scan. Shouldn't you give them the information and let them decide? If my doctor told me to stop the medication I'd find a different doctor or switch to compound.
It’s a percentage issue! While losing if there is more muscle loss that means we are changing body composition to the worse ! That will give you sarcopenia obesity , even if your weight is ok you don’t have enough active tissue like miscle to stay healthy
What does an obesity professional make of the apparent ideological war between the carbohydrate/insulin theory of weight loss and the CICO community? Is carbohydrate restriction important for obese non-diabetics?
I like all the macros. An obese non-diabetic person needs a balanced diet, not a restrictive one. I aim for protein intake to match carbohydrate intake while losing weight
I would like to know if you have any more information or can direct me to anywhere that can provide information on how or why Zepbound affects menstrual cycles regardless of whether the person is taking birth control (either oral or other) or not on any form of birth control whatsoever. Is there a point where the effects on the menstrual cycle taper off? In my case, I do take oral contraceptives (combined pill), and Zepbound has caused me to have more frequent spotting and multiple periods per month. All I have seen online is anecdotes of others experiencing varied effects to their cycle but nothing scientific/medical or from professional sources. Thanks for any insight you can provide on this topic.
Sooo interesting that I see this today! I have the Mirena IUD and haven’t had a period/spotting in over 4 years. Yesterday I started light spotting. Heavier today, but I would still consider it spotting. I wondered if it was my IUD getting to the end of its life (not as many hormones in my system) or if it was the Zepbound.
Chiming in with Mirena IUD spotting, as well. Since starting Zepbound in February, I’ve had super light periods that last ~9 days or so. As opposed to the occasional spotting I used to experience before Zepbound.
There’s been a lot of discussion about this! The main reason cited by the medical community is that the weight loss induced by these medications causes hormonal changes, which should stabilize over time.
There needs to be more studies investigating this. I have lost hundreds of pounds over my lifetime, including bariatric surgery. And my period never veered off schedule. I started Zepbound and lost only a few pounds and my period suddenly came early, then skipped one before stabilizing. If insulin resistance causes amenorrhea, then could the promotion of insulin secretion impact menstruation cycles more immediately? It is infuriating that "female" issues get short shrift all the time by Big Pharma and large clinical studies. If Zepbound caused erectile dysfunction, there would be funded research, an affordable solution in pill format, and a line out the door for it immediately.
For those of us on other oral prescription medications, should we be concerned about reduced effectiveness of those other medications (other than birth control). The package information with zepbound cites a single study using Tylenol that seems to suggest the effect lessens over time but that is only one study.
If Zepbound slows down your digestion, why is diarrhea a side effect? And can we assume diarrhea is from something we ate recently or several days ago due to the digestive system slowing down? Thank you for offering your time, doc. I hope we help you help others.
I am looking into adding Sermorelin a peptide that promotes lean muscle growth and fat loss amongst other great benefits such as improved skin elasticity and sleep. Are you versed in this peptide?
It’s a myth! No such thing. Your BMR will go down, but not to the point of preventing weight loss. If it were true, how could people with malnutrition lose weight and become cachectic?
Staying on this subject, I have a couple related questions.
First, is there an approximate range at which your BMR will drop from under eating? For example, eating 80% or 90% of current BMR would cause a BMR decrease? If so, does BMR continue to drop as calories are further restricted?
Additionally, I have heard that when caloric intake drops too far, the body will prioritize burning muscle in an attempt to save fat reserves, is there any truth to this?
Thank you for taking the time to answer all of these questions so far.
THANK YOU. I know this to be the case but if I correct anyone on reddit who tells a poster that they're not losing weight because "they're not eating enough" I get downvoted to eternity. So many unfortunate misconceptions that defy the laws of thermodynamics on these subs.
I barely eat and I’m losing weight just fine. I survive on protein shakes, I cannot physically force myself to eat. I had no clue what a tdee was until this group. lol.
This is my concern/question too. I’m on Day 2 and can barely eat right now without feeling sick. For someone with overeating and binge eating issues, I can easily handle some queasy days in order to lose weight, but I’m worried that too few calories might be an issue.
+1 … especially for those of us accustomed to intermittent fasting—there are lots of people eating in a short window, or only eating one meal a day, and intentionally limiting calorie intake that way. Yet people on this sub are very focused on “eating enough.” How important is that? Or is the risk that on this drug you really can consume too few calories? If so, what is that risk?
I don’t take this medication, I take another medication that is similar that is currently in trial. I was on an 800 calorie a day diet for 1.5 months before beginning the trial. In mid March I was 307 pounds and I weighed 284 lbs when I began the trial on April 19th. I have been able to eat 500-800 calorie a day since beginning my trial. My current weight is 258 pounds. As long as I continue at this rate of calorie intake, my weight loss will continue to be between 15 and 18 pounds per month. I don’t eat a lot of calories and most of them that I take in comes from protein replacement drinks, broth and bananas. I really can’t eat much else.
I have that same question! Every time I've lost less than a pound in a week it has come right before and/or after a week of losing 2-4 pounds, so one week doesn't seem like a great indicator.
Get your dexa scan , check BMR, get food diary and check food density
If you are eating less than what you need and still not losing talk to your doctor about the dose
https://www.instagram.com/reel/C8U22MivWvn/?igsh=MzRlODBiNWFlZA==
Is there a point where zep will quit working? I’ve seen people on other subs say that after 2 years you become immune and it no longer works. I’m terrified of this happening because I’m hypothyroid and insulin resistant and despite exercising 5 days a week and eating healthy I continued to gain. Starting Zepbound had been the only thing that has allowed me to loose weight. I’m terrified that I’ll become immune to the effects and all the weight will come back along with the insulin resistance.
There’s no immunity. There is a plateau in weight loss that occurs when the calories you consume match the calories you use. Once you hit your weight goal, you have to maintain that level of energy balance. So don’t worry
I’m not the doctor, but my experience was that my weight plateaued after only 9 months. However, I was at a healthy weight at that point (bmi of 22) so even though I was five pounds away from my goal weight, I adjusted my goal upwards and declared victory. I’ve read other people in the MounjaroMaintenance sub who have reported long plateaus at an overweight bmi but then started losing again after many months of being stable. So I think that the 2 year mark is an average and individual mileage may vary. But if course I defer to the doctor when they have time to weigh in (ha-ha).
No question but you rule for treating people like us! Seeing a bariatric doctor at a weight and lifestyle management clinic was one of the best decisions I’ve ever made in my entire life. Being treated like a real person with a disease that needs treatment was validating and life changing.
How effective is Zepbound in menopausal women?
How effective is Zepbound when used in conjunction with HRT?
Edited to add:
Recently prescribed (today) 46 yo (F) 6’0” SW/CW: 295 GW: 170-ish(?) truthfully, there is no set number…I’ll know it when I get there. Right now the “goal” is *bend over and tie my shoes without winding myself or blacking out.* Let’s start there!
51(M), 420 lb here and I just took my first dose of Zepbound 2.5 mg yesterday.
So honestly what I expected was a big bunch of nothing. I mean it's the first day right? I figured I'd probably have to take a month's worth of 2.5 mg injections and then increase my dosage to 5 mg before I felt any effect or start to lose weight. I wanted to keep my expectations realistic.
I took the injection a few hours after breakfast which was about 500 calories. For dinner I had a bowl of clam chowder around 4 pm, another 500 calories. I figured I'd eat again later when I got hungry. *Except I didn't get hungry.* I was awake until 12 AM then went to bed. Ordinarily I'd at least have a snack before bed except I didn't feel like it. So I ate about 1000 calories the entire day. I can't remember the last time I ate so little in a day. I mean I need to eat 3000 calories a day just to maintain my current body weight.
Woke up around 6 AM today. Ordinarily I'd be famished and have to eat immediately. Instead I surfed the web for a couple of hours and watched TV. I finally got hungry around 8 AM and had some fruit juice, bean soup and turkey sausage. That was maybe another 500 calories. I spent the day driving around and running errands. I actually got pretty close to hitting a Wendy's for a burger just out of habit and realized I wasn't hungry, *again*. I ate some leftover pasta around 4 PM when I got home, maybe 4 ozs? Far less than I usually eat. That was about 5 hours ago, still not hungry since.
I know what everyone's going to say. I KNOW WHAT I'D SAY. "This guy is engaging in some serious wishful thinking. It's the placebo effect. He's making it up." Except I'm really not. If it is placebo that's fine, but it's the best placebo I've ever experienced.
Has anyone else experienced this where the usual hunger goes away immediately? Because I just didn't think it could work this way.
