After my one horrific experience with vomiting, I had several weeks where for two days after injecting 7.5 mg I was miserable. So I went down to 5 mg. My weight went up, the nausea went away, but I had to think, what on earth was I eating and what had changed.
The problem was not the Zepbound, the problem was me.
I still journal my daily eating, as much as it is a pain, I still do it. And because of that, I can look back and see what I was doing, why I gained the weight, and why I had the nausea.
On 5 mg, I was not having nausea, but gaining weight. Not much, but I have a three pound window with which I play. If I eat something salty, and have some fried chicken (salty) and some wine the next day, the scale shows an increase, which is salt and water. After a few days, that goes away, and I am back to my normal weight, and hopefully don’t repeat that too often.
But those two pounds became three, and the three became five, and that is when it was time to look back and see what I was doing.
Was I eating more? Yes. My quantity of food had increased. If you have two baked chicken thighs instead of one, that is maybe 100 calories. But if you find the 200 calorie Aloha bar or some Fig bars, or - my favorite - the ice cream bar, those are calorie dense items.
There is a bit of denial with me and my GLP-1. Knowing enough that calories count, it is easy to say “I will make an exception today, because I can afford this snack”.
GLP-1 Allows you to Make Better Choices
I think this is a mantra I have heard before, and I’ve used it. Yes, it does. I can make better choices, but if the drug is not optimized, I can make better excuses.
Don’t feel as if you are a failure when the dose goes down and the appetite goes up. Food noise is real, and for me I measure food noise with my ice cream bar desire. I love ice cream, and yes, in a well designed diet, having some is not a problem. I prefer three at a time. Sorry, those Fat Boys are 110 calories, but the texture, the coldness of the ice cream, the ease at which they chew is delightful to me. So, if I am at the end of the week, or if my dose is too low, I will not have one, I will have three. That is 330 calories. Not a lot in a given day, but add that to my regular diet, and I move from maintaining to adding weight.
Nausea and Increasing Doses
Perhaps after the night of projectile vomiting, my stomach became a bit more sensitive. But for three weeks after, when injecting the 7.5 mg, I had that discomfort. I had to look back and see what I was eating.
There it was. I had increased the fat in my diet. The food the day before each of those was high in fat. Part of that was that I was at the end of the cycle, so I was more hungry and gave myself more license to have fattier foods. One night before the injection, I had two slices of the parmesan stuffed sausage pizza from Dominos. Another week it was a fatty cut of meat. Each time, the reason for the nausea was not some mysterious change in my stomach physiology from Zepbound, it was my diet.
But instead of looking and changing the behavior, I went to 5 mg of Zepbound. The nausea was much better.
Decreasing Doses and Weight
Oh at 5 mg, I was better. I thought this was great. This is my new maintenance, and it is less Zepbound, and I am feeling better.
During that month, two things happened. My signal was the weight increase, and then I looked at the data. My food journal showed increasing food intake, more days with exceptions.
Morality and Medicine
There is the temptation to say temptation and morality enter the picture here. But if I lower my dose of any drug and find the drug had a predictable dose-related effect, the science would support that. For example, if a person lowers their blood pressure medicine, and their average blood pressure increases, we would not think of that as a moral issue. We would say this is predictable.
Shame is easy in the weight loss game. Like the non-empathetic gym bro who is trying to sell you a low carb diet. He tells you it is your fault, you never needed a GLP-1, you needed discipline.
Would you tell a person with type 1 diabetes that rising blood sugar after reducing insulin is a failure of discipline?
In the paid section, I will go over what inspired me to up the dose and what happened. I’ll also go into more discoveries from the food journal. But I also developed some changes.
There is a reason I keep a food journal. That I weigh myself and look at body composition. It gives me useful information, and now I know better what works.
Feel free to share the free section. For paid subscribers, the story continues below with what happened when I increased my dose and the changes I’m making to maintain my weight.
Trepidation and Tirzepatide - moving back
Would staying at 5 mg be enough for me, or would I continue to see my weight slowly increase? And if I went back to 7.5 mg, would I face those two miserable days of nausea every week?
I had already decided that two days of nausea every week was not an acceptable price to pay for maintaining my weight.
But looking back through my food journals, I thought I had found a clue about what was happening.
And then, unexpectedly, I got some inspiration from a friend.
