Most People Who Start GLP-1 RAs Quit Them Within A Year (Here’s Why)
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Specifically, 54% quit within one year, with that number rising to 72% within two years.
We first wrote about GLP-1 receptor agonists (i.e. semaglutide drugs like Ozempic and Wegovy) a couple of years ago when popularity was just beginning to take off:
However, as we had room only to touch briefly on the side effects and what happens when you stop taking it, you might also want to check out:
What happens when I stop taking a drug like Ozempic or Mounjaro?
…and:
Notwithstanding all this information, there’s a lot of science that has still yet to be done. If you’re a regular 10almonds reader, you’ll be familiar with our research review articles—this one was more of a non-research review, i.e. looking at the great absence of evidence in certain areas, and the many cases of research simply not asking the right questions, for example:
❝Of the four studies that actually looked at the macros (unlike most studies), they found that on average, protein intake decreased by 17.1%. Which is a big deal!
It’s an especially big deal, because while protein’s obviously important for everyone, it’s especially important for anyone trying to lose weight, because muscle mass is a major factor in metabolic base rate—which in turn is much important for fat loss/maintenance than exercise, when it comes to how many calories we burn by simply existing.
A reasonable hypothesis, therefore, is that one of the numerous reasons people who quit GLP-1 agonists immediately put fat back on, is because they probably lost muscle mass in amongst their weight loss, meaning that their metabolic base rate will have decreased, meaning that they end up more disposed to put on fat than before.❞
Read in full: Semaglutide’s Surprisingly Unexamined Effects ← there are a lot more (equally concerning) items discussed in this article
Why people quit GLP-1 RAs
There was a large (n=125,474) study of US adults. The average age was about 54 years, and about 65% were female.
From the total data pool (i.e. not narrowing it down by demographic), 54% stopped within a year, and 72% within two years.
The factors most associated with discontinuation were:
- age above 65 years
- not having type 2 diabetes
The main reasons given for discontinuation were:
- High costs: self-explanatory, but it’s worth noting that people who stopped for this reason were more likely to restart later.
- Adverse side effects: the most common ones were nausea, vomiting, diarrhea, constipation, stomach pain, and loss of appetite. Rarer, but more seriously, side effects included: pancreatitis (severe abdominal pain, nausea, vomiting), gallbladder issues (gallstones, cholecystitis), kidney problems, severe allergic reactions (rash, swelling, difficulty breathing), hypoglycemia, especially if taken with insulin or other diabetes medications, changes in vision (worsening diabetic retinopathy), and an increased heart rate.
- Disappointingly little weight loss: the researchers noted that GLP-1 RA results are “heterogenous”, meaning, they differ a lot. For those for whom it didn’t work, quitting was more likely, for obvious reasons. See also: 10 Mistakes To Sabotage Your Ozempic Progress
- Successful weight loss: while it is widely known that if one stops taking GLP-1 RAs, weight regain is the usual next thing to happen, there are a lot of people who go onto GLP-1 RAs with the rationale “I’ll just use this to lose the weight, and then I’ll keep the weight off with my diet and lifestyle”. Which sounds reasonable, but because of the specific mechanisms of actions of GLP-1 RAs, it simply doesn’t work that way (and, as we mentioned above, there are reasons that you may, after stopping taking GLP-1 RAs, be more disposed to put weight on than you were before you started). So, by the best of current science (which admittedly is not amazing when it comes to this topic), it does seem that taking GLP-1 RAs is a lifetime commitment.
You can read the study itself here:
Want to get similar results, without GLP-1 RAs?
Then check out:
5 Ways To Naturally Boost The “Ozempic Effect” ← this is about natural ways of doing similar hormone-hacking to what GLP-1 RAs do
and
Ozempic vs Five Natural Supplements ← this is about metabolism-tweaking supplements
and
Hack Your Hunger ← this is about appetite management
Take care!
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Fermenting Everything – by Andy Hamilton
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This is not justanother pickling book! This is, instead, what it says on the front cover, “fermenting everything”.
Ok, maybe not literally everything, but every kind of thing that can reasonably be fermented, and it’s probably a lot more things than you might think.
From habanero chutney to lacto-lemonade, aioli to kombucha, Ukrainian fermented tomatoes to kvass. We could go on, but we’d soon run out of space. You get the idea. If it’s a fermented product (food, drink, condiment) and you’ve heard of it, there’s probably a recipe in here.
