Should I increase from 2.5mg to 5mg Mounjaro?

[UhOhRatPoo]

Hi. I know that this question will have been asked within lots of the longer threads but I can’t find a reliable way to search them so I hope some kind person with experience will help me in this new thread.

It’s a simple question really- should I increase my dose to 5mg?

I’m on my third 2.5mg pen having started at 81kg and now down to 76.

I’ve had no digestive side effects but I do wake up most mornings feeling a bit nauseous. It subsides after I’ve been up for a while but it means I can’t stomach breakfast first thing.

I am finding I am never hungry for lunch but do force myself to eat and feel better after I have done. Usually hungry for dinner and still enjoy a beer or a couple of glasses of wine with meal at weekends. Still eating chocolate/desserts in the evening but in smaller portions.

I’d say maybe the appetite suppression is diminishing a little bit but hard to tell. I don’t enjoy not feeling hungry as I am enjoying food less and it reminds me of how you feel when you are unwell and “off your food”. But I am determined to reach a healthy BMI.

Is it worth going up to 5, with the risk of nausea and diarrhoea or is this status quo on 2.5 good enough? I’d like to be 65kg by Christmas. But I can’t afford time off work and school runs etc if I get bad diarrhoea.

I've gone to 3.75 after 2 months on 2.5 and have had a lot of stomach aches and diarrhoea so i'm glad I didn't go straight to 5. 2.5 wasn't doing anything for me though, so I did need to move up. Hoping the side effects calm down soon :)

So you’re not interested in reviewing your situation and making long term changes then? Fair enough.

I did 3.75 for a couple of weeks and have just gone back to 3 as the tiredness and nausea was too much

I’ve already told you that I have made changes, changes which I have found easy because of the drug. I’m absolutely relying on it to assist me where my own willpower fails, what’s wrong with that?

When I reach my goal weight and stop taking Mounjaro I will do my best to eat in such a way that I do not regain the weight. That will be a challenge, I am sure. May not work but it’s better than continuing to eat in the same way when you are already overweight.

I am well aware of the theory and I am sure that the positive experience of being a healthy weight will provide plenty of motivation.

Right now all I’m really interested in is the best dose for it to continue working.

what do you WANT from going up a dose?
I think that’s crucial to decide really.

If you want to lose weight faster, then you’ve got two options, both with pros and cons - go up a dose but the side effects you’re having are likely to be exacerbated - or start tracking calories and making sure you’re below a calorie deficit, though that undeniably takes some more effort day to day.

Both options would likely increase your loss, but for me personally I was more keen to stay on a lower dose to avoid side effects and make sure I was getting the most ‘value’ out of mounjaro, and I got away pretty lightly with side effects!

I do understand that it’s a bit of a faff to start working out TDEE and measuring foods and stuff like that, but for me it’s worth doing.

id also say that I noticed a difference in how easy it was to resist treats when I’d eaten a decent amount of food. If I let myself get too hungry then it’s really easy to overeat, but if I can get three meals a day, even if they are light - it seems to keep my hunger at bay more consistently.

I don’t get it when people say they want to diet whilst on mj. Isn’t the whole point of paying an eye watering amount each month to NOT have to do that anymore? That’s what so awesome about it. You don’t have to think about what you are eating and when. OP just edge up slowly and do the most you can handle without feeling like crap that still makes it super easy to lose weight, that’s what you are paying for after all.

all this hand wringing and doom and gloom about you will put it all back on, it’s not a magic bullet, you still have to learn to diet. I think people just want to make it harder than it is. It is a beautiful quick fix. Only downside is it’s exy and there are side effects if you take too much for you. Pretty great though - what a time to be alive!

worry about when you are at goal when u r at goal I say.

The whole point of WLI is that it is MUCH easier to diet because the injections stop you from overeating and having the urge to snack.

Since I have been on WLI I haven't wanted to eat the kind of high calorie / high fat foods i ate before so it's been easy.

Eating a healthy, high protein/ high fibre and low calorie diet while on WLI means that you lose weight quicker on the lowest possible dose. It means less side effects and less cost (the higher the dose the higher the cost).

