Going up doses.

[FatsiaJaponicaInTheGarden]

I'm massively intrigued by the different recommendations of different providers here.

I think 1-2lb is the advised rate of loss...

So if you're averaging 2lb a week I assume it would make sense to stay at a dose as its working?

Yet some people seem to be going up to 7.5 from 5 even if they're averaging 2lb a week.

I know for diabetics the advice was to go up a dose each month u til they have sugar under control but isn't the advice for weight the lowest effective dose?

I'm seeing on the fb group for my provider (one of the ones that doesn't like people to go up the doses) people unhappy about not going up - yet have lost tons in their first 2 months.

I think I'm still getting my head around what's best practice (in part to inform what I do as I have a long game to play with a lot to use)

I see some providers don't like you staying on 7.5 or 12.5 as the original trial had doses at 5,10,15.

Is it the case that people on it for weight loss has only really been the last 2 years, with a lot of people choosing their own doses/buying online so beat practice isn't really established yet?

Also does it make sense to go slow up the doses so "you have somewhere to go" when you stall. Or is it likely that the higher doses just keep working until weight stabilises.

Also - you can't lose weight forever. Do people on them longterm for maintenance become underweight. Or again does it normalise?? And how does the body know what weight to stop at?

My brain loves to understand things but I really don't!!

Oh and presumably if you're eating in a calorie deficit (I'm not counting calories as such but I know I am) presumably there's no point going up.

As in going up is to help you eat less and that's where the weight loss is... Or is the drug doing other fat busting things so we want the higher dose even if we're eating less?

I don't want to eat less than I am!

I am 42 weeks into Mounjaro and I order 5mg pens, but take 3.75mg.

I wouldn't stay with a supplier who blindly followed the clinical trials outcomes to move up doses rather than being experienced with how Mounjaro is working most effectively in real life and being patient led for which dose is best for them.

The ideal of maintenance is you are on a dose that allows you to increase your daily calories to, then stick to your TDEE / no longer in calorie deficit so you maintain weight - it helps with keep food noise at bay so you don't start eating above your TDEE again. For some they can do that on their current dose, for others they taper down doses until they find the one the works best for them.

Whether in weight loss or maintenance you control and manage how many calories you consume. Mounjaro just helps you do that.

Huge appetite suppression on 2.5

Not much on 5 at all, in fact I was getting quite hungry.

So yes, I moved up to 7.5... Terrible side effects for one day. Then nothing, no food noise either.
I can only assume that on 2.5 as with 5, that it all would have come back and been slightly pointless.

I'm going to stay on 7.5 for another month though. I think. It is only week one of it.

Thanks @WeAllHaveWings that's a really helpful answer and amazing you've been on int 42 weeks! It's great to see you can keep losing at a lower dose.

Yes I'd be surprised at any recommendations to move up monthly but some online providers even sell it as a bundle of 2.5/5/7.5 with that expectation before they've even seen how you do!

Your explanation makes sense - it isn't that the MJ causes you to keep losing weight but that say I was to eat X amount of calories that suit a 10stone person, I'll keep losing weight until I reach 10 stone and then maintain as I'm still fuelling enough to maintain. So the mechanism of loss is still the eating less.

@TheBuffetInspector Are you losing on it? I guess if you're losing it makes sense to stay on that does? I completely get that some people need higher doses to lose/for it to work than others.

I think looking at some of the older threads on the board originally people were encouraged to go up the doses each month and perhaps that's changed now to "lowest effective dose"?

Does it keep working indefinitely or wear off do we think? I am wondering if I should stay on lower doses so I don't get "stuck" at a high does with nowhere to go (does that happen??)

I bought a starter pack back in June last year when I started 2.5mg/5mg. And it is part of the reason I moved up to 3.75mg as an interim step to 5mg as I felt I had to. I might have been able to stick at 2.5mg if I didn't do that, but it is working and I didn't want to tempt fate by moving back down.

Everyone is different on how their body responds and it is also subjective, I have read some reaching 15mg and feeling it no longer works, and others staying on 2.5mg for over a year and losing.

Expectations of the medications can vary greatly. Some people chase full suppression all the time, others look for a helping hand, where quietening the excessive food noise, but not having actual suppression is enough to keep them on track.

Logically to me, staying on the lowest dose as long as it gives you enough help, with a bit of willpower thrown in, to keep in calorie deficit makes sense. But at the same time, if more help is needed and having to engage more willpower than someone else might have to is making it too difficult, moving up makes sense too.

