> Some people think of Science, with a capital-“S”, as the official declaration of eternal truths. I prefer to think of science, with a lower-case “s”, as a messy scrabble toward half-truths that are often overturned with further research.
Yes!
It is a process: systematic study of the natural world through observation, experimentation, and evidence-based reasoning.
It is a world view: a way humans try to understand how things work.
It is not a set of immutable facts etched into a stone tablet somewhere in the cosmos waiting to be decoded.
classichasclass · 3h ago
I remember the first patient I put on exenatide, years ago. She was a diabetic that was very brittle and we were having trouble managing it, and I said it was worth a try and she agreed. "It might even cause a bit of weight loss, which I'm sure you won't object to," I said, which we had a good laugh over.
She lost 10 pounds and a whole point off her A1c. And that was just the first of the drug class. She was very pleased with it.
Also, pedantic nitpick: the anglerfish in the photo is female.
andsoitis · 4h ago
> 3. So, should we all be on GLP-1s?
> No. Certainly not now. While I’m excited about the future of these drugs’ development, the side effect profile isn’t worth the risk for otherwise healthy patients. The anti-inflammation and cognitive benefits of the drugs still come with weight-loss effects that many Americans shouldn’t accept.
Another way to fight inflammation is taking Metformin, popular in longevity circles.
burnt-resistor · 24m ago
It's been suggested before that metformin could be safely taken by almost all adults who aren't underweight to improve quality of life and longevity.
genocidicbunny · 1h ago
> popular in longevity circles.
Also with medical practitioners dealing with anything renal. Though for them, it's more that it's one of the drugs you get asked about specifically whenever you have any injections that might be harsh on the kidneys. There's a reason they ask about it when you get contrast for a CT.
falcor84 · 4h ago
That was really well written, and I love how it arrived at the hopeful:
> If the steam engine was the little machine that accidentally explained the universe, the GLP-1 hormone may one day be regarded as the peptide that accidentally decoded the body, the mind, and basis of human health.
BryantD · 3h ago
Very good article.
As someone who is currently on GLP-1 drugs, I will say that if I didn't need to be on them to control my diabetes, I would seriously consider stopping. I am undoubtedly healthier and have lost substantial weight, but the effects on my quality of life are substantial -- I simply don't enjoy food right now. This is in part psychological, because what I used to enjoy was the psychological effect of eating, but not completely. I hope this will ease out over time and if it doesn't, well, I'll cope.
I'm still very interested in the ongoing research.
genocidicbunny · 2h ago
How long have you been on a GLP-1? It took me about a year to start to change my relationship to food. Initially, I had the same reaction -- I stopped enjoying food, which led to problems with caloric deficiency, and especially the lack of protein. But eventually my brain started to rewire itself from thinking food == good, to good food == good. If you've spent a significant part of your life treating food as an addiction, even if the physical urges go away, the mental side takes longer.
Funny enough though, is that it's caused me to spend way more time thinking about food because it's no longer a mindless activity. A bag of crisps can last me a month. The last pint of ice cream I bought got freezer burn because of how long it took me to finish it. If I'm cooking something, it's no longer going to be some recipe where you throw a bunch of stuff together and get a giant pot of food to stuff your face with, it's going to be something that takes effort and time and skill to prepare because it has to be _good_.
BryantD · 2h ago
Coming up on five months now! Thank you very much for your comment -- I've been hoping based on research and talking to people I know that you do rewire eventually, and you reinforced all of that. Appreciated.
And yeah, caloric intake is a concern. The diabetes means I'm also changing my diet a fair bit which doesn't help; I haven't had ice cream in months. I am pretty sure I'm overcompensating and have recently pushed myself into more experimentation with food; the availability of real time glucose sensors is huge even if I feel weird walking around with a Bluetooth device plugged into my arm.
genocidicbunny · 1h ago
Regarding the caloric intake, my GP suggested tracking calories, but also to use protein supplements. It's not the tastiest thing, but it's a fairly easy way to both manage your caloric intake to healthy levels, and to ensure that you're getting enough protein. Otherwise you might end up losing additional weight from losing muscle mass. That makes it even easier to stop performing physical activities, and also puts strain on your kidneys due to the breakdown of muscle mass. Diabetes definitely makes it more challenging since you have to avoid foods that are an easy source of additional calories to make up for the deficit, but it's doable.
