Weight Loss and Mounjaro

I’ve been writing a lot more! But then I got blocked on my last pandemic/schools piece, and found myself in the familiar pattern of starting and not finishing other articles–and not starting articles because it will distract me from finishing the ones I have started. So here’s an attempt to write something non-school related that is hopefully quick and interesting, or at least biographical.

I am ridiculously healthy. My few health problems are chronic and lifelong, but I’m a complier in this area, at least. Apnea: diagnosed in 2019 but given my insomnia concluded to be of long standing. Blood pressure: I was clocking 140/95 when I was an 18 year old athlete and it’s remained high at all weight levels (currently 180/115 unmedicated, which it almost never is).  And of course, my allergies, which are always the first culprit I check with any new health issue.

My weight is not considered a health issue. This despite the fact that my weight, for my height,  is shocking. Fifty pounds below my highest weight would still leave me medically obese. 50 pounds lost moves me at most one or two clothing sizes. I can lose 30 pounds without anyone noticing.

My height and weight suggests a person needing two airplane seats, XXXXL clothing, wheezing, and inability to climb three stairs. In fact I’m in normal clothing sizes, hike and walk frequently, can run a mile if you make me, and only wheeze because of my allergies. I’m not bragging. My weight bothers me. A lot. But I’m grateful that my appearance suggests I need to lose 30-40 pounds, not 100.

My weight history was quite consistent until 2016. I have a big appetite that didn’t make me fat until I was 30. From that point on, I’d have to cut back my intake every five years or so because the same amount of calories wasn’t burning off reliably. I’d ignore my weight gain until something forced me to acknowledge it, then diet to successfully lose weight I’d keep off for five years or more. My methods are a recitation of conventional food wisdom because I always went to doctors to lose weight.

1992: start exercising, cut way back on fat. That rule, I kept as a guideline until 2016. Kept off for five years.

1997: Fenphen,  just in time for the fen to be banned. But phentermine by itself kept working until 2008 or so–that is, slow weight gain but no ballooning. Then my doctor told me I couldn’t have phentermine because of my blood pressure, took me off that and put me on hydrochlorothiazide, which I’ve been on ever since (lisinopril and nifedipine added in 2016).  Ending phentermine kicked off a ballooning that I ignored because I was worried that cutting calories wouldn’t work.

2010: I bit the bullet, just cut calories, and lost over 50 pounds in eight months. At that time, I vowed to monitor my weight and not ignore weight problems and over that time did pretty well. I didn’t keep all the weight off, but keeping a scale kept me from ignoring it and I’d cut back and minimize weight gains, even lose a few pounds.

In 2015, I started renting with my brother, which operated on my eating like an invasive species. His leftovers were my undoing: fettucine alfredo, fried chicken, fried fucking porkchops, fresh baguettes, and he keeps peanut butter on hand. That was when I learned that 30+ years of being solely in control of food purchases had created strictures I didn’t even know existed–like don’t buy it and you won’t eat it. It only took me a year to regroup but that year was a 30 pound weight gain and I was back to my all-time high. Wah.

2016 is when the history pattern changed. I cut calories and didn’t lose weight past a given limit. However, two things occurred that year. First, I got much better at watching my weight. I could gain ten pounds from the low limit and then lose them instead of ignoring the problem. Of equal importance, I decided to cut both calories and carbs, which focused me on carbs for the first time since the 70s and the Atkins plan.

If I were given the choice of (a) abandoning meat and cheese for the Fabulous Four white foods (bread, rice, pasta, potatoes) and vegetables  or (b) abandoning the whites for meat, cheese, and veggies, I’d take (a)  in a heartbeat. But the past six years have made clear that option (b) works better. I’ve cut out all the four whites as well as most corn. Exceptions: sushi rice, the occasional corn tortilla, the occasional slice of bread, and snitched fries. I have had one plate of spaghetti in the past six years–my cousin welcomed me into his home with a homemade sauce and I’m not an asshole and oh, my lord, it was so good. I’ve gone from skim milk to whole to cream in my coffee, which is the only milk I use normally. Sugar hasn’t been an issue for decades. I don’t eat candy enough for it to be an issue. Ice cream is a temptation I avoid by not bringing it home. I haven’t wasted calories on non-alcoholic liquid intake for forty years. If it’s not alcohol it’s sugar free.

