Managing GLP-1 medications like Zepbound and semaglutide requires understanding that GI side effects like constipation require early and decisive intervention rather than waiting for them to resolve, fatty foods can upset the digestive system even without being deep-fried, adequate calorie intake (1,500+ calories) is essential for healthy weight loss, medication adherence requires consistent routines and reminders, dose changes should be implemented promptly when effectiveness decreases, and GLP-1s may need to be used indefinitely for maintenance similar to thyroid medication.
Deep Dive
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Deep Dive
I Made 7 GLP-1 Mistakes (So You Don't Have To)Added:
I've lost about 43% on a GLP-1. I've made plenty of mistakes along the way.
Most of them weren't huge mistakes that would throw me totally off track. In fact, a lot of them were just kind of ridiculous and funny. I'm going to share seven kind of ridiculous mistakes that I've made over these past 70 weeks on a GLP-1 and the lessons that I learned from them so that maybe you don't have to make the same mistakes. Also, the last one, you actually helped me with even if you don't realize it. So, thank you. Okay, let's do it.
I'm coming at you from a hotel this week and my routine is all off right now. Not having a kitchen and not having my meal prep has just kind of thrown me for a loop. It's just I'm all out of sorts.
Being at home makes it a lot easier. If you're new here, hi, I'm Bobby. For about 16 months, I've been sharing my GLP-1 health journey after menopause on YouTube. I'm not a medical doctor and I am a therapist, but I'm not your therapist. So, I am just sharing my experience and what's working for me.
Always check with your own health care providers when you're figuring out what to do for yourself. Real quick, my starting weight was 210.1 lb and my current weight is about 167 as of last week. I do a monthly weigh-in, so that's my most recent weigh-in. I'm closing in on maintenance and my body fat percentage is still a little too high. So, once I get into a normal range of body fat, then I'm going to consider that the upper edge of my maintenance range and I'm going to go into maintenance. I don't know exactly what that will look like. I'm not planning on stopping GLP-1s because the absence of food noise is magical. So, I will stay on them, but I don't know if I'll end up decreasing my dose to maintain my weight or what.
I'm going to figure that out as I go and you are welcome to join me here as I figure that out. I'm currently on 10 mg of Zepbound and that's working well for me, which means I don't have food noise and my appetite is suppressed enough that I can stay in a small calorie deficit without feeling like I'm on a diet. Okay, let's get to these mistakes.
When I first started GLP-1s, I started on compounded semaglutide. One of the side effects that happened is that I got really constipated and that's a common side effect for GLP-1s. All the GI side effects are common. So, when it happened, I quickly learned that it was common and I kind of thought in in retrospect the mixture of like false optimism and denial, I thought that it would just kind of resolve on its own.
You know how sometimes you take medications and you have a side effect that wears off when your body adjusts to the medication. I thought that would happen. So, I just kind of waited to poop and, you know, it wouldn't happen on its own. You know what? I'm going to find that snippet and I'm going to play it for you right now. I've relied on Smooth Moves tea, which has senna in it, which is a laxative, but I feel like I would drink the tea when I knew that I was like overdue to go to the bathroom.
And so, it was always like trying to catch up and my doctor's trying to help me kind of get on top of it so that I can be more regular instead of getting backed up and then catching up and, you know, without being too graphic, I just want to be more regular.
And I'm sure I'll keep talking about my poop in future videos because I do know that this is a common side effect.
I'm not the only one who struggles with it. I'm sure eventually I'll figure out a routine that is effective for me, but right now I'm still kind of struggling after 2 months to figure out how to stay on top of it. So, I was relying on Smooth Moves tea, which has senna in it, which is a stimulant laxative, and I wouldn't poop, and then I'd drink some tea, and I would pretty much clean myself out. Then I would think, okay, now maybe my body will get on track, and I would go through that same cycle again, and eventually my doctor was like, you need to, you know, have some daily interventions. And she was recommending Miralax and prunes and magnesium. So, I started doing that, and my doctor was really helpful, but the mistake that I made is that I was too tentative in my interventions. I kept thinking like, there's no way I could take Miralax every day without like pooping my pants all the time. Or, you know, in the past, if I ate a few prunes, I would go like later that day or the next day.
