Recently, my weight shot up again, and I’ve gone over the weight where I start snoring in my sleep. Since my BMI is now somewhere in the range where I get my own orbit, I decided to do something about it. I recently found out about Semaglutide, and I figured I should give it a shot.

Semaglutide is a new drug for weight loss, or, more accurately, an old drug for diabetes. However, the diabetics who were taking it reported suppressed appetite, so the pharma company thought “hmmmmmm…”, and we got a nice weight loss drug.

Since I don’t like snoring or being overweight, I was curious to try it and see what happens, so I talked to a medical professional and got some prescribed, more out of curiosity than out of need. I think it’s going to be an interesting experiment, and am eager to see whether (and how) it works.

The experience before the medication

My experience regarding food has varied throughout my life. One thing that has remained constant is my ability to ignore hunger for long periods of time. I might go without eating for 36 hours without much discomfort, and I’m too lazy to cook. If there’s no food in the house, I’ll probably order takeout, but it might be a few hours before I get around to it.

If there’s food around the house, however, I think about it all the time. I usually find myself wanting to snack on something, and any trip to the kitchen will result in me snacking on something. Hopefully it will be something light, like a rice cake or some yoghurt, but sometimes it’s candy bars or whatever else there is.

Apart from eating even though I’m not hungry, I also don’t stop eating when I’m full. I might have dessert, and then another dessert, and then more candy shortly after. I only stop eating when there’s nothing left on my plate, or when I physically cannot fit any more food in my stomach.

Basically, the only reason why I’m not an amorphous blob is my intermittent fasting (no eating after 10 pm), my hobbies of cycling and tennis, and really good genetics.

The rationale

The guidelines that I’ve seen try for an approach of “take a large dose so you’re always full, lose a ton of weight, then stop and hope you don’t gain it back”. I think this is good for the average person, but it’s not what I want to do. Instead, what I want is to tweak my “hunger sensor” to be a bit less sensitive than it is now.

This means that, rather than taking the max dose to lose a ton of weight as fast as possible, I want to take enough to feel hungry when I’m very hungry, rather than when food is not currently in my mouth. I also think that this might be more sustainable in the long run, especially since I did lose around 10% of my weight last summer, just by somehow managing to get out of the habit of paying much attention to my desire to eat, so I think I have a good shot at it.

My approach will be to target, at first, a rough amount of food I want to have per day (as a proxy for my target weight). Then, I will take enough Semaglutide to basically tweak my hunger so I want to eat that amount of food, and adjust the dose based on side-effects and whether I think I’m too hungry or not hungry enough. Later on, if I reach my target weight, I will adjust the dose so that I stay on that weight. However, I’m hoping that, at that point, the dose will be zero.

I don’t know if all this is possible to do with the pill, but it’s what I’m going to try for, and it means I’ll have to play with the dosage myself a lot.

The dosage

Semaglutide comes in two forms, pills and injections. The injection has proven to be around twice as effective than the pill form (ie people lost twice as much weight on average), but I prefer the pills because they’re easier to adjust the dose. The injection is taken once weekly, but the pill is once daily.

In an effort to ease the side-effects (nausea and diarrhea, mostly) of Semaglutide, you usually start on a low dose, and then keep increasing it until you reach the recommended dose.

The fact that the pill is taken daily means that I can decrease my dose if I have side-effects, or increase it if I have no side-effects but don’t get enough loss of appetite. In general, my goal is not going to be the recommended “reach 14mg and keep taking that”, I will experiment with the dose to find a happy medium for me. What I also think is likely to happen is that I’ll reach a point where my habits will change from “I need food always” to a healthier “eating when hungry”, and at that point I will either stop the pill or just restart it at a low dose if I notice that I’m thinking about food too much again.

I guess there’s only one way to find out how this will go!

The experience on the medication

I’ll break my experience down into days, and I’ll update this post when something changes.

Day 1

For my first day, I took 3.5mg. I didn’t really expect any effects at all, wanted or otherwise, and I was surprised to get some slight nausea around 30 minutes after taking the pill. I still had a hearty breakfast, but I kind of started not enjoying it as much half-way through.

After breakfast, things started feeling very different. I felt full for many hours, even when I noticed my breath smell changing from the lack of food. In fact, I never stopped feeling full, and wasn’t the least bit hungry at dinner, seven hours later.

The only times I thought about food was when I realized I hadn’t thought about it in a long time. Usually, when I think about food, I think how good it would taste it, and I start to crave it, but today I didn’t really think about how it would taste, and didn’t miss it.

