逐渐增加剂量有助于减肥吗？

[tubby]

issues with hunger at current levels and diet. that is good, generally in a non drug aided diet plan you are going to be some level of hungry and i know everyone here apparently wants to completely avoid that but if you have no issue with it atm why not just cut back a little more to where you do feel a little hunger before titrating up?

I suspect a big part of the lack of hunger for OP is the choice of dietary intervention, as the style of diet they're on (GLPs aside) can be highly effective at keeping hunger at bay. Of course cravings are an entirely different story...

At the same time, I do find myself questioning some of the sentiment here stressing keeping dosage down to the bare minimum until a stall is fully proven out. I think there's a natural tendency to ramp up dose very quickly ("if some is good more must be better" sentiment) and in trying to curb that desire, perhaps we err a little to aggressively towards keeping dose to a minimum.

I generally agree with what you said, though.

 

[tubby]

I am on about 3g/kg/day without any protein powders or shakes, just low fat dairy and meat.

I understand that on a theoretical bases "protein is protein" (although I guess amino acid composition could be dug into a bit deeper). With that said, I know that I've previously found that protein from dairy (whether via protein shakes, cottage cheese, greek yogurt, or otherwise) seems to affect me differently than ground beef or steak.

I'm not sure if it's an absorption rate thing or what exactly is going on, but although I feel better when I eat ground beef or steak, it does seem to drive my weight up for whatever reason. Granted, I'm not doing any body comp scans so it could be a lean mass VS fat thing, but I gained significant weight going from a keto diet to a carnivore diet (as an example).

 

[HereKittyKitty]

At the same time, I do find myself questioning some of the sentiment here stressing keeping dosage down to the bare minimum until a stall is fully proven out. I think there's a natural tendency to ramp up dose very quickly ("if some is good more must be better" sentiment) and in trying to curb that desire, perhaps we err a little to aggressively towards keeping dose to a minimum.

Before glp's broke into the vernacular, my cousin was on one. I remember he said to me that he wished he had titrated up more slowly instead of "blindly" (his language) increasing every 4 weeks. He ran out of runway and still had weight he wanted to lose. He felt very frustrated. I don't know what he ultimately decided to do. But his frustration stuck with me.

This is why I lean conservatively on this topic.

There are now many ways to work around a lack of runway. 4 yrs ago, I don't know what approved tools he had at his disposal to compensate for reaching approved ceiling dosage.

 

[tubby]

Before glp's broke into the vernacular, my cousin was on one. I remember he said to me that he wished he had titrated up more slowly instead of "blindly" (his language) increasing every 4 weeks. He ran out of runway and still had weight he wanted to lose. He felt very frustrated. I don't know what he ultimately decided to do. But his frustration stuck with me.

This is why I lean conservatively on this topic.

There are now many ways to work around a lack of runway. 4 yrs ago, I don't know what approved tools he had at his disposal to compensate for reaching approved ceiling dosage.

I understand that's the reasoning people apply. I just don't find that claim to be remotely plausible. It would imply that your body has some way of remembering the dosage escalation that you followed.

Going back to my speed VS gas pedal analogy earlier, it would be like your car somehow remembering how quickly you ramped up speed and a certain position on the gas pedal (on a specific stretch of highway) now keeping you at 85 MPH instead of 80 MPH because you accelerated differently. I'll acknowledge that on different parts of highway (less wind or different grade) that the same position on the gas pedal will lead to different speeds, but that's very different.

From my past experience with diets, my paradigm of body weight is that you don't "gain" or "lose" weight on different diets, so much as each different diet trends towards a certain weight result. And as you change from one diet to another, you gain or lose weight based on whether the new diet trends to a different weight result than the previous diet you were on. For example, coming from the standard American diet, most people would lose weight by switching to a carnivore diet. Meanwhile, a gaunt raw-vegan with a low BMI switching to a carnivore diet would be expected to gain weight. Which diets trend towards which final weight results will vary somewhat from person to person (since we all have unique hormonal and biochemical factors), of course.

