Some key takeaways from Doctor Mike Hansen's video:
Weight Loss Effects:
Wegovy (Semaglutide) yields an average 15% body weight reduction after one year on the highest dose from clinical trials. Zepbound (Tirzepatide) achieves an average 26% body weight loss after 1.5 years on the highest doses from clinical trials, with a typical 5lb loss in the first month at the lowest dose observed from his patients. Side effects:
Semaglutide: 44% experience GI-related side effects like nausea. Tirzepatide: 25% exhibit similar symptoms. What if I stop the medications:
Individual-dependent outcomes after discontinuation. It can serve as a bridge for habit improvement, encouraging focus on healthier eating habits. Temporary health gains outweigh potential weight regain, even if you regain some weight. Compounded Tirzepatide:
Compounded Tirzepatide versions contain the same active ingredient. Some compounded versions include B6 or B12 which may be helpful for nausea relief and addressing vitamin deficiency. Find a reliable compounding pharmacy.
The original transcript is here:
Right when I was about to post this video, news broke out that the FDA has approved Eli Lilly's diabetes drug Mounjaro for obesity under the new name Zepbound. There are many things I've learned from treating hundreds of patients with Tirzepatide aka Mounjaro, but by the end of this video, I'll share with you the three biggest lies or myths based on my experience.
So starting with the lie that these GLP-1 agonists are miracle drugs. Okay, I'm referring to both the main GLP-1 agonist drugs here, Tirzepatide, Mounjaro, and Semaglutide, which is Ozempic in the lower dose and Wegovy at the higher dose. Semaglutide mimics the GLP-1 hormone in our body, while Tirzepatide mimics both the GLP-1 hormone and the GIP hormone. For these reasons, these medications do a tremendous job of suppressing the food noise, meaning they decrease the cravings for eating the bad stuff. But they're not perfect, and some people do have unpleasant side effects. The most common side effects are GI related, nausea, vomiting, diarrhea, constipation, upset stomach, and heartburn. In my experience, Semaglutide is much more likely to cause these side effects, and this is actually what we see with the studies. For example, this study showed that nausea occurred in 44% of people taking Semaglutide. Another study showed that it was 25% for Tirzepatide. Less common side effects for some people might be fatigue, trouble sleeping, headache, temporary hair loss, local injection site reaction, and skin hypersensitivity. When it comes to pancreatitis or inflammation of the pancreas, this might be a potential side effect, but I haven't seen it develop in any of my patients. It's actually hard to know if pancreatitis is truly a side effect for two main reasons. One is because it rarely happens, and two, because we know that obesity itself is a risk factor for pancreatitis. Regardless, the potential for this to happen is something that needs to be on our radar. Another point is that the risk of GI side effects, that increases if you're eating highly processed foods, particularly added sugar, refined carbohydrates, and fried foods. So it's all the more reason to focus on eating healthy, unprocessed food, especially if you want to get your best results. Besides eating the right foods, exercise is also important, so getting at least 150 minutes per week of moderate intensity. And I highly recommend doing resistance training to prevent muscle loss while on these medications. Other factors that determine weight loss will depend on the drug and the dose. There are now multiple studies showing that Tirzepatide causes major weight loss, and that the highest doses cause the most weight loss. For Semaglutide, the average weight loss after a year was 15% of the body weight. That was when they were on the highest dose, 2.4 milligrams. Now for Tirzepatide, the highest dose caused an average weight loss of 22%. That was based on the SURMOUNT-1 trial. When they did the SURMOUNT-3 and SURMOUNT-4 trials, which was about a year and a half in duration, well, that number jumped to 26% of average weight loss. Now in my experience, when we start these medications at the lowest dose of Tirzepatide, 2.5 milligrams, patients typically lose about five pounds. Sometimes it's less, sometimes it's more. The most I've had someone lose in that first month at that dose of 2.5 milligrams was 17 pounds. They were also eating very healthy and doing a lot of exercises.
So these drugs, they work well for the vast majority of people, especially Tirzepatide, but some people can have issues, especially if they're not eating the right food or getting enough exercise. You need to be on it for life. This is the most commonly asked question I get from my patients. Do I need to be on this medication for the rest of my life? Now, one particular patient of mine has had tremendous success with this drug and has not had to go back on it. The truth is there are no long-term studies looking to see if people really need to be on Tirzepatide for life or for the long term. There are a couple of studies that tried to answer this question with Semaglutide and the results of those studies showed that most people who stopped the medication did end up regaining some of that weight back. But everyone is different and for many people, TIrzepatide can act as a sort of bridge to allow people to improve their habits, including focusing on eating unprocessed food. Even if someone has to go back on the medication, you have to ask yourself the question, is it better to have been healthier for a certain amount of time than to not have been healthy during that time? The answer is yes. Being temporarily healthy is better than not being healthy at all.
Line No. 3, compounded Tirzepatide is the same thing as Zepbound or Mounjaro. Well, the truth is that Tirzepatide is the active ingredient in Zepbound or Mounjaro, which is the same active ingredient in compounded Tirzepatide. Both of them are this exact 39 amino acid sequence molecule, but the compounded version does not come in an auto-injector pen like Mounjaro. Also, sometimes the compounded versions of Tirzepatide are mixed with vitamin B6 or vitamin B12, while Mounjaro is just pure Tirzepatide. Some people want the extra B6 or B12, as some people say that it can help with nausea, but there aren't really good studies on this. Some people, especially those who've had bariatric surgery, they have a higher potential for developing some vitamin and mineral deficiencies such as vitamin B1, B6, B12. Even some get copper deficiencies and selenium deficiencies. So that might be another reason to take vitamin B6 or B12, but another thing is that there are 7,500 compounding pharmacies in the United States and only a handful of good ones that actually compound Tirzepatide. They're pretty hard to come by. Now that Zepbound is FDA approved for treating those with obesity and being overweight, we do expect insurance companies to start covering the cost for that purpose. Right now, Mounjaro and Zepbound can be expected to cost about $1,100 out of pocket. Compared to compounded Tirzepatide, that's about $400 per month.
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