I don't know what your dosing schedule is, so this might not be as applicable. For me, it's weekly, so early on what I started doing was setting it up so that saturday or sunday would be the tail end of the week for the dosing, so that as the effects wore off a little I had more motivation for food. I would then use that to meal prep some easy freezable meals that I would use for the days when I had a longer or more stressful day, and would be even less inclined to cook. Soups and stews were especially good for that. So even if I wasn't feeling hungry, and had no real desire to prep anything, I could just throw something the microwave to heat up over like 30 minutes and I would at least have a good meal to eat, and avoid just skipping the meal entirely due to the lack of desire for food. And since I was cooking these myself still, it gave me some extra motivation to do it well, which eventually grew to the improvement of cooking skills I mentioned in the previous comment.
And as far as the CGM, don't feel too weird about it -- as far as I am concerned you're helping pioneer continuous metabolic monitors that not only monitor glucose levels, but other metabolic and hormonal measurements. I'd love to have a little device I can stick on my arm that gives me continuous monitoring of various metabolic properties instead of needing to have regular blood tests performed for them.
lurking_swe · 1h ago
> I haven't had ice cream in months
i think over time you’ll find yourself getting excited about excellent _meals_ instead of deserts. It’s a journey, hang in there!
The concept of a desert is also subjective. I always challenge people to ask themselves - why can’t our desert after dinner be a bowl of strawberries or an orange? Why must it be a brownie / cookie / ice cream?
Food for thought. :)
skissane · 1h ago
> but the effects on my quality of life are substantial -- I simply don't enjoy food right now. This is in part psychological, because what I used to enjoy was the psychological effect of eating, but not completely. I hope this will ease out over time and if it doesn't, well, I'll cope.
I've been on tirzepatide for 4+ months – I don't have this problem. I don't really care about whether I enjoy eating. It definitely has helped reduce the incidence of stress-induced overeating and binge eating. My main problem has been gastrointestinal side effects (especially acid reflux), but they are manageable and have been moderating with time. I still somewhat enjoy eating (even if not as much as I used to), but are so many other pleasures in life besides food anyway.
I also take lisdexamfetamine. When I first started on lisdexamfetamine, I lost a lot of weight – but then I put it all back on. (It wasn't prescribed for weight loss, that was just a temporary beneficial side effect.) We also had to cut back on the dosage because it aggravates my obsessive traits. Tirzepatide doesn't seem to do anything to aggravate those traits, it is somewhere between neutral and positive in its impact on them – and I don't expect I'm going to "put it all back on" like I did with lisdexamfetamine.
ivape · 3h ago
Isn’t it $200/mo vanity drug for regular people (no medical reason for it)?. You can up with bullshit to get it, but even then it’s expensive.
burnt-resistor · 23m ago
It's not a vanity drug if you're obese due to genetics or side-effects of other medications.
It's myopically arrogant to throw shade with a big brush over fringe cosmetic uses when there's an incredible amount of benefit offered to formerly morbidly-obese individuals and people with seriously decompensated metabolic-associated diabetic conditions. Yes, GLP-1's are absurdly overpriced mostly in America where there are comparatively few healthcare consumer protections.
bicx · 2h ago
I don’t think weight loss is vanity (assuming that’s what you mean). There are many health issues caused by obesity, and a lot of us end up paying for the advanced medical care (regardless of being obese or not) for obesity-caused illness through increased premiums and taxes to cover high Medicare costs.
ivape · 1h ago
I consider obesity a medical condition. By regular people I meant those that let go but are within diet/exercise range (not obese on paper or the eye).
raincom · 1h ago
You can make it for less than $1 per gram. So, it costs about $10 per month.
Yes!
It is a process: systematic study of the natural world through observation, experimentation, and evidence-based reasoning.
It is a world view: a way humans try to understand how things work.
It is not a set of immutable facts etched into a stone tablet somewhere in the cosmos waiting to be decoded.
She lost 10 pounds and a whole point off her A1c. And that was just the first of the drug class. She was very pleased with it.
Also, pedantic nitpick: the anglerfish in the photo is female.
> No. Certainly not now. While I’m excited about the future of these drugs’ development, the side effect profile isn’t worth the risk for otherwise healthy patients. The anti-inflammation and cognitive benefits of the drugs still come with weight-loss effects that many Americans shouldn’t accept.