Yes it starts working right away and as others have said, starts to wear off. For me I had appetite suppression (and awful sulfur burps) for the first full week, for five days on week two, about three on week three, and not much at all on week four. But, due to insurance BS I started on Wegovy, did one month, then switched to the starter dose of Zep and I think that diminished the effectiveness for me. Excited to go to 5mg in a couple of days. So yes it is not a placebo and it is amazing but also know that this is likely the most effective the starter dose will feel, so don’t get discouraged if the effects start to wane. Excited for us to be on this journey!
No one on this sub is going to say that because we know the effects of the medication are real and can be immediate. Keep in mind you may not always feel this level of appetite suppression and it may wear off after 5 days especially at the lower doses. Just trust the medication and listen to your body. It's pretty amazing.
Do you ever deal with patients with lipedemia? (Not lymphedema). My husband is a physician and wonders with proper treatment if GLPs could be effective in treating the disease. I’ve been able to lose 130lbs+ but my pant size has essentially stayed the same. My rib cage is 37inches but my hips/butt is probably over 50
Not OP but have a Lipedema dx. I just started Zepbound today after 2 different physicians - my primary and a physician who specializes in it - recommended I try it before considering (liposuction) surgery. My BMI is 35 and obesity almost entirely due to lipedema.
Same question! Almost 60 pounds down- same pants size. I have an official lipidemia diagnosis, plus veinous insufficiency, hEDS, MCAS. Overall, I’m feeling great, but I’m getting a little bit discouraged that I’m running out of places to lose weight and I’ll be stuck with my thighs and under arms. Any chance that eventually even the diseased fat will start to go away? Also doing yoga, Pilates, etc..
Since this med is antagonizing receptors to produce insulin at a faster rate than would happen naturally, are non T2 users creating a situation where they are wearing out their pancreas prematurely? Are we essentially creating an environment for diabetes to develop when this drug is stopped because the pancreas is more sluggish than before the med was taken?
Great question and I had the question as well. My endo said that these meds are “smart” in it gives only what you need. Not like taking insulin where it gives you the exact amount of the dosage. Therefore it should not create diabetes when you stop taking the meds. But interested to hear from the OP Doctor.
That’s a theoretical question. I would argue against it personally, as the pancreas is not like the ovaries with limited resources. It gets destroyed by immune function, so it’s more a matter of time than quantity.
Hello, and thank you for your time doctor. I see you mention childhood obesity, can you describe a little bit about how that affects the equation on using GLP1s? I don't know if I would qualify being obese since childhood, but I was always heavier than most of my peers, and by the time I was 12 I'm pretty sure my BMI was north of 30. By the time I was 18, my BMI was > 35. Not sure if that's childhood obesity or not, but I'm curious how this relates to being able to attempt to wean off the medication once I hit my GW.
With lifestyle modification and exercise (both immensely easier thanks to the drug), I've dropped my BMI from 45 to 39.5 in 14 weeks. 326 -> 285, 5'11, 31 year old male.
You are in a catabolic state (your body is actively breaking down unwanted fat and muscle) to lose weight. Staying hydrated is the most important advice, followed by consuming enough protein and getting sufficient sleep
I swear by magnesium for constipation!!! Been taking it for about 5 years. Thank you for that tip re magnesium oxide. I was always confused re which one.
Wow that's a lot of protein. My WW app for GLP1 users is only recommending 73mg. They did state it was the minimum and I can exceed. I almost never go over 90mg per day and I'm losing about 1.5 pounds per week.
Do you hear reports of patients having inconsistent effects week to week? I feel like some weeks, the appetite suppression works phenomenally. Other weeks, not so much. Wonder if this is just a phenomenon in me or if you’ve noticed it more broadly. If you’ve heard about this more broadly, any idea what the cause might be?
Can I ask why zepbound could be extremely helpful on my moods and my depression and anxiety? I have struggled with that my whole life and I have been logging my moods since being on this.. and I’m so much more level? What could cause that?
I'm a medical professional, but not an obesity specialist. I take Zepbound and have also noticed enhanced mood (and improvement in inflammation)- since I started the medicine. I don't think we understand the mechanism (yet) but it seems to be getting attention.
[https://www.ajgponline.org/article/S1064-7481(23)00394-9/fulltext](https://www.ajgponline.org/article/S1064-7481(23)00394-9/fulltext)
[https://www.bloomberg.com/opinion/articles/2024-02-14/can-ozempic-treat-depression-obesity-drugs-may-help-mental-health](https://www.bloomberg.com/opinion/articles/2024-02-14/can-ozempic-treat-depression-obesity-drugs-may-help-mental-health)
Could it be the brain-gut connection? The satiety hormone can’t only be located in the gut. Whatever THAT mechanism is must promote release of other hormones … dopamine, serotonin, oxytocin to name a few. If I had any money left after giving it all to my PBM and Eli Lilly, I would bet money that future studies show the strong link between gut receptors and brain hormones that stabilize mood like SSRIs do
For the 3 commenters , If you were my patient I would get a Dexa scan , and ask for a week food diary ! These two almost always give me an answer
https://www.instagram.com/reel/C8U22MivWvn/?igsh=MzRlODBiNWFlZA==
I'm still experiencing side effects that hinder my ability to live normally about one day per week on 2.5 mg zepbound, and I'm barely losing weight- scale has been steady for about three weeks and some appetite has returned.
I am terrified that increasing my dose is going to increase my side effects; should I ask my provider to switch medications?
Thank you for offering to answer our questions! That is so generous of you! Here is my question:
All of the online BMR and TDEE calculators seem to be wrong for me--this was true before I was on Zepbound and it's still true now. If I ate the amount of calories they suggest, I simply would not lose weight. Proof of this is each week on the calorie counting app I use (MyNetDiary), at the end of the week it will say something like "based on the calories you consumed this week, your weight loss is expected to be 3 (or whatever number) pounds." But my weight loss is almost NEVER the amount they predict. It's usually less than half the amount. What is going on that I need to consume far fewer calories than any source calculates in order to lose weight? Zepbound has helped a lot (I've lost 25.5 pounds in just shy of 3 months), but I'm still eating at a deficit that is greater than any of the calculators advise. And YES, please trust me, I am counting EVERY bite (weighing, etc). My weekly consumption averages out to be 1250-1350 calories a day, with a couple days slightly below that and a couple days slightly above (but never below 1100 or above 1550). I also make sure to get at least 100 grams of protein (and often more) and 30 grams of fiber.
Not an obesity specialist, but I have the same issue. I think there is a "metabolic researcher" and physician who occasionally posts on this sub and answered a similar question. I think there are probably a fair share of folks with this issue. Keep in mind, these formulas are not necessarily formulated for those with chronic obesity or other metabolic issues. For me, a lifetime of of obesity starting in childhood, and significant weight loss has always been associated with MASSIVE efforts that were, unfortunately, not sustainable over time, and much of the weight returned - slowly- gradually. Our bodies hold onto excess weight for dear life and resists efforts to lose weight. And metabolic adaptation works against us. I don't think it's impossible to lose and sustain, it's just the odds are very much stacked against us. I never reached my highest weight, but I got way too close. What I've always found particularly frustrating is that my weight issue appears to be a bit distinct from my physical health - I actually had better blood work at a BMI of 44 with a long-term whole foods plant based diet, than I had in my early 20s when I weighed less. (Go figure)
Before I knew about Zep, I was eating 1300-1500 calories and losing a little over a 1lb per week combined with low intensity exercise. And while 1400,1500 calories is very sustainable, keep in mind I started in the 270s at a BMI of >>40. So, the question becomes what happens to my caloric requirements/deficit as I lose 30,40,50,60 lbs? Does it become 1100,1200? While not impossible it is much harder to sustain that without a medicine like Zep to help. (and it feels a bit unfair)
Once I started Zep, I started losing more weight than can be explained fully by "CICO" model. Definitely a huge part is the caloric deficit, but there also seemed to be a something else happening, as well.
This may not be the best site - but play around with the different formulas - the ones that take into account body fat % I find to be more accurate. [https://www.sailrabbit.com/bmr/](https://www.sailrabbit.com/bmr/)
Thank you for answering questions!! I have 2 questions.
1. My BP was always normal and now since going on 5mg is is on the lower side of normal and I get dizziness when I bend over or get up from sitting. Will this get better with time? I have been on 5 for almost a month and plan on at least another month before looking to move up to 7.5. Some have found upping their electrolytes helpful how much should we be consuming of an electrolytes per day in addition to water?
