On the Rebound

The obesity management drugs mentioned by Childhood Obesity News include Ozempic, Wegovy, Mounjaro, and others based on molecules that imitate glucagon-like peptide-1, known familiarly as GLP-1.

Writer Lisa Rapaport composed a list of the five things that happen when a person stops taking (in this case) Ozempic, but all drugs of this type are all based on the same chemicals, so the same results can be expected. The person’s blood sugar will become elevated, indicating the medical necessity for a different medication to be prescribed. The drug’s side effects, including the phenomenon known as “Ozempic Face,” will fade.

But the first two caveats, so eloquently phrased by Rapaport, are the most relevant:

1. Your Appetite Will Return
2. You Will Regain Weight

Such a reversion to the previous state is known as the “rebound effect,” and it is brutal. Here are only a few of the many available opinions about that, from diverse sources.

Writer Taylor Andrews quotes the Journal of Pharmacology and Therapeutics which revealed that patients who quit the weight-loss drug regained two-thirds of the fat they had started out with. On another front, addressing 2.2 million TikTok followers, Remi Bader…

[…] recently opened up about her experience gaining “double the weight back” once she stopped treatment… And when she decided to stop taking the drug, her binge-eating disorder almost immediately returned.

These drugs are not a substitute for conscious eating, nor for giving the body the motion and challenges it needs in order to remain viable. It now appears obvious that anybody who starts on them has made a lifetime commitment, because of a little seven-letter word: rebound.

Meredith Schorr, a young nurse who had gained 50 pounds during the worst of the COVID crisis, successfully shed the unwanted weight by taking Ozempic for 11 months. It caused so much internal discomfort, her doctor also prescribed something to alleviate nausea and vomiting. After a while, in hopes of starting a family, she very responsibly stopped taking the weight-loss drug, and for a short time things seemed okay. Then, after about five weeks, she began to feel ravenously hungry, and guess what?

Within two months of stopping Ozempic, she regained 10 lbs of the 50 she had lost.

(To be continued…)

Your responses and feedback are welcome!

Source: “5 Things That Can Happen After You Stop Taking Ozempic,” EverydayHealth.com
Source: “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension,” Wiley.com, 04/19/22
Source: “Nurse Who Took Ozempic for COVID Weight Gain,” People.com 03/14/23
Image by Shal Farley/CC BY-SA 2.0

Weight-Loss Drugs, Exercise, and General Functionality

The previous post, about obesity management drugs that imitate a natural bodily ingredient called glucagon-like peptide-1, talked about the likelihood that taking these drugs will cause the destruction of not just fat cells but muscle cells. It ended with the observation that we don’t go around cutting off people’s heads (an average of 11 pounds) just to achieve weight loss.

In all seriousness, it is essential to maintain a high level of exercise to not only lose fat but build muscle mass. For the patient, it is essential to get enough protein.

“Simply put, you need to eat a 1:1 ratio of grams of protein to your starting weight in pounds,” Dr. Peter Attia says. He feels that when the Food and Drug Administration approves pharmaceuticals it does not pay enough attention to the exact type of weight loss that is being achieved.

The purpose should be to lose fat tissue, not muscle tissue, and to accomplish that takes a certain amount of work. These drugs have not been around long enough to allow researchers to perceive the whole picture.

Also, as Director of Cognitive Nutrition at Thrive Global and founder of Sia Health Bredesen writes for TIME, aerobic exercise activates the immune system, improves blood flow; improves metabolic health by increasing insulin sensitivity; reduces cardiovascular risk by strengthening the heart; boosts the mood, improves sleep, and “enlarges the hippocampus, the brain area involved in learning and memory.”

And don’t forget strength training. Bredesen writes,

[I]n a recent meta-analysis reviewing data from 1.5 million study participants, strength training activities were associated with a nearly 20 percent reduction in risk of cardiovascular disease, cancer, diabetes, lung cancer, and all-cause mortality.