So, I was like, there's no way I can eat prunes every day. That's crazy. So, I was like trying little things, and nothing was working, and I was like, constipation's really bad. And it took me about 2 months to finally figure out that I needed a lot more than I thought I did. In fact, I needed Miralax every day, Mag O7, which is magnesium supplement, every day, five prunes every day, and then staying on top of my water and fiber, which is the only thing that I was really good about from the beginning was the water and the fiber, but that just isn't enough. Or at least for me, it wasn't enough with the GLP-1.
So, the mistake I made was kind of underestimating just how powerful the constipation was, and the lesson I learned was to intervene early and decisively with constipation. Because my strategy of just sitting around thinking like, oh, I'll poop tomorrow, was a terrible strategy. I wish I had not done that. I wish I had taken it a lot more seriously from the beginning. I was much happier once I did.
Uh-oh.
So, constipation is a common side effect. Another GI effect that GLP-1s have is that they slow down the emptying of the stomach. And because they do that, eating a lot of really fatty foods can really upset your stomach and your whole GI system because fatty foods also empty slower with or without a GLP-1.
So, if you eat a lot of fatty foods with the GLP-1s, it really slows things down and our bodies just do not like that.
So, I was aware of this, but in my head, somehow, I just kind of interpreted that like, "Okay, stay away from really like deep-fried foods." So, I did, and it wasn't hard because my taste changed and fried foods didn't really appeal to me that much. But about 6 weeks into being on a GLP-1, I was on vacation and we went out to a Georgian restaurant and for whatever reason, ordered a very meat and cheese heavy meal, even though Georgian food has a lot of vegetables in it. It's kind of like a Mediterranean/Middle Eastern blend of foods. It is delicious and there are lots of vegetable dishes, none of which I ordered that night. And I ate a bunch of meats and cheeses, and none of it was deep-fried, so I was kind of thinking I was in the clear. And we went back to our hotel or Airbnb, I don't remember. It was an Airbnb cuz it was an apartment. And I was fine. I went to sleep. Oh my gosh, the middle of the night, no. Bathroom emergency. It was really unpleasant. It would have been bad enough at home, but in a strange place where you wake up and you're like, "Oh my god, I need the bathroom. Where is the bathroom? Where am I?" It was very unpleasant. And I kind of knew immediately like, "What was I thinking?
I just ate like buckets of fat." That night made it very clear that it's not just deep-fried foods. I'm not sure why I thought that. It's just fat in general is something that generally does not agree with being on a GLP-1 medication.
I had to learn that the hard way to respect GLP-1's effects on my GI tract.
That's a nice way of putting it because I just don't want to talk about poop the entire episode.
>> [music] >> So, I'd heard like I'm sure many of you have heard throughout your life the whole like 1,200 calorie diet to lose weight and I knew that that wasn't enough for me. I know that it's not enough for most people, but the diet culture sort of common wisdom is to eat 1,200 calories a day to lose weight. So, when I started a GLP-1, I thought I was really doing myself a solid by setting my calories at 1,400 to 1,500 calories a day.
I thought, you know, I'm going to get enough food. I'm not going to undereat.
I'm going to support my metabolism, but my weight loss kind of slowed to a halt even after I got on top of the constipation. This was like in month three. I had a month where I just had stalled out on weight loss even though I was doing all the things and I started to think, "Well, maybe 1,400 to 1,500 calories is too much or maybe it's not enough." And I felt so confused like am I eating too much? Am I not eating enough? What am I doing? And then finally I realized why don't I go talk to a dietitian because they're an expert and they can help me. So, I did and for the first time in my life I went and I talked to a dietitian and she got to know me and calculated given my height and my weight and my activity level that I should eat about 1,700 calories a day to stay in a healthy calorie deficit to lose weight at a healthy rate. And she said definitely don't go below 1,500.