Since 2016, I’ve been carefully monitoring my weight, eating under 100 grams of carbs and usually around 1500 calories a day. I put a lot of fat back into my diet in exchange for carbs without consequence. For most of that time I walked 2 miles a day, sometimes more. I was far more at ease about what I could eat and what I would see when I stepped on the scale.

But. I should have been losing weight. Every so often, I’d cut my calories and carbs very low just as a test, but no weight loss beyond my set point. And if I varied from that routine even slightly, I’d put on 20 pounds in a month–which I could lose pretty easily by returning to the routine. Totally different from the previous quarter century when I had to turn weight loss into a project to get serious.

2019: I was back at my high and decided to get below the set point I stalled at. Cut down to 1100 calories.  Painfully lost 30 pounds in 8 months, absurdly slow for my usual effort and barely ten pounds lower than my setpoint. The pandemic hit, I continued the same behavior but upped my walking to 4 miles a day. Still slowly put on weight and was back to the same 20 pound set weight range.

Fall 2021: For some reason the thousandth time I heard the GoLo commercial the message sunk in. I’ve never used the product and have no idea what it is, but I’m grateful for that ad. For the first time, I linked my recent troubles with my brother’s diagnosis of Type II diabetes a couple years earlier to my father’s and uncle’s insulin shots to my just a tad out of the green range A1C and glucose levels, despite my low carb intake. I’m not prediabetic  in the slightest. But maybe I was insulin resistant?

My doctor was intrigued with my theory and suggested I try intermittent fasting, giving me three dictates. Eat only from 10 am to 7pm or some similar window. Do some kind of 15 minute aerobic activity to raise my pulse rate. Finally, if I consumed a lot of artificial sweetener, particularly in diet drinks, stop. There’s some suspicion that sweet things trigger the wrong insulin response, even if the sweetness is calorie-free.

The first was easy. I generally eat from 12 to 7:30. The second was not. I exercised 15 minutes close to daily religiously for four months, then (for reasons I’ll mention in a minute) cut back. I still manage it about 3-4 times a week. The last was fucking brutal. I miss diet Coke and Ice sooooo much. I cannot deal with unsweetened coffee, even loaded with heavy cream. So I add in one packet of stevia, my least favorite sugar sub.

Without any other changes I lost 20 pounds in four months, from the high to low of my setpoint. Calorie wise, probably a wash? I used to eat 400-500 calories after dinner, because I’m a night owl, and those are gone. But I never used to eat lunch, which I do all the time now.  Still low carb. I tried going keto but didn’t like it, so kept carbs under 100, usually 50-75 grams.

I still stopped cold at my usual set point. I cut calories down to 1000 for a while and exercised more, to no avail. Barely two pounds in four months. By now, I was pretty convinced that insulin resistance was somehow involved, so I kept to the fasting, although I hate raising my pulse so I cut back a bit on the cardio.

My doctor agreed the halt was weird and sent me to a weight loss endocrinologist. That’s when  I learned there were a number of weight loss drugs on the market. I’d been out of touch for a while.

I’m on Mounjaro. Originally intended for Type 2 diabetes, Mounjaro is, like other diabetes drugs, making the move to the weight loss market. My understanding is that it is not yet approved by the FDA for this purpose, but is on the FDA fast track.

“It’s really expensive and may not be covered by insurance” said the endocrinologist.

“How much?”

“1400.”

“A year?”

“A month. But there’s a coupon.”

“How much?”

“Twenty five dollars.”

