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In some instances, its hard NOT to see it. Bruh.
The only thing i didnt quite follow was the sort of “woke” conclusion that peyote should only be a native american thing. With modern agriculture we can allow them to have as much holy cactus as they want while allowing others to also benefit from the medication as well. There is enough for everyone.That was a great watch.
Fun to watch him try the drugs, too
Because....Not sure why this is triggering.
Right now the drugs are pricey, but Lilly’s oral pill is even more effective and will be on the market soon. I think these agents are peptides that can be made quite cheaply. In London, Boots was advertising virtual consultations and had it for 1-200$I've tried it. So while I don't have the insight of a PCP, I do have the insight of a patient. Here's my perspective.
I'm 50, no medical comorbidities and don't qualify for a statin. BP is borderline.
I work out regularly, can do 40 pushups in a row and am fat. (BMI qualifies for Wegovy).
I've fluctuated +/- 30 pounds several times in the last decade. Parents are also fat (and still alive with good PS).
Talked to my wife (who is a pcp but not mine) and my PCP, who was kind enough to get samples. I have very good health insurance.
Started samples (had about 8 weeks worth). You taper up dose, but I noticed a change in appetite quickly. By 4 weeks in, I was eating much less. Ran though my 8 weeks of samples with about a 15 lb weight loss. No desire to eat in my normal way.
Some downside for me. I felt a little flat. I take a lot of joy in eating (and other things) and I think this impacted me. Also, nausea was real. I had to stop a workout early due to nausea (so while I was lighter, my exercise tolerance was not improved during this short interval).
Have not gotten insurance pre-auth for my script yet. Have been informed by pharmacy that even with pre-auth, I'm looking at a 6 week wait (weight) due to shortages.
BTW. My ass is gorgeous.
He is clearly into massive derrières and thicc thighs. No judgement there brotha.Because....
You like big butts
but you try to deny
That you're another lover of the thick thigh
and when phlebotomy leans to go to extremes
You get sprung.
I think it's pretty remarkable. The impact on bariatric surgery is going to be crazy.Right now the drugs are pricey, but Lilly’s oral pill is even more effective and will be on the market soon. I think these agents are peptides that can be made quite cheaply. In London, Boots was advertising virtual consultations and had it for 1-200$
Hyperinsulinemia (blood sugar can still be normal) is probably the underlying cause of many of the diseases of aging.I think it's pretty remarkable. The impact on bariatric surgery is going to be crazy.
I'm aware of some endocrine types who have sworn by metformin (different mechanism entirely) even for non-diabetics for glycemic and weight control (maybe even cancer risk reduction).
I think figuring out the proper use is going to be interesting. I opted to try it because I knew it was effective and was hoping that the weight loss would help me stay off of other meds as I moved from 50-65. (I also just wanted to lose weight).
Metformin improves longevity as well iircHyperinsulinemia (blood sugar can still be normal) is probably the underlying cause of many of the diseases of aging.
The most promising drug in the longevity space is rapamycin. It has improved lifespan in every model organism tested. Being trialed right now in the Dog Aging Project and if positive, will seriously think abt it.Metformin improves longevity as well iirc
Drugs in this class (Saxenda/Victoza, Trulicity) have been around for over a decade. It's not like we have no idea how the drugs behave in large population samples.
Except the drug doesn't let you. Most patients on it have to remind themselves to eat because the urge to eat decreases significantly. Plus the nausea is a real side effect, particularly if you overeat. That's just how these drugs work.
1) All rapid weight loss results in a large amount of muscle loss. This is true whether that loss occurs with severe calorie restriction, fasting, liquid-shake diets, or Wegovy. Care has to be taken to preserve muscle mass, although that also means a slower rate of weight loss.
How many of you heard, or even suggested, 800-1200 calorie diets to patients? Any patient that adheres to one of those severe diets will have saggy skin (and slowed metabolism) because they're losing muscle mass, but I don't see anyone in this forum saying, "Oh yeah, those diets were terrible ideas and why did doctors ever recommend them?"
And, FFS, it's not melting faces. You know better than that.
2) I find it extremely hard to believe that "lots of our office staff are on it" or "all the ladies at the country club are on it." My DIABETIC patients can't even get it because it's been on back order for so long. Many patients are calling 2-3 different pharmacies just to find it.
I have seen exactly two insurance plans pay for it for non-diabetics, and that's even if you try getting it covered under "metabolic syndrome" or "PCOS" or "insulin resistance." Out of pocket, it's $900. How much are you paying your MAs that they can pay for it in cash? What kind of insurance plans are you offering your staff?