The same logic would apply to a gym program. Let's say a certain exercise routine brings you from 250 pounds to 240 pounds. Presumably when you stop that routine, you'd trend back towards 250 pounds again. Meanwhile maybe a different routine brings you all the way down to 230 pounds. It seems unlikely that if you started with the lighter routine (that only got you down to 240) and then switched to the more intense routine that you'd somehow end up at a weight other than 230, just because you started with the other routine first.

Going back to GLPs, it would be very odd for them to be the exception to this where varying the dose escalation would affect final result hormonally. What I do believe is possible (and where I agree with the slower escalation people) is that IF you lost a bunch of weight by quickly jumping to the highest dosing, that might leave you ill-equipped to deal with hunger (due to months of strong suppression) that later surfaces. Meanwhile, the slower escalation people might have formed better habits for dealing with hunger along the way. I'm not sure how powerful that effect would be, of course, but it seems reasonable for something like that to influence the final result in some manner.

 

[lessthanhalf]

Before glp's broke into the vernacular, my cousin was on one. I remember he said to me that he wished he had titrated up more slowly instead of "blindly" (his language) increasing every 4 weeks. He ran out of runway and still had weight he wanted to lose. He felt very frustrated. I don't know what he ultimately decided to do. But his frustration stuck with me.

This is why I lean conservatively on this topic.

There are now many ways to work around a lack of runway. 4 yrs ago, I don't know what approved tools he had at his disposal to compensate for reaching approved ceiling dosage.

I think this way of seeing how GLP's work is based on internet folklore, not the underlying research. There is no evidence that how quickly you increase doses makes any difference to the final amount of weight loss, just the final dose. Increasing slowly is entirely about reducing unpleasant side effects, suddenly starting at max doses would be enough to put a decent percentage of people in hospital with intractable vomiting, so avoiding that and making the experience less unpleasant makes a lot of sense. Equally folklore based is the concept of starting on one less effective GLP so you can switch to a more effective one later once you stop losing weight. It just does not make any sense at all, pick the most effective drug or the one with the least side effects. I cannot see any good reason to use semaglutide currently, given it has more side effects and is less effective.

I think the reason people feel that they "ran out of runway" is just expecting GLP's to work miracles. There is a limit to how much weight people usually lose on them, and a lot of people with more severe obesity have more to lose than these drugs can achieve. And exactly 50% of people are going to lose less than the average amount of weight lost in the trials, and some unlucky people are going to lose a lot less, and a few lucky ones a lot more.

The amounts of weight lost I see on this forum are often higher than the results seen in the studies, and I think it is mainly selection bias, the people who had amazing life changing results are the ones most likely to post and keep talking about it.

People who are at a genuine plateau, that is on maximum standard dose and stuck there for a month or more are just at the limit of what that drug can do for them, and I think it is super important to accept that and stay on it as any significant weight loss will improve health, even if you are not at completely non overweight BMI's. Before GLP's doctors were very happy to claim 5 or sometimes 10% weight loss maintained as a major success, with significant reductions in long term health risks.

There are no proven methods yet to fix this problem, that have actual studies showing that it is safe, but anecdotal reports demonstrate that combining GLP's or increased doses can work, hopefully future research shows that the health benefits outweigh the risks of using unstudied therapies.

 

[bbbilly]

At the same time, I do find myself questioning some of the sentiment here stressing keeping dosage down to the bare minimum until a stall is fully proven out. I think there's a natural tendency to ramp up dose very quickly ("if some is good more must be better" sentiment) and in trying to curb that desire, perhaps we err a little to aggressively towards keeping dose to a minimum.