Agree with PP @taratill

Obviously we are paying to make it easier/actually doable … but the thinking now seems to be apply patience, keep to a low dose for steady weight loss, & move up slowly if no loss over several weeks when you are eating right

Im trying to think about my ‘exit strategy’ as I start to lose weight - it might have to be staying on a low dose long term, and so I don’t want to ramp up my dose too much as if you do the effect of the lower doses if you titrate down is not much

Thats my head talking. In my heart I’m as impatient as anyone and want it done NOW - I just don’t want to be back in the same place a year from now and finding WLI not as effective second time round ..,

No because WLI doesn’t melt fat. You have to ‘diet’ somehow. For some people they chase suppression, eat the same shite as always just less of it and lose weight very quickly, usually with some horrid side effects. At the other end of the scale pejole use it to support a complete overhaul and change in diet and lifestyle, eat clean and minimise side effects whilst losing weight steadily. Obviously these are the 2 extreme and there are many variables and most people will fall somewhere in between the 2 but for those leaning towards the former it’s the least sustainable and safe way to lose weight. If they don’t put in the effort they won’t get the results, sure they will see weight loss but the longer term maintenance and damage to their underlying health absolutely will be compromised.

Yeh I just don’t agree with that. I think people are wanting it to be harder. Psychologically people don’t like it that this magic drug exists so there has to be some effort on our part. It makes it psychologically and sociologically more acceptable to a lot of people if there is still ‘work’. But there just doesn’t have to be. And if you use it at full whack and lose lots of weight and dont track calories etc you aren’t then going to have long term problems. Who on earth said that? This is based on zero evidence. It is a weight loss drug. It is meant to lose weight. That’s literally it.

Looking forward to your humble pie recipe in two years time. 😂

I’m not saying you have to track calories I’m saying if you don’t eat properly you will have long term problems and that’s not something that needs to be proven. We already know that people need a substantial amount of nutrients. For those not getting them they will suffer the repercussions eventually.

I don’t think it’s harder for people who eat properly either so I don’t really know what you mean by that?

But what does ‘eating properly’ actually mean? MJ allows you to do intuitive eating. Eat whatever u want when u want stop when u r full. Cos u can!! Cake, chips, clean, - whatever - because whatever u crave is probably what your body needs at that moment. And eating ‘bad things’ (I don’t believe in that) doesn’t matter anyway because the cake or burgers you’ll hardly be able to eat any of it.

the poster who said if you don’t eat enough nutrients you get sick - true. That’s where supplements come in.

I now just eat intuitively and I know I don’t eat enough sometimes so supplement with huel shakes. I’ve been craving plain chicken today so I know I must be needing the protein so I just ate some drumsticks. If I wanted ice cream though I’d have it.

for the person who said I’ll have egg on my face in 2 years - that’s fine. I’m not worried. I’m thoroughly enjoying being skinny with zero effort: my adhd racy brain has also all but gone and my desire for excessive alcohol (which was an issue). So for me I’m very very happy.

Diet debate aside, I found my prescriber's advice simple and useful:

Reasons to stay at the same dosage:

• You are losing the weight at the expected rate of approximately 1-2 pounds a week.
• If you are experiencing side effects, it may be better to continue with your current dosage to allow these to subside before progressing to the next dosage.

Reasons to increase your dosage:

• You are not losing weight at the expected rate (less than 4 pounds over a 4-week period)
• You are experiencing minimal or no side effects on your current dosage

I’ve been on MJ for two years and right from the start I found I lost virtually all of the craving for crappy, fatty, greasy foods. If I do try to eat them I suffer with horrendous wind and nausea so even if I fancy eating them I rarely do. As my insulin levels have righted themselves and the tiredness from being obese has lessened I also find I don’t crave sugar or carbs as much. I do track calories as it’s still easy for me to eat at maintenance rather than in a deficit these days. Having said that I’m still only on a 8mg dose, I guess if I was on the full 15mg it would be much easier to eat in a deficit.