In my 42 weeks I have had days, or even a week or more where suppression has waned and I found it difficult, but then it kicks right back in again the following day/week. I think it might just be my body responding to the weight loss by sending out more hunger signals rather than MJ stopping working those weeks. I can cope with a few days/week where I need to use willpower. So I wait a couple of weeks to see if it returns before deciding to move up and it has meant I haven't had to move up yet.

Thankyou so much - your experience is really really helpful :)
I have realised it isn't linear/ it bounces around rather than being a regular rate of loss and that realisation helped a lot!

You don't need to share - but now I'm being nosy. How much are you roughly losing a week/month or aiming to lose? Or is it that if you're happy with how much you're eating you're rolling with it.

I do worry that some people don't seem to want to feel hungry at all ever which worries me if they would actually eat enough or if they think they can stop eating altogether for a while but I'm not in that place thankfully.

Ive been over two years now and was with a provider that moved you up monthly. So I was on full dose of Rybelsus (oral) for about a year. Moved to MJ in September last year and went up every pen. I think I'm on my third 15mg now. My family are all diabetics and are on 15mg too. I lose about 4lb a month and it's been the same whichever dose I was on. Except the first three months when I lost more.

I've found the secret is not worrying about anyone else. It's very much your own journey. I aim to lose about half a stone over a month and if I'm way off that I move up. As long as you're not losing more than 2lb a week set a pace you're happy with and adjust as necessary

I started over 21st so have a lot to lose. This is my journey from June when I started to mid Feb, losses have stayed a consistent 1.5-2lb a week since then and I am now at 95lbs lost. 5lbs more and my BMI will be in the overweight range for the first time in probably 25-30 years. (My very high first week loss coincided with a week in bed with covid barely eating at all and not representative of a normal first week!)

But as I said before, everyone reacts differently. You might respond at 2.5mg, you might not respond until 7.5mg or even higher. Work with it, don't expect it to do all the work, and be patient.

There are a couple of good threads one >5st and one >10st which are great for keeping in touch with posters with longer journeys. I am on the >5st one, as I am still not sure if >10st loss is achievable, or even desirable, for me yet.

I’ve moved up when food noise is present more days of the week than it is absent. I don’t think rate of loss has anything to do with it for me.

Thanks all that's all really helpful! I know everyone's doing it their own way so my reason for starting the thread was to see if there were any guidelines and how ti's worked for others.

I think @DarkForces that'd a good guideline of aiming to not lose more than 2lb a week is good but although Google tells me 1-2lb a week is a good idea. A lot of people are happy/aiming for more. It's not that I am fussed with others weight loss it's that I want to knowThe Right Way to do it for me/long term.

Obviously if lots of people lose more/are aiming to lose more per eeek (as it seems in the fb group I'm in) and that's the goal then I'd try and increase the dose. But like you from what I'd read so far I was aiming not to regularly go over 2lb a week. I'm just questioning it all when I realise that's not being told to to most people.

@WeAllHaveWings Thankyou so much for sharing that and your spreadsheet is incredible. I started at 12st10 and 14 weeks in have lost 2 stone. It's not an even 2lb a week at all but it's averaged out that way. I still can't imagine being in the "overweight" bracket rather than morbidly obese you must be over the moon!!! I have my eye on "not being morbid" in about 2 stones time.

I'm on the 10stone thread and a general SheMed one but I didn't want to derail with my over analysing dosing. I especially didn't want to appear critical of anyone else's path as not at all my intention - rather seeking understanding! Without very clear guidlines/GP prescribing I guess people have worked their own way through.

I'm absolutely (currently) about rate of loss (possibly as this is very long term for me maybe?). I don't want to lose too much /too fast and risk losing too much muscle/nutrition deficiency and if I'm losing too slowly then I'm eating too much and can assume I need a higher dose.

Long long term if I can take it down to being able to maintain my weight that would be amazing. But that's miles away!

Meant to say @Doggymummar I'm glad it's still working for you and not "worn off"!

@WeAllHaveWings Oops. I said I'd started at 12st 10... I wish!! 21 stone 10....

12 10 and I'd not be obese 😁😁😁

I lost around 2lb in four weeks on 5mg, and literally had no side effects. I couldn't feel any difference. So happily went up to 7.5mg and still the same story. So it definitely seems like my body needs higher doses to work and I am moving up every four weeks. If there are no major side effects, why wouldn't someone move up?