Another way to fight inflammation is taking Metformin, popular in longevity circles.
Also with medical practitioners dealing with anything renal. Though for them, it's more that it's one of the drugs you get asked about specifically whenever you have any injections that might be harsh on the kidneys. There's a reason they ask about it when you get contrast for a CT.
> If the steam engine was the little machine that accidentally explained the universe, the GLP-1 hormone may one day be regarded as the peptide that accidentally decoded the body, the mind, and basis of human health.
As someone who is currently on GLP-1 drugs, I will say that if I didn't need to be on them to control my diabetes, I would seriously consider stopping. I am undoubtedly healthier and have lost substantial weight, but the effects on my quality of life are substantial -- I simply don't enjoy food right now. This is in part psychological, because what I used to enjoy was the psychological effect of eating, but not completely. I hope this will ease out over time and if it doesn't, well, I'll cope.
I'm still very interested in the ongoing research.
Funny enough though, is that it's caused me to spend way more time thinking about food because it's no longer a mindless activity. A bag of crisps can last me a month. The last pint of ice cream I bought got freezer burn because of how long it took me to finish it. If I'm cooking something, it's no longer going to be some recipe where you throw a bunch of stuff together and get a giant pot of food to stuff your face with, it's going to be something that takes effort and time and skill to prepare because it has to be _good_.
And yeah, caloric intake is a concern. The diabetes means I'm also changing my diet a fair bit which doesn't help; I haven't had ice cream in months. I am pretty sure I'm overcompensating and have recently pushed myself into more experimentation with food; the availability of real time glucose sensors is huge even if I feel weird walking around with a Bluetooth device plugged into my arm.
I don't know what your dosing schedule is, so this might not be as applicable. For me, it's weekly, so early on what I started doing was setting it up so that saturday or sunday would be the tail end of the week for the dosing, so that as the effects wore off a little I had more motivation for food. I would then use that to meal prep some easy freezable meals that I would use for the days when I had a longer or more stressful day, and would be even less inclined to cook. Soups and stews were especially good for that. So even if I wasn't feeling hungry, and had no real desire to prep anything, I could just throw something the microwave to heat up over like 30 minutes and I would at least have a good meal to eat, and avoid just skipping the meal entirely due to the lack of desire for food. And since I was cooking these myself still, it gave me some extra motivation to do it well, which eventually grew to the improvement of cooking skills I mentioned in the previous comment.
And as far as the CGM, don't feel too weird about it -- as far as I am concerned you're helping pioneer continuous metabolic monitors that not only monitor glucose levels, but other metabolic and hormonal measurements. I'd love to have a little device I can stick on my arm that gives me continuous monitoring of various metabolic properties instead of needing to have regular blood tests performed for them.
i think over time you’ll find yourself getting excited about excellent _meals_ instead of deserts. It’s a journey, hang in there!
The concept of a desert is also subjective. I always challenge people to ask themselves - why can’t our desert after dinner be a bowl of strawberries or an orange? Why must it be a brownie / cookie / ice cream?
Food for thought. :)
I've been on tirzepatide for 4+ months – I don't have this problem. I don't really care about whether I enjoy eating. It definitely has helped reduce the incidence of stress-induced overeating and binge eating. My main problem has been gastrointestinal side effects (especially acid reflux), but they are manageable and have been moderating with time. I still somewhat enjoy eating (even if not as much as I used to), but are so many other pleasures in life besides food anyway.
I also take lisdexamfetamine. When I first started on lisdexamfetamine, I lost a lot of weight – but then I put it all back on. (It wasn't prescribed for weight loss, that was just a temporary beneficial side effect.) We also had to cut back on the dosage because it aggravates my obsessive traits. Tirzepatide doesn't seem to do anything to aggravate those traits, it is somewhere between neutral and positive in its impact on them – and I don't expect I'm going to "put it all back on" like I did with lisdexamfetamine.
It's myopically arrogant to throw shade with a big brush over fringe cosmetic uses when there's an incredible amount of benefit offered to formerly morbidly-obese individuals and people with seriously decompensated metabolic-associated diabetic conditions. Yes, GLP-1's are absurdly overpriced mostly in America where there are comparatively few healthcare consumer protections.