You don’t necessarily have to diet but if you’re eating more calories than you are burning, you won’t lose weight - it’s as simple as that. You can eat one meal a day on mounjaro but it’s a 2500 calorie meal of pasta and cheese and cream when you’re TDEE is 2250 for instance, then you won’t lose weight. Consider how hard it is to gauge a portion size of pasta for instance. Or the matchbox sized serving of cheese you’re meant to have - people guesstimate and have much more than they think they are!

some people don’t like tracking calories and its not for everybody, but if I wasn’t losing weight, I’d be questioning if I’m truly eating in a deficit before I consider moving up a dose, even if that just meant tracking calories for a week or two.

Exactly. Studies show thats exactly what it does - appetite suppression and you don't want to/can't eat crap. Or drink alcohol. Not everyone but for the vast majority. If people are not in deficit without having to track then they are on the wrong dose surely. Unless Im missing something.

The few people I know who won’t track their calories are those that dont want to be faced with the stark reality of how many calories are in food. These people have ended up on the highest dose rather than track calories and stay on a lower dose and face up to what they are actually eating and be hungry at times. This is my limited experience with the few people I know on MJ. that refuse to track their intake. The thing is in my opinion at some point we all have to either go on a lower maintenance dose or stop taking it altogether and for either of those things tracking calories is a must.

Well I dont track my calories because I dont need to. I eat like a sparrow. If I really fancy something - which I still do - a couple of mouthfuls and Im done. So it really doesnt matter what it is, I eat like a bird so Im skinny.

Why does being on lower maintenance dose mean you have to track calories? If you start at 100 kg and you want to be 50kg. Then you go on it without tracking calories until you get to 50. Then you go on low dose to maintain. If it creeps up you go a bit higher, but you should be fine because you are now 50kg. Why are people so so insistent that you MUST track calories.

Anyway, I will probably be told I shouldn't even comment as I am one of the naughty peeps who was healthy BMI anyway and just wanted to stay thin/be thinner without having to think about food. The entire point for me was not being on any diet at all and still be slim. I also wanted to be a permanent BMI of 20/21 rather than 23/4 as I just think I look better and I feel better. Im hourglass and at 23 Im still wobbly and have all the chins. At 20 I dont and I feel great. Without MJ staying at a BMI of 23 is an absolute ballache and im constantly depriving myself - being a BMI of 20/21 is impossible without MJ without wanting to cry over feeling so hungry all the times. And I just prefer the way I look at that weight. As I said earlier, Im also ADHD and its totally stopped my racy brain, and I used to be a 'if I open a bottle of wine im finishing it' type gal. Now I crave the wine, pour a huge glass, and find I rarely finish and end up pouring back in bottle.

I swear its saved me money too - I drink less, eat less, and want to go out for meals/have take aways less. Thats easily the cost of the jabs so its win-win for me.

Ready to be flamed....

The main reason to track what you're eating when you are in a significant calorie deficit is to make sure you are getting enough good nutrition. Lots of people will be essentially malnourished when eating 1000 calories a day (which many people are on WLIs), unless they take care to ensure their meals are nutrient dense and balanced overall. It's absolutely possible to be malnourished at any weight...or at the very least sub-optimally-nourished!

It's not just about calories, as you say, that's the easy bit on WLIs.

@seanconneryseyebrow I should have also added that the points I made in my last comment are much less of an issue for someone who has only lost of a few kgs on WLIs (like you). Most people spend months, if not years, eating a very low calorie diet to lose significant amounts of weight on WLIs so it really matters that they get good nutrition.

The MJ makes it impossible to stomach the idea of a 2500 calorie meal of pasta and cheese and cream.

I have no trouble visualising a matchbox. Unless you have been living under a rock it’s pretty easy to know what healthy balanced meals look like, and the Mounjaro controls the portion sizes for you. Counting calories is a miserable way to live.

Come back in a few months and tell us if it’s still the same. You have been on MJ a few weeks just. After 18 months I can tell you that I absolutely could eat a 2500 calorie meal if I wanted to.

I was on it 18 months ago. It worked. I came off it, crept back up to bmi 23 so now I’m on it again. This time I’ll stay on a low dose once I get where I want.

How on earth are you getting these prescriptions @seanconneryseyebrow ?

I generally endorse what you are saying about MJ in terms of how to approach its use, but with the important caveat that I am on it because I started with a BMI of 30 and am still in the overweight range. It’s a shame as I think your credibility is undermined now you have revealed you were never overweight.