Zepboundin': my first month on a GLP-1

Today I finish my fourth 2.5mg injection of Zepbound, a strong GLP-1 drug, and I thought I'd write about the experience of my first month on it, how I got here, and what I expect in the future. It's been wild, and after talking to half a dozen friends that are also trying these things out, it feels like we're all experimenting on ourselves, so it's helpful to share what that's like if you're curious about these drugs.

Anyone considering a GLP-1 should go in knowing what to expect and also what you might not expect.

Weight and metabolism

For most of my life, I was tall and lanky and I ate like crazy but also exercised several hours a day. Both my parents were pretty heavy, with my dad spending most of his life as a 6'1" guy weighing over 300lbs. He had a couple heart attacks in his 40s and a life-altering stroke in his 50s. My mom died a few weeks after her 65th birthday.

After I finished college, I was still pretty fit but I transitioned from distance running to casual cycling, and every few years I gained a few pounds and it definitely felt like my body was shifting into slower gears as I got older.

I dieted and exercised for the last 20 years to keep things just on the high side of normal-to-slightly obese and that was mostly fine until covid hit. The combo of being more sedentary than normal while also stressed and depressed at what was going on contributed to round-the-clock snacking and added another 30-40lbs and ever since, it's been nearly impossible to shed more than a couple pounds through diet and exercise.

I started this being 6'3" and weighing around 258lbs with my blood sugar in a Type 2 pre-diabetic state. I know BMI isn't a reliable metric overall, but I'm in the low 30s and I don't dip below 25 until I get down around 200lbs, which is when I've felt best in the past.

I've spent a couple years walking and riding more and trying to eat less, and still it's quite difficult because now in my 50s, my metabolism feels glacial. I know I should be eating like a bird as I get older but I felt like I was constantly starving myself. I knew a few friends with good experiences taking GLP-1s and I've read plenty about them so I decided to finally give them a try.

The first week was a shock

Hank Green dropped a video about GLP-1 drugs that is mostly positive about them, but I want to underscore how right he is when he says these are very powerful drugs with lots of unknown or unstudied side effects that can surprise you.

It took about 24hrs for the first injection to hit me, but the feeling of it was pretty substantial.

The most shocking thing after my first dose was a complete absence of hunger.

Honestly, it felt bizarre. It was as if all the nerves that linked my brain to my stomach were severed in that first week. I had no idea when I was hungry or when I was full. I could eat two bites or finish a plate of food. My stomach felt completely detached from everything and I had to rethink a lot of things. I ate lightly every few hours just to make sure I had calories going in but I almost had to remind myself to do it.

I was instantly hit by a wave of heartburn/acid reflux, which I rarely experienced in the past. I knew it was coming from my digestive system slowing down, but it was stronger than I expected at first.

The good news is that heartburn did eventually go away after 2-3 weeks as I got used to it and my generally smaller meals. Now in my fourth week, I'm finally starting to feel hunger pains again around lunchtime each day.

If you asked me a few months ago how much time I spent idly thinking about food, I'd probably say not very much, but after I started taking a GLP-1 and my hunger went away it honestly felt like half of my brain was freed up to do other things. I was no longer thinking about my next meal, or the one after that, and it sort of dawned on me that my life was previously way more food-motivated than I thought.

As this first month draws to a close, I'm down a bit over ten pounds and I suspect at the two month mark I might move up to a 5mg dose as the effects start to lessen, which is what most people tend to do on it.

Weird side effects I didn't expect

I read all I could about side effects going into this, but a few things still threw me unexpectedly once I started taking the drug.

A week into this, I ate some dodgy seafood at a restaurant while out with a few friends. One friend got food poisoning from the meal we shared but it passed for them in a day like I expected the same bad food would for me. However, being on a GLP-1, my symptoms lingered for nearly a week as the stuff worked itself out of me quite slowly. There's not much you can do to prevent food poisoning, but know that any time it does hit, it's really going to affect you for 2-3x longer than expected due to your slowed digestive system.