The sad truth

Drugs of this kind are certainly not a substitute for exercise. Researcher and essayist John Mac Ghlionn describes a new study that found that…

[…] not only does exercise build stronger muscles and bones, it also improves an individual’s gut health. The researchers found that exercising for at least 150 minutes per week increases the diversity of the human gut microbiome… The gut, otherwise known as our “second brain,” utilizes the same type of neurons and neurotransmitters that are found in the central nervous system. Ozempic, it’s important to note, appears to actually disrupt the microbiome.

Taking Ozempic, Wegovy, Mounjaro, and similar drugs does not mean a person may now finally get away with eating as much as they want, of anything, and it certainly does not mean they can quit exercising, or continue to avoid it. Ideally, before prescribing, those patients are weeded out, just like obese bariatric surgery candidates who are psychologically unprepared and have an unhelpful attitude toward the whole procedure.

Your responses and feedback are welcome!

Source: “Peter Attia Says Ozempic Could Make You ‘Fatter’,” HoneHealth.com, 05/02/23
Source: “What the Ozempic Obsession Misses About Food and Health,” TIME.com, 02/21/23
Source: “Ozempic, The Atlantic, and the Dangers of Anti-Exercise Rhetoric,” RealClearScience.com, 03/29/23
Image by naitokz/CC BY-SA 2.0

Weight-Loss Drugs and Exercise

The obesity management drugs we have been discussing include Ozempic, Wegovy, Mounjaro, and others based on molecules that imitate GLP-1 (glucagon-like peptide-1).

People who want pharmaceuticals may be disappointed to learn that all these meds are intended to be used along with deliberate diet modification and perpetual exercise. The prescribers are presumably aware of that — it’s their job to know such an elementary fact. Maybe they just don’t do well at conveying the message to patients. Or maybe it’s just that people have a way of ignoring unpleasant truths they don’t want to hear.

According to research published in Diabetes Care, persons who used Ozempic in conjunction with exercise lost considerably more weight than those who used Ozempic alone. Furthermore, individuals who took Ozempic with exercise improved their blood sugar management and cardiovascular risk factors…

To lose overall weight should not be the goal. The idea is to lose fat. Quoted in this piece is Dr. Rob Newton, professor of exercise medicine, at Australia’s Edith Cowan University:

There’s little understanding that a healthy balance of muscle and fat is key to fending off chronic disease and frailty over the long haul. Most chronic disease isn’t driven by fat mass but low levels of muscle mass and inactivity… Muscle loss caused by repeated dieting without exercise is one reason why it can be hard to maintain long-term weight loss.

One writer makes the point:

The aim when losing weight should be to change your body composition — the ratio of fat to muscle — not just become a smaller “skinny fat” version of yourself.

According to endocrinologist Dr. Robert Kushner, “If you lose weight, you never just lose fat… and it’s very hard to gain back muscle mass once you’ve lost it, particularly as you age.” Basically, anyone who undertakes to shed a large amount of weight should engage in “a robust physically active program with both aerobic and resistance training.”

Dr. Nancie Manning says:

Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking or cycling. Strength training is also important for building muscle and improving metabolism.

Longevity expert Dr. Peter Attia has said that “almost every patient we put on [semaglutide] has lost muscle mass at a rate that alarms me.” Body composition is the important thing, but the FDA wants the drug’s results to be measured only in weight loss.

Dr. Attia does have a point. The average human head weighs 11 pounds, but we don’t chop it off just to get a lower number on the scale.

Your responses and feedback are welcome!

Source: “The Benefits Of Combining Ozempic With Exercise For Weight Loss,” PharmacyPlanet.com, 04/29/23
Source: “People who take semaglutide but don’t resistance train,” Insider.com, 02/01/23
Source: “Is Mounjaro the weight-loss drug we’ve been waiting for?,” NationalGeographic.com, 05/02/23
Source: “Ozempic And Exercise The Perfect Weight Loss Combo,” WellnessCenterOfLakewoodRanch.com, current
Source: “Peter Attia Says Ozempic Could Make You ‘Fatter’,” HoneHealth.com, 05/02/23
Image by Daniel R. Blume/CC BY-SA 2.0

Weight-Loss Drugs, Safety, and the Brain

People might tend to think, well, if the FDA approves something, then it must be okay. As an antidote to that delusion, consider the story of phentermine.