So, this whole time I'd been unintentionally undereating thinking that I was like defying diet culture and eating enough, but I wasn't. I was undereating. And once I bumped my calories up to trying to get 1,700, a lot of days I hit more like 1,600, but really trying not to dip below 1,500, I noticed my energy got better and the scale started to move. So, it was a very powerful lesson in just how much fuel we need to stay healthy and vibrant even while we're trying to lose weight. And I had been mistakenly under eating, but thankfully with the help of a dietitian I learned that I need more calories than I thought I did to lose weight and feel really good and have energy to do all the things that I want to do.
>> [music] >> If you're enjoying this, please hit like and subscribe. It really helps the YouTube algorithm to show it to more people who would be interested in this.
I also have an email newsletter I send out every 2 weeks. It's [music] stuff that didn't make it into the videos either because, you know, there's not time to share everything or I forget or it's something a little bit more personal I don't want to put it on YouTube. But yeah, I'll send you an email every 2 weeks and in the first email that you get when you subscribe, you'll get my protein smoothie recipe.
And I want [music] to thank everyone. Oh my gosh, earlier this week I hit 10,000 subscribers. I never dreamed of that.
It's like it's blown me away. Thank you each and every one of you. I truly appreciate that you're here. I'm very grateful for your time and attention. I know there is no shortage of things you could spend your time watching on YouTube. So, thank you for spending this time with me. Okay, back to my ridiculous mistakes.
Uh-oh.
So, a few months into my GLP-1 journey, remember I'd started on compounded semaglutide, I switched to Zepbound. And that is not the mistake that I'm talking about. Zepbound has actually worked out great for me.
The mistake was more like how and why I did it and why I could have been more thoughtful and intentional about it instead of just sort of reacting in a knee-jerk way out of fear.
Let me explain. So, at that time, there were lawsuits going on between compounding pharmacies getting sued by a big pharma and it became a little bit uncertain about whether compounding pharmacies will be allowed to legally offer GLP-1s anymore. That alone, I was kind of keeping an eye on, but it wasn't worrying me. But then, I got a message from the place I was using, which was the Weight Watcher Clinic, that they were going to stop offering compounded semaglutide. In fact, they were switching to something that was already generic that was older, and I knew that it was something older that kind of worked, but didn't work as well, wasn't as effective. So, I wasn't interested in switching to something less effective.
So, my options were really to find another compounded pharmacy to get my medication from or to switch to branded, which I knew my primary care doctor would prescribe for me. She was not willing to prescribe compounded, but she was willing to prescribe branded.
And I just made this knee-jerk reaction instead of shopping around for a compounded pharmacy that, you know, had a good reputation and that I trusted, I just felt like I just jumped right to the more expensive branded version because it was like the quickest fix. Like I could I literally emailed my doctor and asked her if she would prescribe it, and she said, "Yes." And that day, she had sent the prescription to Lilly Direct, and the next day, the meds were being shipped to me.
So, it was really easy. So, I kind of took the easy but expensive way out. I could have switched to compounded tirzepatide. Separate from the access issue was the fact that a few months into things, I'd learned a lot and I had learned that if I knew at the beginning what I knew a few months in, I probably would have tried to start on compounded tirzepatide instead of semaglutide just because it does tend to have less side effects.
But, you know, you don't know what you don't know. And the semaglutide at that point was working. Anyway, I made a decision to switch and instead of going to branded semaglutide, which would have been Wegovy, I decided just to go to Zepbound. So, I did. And that part was a good decision. I have fewer side effects with Zepbound. I don't have to do all that constipation stuff anymore cuz I don't get constipated on Zepbound. So, that's great. But, you know, it was the whole like branded versus compounded thing that I just I don't know. If I'd taken a couple of extra steps, I would have compounded tirzepatide instead of Zepbound and I would have saved hundreds of dollars a month, probably like $250 to $300 a month. And that really adds up. So, it kind of it hurts. It hurts to think about it. But, I didn't know at the time that compounded medication would remain available to Soul Time, like you can still get it. So, for at least the next year, I could have accessed compounded medication. But, I made the quickest choice to calm myself down. And at first, I just felt relief that it was all settled. But, then once the dust settled, I was like, you know, I could have gone about this in a more deliberate way and saved myself money.