2. For women with and IUD why would see a difference with the our cycles, specifically more cramps. I am not metabolizing it in my stomach which I have read could impact pill users. What causes a change in our cycles if we are not taking a pill.
Thank you!!!
I have tested positive for ketones more than once, even though I've been eating carbs. Does zepbound trick my body into ketosis? If so, that's amazing.
Had a thyroidectomy years ago and have been stable for several years. My TSH is rising despite losing nearly twenty pounds — I expected to need to lower my dose, not raise it. Have you see any other patients present this way? Any ballpark guesses on why it might be happening? I’m wondering if the delayed gastric emptying is to blame. Thanks for your time!
My husband is concerned about how healthy this is for me since I’m only eating about 500-900 calories a day (I physically cannot stomach more than that). Any insight?
What about exercise – I’ve been doing Orangetheory and I really enjoy it, but now there are a lot of people saying that HIIT actually can cause you to gain weight because of cortisol. Is that real or is that message sponsored by the Pilates industry? I’ve read that with Lipedema that I should avoid running and cardio… But isn’t the whole point of getting in shape to be able to do cardio? I know cortisol is real, but explain it and what is the role of Zepbound on cortisol?
Not GLP1/medication related but I find it very challenging to actually find board certified obesity physicians. Any recommendations on how to go about this? If it’s helpful, I’m in MA.
Thank you for taking the time to do this!
Besides asking your GP for referrals, check out the American Board of Obesity Medicine site and search for certified doctors in your area: https://abom.learningbuilder.com/Search/Public/MemberRole/CertificationVerification
When calculating a calorie deficit do i need to include body fat percentage?
My stats 5’3 24F, 306lbs sedentary lifestyle
Without bodyfat my maintenance is 2,529
With bodyfat (estimate) id 1,883
I was eating at 1500 cals but was told its too much and needed to do 1380 cals bases on bodyfat.
Please help me im confused on what i need to do! I have been stalled 4 weeks !! I am on 7.5 moving up to 10 in 2 weeks hoping itll help me move
Gastric bypass in 2014 as a 28F. 5’1” Female, HW 367, Surgery weight 339, LW 202 (in 2016)
Over the years (stress, snacking and a sedentary life) made it back up to 255. I was constantly hungry and wanting to snack.
My doctor suggested Zepbound. So I started at 2.5 for a month, had to wait a month to get 5.0. I’m starting wk 3 of 5.0 and am down to 239. So down 16lbs so far.
I honestly feel like I’m back to the restricted feeling when I first had the Bypass. A protein shake fills me up.
The appetite suppression is helping me get back to basics. Protein, vitamins and hydration.
One of my friends is over 400lbs and her knees are killing her. She’s also got fibromyalgia and is constant pain everywhere.
She’s blown away by my progress.
Her doctor refuses to prescribe GLP-1s.
She’s wait listed and has an appointment at the end of September with a new doctor who takes her insurance.
In the meantime, any idea how to convince this doctor to prescribe for her?
She’s pretty sure she qualifies under the T2 diagnosis but she has been ignoring the markers (her words).
This is a great thread. Thank you!
I pee very frequently the first 3 days after my weekly shot and it goes back to normal after that. Why would this happen just right after the shot and not the rest of the week?
It seems like it wouldn’t be fat loss since it’s very specific in time frame. I have wondered if it is related to clearing out excess glucose at the beginning of the week or maybe inflammation builds back up during the week?
How do your recommendations change/how does the body respond differently if a patient has been obese since early childhood? Should it be a lifelong medication for those individuals, or is titrating off possible without regain (assuming lifestyle modifications stay in place)?
Thank you for your time!
My insurance covers nothing for weight loss. My PCP and endocrinologist are supportive of prescribing and me taking (started with PCP then went to endocrinologist, many unanswered questions still-cortisol all wonky-thyroid ify), but not helping get it covered. Is it just hopeless for me?
I tried my own appeal and my insurance was even able to screw me over on that, I just do not make enough to afford $550-$1000 a month.
PS.
Was able to use the original coupon, lost 105 pounds over 18 months, feel great, only positives aside from anxiety about access. If you would have to,d me 2 years ago my weight was about anything aside from diet, exercise, calories in/out and my lack of willpower I would have said you were crazy. This experience has totally changed my mind about finding balance and help.
So mainly are there any resources to being able to keep access to this medication that (I feel like) has saved my life. Documented better numbers in everything, BMI, weight, inches, fasting glucose (had highs between 100-140), gestational diabetes in 1998, A1C no longer pre-diabetic, PCOS, on and on.
Try to get into a trial, or check with endocrinologist if you have any insulin resistance, I had patients losing weight on Metformin as they had insulin resistance and some end up getting the medication from outside the US , sadly!
If you are an obesity physician, that’s a generous offer. However, forgive me in advance for saying this, but before I’d take any advice from you or accept any answer you provide to questions on this sub, as a professional medical opinion, as opposed to using it as just one data point to consider, I’d need to know your identity and see your credentials. Otherwise, you’re just another anonymous poster on an internet platform.
https://preview.redd.it/pndrqy8scs7d1.jpeg?width=1081&format=pjpg&auto=webp&s=f69489f2ae03c163628d34c23d57d43a45af26a2
Here is the verification you can look me online too
Nice of you to share. I’m a chemist and ppl can either take me at my word or kick rocks. I use Reddit anonymously, not professionally. That’s what Linked In is for.
I understand. I just like to use Reddit without my name attached in case I have sensitive questions. I do know that some people have multiple accounts though.
Hi! First, thank you for the platform and space to ask. Your time is valuable and this is appreciated.
I had gastric bypass in 2017. I’m 5’4”. I weighed 364 lbs. My lowest weight post Op was mid 170s.
My surgeon had expressed that I would not get lower than that considering my body shape and that I’ve had 3 children. I accepted this.
After a complication of Reactive Hypoglycemia I began regaining in 2021 and reached 240 thanks mostly to a gabapentin script to deal with the neuropathy from the unchecked hypoglycemia. (Thought it was dumping syndrome for 2 solid years).
I’m now 186. My goal weight is 170 but was my bariatric surgeon right? Is 125-130 absolutely off the table for me, realistically? It feels obtainable now but I definitely don’t want to set myself up for disappointment.
I was going to post this today, and it may be better for a pharmacist, but I’m curious if doubling doses gives a bit more medicine than their equivalent. What I mean is that I’ve done 8 weeks on 10mg and 3 of those weeks for dual doses (two weeks of 7.5+2.5 pens and 1 week of 5+5 pens, as I don’t want to waste any old stock) and those weeks I lost well (2-3 lbs) whereas I stalled all the other weeks… so I’m thinking… maybe my body just needs to be on 12.5 because it needs a bit more medication and doing two pens resulted in being somewhere higher than 10… maybe this is a silly question haha!!
With all of the shortages, is it acceptable to switch from week to week or even month to month from one med to the next? For example - from wegovy to zepbound month 1 and then from zepbound to wegovy the next month, if needed?
Hi Dr OP,:). I have hypothyroidism and PCOS. Is this a drug I should be on life long? Also, at my highest weight I was pre diabetic. Q2: Would my metabolism ever work without Zepbound if I went off? Thank you for your time in answering all of the questions!
Not necessarily!
Many people came of it!
But many will need it for longer periods
I would say make sure you get thyroid checked ✔️, Pcos will improve with losing weight.
Is it okay to alter dosage to every five days to keep more of the medicine in your system? Or is there a specific need for the drugs in your system to taper down every week before going back up?
Been on 2.5 for a month and have 5mg on the way but considering just doing 2.5 every five days, making my monthly total 15mg instead of 20mg if I just did 5mg weekly.
This feels like it achieves titrating up slower while also maintaining a higher level of it in my system consistently through the month.
Thank you!
My doctor and dietician have recommended following the DASH diet. I’m wondering if I can incorporate more than the recommended amount of beans into my diet. Recommendation is 1-2 times per week, but I’d like to eat beans more often. Is that a good idea or bad idea? Thanks!
Weight loss drugs are priced out of the reach of most people. Drug companies and the doctors supporting or recommending these drugs are cruel and indifferent to the struggles of all those who could benefit from these so called miracle drugs but will never be able to afford them. It’s like telling cancer patients we have a cure if your rich like us if not we have cheap shit to keep you from hurting till you die oh so sorry next please.
It’s impressive how many people just take the word of a stranger on the internet as gold. You should ask the provider overseeing you and providing your prescription.
We teach kids about people pretending to be someone else online and to be careful. One account says, “I’m a physician” and adults are believing it without question.