I even saw some tasty-looking cakes, some chocolate, etc, and I thought “eh I’m not really in the mood”, which normally never happens, it was striking. I looked at some cakes and it was as if I was looking at rocks, it didn’t register as something that would give me a jolt of reward if I ate it, it was on the same category as cardboard. I never used to be able to resist a snack, especially if it was in front of me, but today I just didn’t really want to eat much.

I also realized how much of a problem I have with eating. I remember thinking “this is what normal people must feel like, it’s nice to not crave food all day”. It was like wearing vision-correcting glasses for the first time, and you realize that everything actually looks much crisper than you thought.

When I did finally have dinner (mostly because I recognized I need to eat, rather than from any desire to), it tasted just as good as it always had, and I liked eating it, though not in the way that it tastes extra amazing when you’re very hungry. Throughout dinner, though, I felt that I could just stop at any point, and I wouldn’t really want any more. I didn’t feel like eating at any point, before or after, but I still enjoyed the steak I was eating.

After dinner, I would normally rush to eat some dessert, but today I wasn’t in any hurry to. In fact, I didn’t even have dessert for a few hours after the meal, which, again, is very atypical.

Day 2

The effects on the second day have been much less pronounced. I’m not sure if that is because I got used to not being hungry, and I’m not surprised by it (which kind of seems like it would take more than one day to do), or because of the way I cut up the pill (they aren’t designed to be cut up so you aren’t guaranteed to get exactly a quarter of the dose).

I haven’t really wanted to eat today, but I also didn’t have any nausea or the feeling that looking at food is entirely neutral, so there’s definitely less effect than yesterday. I considered not taking the pill in the morning, because I felt like I didn’t want to eat, but I think I’ll take it for at least a week (to establish a baseline) and start the experimentation afterwards.

Day 3

The effects were even less pronounced today, I suspect it’s because I’m cutting the pill in four, I wonder if the Semaglutide quickly gets neutralized by the humidity in the air (as far as I know, the pills are sensitive to humidity). I’m curious to see what will happen on day 5, when I’ll cut up a new pill, and store it in an airtight container.

I had a yoghurt for lunch, but I was very hungry for dinner, and had a bunch of meat and fries, and then dessert. Still, though, I wasn’t constantly thinking about eating, and I was on reasonably little food by the time I was really hungry. If every day ends up being like this one, it will be ideal, I didn’t snack at all and I was still hungry when I needed to be hungry.

Day 4

Same deal as before, I had a salad for lunch and some dessert, so pretty normal. However, I have some chocolate in the kitchen, and usually I’d be doing regular trips to get a piece each time, but now I consider it and think “eh, it’s too far”. Interesting.

Tomorrow I’ll take a quarter of a fresh pill, so I’m interested to see if my experience will be similar to the first day’s or not.

Day 5

I cut up a fresh pill and took a largish piece. The experience was more similar to yesterday than to Day 1, which is both good and bad. Good, because it means that the pills haven’t lost their efficacy in a few days, and bad because it means that I’m not as non-hungry as the first day.

Still, today my appetite has been very close to what I consider ideal. I had an OK-sized lunch, then a yoghurt and a little cereal for dinner, and was unbothered by thoughts of food throughout the day. Even more so, I have my favorite bar of chocolate in the kitchen and I haven’t touched it in a few days, which is pretty encouraging.

I think tomorrow I’ll skip the pill, to see how my hunger levels will be, and compare to how I am when taking the medication.

Day 6

I didn’t take the pill today, just to see what would happen. I didn’t expect much to happen, as the drug is still in my system, but there was something fairly interesting. Even though I had a good lunch and a yoghurt after, I started wanting to drink the chocolate milk I had, and did, since I basically have no resistance.

The previous days, I didn’t really get cravings like this, no matter how small. The effect is still too small to be able to draw conclusions, but the result is that today I consumed a bunch more calories than the other days, because of the milk.

I’m going to end this post here, as it doesn’t seem like there’s any more benefit in writing about every day, they’re mostly the same. I will possibly update it in a month or two, with anything interesting that happened, or any conclusions..

In the mean time, you can get live updates on my current weight from my weight tracking page.

Epilogue

As it looks from this preliminary stage, and as you may have suspected, there is no “normal”. Everyone’s hunger sensitivity is different, and it also varies depending on how much food we’re used to eating. My goal is to change my feelings of hunger so that I eventually manage to stay at a healthier weight without medication, but we’ll see how that goes.

Also, keep in mind that the above is entirely unscientific. For all I know, it might all just be entirely placebo, or depending on my mood that day. It takes weeks for Semaglutide to build the required concentration in your blood (ie “reach steady-state”), and for all I know I’m just experiencing the above because I’m thinking it works, so take that in mind.

As usual, please Tweet or toot at me, or email me directly. You can also find me on Nostr at stavros@stavros.io.