I had a few friends talk about a reduction in inflammation as side effects of a GLP-1 and I know someone taking it to counteract joint pain that they say is quite effective. For me, ever since I started taking it, getting up in the mornings I feel like I have way less aches and pains overall.

I have a long history of back pain and hamstring tightness so much so that I've seen the same massage therapist for the past ten years about once-a-month for some deep-tissue work. Last week I had my first session post GLP-1 and normally it's a slightly painful experience that feels better a day later, but this session felt like my therapist was only pushing my muscles at about 25% pressure. Typically my back feels wrecked immediately after a massage, but in this case I had zero back pain post-session.

It's weird but I'm guessing whatever effects the drug is having on my appetite is also working on pain centers in my body? At this point, I'm considering reducing or eliminating the regular massage entirely. I know people who go to acupuncture regularly that said they've stopped after starting a GLP-1 drug, because they no longer need the pain relief.

Advice for anyone considering these drugs

Here are my lessons learned from being on this and experimenting for the past month.

Use Shotsy

There's a great app for tracking your predicted levels of the drug in your system that can also talk to Apple Health and automatically graph your ongoing weight if you've got a Withings scale that can transmit your daily weigh-ins to the cloud.

Go through your own doctor and health plan

I am doing my first couple months of this through Ro.co and it's pretty goofy. You consult with a "doctor" and "nurses" that feel like AI prompts when they talk to you. Of course, they approve everyone and will ship you injections within a day and it generally runs about $500 a month.

I wish I listened to Hank Green in the video embedded above and went through my local doctor and my own health insurance. Not only would I be getting more personal, comprehensive care, my costs would drop significantly. Friends who converted from a random online "health" store to their health plan typically only have to spend $25-50 per month on these drugs.

Weekly shots are no fun

I kinda hate the delivery of Zepbound, which is a vial of liquid that you have to administer via a shot that I can't make myself do on my own. Once you get health insurance coverage, they can send you pre-filled injectors with smaller needles to make it easier, but honestly, I'm guessing in a few years these drugs might be over the counter as small tablets or gummies instead of injections and I can't wait for that to be the norm.

Expect this for the long haul

Everyone I talk to who is considering a GLP-1 seems to worry about what they'll do after 6 to 12 months of using it once they've lost weight. From all accounts it seems like people who stop regain their appetite and put much of the weight back on. I've been on a couple small doses of maintenance drugs for other ailments that I suspect I'll remain on for life and I think it's not a huge deal to have one more thing to take long term. I suspect I'll go down to a minimal dose once I've shed 50 or so pounds.

Find a social support network wherever you can

The best advice I found about taking GLP-1's is from a private group chat with half a dozen friends who currently take one. We also share the space with a handful of friends who are considering taking it. We post questions about our side effects and get helpful responses from those who've been on the drug longer. New friends are asking lots of questions that we're all answering together and honestly it has been really useful. I don't know of any apps or sites that can fill this void for everyone, but having a small supportive friends network of people going through the same issues has been incredibly helpful.

Final thoughts

Overall, I've had a good experience taking Zepbound that has made me rethink my relationship with food. I still enjoy the taste of things, but my next meal doesn't dominate my thinking like it did before. The side effects are wider ranging than I expected and I think we'll see a lot of interesting research around these drugs in the next few years. I don't know how ubiquitous these prescriptions will become, but I suspect health insurance companies in America will steer people towards it as a form of preventative care.

Now that I've taken this, I have to admit it has more of a "magic pill" effect than I suspected it would. It truly changed overnight how much food I take in, what my relationship is like to food, and helps me get on a better path towards a healthier weight that doesn't stress out my body. I've never been one to trust that miracle drugs could fix all our problems, but this one comes close.

Lastly, I have to acknowledge that as a middle-aged guy I don't go through 1/1000th the societal pressure that other people face around weight, but I don't feel bad about taking this drug and I am definitely seeing my numbers move in a better direction for the first time in years. The benefits seem wide ranging and while the side effects are significant, they're livable and I suspect general exercise and my performance on a bike will improve as my weight goes down over the next few months.