Now, back to the category of synthetic hormones, which several posts here have explored. On the safety question, they are certainly unsafe for diabetics, but not in a way that is obvious to the casual observer. But someone with both diabetes and obesity knows that they might not be able to get the meds on which their very lives depend. The supplies of drugs like Wegovy are depleted, bought up by people who only have obesity.

Check this out:

Novo Nordisk has said it will temporarily reduce production of the lower starting doses of its weight-loss drug Wegovy, as demand for the therapy continues to challenge its ability to supply the market.

The Danish drugmaker said the measure — which effectively restricts new starts on the therapy — is necessary to make sure it has sufficient capacity for the active ingredient semaglutide to safeguard availability for patients already taking the GLP-1 agonist for obesity and/or type 2 diabetes.

Consider another aspect of safety. For a patient who has to self-inject on a daily or weekly basis, one of the important things to know is how to dispose of the gear. The pen is a high-tech syringe, holding several doses. The needle is to be changed each time, and both are to be disposed of in…

[…] an FDA-cleared sharps disposal container […] made of heavy-duty plastic with a puncture-resistant lid, and it is upright, stable, leak resistant, and properly labeled to warn of hazardous waste.

If the manufacturers and stockholders of the weight-loss drug corporations have their way, many more households will soon include a sharps disposal container as part of the standard equipment. Is this a paranoid fantasy? How difficult would it be for hardcore addicts to get hold of these used implements? Granted, neither piece is exactly like the traditional hypodermic syringe and needle, but if anyone can improvise with spare parts and ingenuity, it is a person who needs a fix.

From an anonymous writer in an online forum:

Drug users do use insulin syringes to shoot with… Any size syringe can be gerry-rigged. Even eyedroppers… One use insulin syringes are ideal for i/v use… They’re cheap (10 syringes for 2–5$, at least where I am), easy to get since there are pharmacies everywhere, and easy to use…

A stray thought

In an article about Mounjaro, journalist Tara Haelle quoted two doctors, one being endocrinologist Robert Kushner of Chicago’s Feinberg School of Medicine:

Both GLP-1 and GIP […] circulate in the brain and reduce appetite by affecting how people experience hunger or fullness or contentment between meals, thoughts of food, and cravings for food…

The other is weight management physician Ali Zentner, who is also the medical director of Vancouver’s Revolution Medical Clinic:

Obesity is an inappropriate starvation response. For whatever reason, the brain thinks it’s starving and does what it should do in the presence of famine…

Since the brain is so heavily involved, it would be interesting to look up what results have been obtained with hypnotism, which has had some notable successes in getting people off cigarettes.

Your responses and feedback are welcome!

Source: “The Secret, Scary Way Your Friends Are Losing Weight,” Cosmopolitan.com, 02/12/19
Source: “Novo Nordisk taps brakes on Wegovy as demand soars,” Pharmaphorum.com, 05/05/23
Source: “How to use Mounjaro,” undated
Source: “Are insulin syringes normally used by drug addicts?,” Quora.com, undated
Source: “Is Mounjaro the weight-loss drug we’ve been waiting for?,” NationalGeographic.com, 05/02/23
Image by Fredrik Rubensson/CC BY-SA 2.0

What Else Can Weight Loss Drugs Do?

As we have seen, Mounjaro (tirzepatide) and its relatives Ozempic and Wegovy are not recommended for nursing mothers, or for women who are or might become pregnant, because of possible adverse effects on the developing fetus. So far, the substances are not recommended for existing children either, but that could change. Tirzepatide is being tested on children who can sign up for the program as young as 10. The official literature from Lilly says,

Tirzepatide’s safety and efficacy have not been established in patients under 18 years. SURPASS-PEDS is evaluating tirzepatide in patients 10 to below 18 years old with type 2 diabetes inadequately controlled with metformin, basal insulin, or both.

The safety and efficacy of tirzepatide have not been established in pediatric patients and tirzepatide is not approved for use in patients younger than 18 years.

For some skeptics, it will take a lot of convincing before they believe that these meds can be safe for kids. But the fans have an answer for everything. Facial changes or hair loss? Not an issue, the believers say, because these are common effects of weight loss. People who undergo bariatric surgery or lose weight through behavioral change can also expect to lose hair and see their faces become gaunt and saggy.

