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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by PeterMartin on April 5, 2021, at 0:06:46
I was able to get my pDoc to let me try Rybelsus(Semaglutide), which is an Oral GLP-1 RA Medication. It's the first of this class that comes in a pill. They've been around (Trulicity/Ozempic) but those required you injecting the medication once a week.
I'm on the starter titrating dose of 3mg and am down 5lbs. Bumping up to 7mg tomorrow and at that point it's supposed to really help. I'm very optimistic based on a FB group I'm in and a few recent studies like:
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
Wiki: https://en.wikipedia.org/wiki/Semaglutide
Of course it's crazy expensive at the moment and w/ most insurance it might be difficult to get approval w/o a DX of diabetes. They're definitely working towards getting it approved for wt loss (similar to the GLP-1 med w/ the same drugs as Trulicy called Saxenda).
I have about 40lbs to go....I can update if there's interest.
(Typing stream of thought on my phone so sorry if this is poorly written)
Posted by Lamdage22 on April 5, 2021, at 12:32:59
In reply to I think I found the answer for Weight Loss....., posted by PeterMartin on April 5, 2021, at 0:06:46
I heard about and considered Liraglutide. Do you have side effects? What are the typical side effects? I suspect that Metformin lowers my testosterone.
Posted by Lamdage22 on April 6, 2021, at 2:03:28
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on April 5, 2021, at 12:32:59
This might be my ticket to more testosterone. Thanks for posting. Metformin can help depression though. It is, once again, a gamble, but maybe one that is worth it to try semaglutide.
Posted by PeterMartin on April 6, 2021, at 10:20:14
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on April 5, 2021, at 12:32:59
> I heard about and considered Liraglutide. Do you have side effects? What are the typical side effects? I suspect that Metformin lowers my testosterone.
The only side effects I've had are gastro: Heartburn/Constipation. The heartburn was only for the first 3 or 4 days, and calmed down w/ ginger candies/crackers/gaviscon.
I'm just starting the 7mg therapeutic dose after a month on the 3mg dose (to titrate up and limit side effects). I'm pretty excited.
Metformin kept me weight neutral, for the most part, but I could never be sure it wasn't dampening my response to Nardil which was inconsistent in my trial (I am bp1, though). I do think Metformin has a ton of great benefits though. I may end up adding it back sometime down the road.
Posted by rjlockhart37 on April 10, 2021, at 19:57:44
In reply to Re: I think I found the answer for Weight Loss....., posted by PeterMartin on April 6, 2021, at 10:20:14
there's no way doctor would give me this, she gave me nuvigil, and nuvigil, or armodafnil slightly made me lose weight. Only option im doing right now, is s-t-a-r-v-e from food. Don't hardly eat anything, sometimes i just have a donut during the day.
Posted by Lamdage22 on April 16, 2021, at 23:32:07
In reply to Re: I think I found the answer for Weight Loss....., posted by rjlockhart37 on April 10, 2021, at 19:57:44
How much weight are you losing a week? What is your goal? Were you gaining weight before? Are you on notorious "weight gain meds"?
Posted by PeterMartin on April 17, 2021, at 23:47:09
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on April 16, 2021, at 23:32:07
I'm on Marplan + Low-dose Seroquel. Marplan isn't a huge weight gainer, but w/ this combo I've always trended up a couple lbs a year. Haven't been able to lose at all w/ exercise/starvation.
With Rybelsus, there's a 3mg dose you start w/ for a month to titrate up to avoid side effects at the normal doses of 7mg then 14mg. Some lose weight on 3mg as I did:
So far:
233.0 - March 12 (Start 3mg)
230.8 - March 19
226.2 - March 26
227.1 - April 2 (Started 7mg after 3wks)
225.4 - April 9
222.9 - April 16
I'm ecstatic for ~10lbs in a month w/o changing my routine. The scale has done nothing but creep up the past 5 or so years. I'm in a group on FB and by all indications this medicine really works...w/ people loosing 40, 50, 60+lbs.My first goal is to get under 216lbs which is where I was when 3yrs ago when Marplan went into shortage and I had to switch to Nardil. After that, I'd love to finally get back under 200 for the first time since 2010. And finally if I can get down to "normal" wt for my 6' ht (~185) I'd be soooo happy. I really feel like it's possible.
I'll update down the road.