“That’s not much of a coupon.”

“Oh, it’s not $25 off.  It’s $25 total.”

Imagine my confused face. That’s not what I’d call a coupon. Still, it’s $25/month with free delivery at convenient hours. My insurance covers around $400 of the cost anyway.

I increased my weekly dosage from 2.5 to 7.5 so far. I’ve lost 12 pounds in 10 weeks, ten pounds below my setpoint, without any other changes.  In fact, since school started I’m actually walking a bit less because I’ve got so much going on.

Side effects: occasional nausea, usually 3 days after taking. Nothing horrible. At this new higher dosage I might be eating a bit less. Hard to tell. My medicated blood pressure seems a lot lower. 115/80 at end of day instead of 135/80.

The endocrinologist is constantly asking me how my behavior changes, am I eating less, and so on, and is skeptical that I’m dropping weight with no other changes. My internist is much more friendly to my theory that this drug is changing my body chemistry in some way. Various reddit threads have testimonials to how the drug has stopped the taker’s binge-eating and hunger pangs. None of that applies to me. I wasn’t a binger, had no food issues, and my appetite hasn’t changed much.

My own theory is that changing my carb intake in 2016 took me off the Type 2 diabetes path, but that the insulin resistance path is unaffected by diet changes? Keep in mind I have only a vague idea what insulin does. Science is still the one subject I don’t teach. In any event, if this continues to work, my doctor agrees with me I’ll probably have to take it permanently.

Moral: none.

Well, I would point out that the sarcastic nasties who say “Losing weight is done by reducing calories” are just being shitty. Even at starvation intake, people process calories differently. On the other hand, a lot of the people who are really obese ate themselves that way. Ultimately, I’m not sure it matters. I think a lot of permanent weight loss will involve drugs. In writing this history, I’m struck by the much longer gap there is between my weight rebound from 1997 to 2008, the other time I was on weight loss drugs.

Here’s hoping I keep losing.

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15 responses to “Weight Loss and Mounjaro

  • larrycuban

    Hey, what a story. Thanks for posting it. Larry

  • jb

    Interesting. Your writing gave me the impression of someone skinny! I’ve drifted up and down within a 20 pound range my entire adult life, but it’s never been a big deal. My sister though struggled with weight all her life. Then the pandemic forced her to change her lifestyle, and she dropped a ton of weight, just like that. Cutting carbs seems to have been a big part of it. I love cookies and pastries myself, but I never buy more then I intend to eat on the spot, and I absolutely will not have them in my house. But Diet Coke by the case!

  • amac78

    Great story, EdR. Kudos for the record keeping — only by keeping track have you been able to make sense of the ups, downs, and stalls.

    For those of us in the Clydesdale club (talking about myself here), sustained weight loss is hard, and it gets harder as we age.

    I’ve thought about semaglutide and similar drugs for this purpose for a while… your experience with Mounjaro is encouraging.

    • educationrealist

      It helps that I’m not a yoyo dieter. for most of my life, I would ignore my weight as a task and only take it on when it was a project. So I have clear memories of the three times I did it in 20 years.

      Semaglutide is Ozempic, right? It’s the path that Mounjaro is following. So far studies show Mounjaro is exceeding Ozempic numbers, but Ozempic is pretty impressive, too. As I understand it, Mounjaro only went into weight loss because they saw weight loss among their Type 2 losers.

      It’ll be interesting to see if diabetes meds are working because so many type 2 folks are actually insulin resistant who developed type 2 diabetes because they didn’t realize they were insulin resistant–rather than the other way round. There’s definitely genetic elements to type 2, despite the morality lectures about eating. That is, I think (and my internist agrees with me) what my experience *might*show, assuming it continues. That I was insulin resistant despite low carb diet.

      I don’t know why my endocrinologist put me on Mounjaro instead of Ozempic. Interesting question. I advise trying it. Mounjaro clearly works with people who have trouble with binging and carbs and the like, not just the relatively fringe group like me.