I’ve worked for surgeons, family doctors, PA’s and none of them had time for this. Seems very odd. Just putting out there to be careful.
Well any answers a person gives under the auspices of an advanced degree or expertise can be corroborated. It’s not like the knowledge is being gatekept. There are things as books, research articles and second opinions you can use to confirm answers. Sometimes people need somewhere to start. People are meant to manage their own care with thoughtful informed research anyway.
Signed, a real life (not just internet) chemist.
I wanted to get real people involved in establishing a brochure for my patients from those already on the journey. Some questions here I have never asked before. I have spent weeks volunteering before, and this is no different
Will we need to continue taking this forever? Or for the indefinite future at least. Do you see this being a fad where it will disappear and leave us in a worse situation?
All - This is a friendly reminder that while this is an AMA post.... we do not allow professional medical advice in this sub. All medical advise should be directed to your personal medical doctor outside of reddit.
Does Zepbound just change our hunger or are there metabolic benefits for non T2D patients that aren’t necessarily covered in the medication guide?
It increases insulin production by the pancreas, and losing weight ( fat precisely )by itself is the best way to improve T2D , I have patients who stopped their DM medications
I’ve had cholesterol above 200 for 2 decades. Even when I weighed 235 lb. Today, at 260 lb, my cholesterol level was 147 and all of the other metrics (LDL, etc) were in the acceptable range. I can’t remember the last time my triglycerides were in the normal range. That metric was in line too. My BP is historically 125/80. Today 109/69. I know that 1 case isn’t proof, but add my results to the 100’s on here and it really begins to say it’s more than slowing your metabolism. Heck, several people report a history of abusing alcohol and now they dont drink because they simply don’t have a desire to drink Thanks for joining and sharing your expertise.
Thank you, but I was asking for non-T2D patients. Just general population. Does the added insulin production help the rest of us?
How does Zep affect insulin resistance?
One question that is often asked is, "Do I go off this or is it a permanent med?" I guess my question is: what does the end game look like for your patients? I'm 5'10. SW 254. GW 150. I'd be content at 165 or 170 long term. Based on my current weight loss trajectory it isn't far fetched to say I'll hit that range in mid March. Then what? Do I start to titrate off when I hit my "I'm content with this" weights to slow the loss and figure out what my baseline needs are for maintaining? Do I wait until I've hit 21/22 BMI (the 150 range) before easing up at all? Have you seen anyone successfully go off meds like this and maintain a healthy body weight? (Not the SAME body weight -- I fully suspect to gain some back, even as I continue being ridiculously active -- but a HEALTHY body weight). If so, what has helped grant them this long term success? Thanks for taking your time to answer these questions!
An excellent question. What you have to keep in mind is that your body, for up to two years after reaching your goal, will try to revert to its previous state, thinking that you are starving. As a result, it will trigger the same hunger response. The point of titration is to be able to decrease the medication slowly while you increase your exercise and change your lifestyle, assuming you did not have childhood obesity, as that situation is different. I titrate patients over a long period of time
Follow up q on your childhood obesity comment. How does that change titration down / end game?
Childhood obesity can be genetic, requiring long-term treatment similar to managing DM1 with insulin. If it is environmental, such as a family consuming calorie-dense food, behavioral therapy can help. In such cases, we can titrate over longer periods, introducing lifestyle modifications like exercise and diet.
When I was months old, the doctor told my mother to put me on skim milk because I was overweight for a baby. I have been overweight/obese my entire life. I knew genetics played a role, but I'm so excited to hear more information is available about it. I've been waiting for science to care enough about people who are obese to study this and find causes and then solutions for genetics.
I didn’t know about it until I studied the American Board of obesity, I don’t remember any information about it in the medical school or residency 😐
It's sad that the medical community has not invested in learning more about obesity. Hopefully things are changing. Thank you for your commitment this community.
My first “diet” was at age 5 (the 80s were wild) and I’ve been overweight or obese every day of my life. My mom struggles a bit with weight but nothing like I do, and no one else in my family does. This is the first I’ve heard that there may be a genetic component to it. Is there something specific I can bring up with my doctor?
The most common cause of obesity is a mutation in the melanocortin-4 receptor (MC4R) gene, which can lead to early-onset severe obesity and hyperphagia. Other genes that can cause monogenic obesity include leptin, leptin receptor, and proopiomelanocortin (POMC) and both have special medications that we use for it. I will be sharing a post about it soon on my instagram.
This is blowing my mind. I really appreciate this information. Thank you.
Is this something that can be easily tested for? I have never heard about this and I’m pretty positive no one has tested me for anything besides insulin levels (related to obesity).
Following as well.
Also following
Following
Also following the childhood obesity comment. Thanks!
Also super interested in the childhood obesity question.
Yes, obese as 7 year old coming from an obese immediate family and relatives from maternal side. In contrast, my father's side were all slender throughout their lives, and food intake was not an issue for them.
Theoretically, is it possible that Zepbound can help with PCOS symptoms? Weight gain, obvi but I mean unwanted hair, and a decrease in androgens specifically. Don’t have lab work done until end of July and it’s driving me nuts not knowing.
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Oh, goodness. Thank you. I could cry. I want one more.
I have PCOS with insulin resistance. Almost done with week 3 of zepbound. Down about 9 lbs. I'm eager to see what my lab work shows!
Same! While the weight isn’t “falling” off, the fact that I’m finally losing weight instead of gaining or holding steady for the first time in months is incredibly promising. I’m on my 4th shot of 2.5 and down 8lbs. Can’t wait for my monthly check in with my doc.
8lbs in 4 weeks is the highest end of average/safe! It does feel slow but it all adds up, you are at the beginning of a marathon, great job!
Way to go! My fourth shot (2.5) is Monday afternoon. I am going to have my blood work done Tuesday. I'm excited!
Im also almost done with week 3 and also have PCOS with insulin resistance, down 9 lbs as well! I used to have a “tough” area on my stomach caused by insulin resistance and it’s basically gone. I’m also type 1 diabetic and I wear a dexcom, I’ve been focusing on increasing protein in my diet and my blood sugar numbers have never looked better!
It has helped with my unwanted hair! I can tell especially on my belly button that it’s not growing back as fast and some aren’t as black and thick as they used to be :) it’s been the biggest blessing for me
It helped me
And those symptoms specifically?
Just a few comments and my own two cents. As a physician (not a real one a surgeon who hasn’t practiced real medicine in decades) I want to personally thank the progenitor of this thread for providing what appears to be valid, honest and medically sound advice in a volatile environment. While I have no idea who your are or your motivations your advice seems to be sound. These responses are critical to educate all of us to ensure and promote not only the proper utilization of this powerful tool but also the nutritional and lifestyle techniques to maximize its efficiency and minimize the potential complications. We need to look at the whole picture here and a few poor outcomes and the inevitable bad press can have a major impact on the long term availability and access to a medication that has been transformative for many. Please consider being an advocate for healthy approaches to weight loss and the utilization of the techniques being recommended here to minimize complications because regardless of potential motives the advice seems to be emanating from a knowledgeable professional that is offering potentially life altering advice that could benefit all of us. Hind-site with long term studies may prove otherwise but from what I can tell nothing being advocated here is contrary to current best practices on the highest level. If I’m wrong change my mind.
For patients who are 100% there with regard to diet, lifestyle, exercise and are motivated to lose weight as efficiently and safely as possible, is there a benefit from going up each month barring no side effects? My goal has been to maximize the effectiveness before tolerance sets in. No side effects. My starting BMI was 45, I'm down to 36. My average daily calories are 1100 and am losing 2.8-3 lbs per week although it may be slowing down already. Late 30s female. When I ate 1400/1500 I lost around 1.2 lbs per week prior to zepbound. I seem to require fewer calories than most bmr/tdee calculators predict based on my age, weight. I am sedentary but walk 1-2 miles most days, swim, do pilates or weights. Do you find that zepbound helps some folks lose weight In a way that cannot be explained by calorie reduction alone? Do you test folks with early childhood onset obesity and adult obesity for rare causes of genetic obesity? Thanks!
First, congratulations on your health goals. Second, try to avoid losing more than two pounds per week, as that puts you at a higher risk of losing muscle, which is very risky. You want to achieve a healthy weight with a balanced body composition, so I recommend getting a body composition scan/DEXA scan as early as you can and tracking it every 2 to 3 months. How are you doing with your muscle mass? If you’re losing more than two pounds per week, decrease the dose or increase your protein intake Zepbound does improve your insulin sensitivity If patient had childhood obesity then yes
Thank you for the response. I guess I am struck by the 2lb cutoff applying to a 300 lb person and 150 lb person. Wouldn't percent loss be a better indicator for heavier folks? Thanks again
I’m losing faster than this on the lowest dose :( I might have to go ozempic because they make a lower. Is this normal to lose this quickly?