I generally agree with what you said, though.

yeah, thats why i said i apparently fall into a different category than alot of people here, because to me it feels like the idea of any sort of hunger is a failure on the medication so the solution is to add more and more is very common here. where as i see it and use it more as a tool to help you deal with the level of hunger. you are kind of peckish rather than full on HANGRY levels of ravenous while dropping weight. that's a win, you aren't nearly as clouded by the dark shadow of hunger, rather just reminded that there are clouds in the sky while you go about your day.

i know for me i am currently on 1.5mg tirz every 8 days and that is enough to make me think about the food as i am teetering on the edge of a binge to go "im not ACTUALLY hungry, but i WANT to eat" so i can make my meal prep instead of grabbing whatever is in front of me. and the half life of that waning near my shot day keeps me in a steady place of "ok now i AM hungry, the otherday i guess i was just bored" and can use that reference to also pull me back from the edge of a binge.

i have my own struggles and mind set about things, and i know others are completely different and just as valid as my own. but the idea that any level of hunger is the enemy feels like an easy way to fall into dependance and over consumption

 

[HereKittyKitty]

This conversation took place when Ozempic was being rx'd off label a few years before it was approved for weight loss and rebranded. With little information and almost no context, it is a bold statement to dismiss someone's lived experience as internet folklore.

You've twisted my words. Perhaps I was unclear. They are not concepts I'm interested to hash out tonight. It's been a very long week and I'm tired.

Edited for typo

 

[tubby]

The amounts of weight lost I see on this forum are often higher than the results seen in the studies, and I think it is mainly selection bias, the people who had amazing life changing results are the ones most likely to post and keep talking about it.

I'd wondered about that too. Sure seems like (almost) everyone here is above average. You could be correct and it's just selection bias, but I wouldn't be surprised if being able to more precisely control one's own dosing rate and schedule actually improves results VS a constant dose.

I realize I just got done arguing that dosing escalation rate doesn't really matter, so I probably sound like I'm contradicting myself here. I'm more thinking I wouldn't be surprised if the greater degree to which people here obsess over GLPs and controlling them (VS it just being a thing in the fridge they pop out once a week and otherwise don't really think about) has some indirect effect and perhaps correlates with making other beneficial challenges.

By virtue of having to vet vendors, wrap your mind around crypto, and go through all this extra hassle you have a much stronger psychological investment in the process and result VS just being handed this thing your doctor told you to do every week. Kind of like how you more strongly value that bike you spent the summer working a newspaper route to save up for VS a bike your parents just gave you.

And by trying to maintain minimal effective dosing in the manner bbbilly described, he does seem to be setting himself up for a possible small additional edge at plateau in that it would seem that if he can maintain that habit at plateau it would juice the results, just as were he to engage in that practice before he started he would likely experience some small sustained weight loss from performing it diligently.

 

[lessthanhalf]

Internet folklore is an actual term used by researchers to describe how GLP's or Anabolic steroids are talked about online. It was in no way intended as a personal criticism.

I honestly think that those ways of looking at the drugs are unhelpful, and can lead to worse long term outcomes , and can lead to people being disappointed with the results and giving up.

One of the great things about this forum is people's descriptions of their lived experiences on these medications, that can provide some types of subjective experiences that cannot be worked out from the studies, one thing that is very obvious is how different peoples' experiences of effects and side effects are. But anecdotal reports can be misleading as well, which is why the studies are done double blinded and with all the results added together to separate out placebo effects and real effects.

 

[lessthanhalf]

我也想过这个问题。这里几乎每个人都高于平均水平。你说的或许是对的，这可能只是选择性偏差，但如果能够更精确地控制剂量和用药时间，相比固定剂量，确实能改善效果，我也不会感到惊讶。

我知道我刚才还在说剂量递增速度其实并不重要，所以现在听起来可能有点自相矛盾。我更倾向于认为，这里的人对GLP（良好实验室规范）的执着和控制程度（而不是像有些人那样，只是把它当成冰箱里的东西，每周拿出来一次，平时根本不会去想它）可能存在某种间接影响，甚至可能与他们做出其他有益的挑战有关。

因为需要筛选供应商、理解加密货币，还要经历所有这些额外的麻烦，所以你会对整个过程和结果投入更多的心理，而不是仅仅按照医生的指示每周服用。这就好比你更珍惜自己暑假送报纸攒钱买的自行车，而不是父母送你的自行车。

