我做错了什么？

[HereKittyKitty]

1月2日我把Sema换成了Tz。当时我还有大约20磅要减。三周减了5磅。我不急着减掉剩下的那点儿。

2月20日我开始增加Tz的剂量。七周以来，我的体重一直在0.75磅左右波动。

我一点儿也不觉得饿。食物的诱惑完全消失了！我努力摄取蛋白质和纤维。我每天喝72盎司以上的水。我每周做4-5天的有氧运动和力量训练。

我不知道是不是Tz对我不起作用，我应该换回Sema，然后逐渐增加剂量（剂量要高于推荐剂量，但经过测试！），或者增加Tz的剂量，或者尝试其他组合……

我一直在努力克制自己，不去拿自己的经历去评判我在这里和其他地方看到的那些惊人的减肥成果。有些日子感觉好些，有些日子感觉差些。今天早上体重秤显示，我竟然又反弹了0.75磅。我真想尖叫或者哭出来。或许两者兼有。

尽管我做了大量的阅读、与现实生活中认识的几个头发花白的人交谈、观看相关视频，但我仍然怀疑自己是不是做错了什么。

 

[Vash_]

你在记录卡路里摄入量吗？

 

[tubby]

假设你服用Sema后体重增长已经达到平台期（虽然文中没有明确说明，但我猜测这可能是你改用Tirz的原因），那么Tirz在某种程度上是“有效”的，因为它（以及你采取的其他措施）阻止了你的体重反弹。只是它的效果似乎不足以让你进一步减轻体重。

我认为人们对GLP（良好脂质体）药物的一个误解是，虽然它们确实能减少卡路里摄入，但这并非减肥的全部原因。我发现一篇很有意思的博客文章，它很好地分析了一项关于GLP的啮齿动物研究，这项研究为我们理解这个问题提供了重要的信息：

https://uncertaintyprinciples.suspicious-link-removed.com/p/why-do-we-lose-weight-on-glp-1-drugs

Set aside the fat partitioning and respiratory quotient stuff (where I think Gary may be making some faulty inferences) and just note the study result itself. Specifically, that the matched calorie control group lost less weight than the GLP group (despite having identical calorie consumption).

I can't even begin to guess at the biochemistry going on in your body, other than to note that if it's only been several weeks since you titrated on up tirz, that (due to the half-life of sema and tirz), your GLP-1 to GIP agonism ratio in your body isn't at normal tirz ratios yet and is still leaning more strongly towards GLP-1 agonism (from the residual sema). I can't speculate on whether that's a good or a bad thing, but I can confidently assert that you're not yet at the steady-state GLP-1 to GIP ratio that you'll be at a month from now (assuming you stick with tirz).

As a practical answer to your dilemma, some people where you're at currently will add in maz or survo (the "ghetto reta" method), which (perhaps negatively) tips the scales back towards GLP-1 agonism being stronger, but also flips whatever metabolic switch glucagon agonism is hitting. I have no idea if such an approach is superior to reta, other than to note that people (especially those coming from a sema background) seem to feel more comfortable with the style of appetite suppression that comes from a stronger GLP-1 input than reta on its own delivers. Which is more effective in terms of results? I have no idea!

 

[Arkend]

I switched out Sema for Tz on Jan 2nd. I had 20'ish pounds to go. I lost 5 lbs in 3 weeks. I am not in a hurry to lose this last bit.

I titrated up Feb 20. For 7 weeks, I have lost and gained the same 0.75 lbs.

I have not been hungry at all. Food noise is silent! I work hard to get my protein and fiber. I drink 72+ ozs of water/day. I am doing cardio and resistance work 4-5 days/week.

I don't know if Tz just isn't working for me and I should go back to Sema and titrate above approved (but tested!) dosing or increase Tz or stack or something...

I am working very hard in my head not to judge my experience against the gushing weight loss I read from others here and elsewhere. Some days are better than others. This morning the scale notified that fecking 0.75 lbs was given back to me. I want to scream or cry. Or both.