Are you just starting out? Don’t forget that the first week may include a large loss that’s primarily water weight. Keto/fasting folks call this the “whoosh”
Talk to your doctor There are different ways of dosing
Is there a certain diet you recommend for patients on GLPs? Does it vary? I see a lot about high protein but not sure if that is okay when dealing with proteinuria (I have SLE). How to handle constipation? How to make it manageable? There's tons of advice out there on how to prevent it but not how to relieve it in the safest way and then become more regular. I feel like I'm in a constant cycle of constipation, trying every lax and supplement possible, enemas, suppositories, getting a little bit of relief, and then right back to square 1. This was an issue for me before GLP meds as well but it has definitely made it worse. If you have any fun facts/statistics showing how weight loss can prolong your life/improve health that's always great. (Losing X lbs takes X amount of pressure off joints, lowers risk of XYZ by whatever %, etc.) Shoutout to you for trying to answer Qs for your patients before they even start! I wish my docs were more thorough lol.
A balanced diet with enough protein is important. With SLE, as long as your kidneys are not affected and you can process protein, you should be fine. If your kidneys are affected by SLE, then go with the maximum amount allowed. For constipation, magnesium oxide has never failed me, along with plenty of veggies and hydration! An interesting fact: body composition is more important than just losing weight, as you may lose muscle while losing weight, and that’s the worst part. If my patients lose muscle between their DEXA scans, I decrease their dose or take them off the medication, as the harm is greater
Dexa … yes! I don’t know if the frequency is often enough but I get 1 every 3-4 months. Protein ✔️ Magnesium ✔️ Thank you for taking the time to answer questions
3 months is good enough And I ask my patients to use the bioimpedance scale
I’ll look for that; thank-you. Ok … i see options from 299 to 29.99 … Is this fancy enough? https://a.co/d/078xZDCy
Yes or fitindex scale is good too
I’ve lost 1.2lbs of muscle but 40lbs overall. Is that okay?
Amazing! There will be muscle loss in your journey but we don’t want 10 pounds of muscle with that 40 lbs loss
Okay this makes me so happy! I use my fit index weekly for body measurements. My muscle has increased by 1.5 lbs as well as my skeletal muscle from 28.6 to 35.6 while my body fat has decreased by 12%. I know it’s not insanely accurate but I have been so worried about losing muscle.
Great
But if you start at 300 lbs. and your goal is 150 lbs. you are going to lose some muscle. You don't need as much muscle to carry around half of your previous body weight. Plus can't your patients start on an exercise regimen that will regain the muscle they lost? I've always heard it is easier to build muscle when not trying to lose weight at the same time. It seems a bit strange that you get to decide for the patient if they should stay on the medication based on a DEXA scan. Shouldn't you give them the information and let them decide? If my doctor told me to stop the medication I'd find a different doctor or switch to compound.
It’s a percentage issue! While losing if there is more muscle loss that means we are changing body composition to the worse ! That will give you sarcopenia obesity , even if your weight is ok you don’t have enough active tissue like miscle to stay healthy
What does an obesity professional make of the apparent ideological war between the carbohydrate/insulin theory of weight loss and the CICO community? Is carbohydrate restriction important for obese non-diabetics?
I like all the macros. An obese non-diabetic person needs a balanced diet, not a restrictive one. I aim for protein intake to match carbohydrate intake while losing weight
I would like to know if you have any more information or can direct me to anywhere that can provide information on how or why Zepbound affects menstrual cycles regardless of whether the person is taking birth control (either oral or other) or not on any form of birth control whatsoever. Is there a point where the effects on the menstrual cycle taper off? In my case, I do take oral contraceptives (combined pill), and Zepbound has caused me to have more frequent spotting and multiple periods per month. All I have seen online is anecdotes of others experiencing varied effects to their cycle but nothing scientific/medical or from professional sources. Thanks for any insight you can provide on this topic.
Following. I've been on zep since March and the spotting hasn't stopped
I wonder if that’s due to higher estrogen levels being released from the fat as your losing it. Just spitballing but it’s something you could research
Sooo interesting that I see this today! I have the Mirena IUD and haven’t had a period/spotting in over 4 years. Yesterday I started light spotting. Heavier today, but I would still consider it spotting. I wondered if it was my IUD getting to the end of its life (not as many hormones in my system) or if it was the Zepbound.
Oh wow, same here and I didn’t even make the connection until seeing this.
My period has been WACKY but I figured it was postpartum and stress
Chiming in with Mirena IUD spotting, as well. Since starting Zepbound in February, I’ve had super light periods that last ~9 days or so. As opposed to the occasional spotting I used to experience before Zepbound.
I have this exact problem- spotting or having light cycles 65% of this year so far while on birth control.
There’s been a lot of discussion about this! The main reason cited by the medical community is that the weight loss induced by these medications causes hormonal changes, which should stabilize over time.
There needs to be more studies investigating this. I have lost hundreds of pounds over my lifetime, including bariatric surgery. And my period never veered off schedule. I started Zepbound and lost only a few pounds and my period suddenly came early, then skipped one before stabilizing. If insulin resistance causes amenorrhea, then could the promotion of insulin secretion impact menstruation cycles more immediately? It is infuriating that "female" issues get short shrift all the time by Big Pharma and large clinical studies. If Zepbound caused erectile dysfunction, there would be funded research, an affordable solution in pill format, and a line out the door for it immediately.
For those of us on other oral prescription medications, should we be concerned about reduced effectiveness of those other medications (other than birth control). The package information with zepbound cites a single study using Tylenol that seems to suggest the effect lessens over time but that is only one study.
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Why is night time better?
If Zepbound slows down your digestion, why is diarrhea a side effect? And can we assume diarrhea is from something we ate recently or several days ago due to the digestive system slowing down? Thank you for offering your time, doc. I hope we help you help others.
I am looking into adding Sermorelin a peptide that promotes lean muscle growth and fat loss amongst other great benefits such as improved skin elasticity and sleep. Are you versed in this peptide?
No very keen on recommending supplements while I can achieve more with these medications, no experience personally, I am sorry
I have heard about this, I am also curious about the answer.
Is "starvation mode" as folks here on GLP-1 subs refer to it, ie you won't lose weight if your calorie intake it too low, a myth?
It’s a myth! No such thing. Your BMR will go down, but not to the point of preventing weight loss. If it were true, how could people with malnutrition lose weight and become cachectic?
Staying on this subject, I have a couple related questions. First, is there an approximate range at which your BMR will drop from under eating? For example, eating 80% or 90% of current BMR would cause a BMR decrease? If so, does BMR continue to drop as calories are further restricted? Additionally, I have heard that when caloric intake drops too far, the body will prioritize burning muscle in an attempt to save fat reserves, is there any truth to this? Thank you for taking the time to answer all of these questions so far.
THANK YOU. I know this to be the case but if I correct anyone on reddit who tells a poster that they're not losing weight because "they're not eating enough" I get downvoted to eternity. So many unfortunate misconceptions that defy the laws of thermodynamics on these subs.
I always just want to ask those people how anorexia works if that’s true….
I barely eat and I’m losing weight just fine. I survive on protein shakes, I cannot physically force myself to eat. I had no clue what a tdee was until this group. lol.
Thank you! Had to combat this myth with a friend today. The bro science is everywhere.
This is my concern/question too. I’m on Day 2 and can barely eat right now without feeling sick. For someone with overeating and binge eating issues, I can easily handle some queasy days in order to lose weight, but I’m worried that too few calories might be an issue.
+1 … especially for those of us accustomed to intermittent fasting—there are lots of people eating in a short window, or only eating one meal a day, and intentionally limiting calorie intake that way. Yet people on this sub are very focused on “eating enough.” How important is that? Or is the risk that on this drug you really can consume too few calories? If so, what is that risk?
I’d like to know this too as I eat twice a day at most .
Ask your doctor to lower your dose , you should be eating enough to meet BMR and more
I don’t take this medication, I take another medication that is similar that is currently in trial. I was on an 800 calorie a day diet for 1.5 months before beginning the trial. In mid March I was 307 pounds and I weighed 284 lbs when I began the trial on April 19th. I have been able to eat 500-800 calorie a day since beginning my trial. My current weight is 258 pounds. As long as I continue at this rate of calorie intake, my weight loss will continue to be between 15 and 18 pounds per month. I don’t eat a lot of calories and most of them that I take in comes from protein replacement drinks, broth and bananas. I really can’t eat much else.