I have no idea but from a bystander's point I have watched them go from rather large derriere to melted-butt in a couple of months. Just nuts. It can't be just fat, the gluteal muscle (large muscle), i mean it's like there's nothing there and skin covering bone. Perhaps this is just a matter of not dosing correctly during self-administration? I don't know enough to know what's going on. If this isn't happening during physician-directed weight loss with it, then I believe you but this is what I have seen.
Agree with you completely on all the other points.
Always love when a bunch of Rad Oncs try to discuss super positive things happening in PCP world in a negative light (mehrlicht and spams) and then get shut down by like someone actually living and experiencing it every day.
@mehrlicht and @sirspamalot, your dunning-kruger and biases are showing.
Bruh - most overweight people carry a LOT of fat in their rear end in hips. In women it is traditionally 'coveted'. You're the one who hates 200+ pound women in a swimsuit. Care to guess where a lot of their extra weight is? Could it be that they are losing fat from their butt when they are on Ozempic because that's where they have the most to lose? And those who AREN'T losing it there, may have had plastic surgery to enhance the booty (much more common now than 10+ years ago)? I'm sure @smq123 can regale us with a fair number of horror stories of the BBL...
I was like kinda tempted to just close this thread but letting strong opinions that disagree with one another is one of the penchants of SDN.... so idk, ya just sound kinda silly to me.
mehrlicht - 'Just do a 96 hour fast and eat nothing but protein, GOD, ya ****ing pissants!'
I thought some more about this and realized I was wrong. The bizarre reaction to face melting comments is not about the big-is-beautiful body positivity stuff (which would be ironic because of the vociferous defense of a drug people take with a desire to become slim -- why do you want to be slim if there are beautiful morbidly obese models?). No, the triggering part was "it's obvious" which I hate to break it to you, but it is (because you are rapidly losing an unusual amount of muscle and connective tissue in proportion to body fat (I have seen reports as high as 1:1) than you would by other methods of weight loss). I realized this as it's the same reaction when you try to suggest that breast augmentation or anabolic steroid use is obvious. No guy, I got like this by eating tuna and hard work in the gym, wanna fight huh? </flame_suit_on>
It's obvious! There is data! You just have to look it up! I won't link you anything that explains my minority (in this thread) opinion about the immense dangers of this that you all are otherwise positive about! You just have to do your own research! I've done mine (but won't link to it) and clearly it's just SO negative that all of you are all being fooled by pharma! Ozempic melts butt muscles, not butt fat, there's all sorts of data to prove that it's true! But you have to search for it yourself, I am incapable of providing any literature defending my position! You have to do the research!
That's how you sound like to me. Do you know what that sounds like? A COVID anti-vaxxer. So you sound like a COVID anti-vaxxer to me. I'll leave it up to you to determine whether that is a good thing or not.
Yes, and as a PCP, who probably prescribes Ozempic on a daily basis, has alreayd informed you and us, any strategy leading to rapid weight loss will result in muscle loss, so the same measures tha tshould be taken otherwise should be taken with Ozempic.And you sound unhinged.
Since you brought it up, we can talk about the shortcomings of the covid vaccine if you like (I bet you will not like).
It is not hard to search pubmed: Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus - PubMed
Conclusion: Although semaglutide, dapaglifrozin, and canagliflozin have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in FFM was observed.
I have no idea why the fact that these drugs cause significant very-noticeable muscle loss and efforts need to be taken to try and mitigate that (high protein diet and weight training) bothers you so much.
No, this is what we absolutely do not agree on, and I provided you data to support this increased rates of fat-free mass loss from these drugs as compared to something like a low carb calorie-restricted diet and daily exercise (ie, lifestyle changes) that will preferentially lower body fat levels and minimize lean mass loss if not actually improve it.Do you agree that other forms of rapid weight loss cause similar loss of muscle mass?
Do you agree that we have no data suggesting that Ozempic induced rapid weight loss results in more significant muscle mass loss compared to alternative forms of rapid weight loss?
ps. dude, I'm starting to worry about you. whats next, screaming 'wokism' is ruining america? Say it ain't so!
So, ahh, double?
You will say lifestyle changes are not methods of rapid weight loss. Alright, so even if you want to look at extreme methods of weight loss like bariatric surgery, you still lose more lean mass with Ozempic. And just diet and exercise can be "extreme" too if you cut your calories way down, you just have to survive being hungry all the time.