I do wonder if I am doing something incorrectly despite the seemingly endless reading, talking to the few I know IRL who grey, and video watching I've done.

The body can be a fickle thing. Something I try to remind myself about is that everything little nuance can make a difference. 1 gallon of water weighs around 7 pounds. So if you drank that in one day and didn’t get rid of it all, that would show up on the scale. Add in sodium and you are going to hold onto more water.

I would start with tracking calories and exercise for two weeks and see if there’s a scale change. If not, then remove 100 calories a day and do that for two weeks and see if there is a change. It’s all just pulling different levers to see what works.

 

[HereKittyKitty]

Are you tracking calories?

Yes! I track everything I eat and drink. It also tracks my macros to be sure I hit my protein and fiber goals. I am sitting at 900-1,000 kcal/day. I cannot put anything else into my mouth.

@tubby thank you for the article. I will read it this evening. After losing access to sema, I was glp-free for a few (3?) months. Went back to sema in Sept when I found grey + a month of research. I escalated titration to 2 weeks to hit my last rx dosage. From Sept to Jan 1, I lost a little. Not much at all. Then Jan 2, Tz.

Yes, will read the article after work. Thanks again!

 

[GrandmaJ]

Yes! I track everything I eat and drink. It also tracks my macros to be sure I hit my protein and fiber goals. I am sitting at 900-1,000 kcal/day. I cannot put anything else into my mouth.

Believe it or not, you might be eating too little. I was around 900 calories and my nutrition counselor told me to bump it up to 1250-1300 a day at my height and age(58, 5'2). I started losing again when I starting eating more. It was a challenge but I added in some black beans and sweet potatoes to my salads. Or had a couple of corn tortillas to up the calories. Food has no appeal so the struggle is real!

 

[Jfrick11]

Assuming you had plateaued on sema (which wasn't specified, but I'm guessing that could have been the motivation for making the change to tirz), then tirz is "working" in the sense that it (along with your other changes) has kept you from gaining weight back. It's just not working strong enough to lead to additional weight loss, it would seem.

One thing that I think isn't properly appreciated about GLPs is that although there's a calorie reduction aspect to them, that's not really the full story when it comes to weight loss. I found this to be an interesting blog post, as it does a good job breaking down a really interesting GLP rodent study that informs on this topic:

https://uncertaintyprinciples.suspicious-link-removed.com/p/why-do-we-lose-weight-on-glp-1-drugs

Set aside the fat partitioning and respiratory quotient stuff (where I think Gary may be making some faulty inferences) and just note the study result itself. Specifically, that the matched calorie control group lost less weight than the GLP group (despite having identical calorie consumption).

I can't even begin to guess at the biochemistry going on in your body, other than to note that if it's only been several weeks since you titrated on up tirz, that (due to the half-life of sema and tirz), your GLP-1 to GIP agonism ratio in your body isn't at normal tirz ratios yet and is still leaning more strongly towards GLP-1 agonism (from the residual sema). I can't speculate on whether that's a good or a bad thing, but I can confidently assert that you're not yet at the steady-state GLP-1 to GIP ratio that you'll be at a month from now (assuming you stick with tirz).

As a practical answer to your dilemma, some people where you're at currently will add in maz or survo (the "ghetto reta" method), which (perhaps negatively) tips the scales back towards GLP-1 agonism being stronger, but also flips whatever metabolic switch glucagon agonism is hitting. I have no idea if such an approach is superior to reta, other than to note that people (especially those coming from a sema background) seem to feel more comfortable with the style of appetite suppression that comes from a stronger GLP-1 input than reta on its own delivers. Which is more effective in terms of results? I have no idea!

I hear your frustration.... . You’re doing everything right: tracking calories/macros, staying hydrated, hitting your workouts. That’s a huge effort, and plateaus can feel so defeating, especially after all your hard work.

