Semaglutide, Low Carb, and You (but me)

I have run an experiment, and it is (I think) an interesting one. The peptide Semaglutide (and its cousin Tirzepatide) have catapaulted into the collective consciousness in the past year or so, and potentially, for good reason. There are a lot of nay-sayers, and tons of people that say that it has changed their lives. There seems to be little middle-ground, and even less written about the “reality” of the drug. Maybe I can help. There are lots of considerations for this experience / expermient, and I’d like to set myself up for success, while gathering information to share with my little corner of the internet. It might just make interesting content.

The Goods

GLP-1 agonists work by mimicing the natural hormone production tells us to stop eating. Our friends at the Mayo Clinic describe it as These drugs mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels. Lower blood sugar levels are helpful for controlling type 2 diabetes.

Before we start

This is not something that I take lightly. I have mentioned in lots of other places that I’m very much data-driven, and without extensive research, I do not even consider a medication or treatment path. My doctors occassionally get annoyed by it. It is what it is. Let’s get some things out of the way.

Physical Health

One thing that most “journey” posts do not do is establish a baseline. If you know me, you know some of these things, but probably not all of them, so, about me:

Metric Initial Measurement
Age 38
Weight 246.3 lbs
Height 5’ 7”

I have been weight training for many years, so it may be helpful to catalog my current 1-Rep-Max lifts to establish strength baseline:

Lift 1RM
Bench 275 lbs
Squat 405 lbs
Deadlift 545 lbs
Overhead Press 190 lbs

I am generally low-carb or very low carb and have been for many years. I am on several medications and supplements that may make a difference to you, if you are using my experience to compare to yours. I have been on these supplements and medications for several years, and consider them my baseline. For this reason, I will similarly not include them in any cost estimates, as these are my standard operating costs.

Rx Dosage Method Frequency Timing Purpose
Testosterone Cypionate 10mg IM Q.D. AM TRT
Fish Oil 2000mg Oral Q.D. AM Cardiac Health
CoQ10 200mg Oral Q.D. AM Cardiac Health
L-Carnitine 1000mg Oral Q.D. AM General Health
Magnesium Theonate 288mg Oral Q.D. AM Brain Health, Memory & Attention
Vitamin B Complex   Oral Q.D. AM General Health
Vitamin D3 5000iu Oral Q.D. AM General Health
Vitamin K2 MK4/7 500mcg/100mcg Oral Q.D. AM General Health
Multivitamin   Oral Q.D. AM General Health
L-Lysine 500mg Oral Q.D. AM General Health
Pygeum 500mg Oral Q.D. AM Prostate, Urinary, Bladder
Sunflower Lecithin 2400mg Oral Q.D. AM Liver Function
Selenium 200mcg Oral Q.D. AM Thyroid, Metabolism, Immune System
L-Citrulline 750mg Oral Q.D. AM Metabolism
Korean Ginseng 1600mg Oral Q.D. AM Memory and Mental Health
DHEA 25mg Oral Q.D. AM Immune System and Hormone Balance
Pregnenolone 30mg Oral Q.D. AM Mood and Memory
Pygeum 250mg Oral Q.D. AM Prostate, Urinary, Bladder
Choline 500mg Oral Q.D. AM Memory and Nervous System
L-Arginine 1000mg Oral Q.D. AM Post-workout Support
Zinc 50mg Oral Q.D. AM Immune System
Biotest Superfood 1 Scoop Oral Q.D. PM Antioxidants
Creatine Mono 5g Oral Q.D. PM General Health
Aspirin 325mg Oral Q.D. PM Cortisol / Anti-Aging

I will update my dosages for Semaglutide as I go, but I am generally of the opinion that “less is more”. I will start with 0.25mg as recommended, and when “it stops working”, I will follow the standard dosing schedule.

Hardware

I’ll be using some hardware to help measure my health and my progress.

Withings Scale

The Withings Scale will be used to take daily weight measurements

Dexcom G6 CGM

I have elected to use a continuous glucose monitor because there is very little documentation of Keto / Low carb with GLP-1 agonists. I am looking for blood sugar being too low.

Kardia Mobile

Kardia Mobile takes a 6-lead ECG for me each morning to test a variety of heart rhythm conditions

Resmed Airsense 10

I have sleep apena. Not much to explain here!

Apple Watch

I use the Apple Watch Series 8 to monitor O2, heart rate, and activity throughout the day.

Software

I will be capturing the following information:

Metric Initial Measurement Method Frequency Initial Cost Monthly Cost Location
Body Weight 242.2 Withings Scale Daily $60 $0 Home
Body Comp   Dexa Scan Milestones $89 $0 Bodymass Composition Testing
ECG Normal Kardia Mobile Daily $79 $0 Home
3D Body Scan   Me Three Sixty Weekly $0 $0 Home
Blood Glucose   DexCom CGM Continuous $0 $120 Home
Lab Work   Blood / Urine Milestones $ $ Local

Lab Work

Lab work requires a bit of expansion, because I’m checking for a lot of things. GLP-1 agonists have some associated risks, mostly revolving around pancreas, stomach, and thyroid health. Any time I am putting my body through something, I like to get a Complete Blood Count (CBC) and a Complete Metabolic Panel (CMP). The panel that I will get for this looks like this:

  • CMP
  • CBC
  • Lipid Panel
  • Hormones
  • Liver Health
  • Pancreas Health
  • Thyroid Health
  • Insulin / Glucose

I have used a couple different direct lab work stores in the past, but for this particular mix of tests, the best deal I found is from Whatever Site

Diet

The hardest consideration in this experiment is diet. I have been a disgraced keto / low carb / carnivore for many years, but my adherence rate is generally pretty good. My intention with this experiment is to focus almost entirely on using my available calories for protein, in an attempt to limit muscle wasting. Despite my predilection for carnivore and low carb, and perhaps coincidentally, limiting calories while maintaining protein intake leans one direction: limiting plant foods. In my head, I have set out the density, nutrititional value and bioavailability of the food as the three leading metrics.