Your diet is everything you eat

Another issue shared by adults and children is the difficulty of obtaining sufficient nutrition. One article quotes Dr. Raman Madan, who reminds patients to be sure they are ingesting enough of vital nutrients like iron and B vitamins.

“Often patients on weight loss drugs are eating less,” Madan said.

Well, of course they are, if the drug is working right. Reduced appetite and lowered food intake are the whole point of spending a thousand dollars or more each month for pharmaceutical products. The patients need to be on very strict diets.

A recent Childhood Obesity News post mentioned some of the side effects that could result from using tirzepatide, and some measures that might be taken to reduce harm. We quoted a very informative website that also published a list of foods and drinks that are best stayed away from by anyone taking a weekly shot of Mounjaro, due to the risk of adverse events, a.k.a. side effects.

The list includes bread, carbonated beverages, raw vegetables, cooked fibrous vegetables, tough meats or meats with gristle, red meat, fried foods, heavily seasoned foods, nuts, seeds, and popcorn.

What foods contain iron? Wholemeal breads, nuts, and dark green leafy vegetables, which tend to be eaten raw. What foods contain B vitamins? Again, leafy green vegetables, broccoli, brussels sprouts, and meat. In other words, to fulfill Dr. Madan’s recommendation to seek out these nutrients might be difficult.

Here is the point that seems to escape a lot of people. The avoidance of side effects might depend on a person’s shunning of entire categories of food while using tirzepatide — which, in effect, means for the rest of their life.

Your responses and feedback are welcome!

Source: “Can Mounjaro™ (tirzepatide) be used in children?,” LillyMedical.com, undated
Source: “Ozempic Causing Hair Loss? Why Some People Are Shedding More Than Pounds,” Healthline.com, 05/04/23
Source: “CNMRI: Neurology, Sleep Medicine, MRI,” CNMRI.com, undated
Image by Victoria Reay/CC BY 2.0

Weight-Loss Drugs and Pregnancy

The semaglutide drugs Ozempic and Wegovy, intended to treat Type 2 diabetes and obesity, respectively, are a risky bet for pregnant people.

Ozempic is also used “off-label” for weight loss. A large number of the individuals who would use it for weight loss, along with a large number of Wegovy users, are women of childbearing age. Sadly, what the Food and Drug Administration (FDA) says about that is,

[I]t is recommended that people discontinue use of Ozempic and Wegovy at least two months before getting pregnant due to potential risks of miscarriage and birth defects. For people using Ozempic to treat diabetes, the drug’s label says that patients may continue the drug “only if the potential benefit justifies the potential risk to the fetus.”

Although semaglutide has not been tested on pregnant humans, the animal studies don’t look good. They mention miscarriage, underweight offspring, and an above-average number of birth defects. One unresolved question is, are these anomalies caused by the drug itself, or by the weight loss caused by caloric deficit caused by the drug? Unfortunately, to the developing fetus, that is a distinction without a difference.

The official stance

The FDA tends to believe the harm is from weight loss and poor nutrition, and allegedly there is not yet solid evidence that the drug is directly responsible. But the agency wants to be careful. It asked Novo Nordisk, the maker of Wegovy, to devote further attention to this matter. How soon will we get some answers? “The first study is expected to be completed in 2027 while the second study will be completed in 2033.” But it looks like the door to non-prescription sales will be flung open long before those studies come to fruition, implying a whole lot of use without professional supervision.

Where could that lead? To numerous pregnancies in which the possibility of dangerously undernourished and underweight babies, and babies with possible birth defects, would definitely be a factor. Add to that the new wave of very restrictive policies around abortion, and it is possible to imagine a nightmare scenario in which an already overburdened healthcare system will have to deal with a multitude of damaged infants.

What about tirzepatide?

Currently marked only as Mounjaro, this drug also waves some red flags:

Available information on tirzepatide use in pregnant women is inadequate to evaluate for a drug-related risk of congenital disabilities and adverse maternal or fetal outcomes. [I]ncreased incidences of external, visceral, and skeletal malformations have been observed in animal reproduction studies.