One thing that REALLY stands out to me is your calorie intake. 900–1,000 kcal/day is extremely low, especially with the cardio and resistance work you’re doing. Your body is likely in “survival mode,” holding onto every bit of energy it can, which will completely halt weight loss. It's literally trying to survive starvation.

Sometimes, the best move isn’t to push HARDER, it’s to give your body the fuel it needs and let metabolism reset. That could mean temporarily lowering your dose or easing off intensity so your body can “wake back up” and respond AGAIN. If you cmat fuel your body, especially after this much time on these peptides.... It's time to lower. And if you're truly in that mode... The reset won't be overnight, but if you let off the gas and fuel your body correctly, especially with your other good habits , it will happen.

Remember, slow progress is still progress. Seven weeks of ±0.75 lbs isn’t failure, your body is adapting and protecting itself. Be kind to yourself; the last stretch is always the trickiest.

 

[AcadiaPeptides]

It really sounds like you’re doing everything right, and I get why this plateau is driving you up the wall. That last bit of weight is notoriously slow, and it doesn’t mean you’re doing anything wrong. You’ve got the hunger control, the workouts, the protein, the water — all the hard stuff — locked in.

The comparison trap is rough because people mostly post the dramatic losses, not the weeks of bouncing the same pound around. Your experience is valid, even if it’s not flashy.

If you’re unsure about the meds, that’s something to talk through with your prescriber, (we can only listen) but none of this means you’ve failed. Your body is just being stubborn, not sending a message about your effort.

You’re not alone in this, and you’re not doing it wrong. You’re just in the slow part.

 

[tubby]

I don't think anyone knows how GLPs and "starvation mode" (whatever that effect really is) interact with each other, but I feel like OP would notice it if their body had ramped down enough for that to be the full story there (like constantly cold and lethargic in a very noticeable way). Another possibility is simply body recomposition. Adding in GIP agonism (and at a very high level), while backing off on GLP-1 agonism could conceivably counter some of the muscle loss you may have experienced on sema with more of your protein intake being redirected towards muscle and lean tissue growth.

I really think OP is underestimating how drastic of a change going from sema to tirz is going to be in terms of hormonal effects.

 

[WLBLD]

I switched out Sema for Tz on Jan 2nd. I had 20'ish pounds to go. I lost 5 lbs in 3 weeks. I am not in a hurry to lose this last bit.

I titrated up Feb 20. For 7 weeks, I have lost and gained the same 0.75 lbs.

I have not been hungry at all. Food noise is silent! I work hard to get my protein and fiber. I drink 72+ ozs of water/day. I am doing cardio and resistance work 4-5 days/week.

I don't know if Tz just isn't working for me and I should go back to Sema and titrate above approved (but tested!) dosing or increase Tz or stack or something...

I am working very hard in my head not to judge my experience against the gushing weight loss I read from others here and elsewhere. Some days are better than others. This morning the scale notified that fecking 0.75 lbs was given back to me. I want to scream or cry. Or both.

I do wonder if I am doing something incorrectly despite the seemingly endless reading, talking to the few I know IRL who grey, and video watching I've done.

Sounds like me. I just started Feb 1st time ever on GLPs. In the 1st 2 weeks lost 2lbs then 1 more to 3lbs then it goes up & down but I am very new to this. Drinking enough water, & watching everything I eat.

What dose are you at? I started w 1mg T, then up to 1.65mg the next week (to start slow), then like 4 days later I decided to listed to everyone to try the Reta instead, did .5mg, then the next week 1mg & here I am going up & down. Its crazy bc before this no matter what I could not loose weight tried everything for yearssss, but had no appetite so was able to eat well. Now I am hungry (but have control & don't eat anymore to compensate at 1,000-1,200cal). Everyone has lost their appetite & now I've just gotten one. I have 50lbs to loose

 

[indolent]

In addition to the advice already given, I'd focus on

minimizing carbs (and being strategic about carbs with benefits, like the high protein/fiber content of a couple of tablespoons of black beans without rice)

paying attention to varying daily salt intake (= water retention). But note that we need some salt.

