Comment by tomhoward
2 months ago
I'm not commenting specifically on the heart-muscle aspect of the study, but it shouldn't be a surprise that the weight loss from this drug is significantly attributable to muscle loss; it almost always is when dieting. It's the same with keto/low-carb or any other kind of caloric-restrictive dieting (which Ozempic facilitates).
The modern weight-loss programs I'm seeing now (at least those aimed mostly at middle-aged men) emphasize consuming significant amounts of protein (2g for every 1kg of body weight each day) and engaging in regular resistance training, in order to maintain muscle mass.
The article addresses this:
To keep muscle strong while losing weight, Prado says it is essential to focus on two main things: nutrition and exercise. Proper nutrition means getting enough high-quality protein, essential vitamins and minerals, and other “muscle-building” nutrients. Sometimes, this can include protein supplements to make sure the body has what it needs.
Perhaps there needs to be more formal research into this, and a strong recommendation made to everyone using these drugs that this kind of diet and exercise plan is vital.
The percents are very different. For example in bodybuilding one normally 'bulks' while working out, because it maximizes muscle gain. But then naturally this needs to be paired with cutting, unless you're a Greek Grizzly, but the total muscle loss is relatively negligible, especially when maintaining a proper high protein diet.
At 40% muscle loss you're getting awful close to losing weight while increasing your body fat percent!
But of course you're right that diet+exercise is key but for those maintaining such, they wouldn't end up on these drugs to start with.
For example in bodybuilding one normally 'bulks' while working out, because it maximizes muscle gain. But then naturally this needs to be paired with cutting
This comes from professional bodybuilding, where people are using steroids, along with various, uh, interesting chemicals on the cut[1]. It has almost no benefit to (real) natural bodybuilders. It's closely tied to cycles of steroids.
[1] Ephedrine, Albuterol, Clenbuterol (literally only approved for horses in the US), DNP, and probably more that I haven't heard of. Here's an NIH article on the dangers of DNP, to put it in perspective: https://pmc.ncbi.nlm.nih.gov/articles/PMC3550200/
Natural bodybuilders 100% go through bulking and cutting cycles.
Outside of noob gains it is incredibly difficult for a natural to add muscle mass when in a calorie deficit and recomposition at maintenance calories is also inefficient in the vast majority of cases.
They won't bulk the same way someone on gear does, but it's still the most efficient way to add muscle mass in the vast majority of cases.
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Are you claiming that a drug free person can gain as much muscle mass while in a calorie deficit as while in a calorie surplus?
If so, I would be very curious to that reference.
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The most important cutting aids are the same ones in bulking - AAS like testosterone and its close (cheaper) variants like trenbolone and methylated testosterone but yeah, the interesting chemicals are featured too.
Most natural bodybuilders recommend the 'clean bulk' where one simply eats the same cutting foods but in larger proportions. And also not to be too strict in general - that way lies disordered eating, binges, purges etc.
In order to gain more muscle mass, at some point you need to be in a caloric surplus. You can't make something out of nothing - your body needs the extra resources to make itself bigger.
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Whilst it is 95% calories in calories out, keto (not low carb, as low carb doesn't include high fat) can be good for muscle retention whilst in a defecit - as more foods that you consume naturally have higher protein (I utilise keto when looking to drop body fat, consuming a lot of slightly higher fat cuts of meat as a replacement for the carb calories, so chicken thighs instead of breast, 10% ground beef,etc). The higher fat content correlates to higher testosterone count, and higher protein means greater muscle retention.
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Carbs are harder to control for many people, and less forgiving. A side effect of keto is decreased appetite. A side effect of carbs is overeating.
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To be clear, these recommendations are already made very clearly before you take the medication. There is absolutely nothing in your comment that isn’t already clearly spelled out. Your last paragraph is literally already being done.
This isn’t a surprise unless people ignored reading about the drugs before taking it and ignored the doctors.
It's why the medication should never be given to people on its own (although I'm sure it happens all the time), but should be a part of a comprehensive weight loss, exercise and dietary plan. Same with other invasive weight loss treatments, you can't just get a gastric belt or whatever fitted if you ask for it, you need to do the work yourself first, and you get a diet plan assigned if you do end up with one.