Doctors are strongly urged to discuss these possible teratogenic effects with fertile women, recommend reliable contraception, and warn patients that tirzepatide weakens the effectiveness of hormonal contraceptives that are taken by mouth.

And once the child is born, what about breastfeeding? So far, no studies have been done. The best available advice at present is to use the drug “cautiously” because it could cause damage to children. If mothers who love their weight-loss drug decide not to risk breastfeeding, that could cause damaged children, like for instance, obese ones. Because women are frantic to lose the pounds they gained while pregnant, all the progress made in recent years, by efforts to encourage breastfeeding, could be negated.

Your responses and feedback are welcome!

Source: “Weight-loss drugs are booming,” Advisory.com 04/19/23
Source: “Tirzepatide, NIH.gov, 12/27/22
Image by BlueGoa/CC BY-SA 2.0

What Else Can Tirzepatide Do?

In addition to the possibility of hypoglycemia, this drug has been known to cause hair loss, which sounds bad. But to be fair, a slender model can fake having hair by wearing a wig, while an obese model with the world’s greatest mane will probably not get the job.

Ozempic (generically semaglutide) is known to cause hair loss, and Mounjaro is made from the same basic ingredient plus another very similar one. And in fact, clinical trials showed that tirzepatide users lose more hair than semaglutide users. But while a certain amount of formal investigation has been done, a lot of concerned Americans are getting their information on this subject from social media platforms of questionable repute.

For Healthline, Beth Ann Mayer described the state of knowledge so far. According to experts she consulted, it is quite possible that the hair loss experienced by some patients is not caused by medications of this kind. However drastic weight loss, by whatever means it is achieved, can lead to hair loss.

As it turns out, cutting weight causes a lot of wear and tear on the body, which in some cases will react with telogen effluvium, or “a diffuse shedding of hair that occurs approximately three months after a major stressor.” Those are the words of dermatologist Dr. Susan Massick of Ohio State University.

Another dermatologist, Dr. Raman Madan of Northwell Health, gave the writer an explanation that curiously echoes Grandma’s tale of when her sister had diphtheria back in 1900 or thereabouts. The doctor shaved the little girl’s head because her luxuriant hair was stealing the energy that was needed to heal the rest of her body.

The modern-day Dr. Madan explained that the body takes essential resources away from the hair. (So, why shouldn’t that be a two-way street? Maybe the old-time doctor was not crazy.) When this happens, the hair goes into a “resting phase.” Mayer wrote,

Madan explained that there are three phases of hair loss:

Anagen hair loss occurs when the hair is growing. “This phase can last for years,” Dr. Madan says.
Catagen hair loss is a transition where the hair stops growing and separates from the follicle, a phase that lasts about two weeks. Telogen is the resting phase before it falls out, which Madan says can run for about two to three months.

In other words, sudden weight loss sends a lot of hairs into the resting phase, but new ones do not start growing to replace them. For now, the received opinion seems to be that, depending on how long it takes for a person’s weight to stabilize, the hair will eventually grow back and regain its previous glory.

Your responses and feedback are welcome!

Source: “Ozempic Causing Hair Loss? Why Some People Are Shedding More Than Pounds,” Healthline.com, 05/04/23
Image by Amy/CC BY 2.0

What Tirzepatide Can Do

As previously mentioned, unsupervised use of this drug can bring about hypoglycemia (low blood sugar), with consequences like “dizziness or lightheadedness, blurred vision, sweating, slurred speech, hunger, drowsiness, shakiness, weakness, headache, fast heart rate and feeling jittery.” For people with diabetes, using it in conjunction with alcohol can both increase the risk, and mask the warning signs, of hypoglycemia.

And that’s not all

The possible side effects of tirzepatide, currently marketed only as Mounjaro, range from embarrassing eructation (or in plain English, burping) to quite serious. One might experience nausea, vomiting, stomach pain, indigestion, diarrhea, and paradoxically, constipation. The likelihood of abdominal pain increases if the drug is used in conjunction with fizzy drinks. In the realm of small sacrifices, this is one that a person will hopefully not have too much trouble choosing to make.