 

[Vash_]

Yes! I track everything I eat and drink. It also tracks my macros to be sure I hit my protein and fiber goals. I am sitting at 900-1,000 kcal/day. I cannot put anything else into my mouth.

What are your macros? Might need to adjust your ratios.

 

[HereKittyKitty]

In addition to the advice already given, I'd focus on

minimizing carbs (and being strategic about carbs with benefits, like the high protein/fiber content of a couple of tablespoons of black beans without rice)

paying attention to varying daily salt intake (= water retention). But note that we need some salt.

Thank you.

My carbs are in check. T2 diabetic in remission and am conscientious to remain in remission.

Salt I will definitely look at!

 

[HereKittyKitty]

What are your macros? Might need to adjust your ratios.

That's the thing.... I am below calculator macros on carbs and have been for 7 years.

Protein is a little lower than one might expect. I go for 100g/day. It's a hard númber to hit every day. I can only eat so much. I don't eat empty calories. Everything is protein- and fiber-focused. I don't eat anything under 15g/serving. I supplement with protein powder because I cannot eat enough. It's definitely my biggest challenge.

 

[mtomm]

I think it's water retention. Tracking your calories shows you're definitely in a deficit. But any stressor, low calories and switching peps can certainly be something that makes you hold on to water. I'd give it a few more weeks. I wouldn't be surprised if you get a big whoosh.

 

[HereKittyKitty]

Assuming you had plateaued on sema (which wasn't specified, but I'm guessing that could have been the motivation for making the change to tirz), then tirz is "working" in the sense that it (along with your other changes) has kept you from gaining weight back. It's just not working strong enough to lead to additional weight loss, it would seem.

One thing that I think isn't properly appreciated about GLPs is that although there's a calorie reduction aspect to them, that's not really the full story when it comes to weight loss. I found this to be an interesting blog post, as it does a good job breaking down a really interesting GLP rodent study that informs on this topic:

https://uncertaintyprinciples.suspicious-link-removed.com/p/why-do-we-lose-weight-on-glp-1-drugs

Set aside the fat partitioning and respiratory quotient stuff (where I think Gary may be making some faulty inferences) and just note the study result itself. Specifically, that the matched calorie control group lost less weight than the GLP group (despite having identical calorie consumption).

I can't even begin to guess at the biochemistry going on in your body, other than to note that if it's only been several weeks since you titrated on up tirz, that (due to the half-life of sema and tirz), your GLP-1 to GIP agonism ratio in your body isn't at normal tirz ratios yet and is still leaning more strongly towards GLP-1 agonism (from the residual sema). I can't speculate on whether that's a good or a bad thing, but I can confidently assert that you're not yet at the steady-state GLP-1 to GIP ratio that you'll be at a month from now (assuming you stick with tirz).

As a practical answer to your dilemma, some people where you're at currently will add in maz or survo (the "ghetto reta" method), which (perhaps negatively) tips the scales back towards GLP-1 agonism being stronger, but also flips whatever metabolic switch glucagon agonism is hitting. I have no idea if such an approach is superior to reta, other than to note that people (especially those coming from a sema background) seem to feel more comfortable with the style of appetite suppression that comes from a stronger GLP-1 input than reta on its own delivers. Which is more effective in terms of results? I have no idea!

Thank you so much, @tubby, for your feedback. The article was both enlightening and educational. I don't buy the CICO argument. I did keto many years and I def feel similarly the last month or so as I did then with some of the same (though milder) side effects.

Everyone who has taken time to read my struggle and reply has given me a lot to think about and sort through, including where you've reminded me to slow down and suggested I give myself some grace.

This evening, I am combing through the last year of meal tracking data to see what I can see in there that will help me now. My daily kcal is significantly lower than the marcos calculators advise. I don't know how I can eat more than I am but it needs careful looking at.