That said, I'm still taking branded Zepbound through LillyDirect. And it's kind of inertia. The fact that it costs more hurts, but it's not a big hardship.
I just don't feel like mixing it up still. So, it's kind of like, is it a mistake that I continue to make every month or is it just am I doing the best I can? I don't know. I don't have it in me to like make the switch. So, maybe that's my answer.
>> Uh-oh.
If you're on a GLP-1, have you ever forgotten to take your dose? I totally have, and sometimes I just plain forget.
Like I know it's my shot day, and I just forget and I take it the next day, and my doctors told me it's no big deal. As long as you're within like a 3-day window, you can take your regular dose.
So, you know, sometimes that happens and it's not a huge deal. But once I was like ready for my shot. I was feeling hungry and I was like, "Oh, yeah, I need more GLP-1 in my system." But I was like, "Oh, but my shot night's tomorrow night, not tonight." So, I didn't take it, and then the next morning I realized that I didn't even know what day of the week it was, and it had been my shot night the night before. It didn't help that it was time for a dose increase anyway, so I was really feeling like less effects of the medication. My shot night is on Thursdays. So, on Wednesday night I was thinking, "Maybe I should take my shot a night early. I just feel like eating everything that isn't nailed down." And I was like, "No, you can wait one more night." Then the next day came, today, and I realized it's Friday.
Last night was my shot night.
>> [laughter] >> And I didn't take it. I didn't forget. I just didn't know what day of the week it was.
So, this is just one of those ridiculous things where I was like, "Oh my god, I missed my shot because I thought it was Wednesday and really it was Thursday."
So, I took it a day late. It didn't totally derail me, but it did lead to, you know, a little period of time where I had to deal with more food noise and hunger than I otherwise would have.
Routines and setting reminders are really helpful for me. It all worked out fine. It's more just hilarious that sometimes I don't know what day of the week it is.
>> [music] >> Uh-oh.
There was another really like careless medication mistake that I made around dosing and units. I forgot to read the dosing instructions when I went up a dose because I take the medication comes in a vial, you know, and I load it into a syringe. So, I went up a dose and in the next couple days I didn't feel any effects. I felt like I had skipped a dose and I was like, "Oh my gosh, did I get a bad batch of medication?" I went back to look at the medication to see if somehow I was sent like a really expired batch or something and I realized that I had pulled the wrong number of units because I hadn't read the prescription and I was supposed to take eight different number of units to get this new dose. And I was like, no wonder I'm feeling like I'm not on any medication.
And it had been a few days, so I just went ahead and administered myself an entire dose because it had been long enough. In general, I would say check with your doctor before you do that, but because she had told me before that shouldn't you shouldn't have your doses any closer than three days apart. I kind of knew it had been three days and then I could do it. It was okay. But it was a good lesson in checking, especially when there's any change. Just double and even triple check that you're taking the right amount. And if you ever have any questions, double check with the pharmacist or your doctor. It can get confusing around units and dose. So, if you're ever not sure, double check. In this case, I was just kind of cavalier and maybe I was just in my routine and it just didn't even occur to me to double check because it was a new dose. It wasn't the end of the world, but it did mean a few days of not feeling the effects that I'm used to feeling on this medication.
>> [music] >> Oh.
Okay.
This last one, you didn't know it at the time, but you helped me solve this.