All in all, this is a great way to get in your gut-healthy daily dose of fermented products!
He does also talk safety, and troubleshooting too. And so long as you have a collection of big jars and a fairly normally-furnished kitchen, you shouldn’t need any more special equipment than that, unless you decide to you your fermentation skills for making beer (which does need some extra equipment, and he offers advice on that—our advice as a health science publication is “don’t drink beer”, though).
Bottom line: with this in hand, you can create a lot of amazing foods/drinks/condiments that are not only delicious, but also great for gut health.
Click here to check out Fermenting Everything, and widen your culinary horizons!
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Healthy sex drive In Our Fifties
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: What’s a healthy sex drive for someone in their 50s?
A: If you’re happy with it, it’s healthy! If you’re not, it’s not.
This means… If you’re not (happy) and thus it’s not (healthy), you have two main options:
- Find a way to be happier without changing it (i.e., change your perspective)
- Find a way to change your sex drive (presumably: “increase it”, but we don’t like to assume)
There are hormonal and pharmaceutical remedies that may help (whatever your sex), so do speak with your doctor/pharmacist.
Additionally, if a boost to sex drive is what’s wanted, then almost anything that is good for your heart will help.
We wrote about heart health yesterday:
What Matters Most For Your Heart?
That was specifically about dietary considerations, so you might also want to check out:
Take care!
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The Smartest Way To Get To 20% Body Fat (Or 10% For Men)
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20% body fat for women, or 10% for men, are suggested in this video as ideal levels of adiposity for most people. While we certainly do have wiggle-room in either direction, going much higher than that can create a metabolic strain, and going much lower than that can cause immune dysfunction, organ damage, brittle bones, and more.
This video assumes you want to get down to those figures. If you want to go up to those figures because you are currently underweight, check out: How To Gain Weight (Healthily!)
Look at the small picture
The main trick, we are told, is to focus on small, incremental changes rather than obsessing over long-term weight loss goals (e.g. 20% body fat for women, 10% for men).
Next, throw out what science shows doesn’t work, such as restrictive or extreme dieting:
- Restrictive dieting doesn’t work as the body will try to save you from starvation by storing extra fat and slowing your metabolism to make your fat reserves last longer
- Extreme dieting doesn’t work because no matter how compelling it is to believe “I’ll just lose it in this extreme way, then maintain my new lower weight”, the vast body of research shows that weight loss in this way will be regained quickly afterwards, and for a significant minority, may even end up putting more back on than was originally lost. In either case, you’ll have put your mind and body through the wringer for no long-term gain.
The recommendation comes in three parts:
- Shift your mindset: detach motivation from timelines and vanity goals; focus instead on lifelong health and sustainable habits.
- Use an analytical approach: apply engineering principles: collect honest data and identify bottlenecks. Track food intake consistently, even during slip-ups, to identify areas for improvement. You remember the whole “it doesn’t count if it’s from someone else’s plate” thing? These days with food trackers, a lot of people fall into “it doesn’t count if I don’t record it”, but a head-in-the-sand approach will not get you where you want to be.
- Tackle bottlenecks incrementally: focus on one small, impactful change at a time (e.g. reducing soda intake). This way, you can build habits gradually to prevent willpower burnout and sustain your progress.
As an example of how this looked for Viva (in the video):
- > 30% body fat stage: she focused on reducing processed foods and portion sizes.
- 29–25% body fat stage: she prioritized nutrient-dense foods and reduced dining out.
- 24–20% body fat stage: she added strength training, improved sleep, and addressed her cravings and energy levels.
In short: look at the small picture; adjust your habits mindfully, keep a track of things, see what needs improvement and improve it, and don’t try to speedrun weight loss; just focus on what you are tangibly doing to keep things heading in the right direction, and you’ll get there 1% at a time.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Lose Weight, But Healthily ← our own guide, which is also consistent with the advice above, and talks about some specific things to pay attention to that weren’t mentioned in the video
Take care!
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Melatonin: A Safe, Natural Sleep Aid?
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Melatonin: A safe sleep supplement?
Melatonin is a hormone normally made in our pineal gland. It helps regulate our circadian rhythm, by making us sleepy.
It has other roles too—it has a part to play in regulating immune function, something that also waxes and wanes as a typical day goes by.