In addition, it affects body parts other than the digestive system. The obvious one to look out for is a reaction at the injection site, in the form of swelling, redness, or itching. If the patient does not rotate injection sites according to a careful protocol, other local problems can develop.

Further possibilities include hair loss and headache, both of which a lot of people might be willing to endure in exchange for elusive slimness, but it just gets worse from there. These other things happen rarely, but there are reports of eye problems, renal failure, pancreatitis, hypoglycemia, and gastrointestinal bleeding. People with an inherited tendency toward thyroid tumors should probably stay away from tirzepatide.

Interestingly, one possible side effect is listed as “decreased appetite,” which is certainly to be hoped for because after all, isn’t that the whole point? On the bright side, it is said that many of the common side effects are mild, and some disappear after a few days. Or weeks.

Avoidance

A helpful website lists several moves a patient can make to avoid unnecessary side effects, and actually this list would benefit just about anyone:

— Drink 64 ounces of fluid a day.
— Sip liquids between meals, not with meals.
— Wait about 30 minutes after a meal to drink anything and avoid drinking 30 minutes before a meal.
— Eat smaller meals (try not to eat until you are full).
— Eat lean, protein-rich foods daily.
— Choose foods and drinks that are low in fats and sugar (low carbohydrates.)
— Avoid alcohol.
— Chew foods thoroughly to help with digestion.
— Take a short walk after eating.

Your responses and feedback are welcome!

Source: “Mounjaro,” Drugs.com, undated
Source: “Possible side effects,” Mounjaro.com, undated
Source: “CNMRI: Neurology, Sleep Medicine, MRI,” CNMRI.com, undated
Image by Eli Lilly

The Equivocal Promise of Tirzepatide

The American Academy of Pediatrics has passed down the okay for people as young as 12 to be prescribed weight-loss medicines. Meanwhile, authorization of the injectable diabetes drug Mounjaro to be prescribed for the separate purpose of weight loss looks like a pretty sure bet. In that eventuality, it will be legal to prescribe Mounjaro (the only medication that contains tirzepatide) to obese young teens.

If tirzepatide is authorized for weight loss under that trade name or another, there will be a big push to make it available without a prescription, which could easily happen. If grownups are allowed to buy it over the counter, chances are it will find its way into the hands of kids, just as surely as cigarettes and beer have been accustomed to do.

Whether the route is legal, semi-legal, or downright black market, and whatever name it goes by, the substance will still be tirzepatide. The previous post mentioned some of the mental and emotional problems that can arise, especially when it is obtained with a prescription, but for “off-label” use, namely, weight loss. It can cause side effects, including the whole slew of symptoms that show up if a person’s blood sugar gets too low.

The potential for allergic reaction always exists, in addition to the enormous realm of possible interactions with other prescription medicines the patient might be taking. Some rogue substances, like grapefruit juice, can really mess things up, and patients need to be aware.

Danger lurks

The standards of pharmacovigilance demand that information on a medication’s side effects (more formally known as adverse events) be collected during the testing phases and also after the release of the drug for use by the public. Predicting the statistical frequency of various side effects is a field of study in itself, and necessary to risk-benefit assessment, but we won’t go that far into it here.

Sometimes an adjusted dose or a change of medication can make life easier for a patient, but often the troublesome side effects just have to be endured for the sake of the greater good — the hope of retaining health.

This is where the door opens to a lot of problems. Many people take weight-loss drugs in pursuit of the general goal of improved health. If a pill or injection bugs them too much, they have the good sense to back off and try another modality. But obesity is such an emotionally and societally fraught condition, it causes many other people to have a heavy emotional investment in the outcome. For an adult, the fear may be that if they don’t lose weight, divorce will follow. For a younger person, popularity (or at least, not being scorned) at school might be the goal.

A person with a heavy emotional investment in a certain goal can make a lot of mistakes. It is one thing to endure unpleasant side effects while trying to recover from cancer. But to put up with awful sensations and incidents for the sake of shallow and fleeting approval from immature peers, that’s a whole different story.

All that was by way of introduction. The next post will get down to the nitty-gritty, in the matter of tirzepatide side effects.