Density

Vegetables and legumes as a good source of protein is a matter up for debate. What isn’t up for debate is that animal products are much denser for the protein to calorie ratio. Cite my sources:

I started here: Wikipedia.

The lead driver of my decision is Protein Efficiency Ratio. While trying to maximize the density of protein per calorie, this is really the first stop. In this metric, we see that Egg, Whey and Beef are the most “worth it” in this metric. We can dig a little deeper to figure out which direction I should go, but I’m fairly convinced.

Nutritional Value

The density of your food source has the protein per calorie piece covered, but not the nutrients. I have already listed the battery of supplements that I take, so without hiding the ball, I do not think that plants are going to be the way here. Using this handy article, the metrics used for nutrient density seem to heavily skew that I’ll be fine eating beef.

Bioavailability

There is huge aggressive speculation (specifically among the vegetarian and vegan sect) that plant-based protein is “as good” or somehow superior to animal product. There is no literature that I have ever found that supports this claim. The overarching sentiment in most studies is that animal products are remarkably more bioavailable than plant products when consuming whole foods. There is a potential argument to be made for soy isolate in protein powder, but in all metrics, whey is cheap and bioavailable.

The Diet Plan

I want to give myself a little wiggle room, while still eating the things I like. My tentative plan (definitely subject to change) is as follows:

My Resting Metabolic Rate (RMR) is {FUTURE}, as the folks at BodyMass calculated (and my Total Energy Expenditure is {FUTURE}). Based on that, I need to eat less than that to lose. Given my level of activity, desired level of protein intake, and the food density we just went over, that leaves me with a 2000 calorie budget to hit 200g of protein each day. A tall order. Due to the GLP-1 agonist digestion slow-down, I am planning interchangable meals to hit those numbers. The protein number will be tough to hit, and at the end of the day, the calories are more important (I think. I could be proven wrong).

It should be noted that I’ve got a few dining-out options that I’ll catalog here. I’m not amazing at meal prep.

Homemade Cheeseburger

Food Item Serving Size Calories Fat Carbs Protein
Ground Beef 85/15 4 oz 240 17 0 22
White American Cheese 1 oz 100 9 2 5
MyProtein Clear Whey 1 scoop 80 0 0 20
Total   420 26 2 47

Texas Roadhouse

Food Item Serving Size Calories Fat Carbs Protein
Sirloin Steak 11 oz 460 11 6 84

McDonalds

Food Item Serving Size Calories Fat Carbs Protein
Double QP - Only meat and cheese 8 oz 540 40 4 42

I mostly eat these things today. I am sure there will be some fast math with other meals occasionally, but these are going to be the cornerstones.

Mental Health

The most fascinating piece of the GLP-1 Agonist class of drugs has been the overwhelming reports that “The food noise is gone”. When I initially went carnivore (or mostly carnivore) in 2022, the most remarkable feature of the diet was the severe reduction of “food noise”. It wasn’t gone but it was severely diminished.

I have a blog post that I published recent that I’d been poking at on and off for about 6 months. The idea of “food noise” is insane to me, because for the entire length of humanity (until the last 100 years or so, and its still not globally true), if there was food in front of you, you ate it, all of it, because tomorrow there is no food and you’ll starve to death. We evolved to store food during times of feast so that we didn’t die during times of famine. Only in the modern era have we, effectively, evolved past hunger. That deserves more thought. I am not saying that being overweight is healthy… But it is a defense mechanism. At this point in history, we have never had more food that is more palatable. It tastes good because its engineered to taste good. On top of that, many foods offer very little in the way of nutrition, so the whole equation becomes: We are eating endless amounts of the best tasting food and deriving very little nutrition from it, as a defense mechanism against starvation.

I have, of course, known about “food noise” for my whole life. Only recently have I taken to call it what it is: Compulsive Eating. I have never been diagnosed with Binge Eating Disorder, but the technical definition of compulsive eating fits me to a T. I often eat way more than I should, and when I’m on a mission, nothing is stopping me. Appetizer or two, entree, drinks, dessert. Compulsive. The most alluring piece of the GLP-1 agonist puzzle, for me, is the food noise silence. All of my weight loss trials and tribulations have been thwarted by it. It is painful to me to betray myself, and this is the most hopeful I’ve been about a drug helping me with that.

The mental challenge will be as hard as the physical challenge. My log of this experiment will include physical, mental, and emotional updates. My goal here is to utilize semaglutide to get into the best shape of my life.

Daily Blog

October 2023

October 4, 2023

Current Weight Sleep Semaglutide Dosage
246.3 06:27 0.0mg

Still gathering materials, but starting the daily blog now. Diet has been on-track but calorie heavy for a few days now. I need to figure out how to aggregate the data in my daily posts, as well as my steps, weight, etc. I am tracking it in an Excel document for now.