The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis
Postbariatric loss of muscle tissue could negatively affect long‐term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta‐analysis aimed to unravel time‐dependent changes in ...www.ncbi.nlm.nih.gov
Our meta‐analysis demonstrated over 8‐kg FFM and LBM loss within 1‐year postbariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.
So fat-free mass loss of 21% and lean body mass loss of 22% with bariatric surgery
vs. numbers near 40% reported for the drugs in question.
So, ahh, double?
That donut looks effing delicious!Maybe we need to design invisible force fields, or maybe just good old fashioned mouth clamps. I told my wife if someone with a BMI>45 walks up to McDonalds, BY LAW, they should not be allowed to order anything but SALAD and plain chicken. Sales of Soda would be treated the same as beer.
Imagine the black market for nuggets and beer. I know I know.. I'm weird.
SGlT2 inhibitors- (5 of them) stop kidneys from reabsorbing sugar. They are now standard of care in NON-diabetics with heart failure and kidney disease as they slow progression. (multiple NEJM articles) Also in the NIH's National intervention testing program, SGLT2 inhibitors make mice live longer. So diabetic drugs are affecting overall health (I posted on this before). Wegovy (GLP1R agonist) is also being trialed phase 3 internationalfor alzheimers. Pill formulations are coming soon
I agree. I am not a GLP-1 expert at the basic science level or really any level. But I was getting chewed out for suggesting that these drugs are not 1:1 comparable to things like bariatric surgery and causing pancake-butts, which I have just false and I have demonstrated that with data as requested.
My suspicion is that they may end up causing a lot of harm when used in certain populations. And I have some concerns about how they are being presented as a magic-bullet quick-fix and gobbled up by mildly overweight middle aged women. I am always immediately suspicious of things that promise to easily solve complicated problems (as is probably obvious from my comments about you know what).
My other concern is that people will use the med as a way to get away with avoiding healthy lifestyle modifications. I don't envy you in having to deal with that and convince people that the drug can be dangerous on its own and it still takes work from the patient to be healthy.
Maybe we need to design invisible force fields, or maybe just good old fashioned mouth clamps. I told my wife if someone with a BMI>45 walks up to McDonalds, BY LAW, they should not be allowed to order anything but SALAD and plain chicken. Sales of Soda would be treated the same as beer.
Imagine the black market for nuggets and beer. I know I know.. I'm weird.
The people irresponsibly prescribing Wegovy were previously irresponsibly prescribing Phentermine. Anything can be turned into a magic bullet if you are greedy enough. Isn't that how we ended up with, what, 900 proton centers in this country?
Most of the patients who ask for it have tried everything. I think you are underestimating the amount of fat shaming (and also, internalized fat shame) that the obese have encountered. Almost all of them have hired a personal trainer or have gone to Orange Theory on a regular basis, have done Weight Watchers, have done keto/paleo, etc. And it wasn't sustainable for most, or they didn't see results, so they stopped - hard to blame them. So they see their doctor to ask about this drug, which is fair. They're very well aware that it takes work to be healthy - they've done that work but they didn't see any significant weight loss from it.
You will say lifestyle changes are not methods of rapid weight loss. Alright, so even if you want to look at extreme methods of weight loss like bariatric surgery, you still lose more lean mass with Ozempic. And just diet and exercise can be "extreme" too if you cut your calories way down, you just have to survive being hungry all the time.
The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis
Postbariatric loss of muscle tissue could negatively affect long‐term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta‐analysis aimed to unravel time‐dependent changes in ...www.ncbi.nlm.nih.gov
Our meta‐analysis demonstrated over 8‐kg FFM and LBM loss within 1‐year postbariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.
So fat-free mass loss of 21% and lean body mass loss of 22% with bariatric surgery
vs. numbers near 40% reported for the drugs in question.
So, ahh, double?
Huh?Go to Australia and buy a 6 pack of craft beer. It cost me $55. It's a nanny state with a lot of sin taxes. Yet, still very high rates of alcoholism.
Excise taxes on things like soda have been failures in the past too.
These types of taxes unfairly burden the poor, unfortunately since they are regressive by design.
Government always screws it up. Because it has one tool: A big hammer to try and force things. Mouth clamp? Have you never had patients put beer through the PEG tubes before? People always figure out a way to get what they want...
Out of curiosity (no judgment), was this a "I know these numbers because I've studied this previously" or "I had a conclusion in mind and I was able to find studies that supported it"
Why does nobody believe me about anything!