Your responses and feedback are welcome!
Image by Neale Bryan/CC BY-SA 2.0

The Allure of Tirzepatide, Continued

In their generic form, pharmaceuticals go by science-oriented names that start with lower-case letters, like tirzepatide. Being a commercially marketed product, Mounjaro starts with a capital letter, and there is no other tirzepatide on the market, so at this point in time, they might as well be synonyms. Mounjaro was approved for the treatment of diabetes only a year ago, in May of 2022, but that wasn’t the big news.

Required and routine human testing had made it clear that tirzepatide might turn out to be the most spectacularly effective weight-loss drug ever, and it appears to be on the verge of approval for that purpose. Eli Lilly’s diabetes medication plant in North Carolina is going to end up costing close to two billion dollars, so obviously the corporation is optimistic about both the need and the demand for its products.

Other important names in this realm are the semaglutide weight-loss drugs Ozempic and Wegovy, which only imitate one natural hormone, whereas tirzepatide imitates that one, plus an additional hormone with which it works synergistically.

Say what?

Tirzepatide was described by a writer as psychoactive, a term that might not be recognized as problematic by someone for whom English is not their first language. In the U.S. (colloquially, at any rate), we tend to reserve that term for LSD, mescaline, and other substances of the hallucinatory and mind-bending variety. Nevertheless, tirzepatide does have effects other than somatic on some people. Also, some weight-loss pills allegedly contain plant-based stimulants to help with the hunger-reduction and energy-increase aspects of their action.

An intriguing line on a website from India says,

The bulk of Eli Lilly’s (Tirzepatide) Weight Loss Drugs include stimulants like Garcinia Cambogia in their formulations. They reduce hunger while also speeding up metabolism and boosting energy levels.

The author did not offer a source, and the article was admittedly “sponsored,” so could have been written by an enemy of Lilly. Also, it was not possible to chase down any more references to that assertion, so who knows? On the other hand, such things apparently do happen. It was possible to find a paper titled “Nine prohibited stimulants found in sports and weight loss supplements: deterenol, phenpromethamine (Vonedrine), oxilofrine, octodrine, beta-methylphenylethylamine (BMPEA), 1,3-dimethylamylamine (1,3-DMAA), 1,4-dimethylamylamine (1,4-DMAA), 1,3-dimethylbutylamine (1,3-DMBA) and higenamine”

Still, the damage could be done

Irresponsible use of just about anything could hurt people. Unsupervised use of tirzepatide, for instance, if it becomes available without a prescription, could dangerously lower a person’s blood sugar leading to irritability, confusion, anxiety and/or and mood instability. Writing for The New York Times, journalist Dani Blum notes,

But it’s not yet clear what the long-term effects of taking Mounjaro might be — a pressing issue, given that people need to keep taking the drug for continued results, said Akshaya Srikanth Bhagavathula, a postdoctoral fellow at the University of Arkansas who has studied tirzepatide.

This vast unexplored area is particularly worrisome if eventually the medication is sold over the counter (without a prescription). For instance, little is known about how tirzepatide affects people who have neither diabetes nor obesity. We don’t know what it does in people who just want to shed 20 pounds of winter weight and get back their beach bodies. The risk of malnourishment and disordered eating calls for close medical supervision — something that is unlikely to happen in all cases.

Another thing: It is seriously recommended that weight-loss drugs not be combined with alcohol, but let’s face it: In the Venn diagram of people who would self-medicate with them in order to look good at the club on Saturday night, and of people who drink alcohol, there is a sizeable overlap.

Your responses and feedback are welcome!

Source: “The Diabetes Drug That Could Overshadow Ozempic,” NYTimes.com, 04/11/23
Source: “Newly Approved Diabetes Drug Has Record-Breaking Weight Loss Effect,” NatureWorldNews.com, 06/07/23
Source: “Eli Lilly Weight Loss: Top 5 Over The Counter Alternatives To Eli Lilly (Tirzepatide) Weight Loss Drug,” OutlookIndia.com, 01/27/23
Source: “Nine prohibited stimulants,” Tandfonline.com, March 2021
Source: “Mounjaro,” Drugs.com, undated
Image by GovernmentZA/CC BY-ND 2.0