To increase or not to increase...that is the question!!

[Lovesabadboy]

Looking for reassurance with going up to 5mg!

I have been on 2.5mg since starting on 12 October 25 and have lost 3 stone.
This past month, though, the suppression has worn off a lot and the food noise is coming back. I have also only lost 5lbs this month, so I feel it is time to move up to 5mg, but I can't get all the horror stories out of my head.

I will caveat this by saying that I do have health anxiety and so will always imagine worst case scenario - even though I have had zero side effects with 2.5mg.

It seems to be a waste of money to stay on 2.5mg for any longer now that the effectiveness is wearing off, so please all tell me your good experiences of moving up to 5mg, please!

The way I decided if I increased or not was if I stopped losing weight or slowed down too much I would first recalculate TDEE and then track calories closely again for 2-3 weeks to see if I was hitting/could hit my deficit and macros (protein and fibre), and minimising UPF, sugar/sweeteners/snacking which drive my cravings/food noise. I would also use my water reminder again to make sure I was getting in 2-3L a day.

Every time I did that I realised it was because I was slipping backwards into old habits and once I was back on track for a couple of weeks the cravings reduced sufficiently to let me stay in deficit without a dose increase. I never needed to increase beyond 3.75mg.

Of course everyone is different and many genuinely need to increase, but I also think it is crucial for each of us to personally work out how the medication and our own behaviour work together, especially for long term success.

If you do decide to increase and are worried you could try 3.75mg for 4 weeks to increase slowly.

Also be aware of the advice/warnings when increasing if you are on oral contraceptives or oral HRT.

5lbs in a month is a healthy amount to lose. I’d wait a bit longer personally.

There are no prizes for sticking to the lowest dose. If you feel like the effects of medication are wearing off then give 5mg a try. You can always go back down if you don't feel well on it.

Similarly to you, I was lucky to not have any side effects on 2.5mg. I had no side effects when I moved to 5mg either. People are always more likely to write about horror stories than to report they felt fine.

5lbs off in a month is a significant loss, What’s the rush?

From the offset, I wanted to lose slowly as I don’t want loose skin.

I was on 2.5 mg for 3 months, then slowly increased to….

2.8mg, 3mg, 3.25mg, 3.5mg, 3.8mg, 4mg, 4.25mg,4.5mg then after a whole year of titrating slowly upwards, I reached 5mg. I lost 5 stone.

Everyone’s body is different, you do what suits you.

@WeAllHaveWings did you literally check out your maintenance TDEE and then make sure you were below that? How far below would you aim for? Thanks.

This.

Also I increased my doses in smaller amounts after jumping from 2.5 to 5mg and being really unwell one time so I decided to go from 2.5 to 3 then to 3.5 and so on

TDEE - 500 calories is a good place to start but is a blunt instrument.

Removing 500 calories a day = 3,500 / week = notionally is 1lb loss a week.

Monitor for 2-3 weeks and tweak up or down as necessary for a healthy weight loss.

“Healthy” depends on your starting point, 2-2.5lb/week consistently might be considered ok if severely obese, but rapid if “only” overweight.

Also, for satiety, it isn’t just about calories, watch your macros - protein and fibre targets. And hydration!

It's great that low doses are working for so many people and I agree that 5lb/month is a good result.

However, I think it needs to be said that losing weight on its own is not enough to prove the medication is working as intended. It's perfectly possible to lose weight without any medications, just by sticking to a calorie deficit. The medication is working if it decreases food noise and suppresses appetite. If it's not doing that then what's the point of taking it? It doesn't have to be (and shouldn't be) complete suppression but it needs to be there, otherwise you could just as well inject water and count calories.

Yes, it's better to stay on a lower dose if possible but it's not a failure to need a higher one.

Are you near to your goal? Weight loss often slows down as you get within a stone of your target weight.

I’ve been on MJ for about 7 months and lost 3 stones but my loss is averaging 1-1.5 lb a week. I moved up to 3mg in November and to 3.5mg in February. I find that a gradual increase works for me.

The point is to step up, so unless you are having too high supression and not eating or horrendous side effects, go up to get the best out of them. people have side effects on all different doses, and some have none at all. so take a chance so you get the benefits, will save you money in the end

I’d echo the comments on getting a 5 mg pen and going up slowly. I’m doing that due to experiencing serious side effects on 2.5mg. In your case, I’d trust in what you feel is happening to you psychologically and if you sense the good noise is coming back more noticeably then move on up a dose. It’s not a competition to see how low you can stay on the drugs.