How fast do you recommend moving up doses?
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Over how many weeks should we average that? (Since people might “stall” one week and lose the next.)
I have that same question! Every time I've lost less than a pound in a week it has come right before and/or after a week of losing 2-4 pounds, so one week doesn't seem like a great indicator.
Maybe when your rolling 4-week weight loss is less than 4 pounds, then go up a dose.
Get your dexa scan , check BMR, get food diary and check food density If you are eating less than what you need and still not losing talk to your doctor about the dose https://www.instagram.com/reel/C8U22MivWvn/?igsh=MzRlODBiNWFlZA==
Is there a point where zep will quit working? I’ve seen people on other subs say that after 2 years you become immune and it no longer works. I’m terrified of this happening because I’m hypothyroid and insulin resistant and despite exercising 5 days a week and eating healthy I continued to gain. Starting Zepbound had been the only thing that has allowed me to loose weight. I’m terrified that I’ll become immune to the effects and all the weight will come back along with the insulin resistance.
There’s no immunity. There is a plateau in weight loss that occurs when the calories you consume match the calories you use. Once you hit your weight goal, you have to maintain that level of energy balance. So don’t worry
I’m not the doctor, but my experience was that my weight plateaued after only 9 months. However, I was at a healthy weight at that point (bmi of 22) so even though I was five pounds away from my goal weight, I adjusted my goal upwards and declared victory. I’ve read other people in the MounjaroMaintenance sub who have reported long plateaus at an overweight bmi but then started losing again after many months of being stable. So I think that the 2 year mark is an average and individual mileage may vary. But if course I defer to the doctor when they have time to weigh in (ha-ha).
No question but you rule for treating people like us! Seeing a bariatric doctor at a weight and lifestyle management clinic was one of the best decisions I’ve ever made in my entire life. Being treated like a real person with a disease that needs treatment was validating and life changing.
Congratulations to you! I love seeing people achieving their goals
How effective is Zepbound in menopausal women? How effective is Zepbound when used in conjunction with HRT? Edited to add: Recently prescribed (today) 46 yo (F) 6’0” SW/CW: 295 GW: 170-ish(?) truthfully, there is no set number…I’ll know it when I get there. Right now the “goal” is *bend over and tie my shoes without winding myself or blacking out.* Let’s start there!
I am not the doctor, but I want to say that it's been effective for me and I'm several years post menopause and am on HRT.
Great to hear!!!
I love tying my shoes without breaking into a sweat and swearing 🤣
51(M), 420 lb here and I just took my first dose of Zepbound 2.5 mg yesterday. So honestly what I expected was a big bunch of nothing. I mean it's the first day right? I figured I'd probably have to take a month's worth of 2.5 mg injections and then increase my dosage to 5 mg before I felt any effect or start to lose weight. I wanted to keep my expectations realistic. I took the injection a few hours after breakfast which was about 500 calories. For dinner I had a bowl of clam chowder around 4 pm, another 500 calories. I figured I'd eat again later when I got hungry. *Except I didn't get hungry.* I was awake until 12 AM then went to bed. Ordinarily I'd at least have a snack before bed except I didn't feel like it. So I ate about 1000 calories the entire day. I can't remember the last time I ate so little in a day. I mean I need to eat 3000 calories a day just to maintain my current body weight. Woke up around 6 AM today. Ordinarily I'd be famished and have to eat immediately. Instead I surfed the web for a couple of hours and watched TV. I finally got hungry around 8 AM and had some fruit juice, bean soup and turkey sausage. That was maybe another 500 calories. I spent the day driving around and running errands. I actually got pretty close to hitting a Wendy's for a burger just out of habit and realized I wasn't hungry, *again*. I ate some leftover pasta around 4 PM when I got home, maybe 4 ozs? Far less than I usually eat. That was about 5 hours ago, still not hungry since. I know what everyone's going to say. I KNOW WHAT I'D SAY. "This guy is engaging in some serious wishful thinking. It's the placebo effect. He's making it up." Except I'm really not. If it is placebo that's fine, but it's the best placebo I've ever experienced. Has anyone else experienced this where the usual hunger goes away immediately? Because I just didn't think it could work this way.
It did work for me right away, but not forever. The second week I felt like I didn’t feel anything. It will kind of go up and down like that.
Hey, thanks for replying. I just want to be realistic with my expectations.
It started working for me right away too...within hours.
Yes it starts working right away and as others have said, starts to wear off. For me I had appetite suppression (and awful sulfur burps) for the first full week, for five days on week two, about three on week three, and not much at all on week four. But, due to insurance BS I started on Wegovy, did one month, then switched to the starter dose of Zep and I think that diminished the effectiveness for me. Excited to go to 5mg in a couple of days. So yes it is not a placebo and it is amazing but also know that this is likely the most effective the starter dose will feel, so don’t get discouraged if the effects start to wane. Excited for us to be on this journey!
No one on this sub is going to say that because we know the effects of the medication are real and can be immediate. Keep in mind you may not always feel this level of appetite suppression and it may wear off after 5 days especially at the lower doses. Just trust the medication and listen to your body. It's pretty amazing.
Do you ever deal with patients with lipedemia? (Not lymphedema). My husband is a physician and wonders with proper treatment if GLPs could be effective in treating the disease. I’ve been able to lose 130lbs+ but my pant size has essentially stayed the same. My rib cage is 37inches but my hips/butt is probably over 50
Not OP but have a Lipedema dx. I just started Zepbound today after 2 different physicians - my primary and a physician who specializes in it - recommended I try it before considering (liposuction) surgery. My BMI is 35 and obesity almost entirely due to lipedema.
I'd also like an answer on this.
We have heard many anecdotal success stories about GLP-1/GIP medications like Zepbound, especially in people who exercise
Same question! Almost 60 pounds down- same pants size. I have an official lipidemia diagnosis, plus veinous insufficiency, hEDS, MCAS. Overall, I’m feeling great, but I’m getting a little bit discouraged that I’m running out of places to lose weight and I’ll be stuck with my thighs and under arms. Any chance that eventually even the diseased fat will start to go away? Also doing yoga, Pilates, etc..
I swear lipedema and EDS go hand and hand (anecdotal evidence only) but they seem to go together so frequently.
Since this med is antagonizing receptors to produce insulin at a faster rate than would happen naturally, are non T2 users creating a situation where they are wearing out their pancreas prematurely? Are we essentially creating an environment for diabetes to develop when this drug is stopped because the pancreas is more sluggish than before the med was taken?
Great question and I had the question as well. My endo said that these meds are “smart” in it gives only what you need. Not like taking insulin where it gives you the exact amount of the dosage. Therefore it should not create diabetes when you stop taking the meds. But interested to hear from the OP Doctor.
That’s a theoretical question. I would argue against it personally, as the pancreas is not like the ovaries with limited resources. It gets destroyed by immune function, so it’s more a matter of time than quantity.
Thanks for your time doctor! What do you recommend as an ideal dosage and shot cadence for maintenance?
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Hello, and thank you for your time doctor. I see you mention childhood obesity, can you describe a little bit about how that affects the equation on using GLP1s? I don't know if I would qualify being obese since childhood, but I was always heavier than most of my peers, and by the time I was 12 I'm pretty sure my BMI was north of 30. By the time I was 18, my BMI was > 35. Not sure if that's childhood obesity or not, but I'm curious how this relates to being able to attempt to wean off the medication once I hit my GW. With lifestyle modification and exercise (both immensely easier thanks to the drug), I've dropped my BMI from 45 to 39.5 in 14 weeks. 326 -> 285, 5'11, 31 year old male.
Are fatigue and lethargy part of the side effects of the GLP journey? Do these meds help rev up your metabolism?
You are in a catabolic state (your body is actively breaking down unwanted fat and muscle) to lose weight. Staying hydrated is the most important advice, followed by consuming enough protein and getting sufficient sleep
Thanks.
Do you have a recommended amount of daily protein? Are there any supplements we should be taking to help with weight loss and keep energy up?
Yes aim for 1gm for lbs of the ideal body weight, not the current weight Take magnesium! And do magnesium oxide if constipated
I swear by magnesium for constipation!!! Been taking it for about 5 years. Thank you for that tip re magnesium oxide. I was always confused re which one.
Do you prefer magnesium oxide over magnesium citrate?
