GLP-1 and Me

I’ve written plenty about my health/nutrition/weight maintenance experience as a woman steeped in perimenopause. The reality: it just gets harder to keep up as the years pass, as the hormones wane, and as I go out and do more adult-y things (like eating at restaurants). This article is about my decision to try the GLP-1 route.

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During the summer, I went to all my yearly doctor checkups: internist, gynecologist, and endocrinologist. The latter, because 30 years ago, I had my thyroid surgically removed after the doctor found cancerous cells. That’s a whole other story, but the end result is I’m fine, I take a tiny pill every morning, and life is great.

Every year, my endocrinologist marvels at my general health. I’m probably his healthiest regular patient, and he looks forward to our annual visits, given the amount of metabolic illnesses he treats daily. We do a full blood panel to check the nitty gritty details to see if anything needs to be tweaked. Cholesterol has generally improved with nutrition and movement, up and down a few points here and there.

But in recent years, as predicted, the midlife belly creep was starting to get the better of me. As we discussed my numbers, I asked him if it was a good idea to consider starting a GLP-1.

To be clear, I am not obese. I am just over 5′ 7″ (down from my younger adult height of 5’8″), active and muscular, but my weight had crept back up into the 180s. I was not happy with this, seeing how my clothes were fitting a more snugly and I could see the difference in the mirror. I knew I hadn’t gained that much extra muscle mass, certainly around my belly. I’m well aware of the pitfalls of being overweight at this time in my life, and how hard it is to come back from gaining too much.

My endocrinologist said, “I think it would be a good idea if everybody tried a GLP-1.” That surprised me. But, I had heard stories that cardiologists take it for the heart health benefits, just as a matter of course. I’ve been seeing more reports of the discoveries of long-term health benefits, other than weight loss, including improving metabolic health and insulin sensitivity, reducing blood sugar and cholesterol levels. It seemed that there were significant reasons, other than just losing weight, for this midlife chick to give it a try.

Of course, for insurance to approve it automatically, your BMI (Body Mass Index) must be 30 or higher. Mine was 28.5, just under the threshold. In this case, the doctor needed to provide a co-morbidity to support the use of a GLP-1. In this blood work, my total cholesterol and LDL (low-density lipoprotein—the “bad cholesterol”) this time around was slightly high. Without blinking, he started the process for insurance approval. A few days later, it was approved.

Getting started

I landed on Zepbound (tirzepitide) and decided I’d take the starting dose (2.5 mg) for as long as I could before titrating up. After all, there are potential side effects to manage; nausea and constipation are the worst culprits as your body acclimates to the chemistry changes. While I wasn’t excited about the prospect of experiencing either of those, I knew there were remedies for them too.

In six months, I’d return to the office for a full blood workup to see if there were any changes.

I took my first dose on August 8, a Friday. I figured, if I had any side-effects, I could navigate them over the weekend. I took the first shot out of the refrigerator, let it warm up for a bit, then gave myself a jab in the right thigh. A click, a sting, another click, and done. Over the next 24 hours, I’d monitor myself for side effects.

Fortunately, the nausea never really happened. I was anticipating it, so I bought all sorts of anti-nausea remedies (which I never used). The constipation, well, that’s a different story. Without going into the ugly details, it’s something that must be managed daily with a variety of strategies. You can look those up yourself.

The first nine weeks

After the first four weeks on the starter dose, I saw a pretty remarkable initial loss: about 6.5 pounds. From there, it leveled off a bit. In week nine, I started to see another slight drop, about a pound and a half. The question of whether I should stay the course or try the 5 mg dose always floats around in my head.

The medication at the starting dose has significantly affected my appetite, so I have a fear of not getting enough nutrients if I increase to the next one. My portion sizes are much smaller than they once were. I don’t go for seconds. There’s often more time in between meals/snacks as well.

I feel fuller faster, and it takes a lot longer for the food to digest. It sits in the stomach, waiting to be processed, which makes me much less interested in touching any other food for a while. The next time I do eat, I am very mindful of the full feeling coming much sooner. The last thing I want is to overeat and then feel nauseated. I don’t want food to become something I avoid because it becomes a negative experience. I simply want to manage it better.

That’s the point, of course, to manage our food intake more wisely. The medication does a great job of that. But when you are trying to build muscle and bone density, you have specific nutritional needs to maintain. A balance must be struck.

What’s my weight loss algorithm?

Part of what I’m grappling with is, how much do I really want to lose?

I am moving every day, doing gymnastics three times a week, and I lift heavy things when I can. I’m not engaged in a specific, dedicated strength program, but the work I do in gymnastics covers a lot of that. I want to continue building muscle, so prioritizing protein is a must. Taking creatine, collagen and fiber every day is an essential part of my daily nutrition habits.

According to the BMI charts, to get into the “healthy” body weight category, I’d have to shrink down to 155 pounds. I haven’t been that weight since high school, and I’ve been a dancer my whole life. To me, that number seems a little absurd, especially given the amount of muscle mass I’ve built up over the years.

BMI is not the greatest indicator of overall health, so I don’t want to use it as fitness gospel. Instead, BMI is a guideline with the caveat that it’s a rather myopic way of looking at overall health. There are many other factors involved that give a much broader perspective.

For clarity, this is a statement from the NIH (National Heart, Lung and Blood Institute):

Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women. Your BMI is just one piece of the puzzle. It’s based on height and weight but doesn’t take into account your muscle mass, bone density, or body composition. Your healthcare provider will consider whether your BMI is too high or too low for you.

Without establishing an arbitrary “end goal,” I think it’s important to gauge how I’m feeling and functioning as I lose fat weight. Can I continue to gain muscle mass? Will I maintain the energy that I have to do all the things I want to do? Are the numbers reflected in my bloodwork optimized for future health outcomes? Am I maintaining my stellar bone density? How is my mood every day?

For the moment, I’ve decided to remain on the starting dose. I know it’s generally not the way the medication is intended, but if it is doing it’s job, there’s no reason to increase. If I see a change in my appetite, I’ll revisit the decision.

As I’ve always believed, creating long-term healthy habits is the way to make the life changes we seek. If anything, the low dose GLP-1 is helping me to establish those eating habits for the long run.