5lbs in 4 weeks? That’s amazing, why do you think otherwise?

Thank you @WeAllHaveWings

Me too. I was ill on 5 so I went up slowly in .5 increments every week til I finally got to 5 again this week and I feel great. The suppression is back, the food noise is gone, I feel refreshed and like I did at the start again. Go for it! You can always go back down if you get poorly.

5lb a month is a good loss. But you’ve been on 2.5mg for a while without side effects. The truth is that 5lb a month is perfect loss to reduce the risk of muscle loss or loose skin. Any faster and your risk of muscle loss is much higher (unless eating a lot of protein and lifting heavy weights).

Thank you all for your replies.😊

I had to order my next pen by today so have gone for the 5mg to give me flexibility to do different combinations of doses and can just revert to 2.5mg if I am struggling with side effects.

I still have about 2.5 stone to lose and although I am not in any rush to lose it, it does seem to be throwing good money away if I am not getting the full effects of the drug...like @GreenLemonade pointed out.

Many of you mention increasing the dose slowly until getting to 5mg, which I think would be good for me...and then if I find that I am experiencing good suppression at 3.75mg, for example, then I will stay there.
I am a very much a boring rule-follower so have never done the Golden Dose or anything, so doing this goes against the grain! 😆

Do your suppliers get annoyed when you are taking longer to get through a pen than you would if you were using 4 x 5mg?

I know there is a click counting chart somewhere but does any one have a link or instructions in words of one syllable of how to go about doing the interim dose amounts, please?
I think I would start with 3mg for a week and then up to 3.5mg etc.

Thanks again everyone!

It’s just a simple calculation to work out the clicks that you need.

(dose you want in mg / pen strength in mg) x 60

so, if you wanted 3mg from a 5mg pen you’d do (3 / 5) x 60 which would be 36 clicks.

Partial dosing is easy … attach needle as usual and prime, then instead of turning all the way to 1, turn slowly and count the number of clicks until you reach your desired dose (2.5 mg from 5mg pen is 30 clicks).

then carry on as though you were injecting as normal.

A full dose from any pen is 60 clicks, so to do 3.75 from 5mg, you do 3.75/5*60 =45 clicks….

in terms of suppliers, most will allow 1-2 weeks over when you order, but you will need to keep ordering and build a small stockpile.

You should keep the pen in the fridge and be really scrupulous about cleaning before use each time as you will be going past the 30 days once first used.

What ever dose you go for I would stick with it for a few weeks, as it builds up in you body for 4 weeks before levelling off.

I went for half way between 3.75mg = 45 clicks and stuck there for 20 months! You will get 5 doses from the pen this way using your normal pen needles on days 0,7,14,21,28 before it locks and without messing around with syringes and within 30 days.

First time count the clicks and mark the spot in the window with a ballpoint so you know where to go to next time.

A lot of suppliers you can say you skipped a week because of holiday, ill, forget, special event etc and they let you reorder every 5-6 weeks.

The point is to step up

Why, if the lower dose is working just fine? I lost pretty much all my weight on the smallest dose and if it ever stops working, I will have more options than if I was already on max dose.

Thank you for this @WeAllHaveWings .

This is what I think I will do.
I am keen on the fact that I can still use the normal needles and that it will still get used within the 30 days. Those things were worrying me!

You did so well keeping on it for 20 months - that is amazing!
I though I had done well staying on 2.5mg for 5 months and it still working.

My 5mg pen arrived today and I am looking forward to jabbing again on Sunday!

Thank you all for your advice.

Some providers say if you’re losing less than 6lbs a month, to go up to the next dose. I wish I could remember who it was but I remember reading it when I ordered one of my pens and being surprised by it!

its not the way I take it though, particularly if my loss is less than that but I’ve been out a fair bit that month or something.

The point is that you step up because the % lose increases with each dose increase, so if you want to maximise it then its good to move upwards to maintain the supression etc.
so really its about how much you want to spend versus the weight loss, if you want to be on it long term or its a short term fix.

yes you will get to move up if its not working sometime later, but you also could have lost more in a shorter space of time. that obviously depends on your comfort level and reaciton to the drug.

If you're talking about the clinical trial data, then the average weight lost was higher at 10mg and higher again at 15mg, than at 5mg. But that's an average across all the trial participants and is not necessarily relevant to any one individual's response to the medication.

There is no point at all in moving up a dose if you are experiencing good suppression and losing weight at a decent rate. As you say, it depends on your own individual reaction to the drug.

This is the opposite to how I use MJ.

Chasing suppression to maximise weekly loss is not remotely healthy.