Thank you. I'll hang in there and work through the suggestions given to me today. I appreciate your each taking time to share your knowledge and insights. So often I can't see in myself what others easily observe.

 

[WLBLD]

Another thing I thought of, have you been drinking electrolytes? Some have a lot of sodium

 

[HereKittyKitty]

I have not. That would be a sneaky place to pick up sodium.

 

[lessthanhalf]

Without knowing start weight, age, height, how much you lost on Sema at what dose, and current dose of tirz, and current weight, it is not really possible to answer the question properly.

The level of metabolic adaptation required to not lose any fat at 900 kcal/day is extreme and would only make sense if you were short, female and had lost a very large amount of weight and even then is one of the lowest calorie intakes I have ever seen maintaining weight. My energy expenditure dropped 1500 kcal/day over a year to 1600kcal/day at stable weight about 50% lower, so the effect is very real, but 900 is super low, especially considering the exercise.

Is it possible your calorie counting is not correct? You may need to go back and weigh and recalculate everything. Studies show peoples' estimates of calorie intake are extremely inaccurate, this is not in any way intended as a criticism, but it could explain the lack of weight loss at that intake.

A few people on here have said increase calories, I have never seen any science that says this is a valid concept. If anyone has actual journal references I would love to see them.

Cico is real, the second law of thermodynamics cannot be evaded, it is nowhere near as simple in practice given that no one ever actually knows their measured energy expenditure and it can vary hugely with activity level and with weight loss, but I doubt 900 kcal/day is enough to keep weight stable long term.

If I had to guess, I would think you probably are still losing fat very slowly and the stall is more fluid balance shifts, just going on the calorie intake.

Given you only started tirz recently , I am guessing you are not at 15mg. Is there any reason not to increase the dose? Even at the same calorie intake it does have metabolic effects that encourage fat loss. Switching to reta is an option as it does have effects increasing metabolic rate especially at higher doses of 1-200 kcal/day, but not sure if it is needed if you have not tried higher dose tirz yet. And swapping over will take time and messing around.

Might be worth checking thyroid hormone status?

 

[tubby]

A few people on here have said increase calories, I have never seen any science that says this is a valid concept. If anyone has actual journal references I would love to see them.

It's not peer reviewed, but I'd refer you to this post from a GLPForums regular describing how (as an example) "protein" calories could be argued to provide less metabolic energy than calories associated with other macros.

Does Titrating up help weight loss?

RS has been on Tira 7.5mg with only 15 pounds to go to goal weight. Loss 80 pounds total. They hit a stall now. Will titrating up actually help with the weight loss or just control appetite better? RS doesn't generally have hunger issues at this dose running keto in calorie deficit . Also...

glp1forum.com

But people get way too obsessed with tracking calories for their own good. The only objective measure of calories that we have (which is where the number on the label comes from) is from bomb calorimetry data, which is a very different thermodynamic pathway. In a calorimeter, it's just measuring heat evolved from oxidizing the substance down to carbon dioxide and water. That's very different than the useful work that can be evolved from shuttling around, processing, and ultimately metabolizing those same substances in a human body.

It would be comparable to noting how much heat is evolved from burning a gallon of gasoline and then trying to use that value to infer how much useful work the engine in your Toyota Camry can perform from combusting that same gallon of gasoline (which would be significantly less). Sure, thermodynamics tells us that the work + heat evolved in the engine should add up to the same total as the heat measured from straight combustion, but in the Camry example some work energy further has to be wasted dealing with that excess heat and that will vary depending on the temperature outside.

Similarly, in the human body, there are a lot of complicating factors determining how much of that food energy (calories) translates to productive biological processes, how much gets wasted on overhead, and that's not even touching on how hormonal signaling can override such processes. The calories people will lump and blur that all together into TDEE, but that's just because they're locked into that framework and their only means of coping is to pretend it can all be averaged and blurred, since trying to deal with those actual intricacies would reveal that their model is junk.