通过像bbbilly描述的那样尝试维持最低有效剂量，他似乎确实在为平台期的一个潜在优势做准备，因为如果他能在平台期保持这个习惯，就能增强效果，就像如果他在开始之前就养成这种习惯，并且坚持下去，很可能会获得一些持续的小幅减重一样。

安慰剂效应无疑会因复杂性、成本以及时间和精力的投入而增强。安慰剂手术或假手术通常能最大程度地发挥安慰剂效应。正品在成本方面绝对胜出，而且在我看来，人们似乎忘记了这些药物有多么神奇，以及研发出真正有效的减肥药经历了多么漫长的过程，仅仅因为它们来自中国，价格低廉。

灰色版本则在复杂性和所需投入的时间精力方面更胜一筹，几乎没有人需要用特殊液体溶解药瓶，并非常仔细地计算剂量，更不用说整个购买过程的半非法性了。很难说哪种方式最终胜出。

 

[Sasquatch]

我也不知道，伙计们，我真的只按药柜里那个小矮人告诉我的量来用药

。

 

[tubby]

安慰剂效应无疑会因复杂性、成本以及时间和精力的投入而增强。安慰剂手术或假手术通常能最大程度地发挥安慰剂效应。正品在成本方面绝对胜出，而且在我看来，人们似乎忘记了这些药物有多么神奇，以及研发出真正有效的减肥药经历了多么漫长的过程，仅仅因为它们来自中国，价格低廉。

灰色版本则在复杂性和所需投入的时间精力方面更胜一筹，几乎没有人需要用特殊液体溶解药瓶，并非常仔细地计算剂量，更不用说整个购买过程的半非法性了。很难说哪种方式最终胜出。

到了那个时候，还能把它称为安慰剂吗（如果它产生了影响结果的连锁反应）？我认为完全有可能，在他们的认知里，所有这些额外的努力可能并不完全属于良好生活质量（GLP）的范畴，而是被视为更广泛的减肥目标。如果是这样的话，这或许会提高他们加入健身房、采取专门的饮食策略（不仅仅是GLP）或其他行为的可能性？

我想，这或许仍然可以算作“安慰剂效应”。我不确定还有没有其他更合适的词来形容它。

 

[lessthanhalf]

我发现你发的关于reta试验中安慰剂组体重减轻的图表很有意思。总体而言，一年后安慰剂组的体重减轻幅度确实比GLP组小得多，但安慰剂组确实有一个人减重了20%左右，而且这个数字肯定不在零点的正负两端。

大多数人对药物，尤其是安慰剂，会改变他们的行为感到非常不舒服，特别是那些通常被认为是受意识控制的行为，但GLP药物确实会改变这些行为，比如改变食物购买选择、酒精或药物摄入量，以及其他很可能多种行为。

 

[tubby]

我发现你发的关于reta试验中安慰剂组体重减轻的图表很有意思。总体而言，一年后安慰剂组的体重减轻幅度确实比GLP组小得多，但安慰剂组确实有一个人减重了20%左右，而且这个数字肯定不在零点的正负两端。

大多数人对药物，尤其是安慰剂，会改变他们的行为感到非常不舒服，特别是那些通常被认为是受意识控制的行为，但GLP药物确实会改变这些行为，比如改变食物购买选择、酒精或药物摄入量，以及其他很可能多种行为。

我的意思是，你说得对。看来需要调整的是我对“安慰剂”这个词的个人定义。这让我不禁想知道，研究界是否研究过这个问题：他们是否尝试过进一步细化或分类安慰剂的类型？

显然，最经典的例子就是糖丸，但我觉得区分“我肯定服用了药物，所以我期望效果更好”的安慰剂效应和“既然我投入了某种特定的方式来实现某个目标，我会潜意识地影响我生活中的其他行为，使其也朝着实现同一目标的方向发展”的安慰剂效应是有意义的。不过，我想这个问题更应该咨询专业的心理学研究人员。