Last October, I started to feel like the 5 mg of Zepbound that I was on had become a little less effective and that I needed to go up to 7.5. And so, I contacted my doctor and she said, "Great." And she put the order in and it arrived. And when it arrived, I still had 5 mg vials left. And I told myself because I don't know, cuz sometimes I just it doesn't occur to me to like give myself a break, I told myself I can power through. I can use the last vials of 5 mg and then start my new higher dose. And I felt okay about that decision and then I was sitting down to record my weekly episode and I started explaining that decision to you. And as I was explaining it, it became more and more apparent that I was suffering for no reason at all. I am at this point really looking forward to my dose increase. I'll move up from 5 mg to 7.5 mg on Zepbound in 2 weeks. And the food noise has crept back in since about 2 or 3 weeks ago. I'm working a lot harder at trying not to think about food or trying not to eat just because I'm thinking about food. So, yeah, it's labor intensive. I'm really looking forward to a break. But I'm also proud of myself that the food noise hasn't meant that how I'm living my daily life looks very different. I guess now that I'm saying that out loud, that kind of makes sense because until 9 months ago, the food noise was my constant companion. So, I was kind of used to dealing with it and until menopause, I was able to stay at a relatively normal weight. And after menopause, my eating habits didn't change, but I could not stay at a normal weight. Like my weight kept creeping up and up. So, I think I've just sort of defaulted back to whatever it was I was doing before when I had all the food noise that helped me to, you know, not overeat being plagued by this constant barrage of thoughts about food. And yeah, I I miss the quiet. I'm really looking forward now that I think about it, I might not wait 2 weeks. Now that I hear myself saying this, I'm like, why am I going to suffer for 2 weeks? Yeah, I think I might bump up sooner. Yeah.
Thanks for listening. I [laughter] just worked through this.
So yeah, I was toughing it out for no good reason. And so I went ahead and I went up and dosed right away. And those 5 mg vials, it's not that they went to waste. I used them to dose 7.5 mg to myself. But yeah, once I realized how much I was kind of struggling with food noise, I was like, this is not serving me well. I mean, except to remind me of what life was like before GLP-1s with food noise. And how the GLP-1s fixed the food noise in my brain. It's not just the stomach or the digestive system it acts on. It is a medication that affects how our brains think about food. But I already knew that the GLP-1s helped my food noise and that I had realized that I'd had food noise my whole life. I didn't need to suffer for a couple weeks to relearn this. So it was a good decision to change my mind and go up right away instead of making the mistake of trying to tough it out. It was just a good lesson for me that dose changes exist for a good reason and there's no need to struggle more than necessary.
And yeah, many of you have asked me as I'm getting closer to maintenance, if I am going to stay on GLP-1s or change my dose or anything. And I'm definitely staying on GLP-1s in maintenance and indefinitely, probably for my whole life. I kind of think of it the way I think about my thyroid medication is my thyroid levels, you know, are in the normal range, but that doesn't mean like, okay, I'm cured. My thyroid is normal, I can go off my thyroid meds.
That's what's keeping my thyroid levels normal. So, without this GLP-1, all of that food noise, oh God, I would just have to struggle with it again.
And it changed my metabolism in a way that nothing else did after menopause.
So, yeah, I'm definitely staying on the GLP-1, but I don't know if I'll need to go down in dose to stop losing weight or what I'll need to do. Yeah, I really have no idea. I will figure all that out as I go. Those are my seven mistakes.
They were all just, I don't know, I think they were incredibly human and each one taught me something that helped me on the rest of my journey. So, I really hope that sharing them helps some of you to avoid some of these traps. As I'm talking about these mistakes, I'm realizing a lot of them are in my mindset. Like the recurring theme is me thinking, I can just do this, like I can stay on the lower dose or I can just wait for the constipation to end instead of, you know, taking action and taking care of myself. I don't know, do you guys struggle with that? It's a theme for me. It's definitely a theme for me that I feel like I should have it all figured out on my own and not need help.
I would love to hear from you. Have you made any of these mistakes? Have you made other mistakes that I didn't mention that you've learned from? We all learn from each other in the comments. I know I do every week. Thank you so much for watching all the way to the end. I will see you next week. I will be back at home filming. Thanks so much. Love you guys. Bye.
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