It's the same with e.g. human growth hormones, one theory is that Elon Musk is / has used them, but without the weight training that should go with it, so his body has developed really weirdly.
I've heard this feedback on Ozempic et al from my wife who is a GP some 6 months ago, when I mentioned how US is too much in comfort zone and addicted to HFCS to actually lose weight permanently, ever, so in good old weight-losing fads fashion they will just throw money at the problem, experiencing somewhat variable success and who knows what bad side effects.
My wife told me exactly this - potentially all muscle mass loss (and she made sure I understood that 'all' part), yoyo effect once stopping, potentially other nasty long term/permanent side effects, and overall just a bad idea, attacking the problem from a very wrong direction. Just look at musk for example - he pumps himself with it obsessively and the results even for richest of this world are... not much there (or maybe his OCD binging would make him 200kg otherwise so this is actually some success).
Then all the folks come who say how to helped them kickstart a positive change, like its something against those facts above. All the power to you, just don't ignore facts out there and don't let emotions steer your decisions. You only have 1 health and it doesn't recharge that much, and that short time we have on this pale blue dot is significantly more miserable and shorter with badly damaged health.
> like its something against those facts above
I’ve seen multiple friends go from eating like shit, including chugging sodas, to not compulsively ordering dessert and no sodas in the house. I think all of them have since quit Ozempic, each seeing some rebound but nothing comprehensive and, most notably to your argument, not in the behaviour modifications.
The only way to lose weight without damaging oneself is to combine more exercise with less eating, which means becoming comfortable being hungry. Yes, it's difficult -- especially after developing bad eating habits over a long time -- but moderation is required in all things. It takes a long time to become overweight, so the ramp down to a leaner existence must necessarily take a significant amount of time, or there's going to be added risk.
Just like in programming, there is no silver bullet; there's only hard work.
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> addicted to HFCS
HFCS consumption (along with added sugar consumption in general) peaked in 2000 and declined steadily until 2020: https://news.ycombinator.com/item?id=38094768
It doesn't give me much confidence bringing it up at all in this convo. As if replacing HFCS with cane sugar (55% vs 50% fructose) changes anything about junk food.
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> (2g for every 1kg of body weight each day)
This equates to a 300lb male consuming 272g of protein per day. There are 139g of protein in 1lb of chicken breast.
The RDA to prevent deficiency for an average sedentary adult is 0.8 grams per kilogram of body weight. A 300lb male needs about 110g/day at this RDA.
For the people who lift weights while on this/these drugs, how much lean muscle do they lose?
The point is is that most people lose muscle because they’re not lifting. You will lose muscle if you lose weight no matter the cause, if you are not lifting weights.
Not sure how much I lost during, but a substantial amount. I have been working out since about 20lbs from my goal weight and now roughly a year later - and have gained strength (based on the numbers I can lift) from before I lost 100lbs.
I don’t think it would have been possible to not lose substantial muscle mass while rapidly losing 100lbs over 9mo, even with extreme resistance training added to the mix. While DEXA scans are not super accurate, I’ve put on about 17lbs of muscle since my first scan 10mo ago, while maintaining a 12% or less bodyfat ratio.
That said, I’ve been eating extremely healthy both before and after being on the drug which helps a lot. The drug simply gave me the mental space to avoid the binges which were my particular problem. That and it controls portion sizes to European dinner vs. American restaurant sized meals for me.
100 lbs that’s significant. What are the implications of rapidly losing weight ? ( I’d expect even your body image changing to not be very easy )
> For the people who lift weights while on this/these drugs, how much lean muscle do they lose?
I was 92kg when I started on liraglutide (I was doing GLP-1 agonists before it was cool!) and 67% of muscle mass (61kg). I'm now at 69kg and 82% of muscle mass (56kg). I'm doing weight and resistance training twice a week, in addition to aerobic training.
One nice thing, while muscles don't become more massive, they for sure become more pronounced and visible with weight loss.
I'd bet you are stronger now despite slightly lower muscle mass.
Probably the muscle tissue people lose first are crappy cells. Weak, nonfunctional, senescent or even maybe some muscle embedded fat.
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Those muscle mass percentages cannot be right. How were they measured?
