Better living through chemistry and all that

[jducoeur]

(CW for discussions of weight, health, medicine, side-effects, that sort of thing.)

No surprise to those who know me, I've fought my weight basically my entire life. For most of that time, it wasn't too a big a deal -- I haven't been the weight I would prefer since college, but I've generally been in decent health. (While I'm by no means an athlete, I do make sure to get moderate exercise regularly, and I'm on my feet all day every day.)

That said, it's slowly been sliding over time. I was borderline diabetic for a lot of years; that became not-quite-so-borderline a while ago. Still a mild case, but it's not a line I was looking to cross.

I was generally keeping things reasonably steady -- but then, at the beginning of the year, we both caught Covid. And while it's hard for me to call the after-effects "long covid" -- they're nowhere near as serious as what many people have been dealing with -- it's pretty clear that my self-control has gone to hell, and the timing is suspiciously correlated.

Specifically, my willpower when it comes to food fell to zero. While I've only gained a few pounds this year, they've all been in my jowls and waist; I've gone up by two belt sizes, and the last thing I want is for that diabetes to get worse. So it was time for serious action.

After a two-month runaround from CVS (who kept saying "please try again in a few days" and eventually threw up their hands and refused to even try to fill the prescription), I went to the pharmacy attached to my doctor's office, and they managed to score me some Ozempic. I've been on the lowest dose for two weeks now, and it's been fascinating.

I confess, while I had looked into the side-effects, I hadn't really understood what semaglutide does. Broadly speaking, it slows the clearing of food from your stomach. What you eat is just there longer, making it less fun to eat too much. I get full much faster, and stay that way much longer, than I am used to.

(Far as I can tell, it's kind of the drug-induced version of bariatric surgery. Instead of preventing you from overeating by making your stomach smaller, it does so by bottling your stomach up a bit.)

Anyway -- the results are kind of startling. My doctor is titrating me up slowly from a minimal dose, so I had figured this month would be basically "Are the side-effects too bad?" before moving up to a dose that actually does something. But it's nothing of the sort: by about four days into it, I was already feeling the effects pretty strongly, and it's already affecting my habits.

I should be clear about one thing: this is not a miracle drug. It doesn't let you eat everything you want, and the pounds magically melt off. Quite the opposite: this is basically a permanent, drug-enforced diet. I found, pretty quickly, that eating as much as I've been doing is just plain unpleasant: a meal of the size I would have casually eaten two weeks ago leaves me feeling bloated (really, I can't even finish it), and the idea of eating much dessert afterwards is just kind of ghastly.

For a lifelong gourmand, that's a little sad: I'm quickly finding that I need to get much more picky about what I eat, since I can't eat so much -- I can't just have everything I would like. But that's not an awful thing, just a serious change of mindset, needing to consciously pick my battles. For example, tonight was Indian food, and I left the garlic naan off the order. I always order garlic naan; I'm quite fond of it. But I need to prioritize, and focus on the foods I enjoy more and have a bit more nutritional value.

Semaglutide famously comes with a host of possible side-effects, especially nausea. So far, I've been fortunate there (knock on wood) -- just the tiniest hint of queasiness some of the time, but nothing that rises beyond "mild discomfort".

The one side-effect I have had to deal with is constipation, which is seriously New and Different for me: it's a problem I've really never had to deal with. So I've teaching myself to push the fruit and veg even harder (Kate has been good for my eating habits in that respect, but there's a lot of room for improvement). And heaven help me, I've started discovering the joys of Metamucil -- yay for feeling just that little bit older.

Also, my metabolism is ferociously confused. I've been running pretty draggy for the past week, and while some of that is due to the cold I'm fighting off, and work stress making my sleep less-than-ideal, I think some of it is my metabolism sitting in the corner and pouting about being put through this sudden reduction in intake. I figure I'll get past that in due course.

We'll see where we go from here. Given that it's already affecting me strongly, my doctor and I have agreed that we're going to go slow on titrating it: I see no compelling reason to scale up to higher doses until and unless things seem to be stalling out on the lowest-possible-dose that I'm taking now. I think I've lost a couple of pounds so far -- nothing dramatic -- but slow-and-steady is fine by me, so long as we gradually make progress.

Fingers crossed, we'll see where all this goes next...

Comments

[squirrelitude]

Huh, I hadn't known about the stomach-slowing part of it! I had heard of it as "increasing the satiety response", but maybe that's part of what that *does*.

[jducoeur]

I mean, this is purely a layman's understanding, so don't take my word as gospel. But that's the description I heard from a couple of doctors (including my ophthalmalogist, who finds the whole idea deeply suspicious), and it seems to fit the facts, so I think that's what's going on.

As for "satiety response", that seems to be a fancy way to say "you feel full", which, yes, is basically the effect, and I think that's because it's more or less literally true.

(But actual medical professionals are welcome to correct me if I am misunderstanding.)

[writerkit]

I have always found Benefiber to taste *considerably* better than Metamucil (to the point where during the Benefiber shortage I was making serious active efforts not to have to try other brands), in that it dissolves so thoroughly it's like drinking a glass of plain water.

[jducoeur]

I don't mind the Metamucil, honestly -- I find its gumminess weirdly fun. But yeah, my doctor turns out to recommend Benefiber instead, so I'm planning on trying that after my next shop.

[mindways]

This is also my experience. But, that's because Benefiber is a different thing than Metamucil. On a very high level they're both "fiber", but Benefiber is 100% a type of soluble fiber, whereas Metamucil is made of stuff that also has insoluble fiber.

For some folks / some situations, either will do, but the two types of fiber(*) can have dramatically different effects in the GI tract - if what one needs is insoluble fiber for bulking/softening, then Benefiber isn't particularly useful. (This is usually the case for me.)

(*) = Which is a vast oversimplification. I find notable differences in GI behavior even between different types of soluble fibers, for instance, or different sources of insoluble fiber.

I've started discovering the joys of Metamucil -- yay for feeling just that little bit older

FWIW, I've been dealing with fiber supplements since my mid 20s, and had to buy one of my kids an OTC laxative a couple months ago - they're totally for young 'uns, too! Just, nobody much *talks* about it.

[hudebnik]

I've been taking psyllium capsules (1-3 a day) routinely for a couple of years now -- originally for a bout of painful constipation, but then as a maintenance dose on the general principle that "fiber is good, m'kay?" And I haven't had a bout of painful constipation in a long time. Since they're capsules, they taste like nothing at all.

[andrewducker]

One of the things I find fascinating about it is that it seems to help with alcohol use disorder, and so is clearly acting at least somewhat on the part of our systems that craves things.

Really glad it's helping you!

[brainwane]

Appreciating you sharing the journey!