  • Some Guy

    Potatoes are supposed to be the most filling food for how many calories they contain, there’s a whole “potato diet”-thing for weight-loss.

  • Anonymous

    Doug McGuff
    Youtube his insulin 101.
    Weight training of 15 minutes every 1 or 2 weeks handles the non diet insulin resistance.

    By the way, you are an awesome writer and educator. Best wishes in every way.

  • Aung

    First discovered your blog years ago (funnily enough while I was in high school) and appreciate how you are venturing into (apparently) unchartered territory of your personal health. I thought I might share some information.

    I am currently helping my father treat his Type 2 diabetes which he did not know he had until he experienced a TIA which landed him at hospital and saw him diagnosed with a slew of common comorbidities after doctors administered tests. He was not fat and seemed (relatively) healthy, except for a major alcohol problem.

    Subsequent tests actually revealed atherosclerotic cardiovascular disease, albeit fairly unadvanced, which probably what saved his life, high hba1c, and extremely high LDL-cholesterol and dyslipidemia.

    I don’t trust doctors because of my own experiences with them (a chronic medical condition misdiagnosed as a teenager until I self-diagnosed and took the appropriate tests), so I made a vow to become as informed on the subject as I possibly could.

    My immediate discovery was the tremendous gulf between popular understanding and established medical understanding at the highest level of research. Some of the conclusions are extremely counter-intuitive. Specifically:

    1. The cause of pathogenesis is linked to genetics, which I don’t think surprises anybody, but also to excess calorie intake, of which dietary saturated fat and simple sugars are especially implicated, especially saturated fat, more than carbohydrate intake.

    2. Carbohydrate restriction to control diabetes is actually not recommended in the medical literature at all – I cite the two most respected textbooks on diabetes Joslin’s Diabetes Mellitus & International Textbook of Diabetes Mellitus. It doesn’t lessen mortality or morbidity in the absence of weight loss, and indeed may be dangerous because of its contribution to various risk factors for heart attack and stroke, which would be in addition to diabetes (itself a risk factor), if they are based around high saturated fat diets.

    3. Excess blood sugar is a marker, not the driver of the disease – and the most dangerous sequelae of diabetes is cardiovascular disease, which treatment is focused on stopping from progressing. Lowering blood sugar and doing nothing else, ie. not losing weight, may have little benefit.

    4. Diabetes treatment, aside from managing risk of heart attack and stroke, is fundamentally about weight loss.

    Hyperinsulinemia can actually be a warning sign of diabetes developing, often preceding the onset of diabetes by years.

    High blood sugar readings are actually very easy to come by on extremely low carb diets (including for celebrity doctors promoting low carb diets like Tim Noakes as well as Shawn Baker – the former who takes Metformin for his Type 2 diabetes despite being on a low carb diet and the latter an athlete who promotes a zero carb, wholly meat diet (yes) who had extremely high blood sugar bordering on diabetes on his lab tests, which he made public). OGTTs showing reversal of diabetes mellitus on low carb diets are very scarce.

    It seems the fundamental driver of elevated blood sugar is the liver, which produces sugar de novo after a meal, not dietary excess of carbohydrate, and the accumulation of fat in the liver, secondary to adipocyte dysfunction, seems to be where and how the diabetes is induced. Exactly how early the adipocyte dysfunction starts to occur may be highly variable in individuals which may explain your health in spite of your weight problem.

    In any given individual, lowering calories will produce an effect toward weight loss no matter what. Your observation is obviously correct though that people metabolize energy completely differently, as we’ve all seen in our personal experience.

    If low carb diets help you lose weight more easily, it may be wise to build one based on healthier fats (some people have apparently done it, and one lady who seems to be taking this seriously is The Skeptical Doctor if memory serves me right).