Posted by PeterMartin on April 17, 2021, at 23:53:44
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on April 16, 2021, at 23:32:07
Also, you mention Metformin helps depression, these GLP-1 medicines may turn out to have benefits for mood/the brain as well. Still a lot of research to be done, but recent paper (March '21) discusses the potential:
https://pubmed.ncbi.nlm.nih.gov/33741445/
The therapeutic potential of GLP-1 analogues for stress-related eating and role of GLP-1 in stress, emotion and mood: a review
Abstract:
Stress and low mood are powerful triggers for compulsive overeating, a maladaptive form of eating leading to negative physical and mental health consequences. Stress-vulnerable individuals, such as people with obesity, are particularly prone to overconsumption of high energy foods and may use it as a coping mechanism for general life stressors. Recent advances in the treatment of obesity and related co-morbidities have focused on the therapeutic potential of anorexigenic gut hormones, such as glucagon-like peptide 1 (GLP-1), which acts both peripherally and centrally to reduce energy intake. Besides its appetite suppressing effect, GLP-1 acts on areas of the brain involved in stress response and emotion regulation. However, the role of GLP-1 in emotion and stress regulation, and whether it is a viable treatment for stress-induced compulsive overeating, has yet to be established. A thorough review of the pre-clinical literature measuring markers of stress, anxiety and mood after GLP-1 exposure points to potential divergent effects based on temporality. Specifically, acute GLP-1 injection consistently stimulates the physiological stress response in rodents whereas long-term exposure indicates anxiolytic and anti-depressive benefits. However, the limited clinical evidence is not as clear cut. While prolonged GLP-1 analogue treatment in people with type 2 diabetes improved measures of mood and general psychological wellbeing, the mechanisms underlying this may be confounded by associated weight loss and improved blood glucose control. There is a paucity of longitudinal clinical literature on mechanistic pathways by which stress influences eating behavior and how centrally-acting gut hormones such as GLP-1, can modify these. (250).
Posted by Lamdage22 on April 18, 2021, at 3:20:01
In reply to Re: I think I found the answer for Weight Loss....., posted by PeterMartin on April 17, 2021, at 23:53:44
Do you think I could combine Rybelsus with Metformin without going hypoglycemic? Thinking about Rybelsus as a "diet booster". I lost 3 kg and am struggling to lose more. I am on the "nightmaire combo" of Seroquel and Zyprexa. High dose.
Posted by Lamdage22 on April 18, 2021, at 3:20:39
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on April 18, 2021, at 3:20:01
Im not diabetic
Posted by PeterMartin on April 20, 2021, at 0:40:47
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on April 18, 2021, at 3:20:39
I'm not diabetic either. I know people in the FB group I read are on both Metformin and Rybelsus. I don't think either cause hypoglycemia - just bring the levels down (but worth asking).
One thing Rybelsus (semaglutide) does do is slow gastic emptying. I suppose that could raise levels of some medications (I haven't noticed any mood changes).
Best I can say is ask your doc or GP. Getting insurance to cover it might be tricky, but being on Metformin will definitely help that cause. Often insurance companies will make you "step up" to these more expensive new drugs, and Metformin would be the 1st line treatment for metabolic issues.
Posted by Lamdage22 on May 17, 2021, at 4:43:33
In reply to Re: I think I found the answer for Weight Loss....., posted by PeterMartin on April 20, 2021, at 0:40:47
Many people can't fathom that there are reasons to take Metformin other than diabetes. I am losing weight quickly enough as it is. So yeah, pretty happy with that. In a couple of months, I should be at my desired weight. I agree that obesity has many many drawbacks. A medication that helps losing weight would have to be real toxic to have as many side effects as obesity does. I swear by genuine vanilla. No side effects.
Posted by Lamdage22 on June 4, 2021, at 1:29:29
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on May 17, 2021, at 4:43:33
When could Rybelsus be approved for obesity?
Posted by Lamdage22 on June 4, 2021, at 2:53:35
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on June 4, 2021, at 1:29:29
And what is the price? Thanks!
Posted by undopaminergic on June 4, 2021, at 7:45:28
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on June 4, 2021, at 2:53:35
> And what is the price? Thanks!
Why don't you ask a local pharmacy? The price in Germany would be different from its price in the US.
-undopaminergic
Posted by Lamdage22 on July 7, 2021, at 7:31:38
In reply to I think I found the answer for Weight Loss....., posted by PeterMartin on April 5, 2021, at 0:06:46
Do you have continued success?
Posted by Lamdage22 on July 18, 2021, at 1:21:22
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on July 7, 2021, at 7:31:38
I am waiting for some more safety data. Metformin works, but not quite well enough and I suspect that my Testosterone is significantly lowered because of M. It is infamous for that. If you are depressed, lowered testosterone is not in your best interest. T is still in the reference range but close to the low end. Keeping a close eye on Rybelsus!
Please let us know how your weight loss progresses from time to time!
Posted by undopaminergic on July 18, 2021, at 7:49:27
In reply to Re: I think I found the answer for Weight Loss....., posted by Lamdage22 on July 18, 2021, at 1:21:22
> Keeping a close eye on Rybelsus!
>
> Please let us know how your weight loss progresses from time to time!I think many people don't check topics so far back in time. I wish responding to an older topic would bring it to the front.
It may help to use the "add name of previous poster" feature.
-undopaminergic
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