Additionally, since melatonin and cortisol are antagonistic to each other, a sudden increase in either will decrease the other. Our brain takes advantage of this, by giving us a cortisol spike in the morning to help us wake up.
As a supplement, it’s generally enjoyed with the intention of inducing healthy, natural, restorative sleep.
Does it really induce healthy, natural, restorative, sleep?
Yes! Well, “natural” is a little subject and relative, if you’re taking it as a supplement, but it’s something your body produces naturally anyway.
Contrast with, for example, benzodiazepines (that whole family of medications with names ending in -azopan or -alozam), or other tranquilizing drugs that do not so much induce healthy sleep, but rather reduce your brain function and hopefully knock you out, and/but often have unwanted side effects, and a tendency to create dependency.
Melatonin, unlike most of those drugs, does not create dependency, and furthermore, we don’t develop tolerance to it. In other words, the same dose will continue working (we won’t need more and more).
In terms of benefits, melatonin not only reduces the time to fall asleep and increases total sleep time, but also (quite a bonus) improves sleep quality, too:
Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders
Because it is a natural hormone rather than a drug with many side effects and interactions, it’s also beneficial for those who need good sleep and/but don’t want tranquilizing:
Any other benefits?
Yes! It can also help guard against Seasonal Affective Disorder, also called seasonal depression. Because SAD is not just about “not enough light = not enough serotonin”, but also partly about circadian rhythm and (the body is not so sure what time of day it is when there are long hours of darkness, or even, in the other hemisphere / other time of year, long hours of daylight), melatonin can help, by giving your brain something to “anchor” onto, provided you take it at the same time each day. See:
- Is seasonal affective disorder a disorder of circadian rhythms?
- The circadian basis of winter depression: the case for low-dose melatonin use
As a small bonus, melatonin also promotes HGH production (important for maintaining bone and muscle mass, especially in later life):
Anything we should worry about?
Assuming taking a recommended dose only (0.5mg–10mg per day), toxicity is highly unlikely, especially given that it has a half-life of only 40–60 minutes, so it’ll be eliminated quite quickly.
However! It does indeed induce sleepiness, so for example, don’t take melatonin and then try to drive or operate heavy machinery—or, ideally, do anything other than go to bed.
It can interfere with some medications. We mentioned that melatonin helps regulate immune function, so for example that’s something to bear in mind if you’re on immunosuppressants or otherwise have an autoimmune disorder. It can also interfere with blood pressure medications and blood thinners, and may make epilepsy meds less effective.
As ever, if in doubt, please speak with your doctor and/or pharmacist.
Where to get it?
As ever, we don’t sell it (or anything else), but for your convenience, here is an example product on Amazon.
Enjoy!
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Broccoli vs Cabbage – Which is Healthier?
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Our Verdict
When comparing broccoli to cabbage, we picked the broccoli.
Why?
Here we go once again pitting two different cultivars of the same species (Brassica oleracea) against each other, and/but once again, there is one that comes out as nutritionally best.
In terms of macros, broccoli has more protein, carbs, and fiber, while they are both low glycemic index foods. The differences are small though, so it’s fairest to call this category a tie.
When it comes to vitamins, broccoli has more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, E, K, and choline, while cabbage is not higher in any vitamins. It should be noted that cabbage is still good for these, especially vitamins C and K, but broccoli is simply better.
In the category of minerals, broccoli has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while cabbage is not higher in any minerals. Again though, cabbage is still good, especially in calcium, iron, and manganese, but again, broccoli is simply better.
Of course, enjoy either or both! But if you want the nutritionally densest option, it’s broccoli.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
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What You Should Have Been Told About The Menopause Beforehand
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What You Should Have Been Told About Menopause Beforehand
This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.
When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?
And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!
So, what does Dr. Gunter want us to know?
It’s a time of changes, not an end
The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.
And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.
Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and
not to mention butwe’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.
Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.
Bridges can be dangerous to cross! But they can also get us safely where we’re going.
Ok, so how do we manage those things?
Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.
See also: Meet Goop’s Number One Enemy
For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).
This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.
Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.
To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:
Dr. Gunter’s Guide To The Hormone Menoverse
What about natural therapies?
There are some non-hormonal things that work, but these are mostly things that:
- give a statistically significant reduction in symptoms
- give the same statistically significant reduction in symptoms as placebo
As Dr. Gunter puts it:
❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.
In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.
Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”
You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞
However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!
For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:
Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended
Want to know more?
Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.
Enjoy!
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