    I can recommend some sources which I have found helpful:

    Evan Allen, particularly his book ‘Oversaturated: A Guide to Conversations about Fats with Your Patients’ – also check out his Twitter EAllen0417 – his story is actually similar to yours

    Joslin Center for Diabetes on YouTube

    C. Ronald Kahn, specifically his video ‘Does Eating a Lot of Sugar Cause Diabetes?, on YouTube and WebMD

    The latter two are highly respected and mainstream sources and are pioneers. If you take the time to listen to C. Ronald Kahn, I think you will be surprised at what you hear.

    Evan Allen has written an entire chapter in his book about a novel mechanism whereby saturated fats contribute to heart disease, unrelated to LDL-cholesterol.

    Keep us updated!

    • educationrealist

      Interesting! I, too, am not overly trusting of doctors. To be clear, I am not pre-diabetic, type 2 or otherwise. I don’t have high cholesterol or high hb1ac counts. All my bloodwork is aggressively normal, which is what’s so weird.

      I am not keto. Didn’t like it at all. I don’t restrict carbs. I just don’t each much of the four whites or sugar. I definitely eat healthy fats. I would love a world where I eat lots of legumes and rice but I put on weight easily on legumes.

      I’ve read some of the healthy diet stuff for diabetes and they all encourage relatively low meat, lots of legumes and vegetables, and relatively low fat and that’s a diet that causes me to balloon, so I’m going to have to pass on that. But in general, I have a very healthy diet and while I’m usually under 100 grams of carbs a day, I’m eating lots of vegetables and healthy fat.

      Thanks for the info!

      • Aung

        Well, I agree. Diets are hot issues because everybody, literally everybody, makes choices about what to eat, likes to think they’re making informed choices and has privileged information. Also the promise of overriding genetics that seem to program some to intractably put on excess weight in conditions of food surplus. Yet I have put, and lost, weight on a low carbohydrate/high fat, high carbohydrate/low fat diet, been slim (and fatter) on a meat-based diet and a vegetarian diet, and even lost weight eating mostly chocolate – each of these would seem to defy at least one widely believed theory about what constitutes a ‘healthy’ diet for weight management. Add to that the unsolved riddles of appetite regulation – for example, why anti-psychotics induce weight gain for so many people who take them. As well as other ‘missing pieces’ that seem to be consequential – such as the gut microbiome (Kahn also has a lecture on this).

        Your post suggested to me you had normal blood sugar but were hyperinsulinemic, which was a red flag, but if your blood work is normal, then that may not be the case.

        The primary takeaway of my research is extremely aggressive reduction in saturated fat – for weight control, avoiding diabetes and stopping complications of diabetes – which may be of some relevance to you, if you haven’t tried it before. Sources can be tricky – a packet of instant noodles can have as much saturated fat as a cheeseburger (the good thing about avoiding refined carbohydrates is you avoid many categories of food also low in saturated fat), cooking oils, meat that isn’t fish, are all culprits.

        Keep us posted on what happens with you.

      • educationrealist

        I’m not sure of the line between healthy and saturated fats.

        Healthy fats I eat: olive oil, tofu,edemame beans, salmon, avocado, occasional dark chocolate, nuts.
        Saturated fats I eat: cheese, cream, meat, poultry, butter.

        I have fricking awesome cholesterol levels, so I’m doing something right and I am not messing with my fat intake. Besides, last I checked they’d concluded there was no evidence to support the dietary guidelines on saturated fat.

        Like you, I’ve lost weight both by cutting fat and cutting carbs and just cutting calories without respect to type. Of all the diets that made me feel the most in control and not hiding from the scales was reduced carbs, high protein and fat, but not keto.

        I’ve lost 20 pounds as of Sunday, whoo.

  • Post-Pandemic Update | educationrealist

    […] going fine. I’ve been so busy I haven’t had time to write, plus the Mounjaro tends to wipe me out (22 pounds! although it’s a lot more expensive now).  But this year has […]

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