@FatsiaJaponicaInTheGarden 🤣 I guessed it was a typo or you would disappear if you are on the >10st thread and plan to lose 10st!

I need to be <11st 13lbs to be at the top of a healthy BMI, which is around 10st loss too, but not sure if that is realistic at my age 56, post menopausal etc. Will wait and see how I get on getting comfortably into overweight first which will be at around 7-8st loss. I might just join you all on the 10st thread one day!

If you're not losing appropriately (and I guess those with less to lose might lose slower? I don't know) and there's no side effects it makes sense to move up. I hope the next dose works for you x.

For me I'm going to be on it over a year so I think I am aiming to pace myself with the doses so I have "somewhere to go" when it stalls. But yes I'm losing roughly 2lb a week my question was more around why people move up when they are losing similarly.

Yes I'm not sure where I expect to end up at this point but being so close to "not obese" must be amazing!!!

Does life feel very different??

@FatsiaJaponicaInTheGarden Physically in many ways yes, I can walk up the hill to work/up the stairs at work without having to stop at the top for 5 mins to catch my breath hoping I don't bump into anyone else going into work who wants to chat because I can't talk! I can sit in work chairs without the handles digging into my sides. I could walk from work to a restaurant a fair trek away when my boss was up visiting last week without feeling like I couldn't keep up with everyone else or going red in the face. I can run/look after my 2 year old great niece, go with her and my niece to country parks or out with the dogs and walk much further without my feet burning. I no longer suffer from acid reflux or need to take daily Omeprazole. I am monitoring my blood pressure over the next couple of weeks hoping to reduce blood pressure medication. Love picking up my size 16 knickers every day and thinking how small they look and they fit! Size 18 jeans are getting too loose but size 16 jeans I can squeeze into but are a little too tight to comfortably wear, but it won't be long!

I notice it in lots of ways and logically I know it is amazing - but not quite enjoying it yet as it has triggered menopause symptoms coming back (probably something to do with estrogen being released/less stored in fat as I have lost weight) so I started getting hot flashes etc again giving me very little and broken sleep, and it has impacted my sleep/mood/brain fog/energy levels etc, but I have started HRT now and hopeful that helps with that side of things in the coming months and once I've got the right levels of that sorted then I will be super woman!!!!!! 🦸‍♀️

Wow that is an amazing list!!

I'm waking up at night and am likely in peri but yes after being diagnosed with adhd and starting elvanse and starting MJ I wanted to get on top of these things so I can stop the "well you need to lose weight" comments at the GP when I go in about anything!!

Im already walking more. I think it must be reduced inflammation or increased blood flow or soemthing as I couldn't walk very well at all in a January and I've only lost 2 stone so far!

I didn't know about estrogen/fat. That's given me another Google rabbit hole to go down...

I'm on 10mg, I have insulin resistance so though I had suppression on most doses, they didn't last and more importantly my blood sugars weren't stable until I reached 10mg. I did 2 x pens on 7.5mg and now 2nd on 10mg. Started in October at 13 stones 1lb and now I'm 11st 0.3lbs just hit 2 stones loss bmi from 32.4 to 27.3 it's taken 2 months average 1lb loss a week but I wasn't far above obese so it's harder to lose when you're smaller, or so I've been told. I do calorie deficit too of 1200 now. In 6 months I only gained 1lb twice and then lost it, the rest was consistent losses so I can't complain!
Finally my blood sugars are stable, no more feeling dizzy, faint, having shaking hands or feeling ravenous from not eating for 3hrs!

Wow that's a fantastic result!

@FatsiaJaponicaInTheGarden Yes, I'm losing on 7.5. I've lost on all but it's been a roller-coaster due to water, peri, being given extra pregosterone (? I've forgotten the word!) due to awfully excessive bleeding.
I've lost on all. 20lbs total in 9 weeks.

I'm only thinking of staying on 7.5 as first week left me feeling very sick for 2 days.

Wow that's a fab loss - yes I'd absolutely stick there for a while if it carries on working. I got side effects starting/going up to 5 and randomly during my second 5 pen - that's another good reason to stick if somethings working!

It sounds like it's been a real roller coaster for you - but all things going in the right direction on both fronts it sounds 😊.