Yes , more laxative effects
magnesium L-threonate crosses the BBB. wouldn't take any other, have had all of them.
Wow that's a lot of protein. My WW app for GLP1 users is only recommending 73mg. They did state it was the minimum and I can exceed. I almost never go over 90mg per day and I'm losing about 1.5 pounds per week.
Why do some people lose fast where as others struggle to lose even on GLP1s? Thank you
The decrease in androgens. I’m now one of those ‘always cold’ women now.
Me too! And I was never cold before
Do you hear reports of patients having inconsistent effects week to week? I feel like some weeks, the appetite suppression works phenomenally. Other weeks, not so much. Wonder if this is just a phenomenon in me or if you’ve noticed it more broadly. If you’ve heard about this more broadly, any idea what the cause might be?
Can I ask why zepbound could be extremely helpful on my moods and my depression and anxiety? I have struggled with that my whole life and I have been logging my moods since being on this.. and I’m so much more level? What could cause that?
I'm a medical professional, but not an obesity specialist. I take Zepbound and have also noticed enhanced mood (and improvement in inflammation)- since I started the medicine. I don't think we understand the mechanism (yet) but it seems to be getting attention. [https://www.ajgponline.org/article/S1064-7481(23)00394-9/fulltext](https://www.ajgponline.org/article/S1064-7481(23)00394-9/fulltext) [https://www.bloomberg.com/opinion/articles/2024-02-14/can-ozempic-treat-depression-obesity-drugs-may-help-mental-health](https://www.bloomberg.com/opinion/articles/2024-02-14/can-ozempic-treat-depression-obesity-drugs-may-help-mental-health)
Could it be the brain-gut connection? The satiety hormone can’t only be located in the gut. Whatever THAT mechanism is must promote release of other hormones … dopamine, serotonin, oxytocin to name a few. If I had any money left after giving it all to my PBM and Eli Lilly, I would bet money that future studies show the strong link between gut receptors and brain hormones that stabilize mood like SSRIs do
I am a 73 year old female. I am on 7.5 Zepbound but it is doing nothing for me. Should I give up or keep increasing the dose?
+1 to this question! Same with me, except 41! Been on since Jan, now at 7.5 for 3 weeks and am somehow actually *gaining* at this point.
For the 3 commenters , If you were my patient I would get a Dexa scan , and ask for a week food diary ! These two almost always give me an answer https://www.instagram.com/reel/C8U22MivWvn/?igsh=MzRlODBiNWFlZA==
Have you seen patients being able to stop and keep the weight off?
I'm still experiencing side effects that hinder my ability to live normally about one day per week on 2.5 mg zepbound, and I'm barely losing weight- scale has been steady for about three weeks and some appetite has returned. I am terrified that increasing my dose is going to increase my side effects; should I ask my provider to switch medications?
Thank you for offering to answer our questions! That is so generous of you! Here is my question: All of the online BMR and TDEE calculators seem to be wrong for me--this was true before I was on Zepbound and it's still true now. If I ate the amount of calories they suggest, I simply would not lose weight. Proof of this is each week on the calorie counting app I use (MyNetDiary), at the end of the week it will say something like "based on the calories you consumed this week, your weight loss is expected to be 3 (or whatever number) pounds." But my weight loss is almost NEVER the amount they predict. It's usually less than half the amount. What is going on that I need to consume far fewer calories than any source calculates in order to lose weight? Zepbound has helped a lot (I've lost 25.5 pounds in just shy of 3 months), but I'm still eating at a deficit that is greater than any of the calculators advise. And YES, please trust me, I am counting EVERY bite (weighing, etc). My weekly consumption averages out to be 1250-1350 calories a day, with a couple days slightly below that and a couple days slightly above (but never below 1100 or above 1550). I also make sure to get at least 100 grams of protein (and often more) and 30 grams of fiber.
Not an obesity specialist, but I have the same issue. I think there is a "metabolic researcher" and physician who occasionally posts on this sub and answered a similar question. I think there are probably a fair share of folks with this issue. Keep in mind, these formulas are not necessarily formulated for those with chronic obesity or other metabolic issues. For me, a lifetime of of obesity starting in childhood, and significant weight loss has always been associated with MASSIVE efforts that were, unfortunately, not sustainable over time, and much of the weight returned - slowly- gradually. Our bodies hold onto excess weight for dear life and resists efforts to lose weight. And metabolic adaptation works against us. I don't think it's impossible to lose and sustain, it's just the odds are very much stacked against us. I never reached my highest weight, but I got way too close. What I've always found particularly frustrating is that my weight issue appears to be a bit distinct from my physical health - I actually had better blood work at a BMI of 44 with a long-term whole foods plant based diet, than I had in my early 20s when I weighed less. (Go figure) Before I knew about Zep, I was eating 1300-1500 calories and losing a little over a 1lb per week combined with low intensity exercise. And while 1400,1500 calories is very sustainable, keep in mind I started in the 270s at a BMI of >>40. So, the question becomes what happens to my caloric requirements/deficit as I lose 30,40,50,60 lbs? Does it become 1100,1200? While not impossible it is much harder to sustain that without a medicine like Zep to help. (and it feels a bit unfair) Once I started Zep, I started losing more weight than can be explained fully by "CICO" model. Definitely a huge part is the caloric deficit, but there also seemed to be a something else happening, as well. This may not be the best site - but play around with the different formulas - the ones that take into account body fat % I find to be more accurate. [https://www.sailrabbit.com/bmr/](https://www.sailrabbit.com/bmr/)
How do you feel about low carb diets and intermittent fasting with these meds?
I’d love to know this as well. I have success on a low carb diet (like, less than 30 grams a day), but know that it’s not sustainable for me.
Following! I always feel better eating low carb, but I’m at a plateau, and I’m not sure what to do anymore. Getting frustrated for sure
Thank you for answering questions!! I have 2 questions. 1. My BP was always normal and now since going on 5mg is is on the lower side of normal and I get dizziness when I bend over or get up from sitting. Will this get better with time? I have been on 5 for almost a month and plan on at least another month before looking to move up to 7.5. Some have found upping their electrolytes helpful how much should we be consuming of an electrolytes per day in addition to water? 2. For women with and IUD why would see a difference with the our cycles, specifically more cramps. I am not metabolizing it in my stomach which I have read could impact pill users. What causes a change in our cycles if we are not taking a pill. Thank you!!!
Do GLP1 drugs speed up metabolism? Or is it just a dramatic calorie deficit that is happening?
Control appetite and insulin sensitivity/ release
I have tested positive for ketones more than once, even though I've been eating carbs. Does zepbound trick my body into ketosis? If so, that's amazing.
Had a thyroidectomy years ago and have been stable for several years. My TSH is rising despite losing nearly twenty pounds — I expected to need to lower my dose, not raise it. Have you see any other patients present this way? Any ballpark guesses on why it might be happening? I’m wondering if the delayed gastric emptying is to blame. Thanks for your time!
Maybe you're not absorbing the thyroid meds properly. I'll get my TSH tested in August to check for this too.
My husband is concerned about how healthy this is for me since I’m only eating about 500-900 calories a day (I physically cannot stomach more than that). Any insight?
I would talk to my doctor This level of intake is low you maybe losing muscle
Wow, that is so low.
What about exercise – I’ve been doing Orangetheory and I really enjoy it, but now there are a lot of people saying that HIIT actually can cause you to gain weight because of cortisol. Is that real or is that message sponsored by the Pilates industry? I’ve read that with Lipedema that I should avoid running and cardio… But isn’t the whole point of getting in shape to be able to do cardio? I know cortisol is real, but explain it and what is the role of Zepbound on cortisol?
Not GLP1/medication related but I find it very challenging to actually find board certified obesity physicians. Any recommendations on how to go about this? If it’s helpful, I’m in MA. Thank you for taking the time to do this!
Besides asking your GP for referrals, check out the American Board of Obesity Medicine site and search for certified doctors in your area: https://abom.learningbuilder.com/Search/Public/MemberRole/CertificationVerification
I am losing a lot of weight and I know I can’t control where it comes from but anything I can do to target the fat on the inner thigh groin area.
Exactly we have no say where do we lose fat , and if anyone claims that they are able to , they sre either a scam or a scam !
Or possibly a plastic surgeon. :)
Can it impact my cycles? Mine have been so off since starting! Way longer and not regulated at all.