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I know 2 competitive athletes (both MMA) who experimented with it. Both came off of it within ~6 weeks because of complications, mostly related to mood (they got very, very temperamental on it). The athletes in my sphere know about it but aren't interested. The 2 who experimented have a non-trivial social media presence and, ultimately, that is what drove them to experiment.
On top of that wouldn't even liposuction already reduce heart muscle over time because of the lower amount of vasculature extent afterwards? Less volume to need to pump through and less metabolic and oxygen demand.
There is significant heart remodeling after even things like major amputations because of the changing demands on the heart.
Diet and exercise. It always comes back to that, yet people avoid it like the plague.
The modern weight loss program you described is pushed because that's what people want; an extremely low-effort methodology that yields extremely high results.
The idea that their is some silver bullet to weight loss has dominated the US health market for ages now because selling someone a pill that they don't have to do anything but swallow and be cured is really, really easy.
Having gone through my own weight loss journey, I have seen first hand how attractive that is and fell for it myself twice. So have loved ones, one whom is no longer the same person because they got gastric bypass which resulted in a massive change to gut and brain chemistry, something that we seem to be just figuring out is connected. My own journey is not over, but there are no longer any medications or supplements involved, because I can say with authority that none of them work without good nutrition and physical exercise.
As I realized this and just put more work into eating better and doing more activities (I did not join a gym, but started riding my bicycle more, walking neighbor's dogs, and doing body-weight exercises at home, etc, making it more integrated into my day rather than a separate event I could skip), I lost a healthy amount of weight and got stronger.
It took a lot longer, of course, than what the pills promised, but that's the trick of the whole weight loss industry...and make no mistake, it is an industry. Short-term results in exchange for your money. It was never about helping people be healthier and always about myopic profits, therefore we should not be trusting any claims these companies make that their silver bullet is the correct one, finally.
And yet.
> The modern weight loss program you described is pushed because that's what people want; an extremely low-effort methodology that yields extremely high results.
I think it's a mistake to think of it as what people want. It's what people can do.
We have to acknowledge a fundamental struggle that we have with dieting and working out. Pretending it's just hard, when statistics show what is true at a societal level, will not bring us solutions.
We need something else. Either that's massive societal change to i.e. approach something like the diet/workout culture you have in Japan. That's hard. Or, as with many other of our health problems that we can't just will away, it's drugs.
Not believing in progress here, when drugs progress everywhere, is unnecessary. Current generations might have issues. Drugs will be better. We won't.
I still disagree. Simplicity and convenience is what people not only want, but demand. And this extends beyond weight loss solutions to our modern world of ever-converging technologies creating ever-complex systems under the guise of efficiency. Multiple cultures have supported these values since the times of snake-oil salesmen, which did not exactly vanish with history, as we so often forget. Look at products like Optavia, Xenedrine, etc.
It keeps happening because the market wills it to, but not without good reason. It is perfectly rational to want something to be easy, especially now as our modern lives are inundated with a tremendous amount of stressors and tasks we must constantly attend to. So yes, we wish for convenience, but it is not the solution we always need.
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I don’t think anyone is disputing that changes to diet and exercise are required.
Based on people who I know have been taking these drugs, they make it much easier to reduce calorie intake by promoting satiety. That’s the benefit.
Doing the rest of your life while you feel hungry is not fun, and willpower is not infinite.
I don't know it is always avoidance when it comes to diet and exercise. I think oftentimes it comes down to overscheduling. I like to exercise, I like to eat healthy. Those two are oftentimes the first things on my chopping block when I am hurried
How has the gastric bypass affected this person? It would not have occurred to me that the brain would be affected.
We were surprised, too. Their personality changed to be a lot more aggressive and they started compulsively lying, then stealing things from stores, and some strange draw toward self-harm and getting "corrective" surgeries. Previously, this person was typically pleasant, if not a little outspoken at times.
There is suspicion that they had a pre-existing mental health issue they were hiding, and the very fast changes that happened in their body triggered it to either manifest or get worse. We are left guessing because they refuse to see any doctors that won't just write prescriptions for meds or minor elective surgeries, now.
These days, more and more evidence is piling up about the gut-brain connection, but no conclusions are being drawn quite yet. Though, from my own experience, it is not difficult to convince me that one certainly impacts the other.
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