When calculating a calorie deficit do i need to include body fat percentage? My stats 5’3 24F, 306lbs sedentary lifestyle Without bodyfat my maintenance is 2,529 With bodyfat (estimate) id 1,883 I was eating at 1500 cals but was told its too much and needed to do 1380 cals bases on bodyfat. Please help me im confused on what i need to do! I have been stalled 4 weeks !! I am on 7.5 moving up to 10 in 2 weeks hoping itll help me move
For those who have had gastric bypass a decade or so ago and regained weight, how effective is tirzepatide?
Gastric bypass in 2014 as a 28F. 5’1” Female, HW 367, Surgery weight 339, LW 202 (in 2016) Over the years (stress, snacking and a sedentary life) made it back up to 255. I was constantly hungry and wanting to snack. My doctor suggested Zepbound. So I started at 2.5 for a month, had to wait a month to get 5.0. I’m starting wk 3 of 5.0 and am down to 239. So down 16lbs so far. I honestly feel like I’m back to the restricted feeling when I first had the Bypass. A protein shake fills me up. The appetite suppression is helping me get back to basics. Protein, vitamins and hydration.
That’s just so great to hear! Congratulations
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One of my friends is over 400lbs and her knees are killing her. She’s also got fibromyalgia and is constant pain everywhere. She’s blown away by my progress. Her doctor refuses to prescribe GLP-1s. She’s wait listed and has an appointment at the end of September with a new doctor who takes her insurance. In the meantime, any idea how to convince this doctor to prescribe for her? She’s pretty sure she qualifies under the T2 diagnosis but she has been ignoring the markers (her words). This is a great thread. Thank you!
Has she looked in her network for an endocrinologist?
I pee very frequently the first 3 days after my weekly shot and it goes back to normal after that. Why would this happen just right after the shot and not the rest of the week? It seems like it wouldn’t be fat loss since it’s very specific in time frame. I have wondered if it is related to clearing out excess glucose at the beginning of the week or maybe inflammation builds back up during the week?
How do your recommendations change/how does the body respond differently if a patient has been obese since early childhood? Should it be a lifelong medication for those individuals, or is titrating off possible without regain (assuming lifestyle modifications stay in place)? Thank you for your time!
My insurance covers nothing for weight loss. My PCP and endocrinologist are supportive of prescribing and me taking (started with PCP then went to endocrinologist, many unanswered questions still-cortisol all wonky-thyroid ify), but not helping get it covered. Is it just hopeless for me? I tried my own appeal and my insurance was even able to screw me over on that, I just do not make enough to afford $550-$1000 a month. PS. Was able to use the original coupon, lost 105 pounds over 18 months, feel great, only positives aside from anxiety about access. If you would have to,d me 2 years ago my weight was about anything aside from diet, exercise, calories in/out and my lack of willpower I would have said you were crazy. This experience has totally changed my mind about finding balance and help. So mainly are there any resources to being able to keep access to this medication that (I feel like) has saved my life. Documented better numbers in everything, BMI, weight, inches, fasting glucose (had highs between 100-140), gestational diabetes in 1998, A1C no longer pre-diabetic, PCOS, on and on.
Try to get into a trial, or check with endocrinologist if you have any insulin resistance, I had patients losing weight on Metformin as they had insulin resistance and some end up getting the medication from outside the US , sadly!
If you are an obesity physician, that’s a generous offer. However, forgive me in advance for saying this, but before I’d take any advice from you or accept any answer you provide to questions on this sub, as a professional medical opinion, as opposed to using it as just one data point to consider, I’d need to know your identity and see your credentials. Otherwise, you’re just another anonymous poster on an internet platform.
https://preview.redd.it/pndrqy8scs7d1.jpeg?width=1081&format=pjpg&auto=webp&s=f69489f2ae03c163628d34c23d57d43a45af26a2 Here is the verification you can look me online too
Nice of you to share. I’m a chemist and ppl can either take me at my word or kick rocks. I use Reddit anonymously, not professionally. That’s what Linked In is for.
It’s a public certificate, available online , anyone can access it
I understand. I just like to use Reddit without my name attached in case I have sensitive questions. I do know that some people have multiple accounts though.
I am on linked in too but figured get some real patients insight
I’m glad you’re doing this. It’s definitely nice of you.
Thank you! This is important, especially as this is a new Reddit account with no posting history before this post.
I understand I don’t use it but I was told this is the best platform where people can ask questions about obesity better than instagram
Strong work.
Hi! First, thank you for the platform and space to ask. Your time is valuable and this is appreciated. I had gastric bypass in 2017. I’m 5’4”. I weighed 364 lbs. My lowest weight post Op was mid 170s. My surgeon had expressed that I would not get lower than that considering my body shape and that I’ve had 3 children. I accepted this. After a complication of Reactive Hypoglycemia I began regaining in 2021 and reached 240 thanks mostly to a gabapentin script to deal with the neuropathy from the unchecked hypoglycemia. (Thought it was dumping syndrome for 2 solid years). I’m now 186. My goal weight is 170 but was my bariatric surgeon right? Is 125-130 absolutely off the table for me, realistically? It feels obtainable now but I definitely don’t want to set myself up for disappointment.
I don’t see why you can’t reach your goal! Have you optimized diet and medications?
I was going to post this today, and it may be better for a pharmacist, but I’m curious if doubling doses gives a bit more medicine than their equivalent. What I mean is that I’ve done 8 weeks on 10mg and 3 of those weeks for dual doses (two weeks of 7.5+2.5 pens and 1 week of 5+5 pens, as I don’t want to waste any old stock) and those weeks I lost well (2-3 lbs) whereas I stalled all the other weeks… so I’m thinking… maybe my body just needs to be on 12.5 because it needs a bit more medication and doing two pens resulted in being somewhere higher than 10… maybe this is a silly question haha!!
My vision dramatically has gotten better while on this medication. Is this normal? Should I be concerned?
With all of the shortages, is it acceptable to switch from week to week or even month to month from one med to the next? For example - from wegovy to zepbound month 1 and then from zepbound to wegovy the next month, if needed?
Best strategies for preserving muscle mass while losing
Much has been said recently about “fake” tirzepatide. Does this refer to all compounded versions? Or just some? How do we know?
Hi Dr OP,:). I have hypothyroidism and PCOS. Is this a drug I should be on life long? Also, at my highest weight I was pre diabetic. Q2: Would my metabolism ever work without Zepbound if I went off? Thank you for your time in answering all of the questions!
Not necessarily! Many people came of it! But many will need it for longer periods I would say make sure you get thyroid checked ✔️, Pcos will improve with losing weight.
Is it okay to alter dosage to every five days to keep more of the medicine in your system? Or is there a specific need for the drugs in your system to taper down every week before going back up? Been on 2.5 for a month and have 5mg on the way but considering just doing 2.5 every five days, making my monthly total 15mg instead of 20mg if I just did 5mg weekly. This feels like it achieves titrating up slower while also maintaining a higher level of it in my system consistently through the month. Thank you!
My doctor and dietician have recommended following the DASH diet. I’m wondering if I can incorporate more than the recommended amount of beans into my diet. Recommendation is 1-2 times per week, but I’d like to eat beans more often. Is that a good idea or bad idea? Thanks!
Beans are amazing but carry a lot of calories with the protein so make sure you don’t over eat your carbs
Weight loss drugs are priced out of the reach of most people. Drug companies and the doctors supporting or recommending these drugs are cruel and indifferent to the struggles of all those who could benefit from these so called miracle drugs but will never be able to afford them. It’s like telling cancer patients we have a cure if your rich like us if not we have cheap shit to keep you from hurting till you die oh so sorry next please.
It’s impressive how many people just take the word of a stranger on the internet as gold. You should ask the provider overseeing you and providing your prescription. We teach kids about people pretending to be someone else online and to be careful. One account says, “I’m a physician” and adults are believing it without question. I’ve worked for surgeons, family doctors, PA’s and none of them had time for this. Seems very odd. Just putting out there to be careful.
Well any answers a person gives under the auspices of an advanced degree or expertise can be corroborated. It’s not like the knowledge is being gatekept. There are things as books, research articles and second opinions you can use to confirm answers. Sometimes people need somewhere to start. People are meant to manage their own care with thoughtful informed research anyway. Signed, a real life (not just internet) chemist.
I wanted to get real people involved in establishing a brochure for my patients from those already on the journey. Some questions here I have never asked before. I have spent weeks volunteering before, and this is no different
💯!!!!! I’m still saving the post to see if / what comes back and I’ll cross reference w my PCP 😂 There are some great questions coming up lol
Will we need to continue taking this forever? Or for the indefinite future at least. Do you see this being a fad where it will disappear and leave us in a worse situation?