this post was submitted on 20 Jun 2025
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Looks like a cool channel, subscribed, thanks!
I've seen some worrisome data. Semaglutide doesn't teach people a better eating pattern, it doesn't push people toward more satiating nutritious food. It appears to reduce hunger (nausea) but unless people eat better food they are going through a very slow from of malnutrition while they are on the drug. Eventually people need to come off the drug, and at that point they have lost a considerable amount of muscle mass (something like 40% of the weight loss on the drug is muscle mass) but haven't necessarily improved their eating patterns.
I think these type of drugs are a great tool for people who can't do a health intervention, but it should be seen as a bridge to helping someone build better behaviors not as a replacement for better eating.
Be strong! This is where online communities are important to help people develop and maintain better habits.
I can't speak for other people but my experience with it was that it forced me to eat at regular times. Forced me into strict portion control, whereby too much and I felt nauseous and too little and I had acid reflux. This in turn meant that I had to quickly figure out what I could and couldn't eat and made sure I was eating nutritious enough meals to get me through my days as I had to make the most of what little I could eat. Even in terms of drink, I had to cut juice and alcohol as my body just couldn't handle anything. I'm probably the exception rather than the rule, but it changed my life and allowed me to put into action things I had always theorised about but couldn't reconcile.
Ugh, don't get me started on how much weaker I am, but it's something to work on.
Sometimes people just need help and it's not one size fits all. This is why we need doctors that are hands on so they can understand the optimal treatment for each patient.
Wow, that is really great! Thank you for sharing your experience.
100%
Have you transitioned off the drugs and are on a maintenance nutrition program? I've done a huge amount of reading in the ketogenic / zero carb space and I'm happy to share any literature on muscle improvement and sustainment that could be helpful to you
I'm still on the drugs, though as I approach my one year anniversary, I suspect I'll start having those conversations with my doctor. But please do share your findings and insights on diet. Right now, although I'm eating a balanced diet, I feel like the calorie deficit is doing the heavy lifting.
Full disclosure I run the !ketogenic@dubvee.org and !carnivore@dubvee.org communities, so I have quite the bias.
People following a low-carb nutritional protocol have reported better results then slgt2/glp1 inhibitors alone, especially when considering muscle wasting (a ketogenic intervention usually gains muscle)
The muscle loss is thought to be due to nutritional deficits rather then the drugs themselves. Since you said your eating a balanced diet - does that mean your getting 2g per kg of ideal body weight complete (ASF or high DIAAS) protein per day?
CICO is technically true, but not clinically relevant - the carbohydrate model of obesity has more clinical impact. I can send over the paper if you want the details but if the bodies hormones are allowed to operate normally (without elevated insulin) the normal hunger and satisfaction signals are sufficient to get healthy.
Are you measuring your muscle over time? With a inbody scale, or dexa scan? That can be helpful
As far as I'm aware a low carbohydrate diet can be combined with the drugs
Update
I agree that carbs aren't great, but they do have their place and can be vital to overcoming diabetes in some patients.
Probably not to be honest. I'm struggling to get enough protein.
What is this?
Please do
I haven't. I've never even heard of a dexa scale.
I think, especially in a cooler climate such as the UK, low carbs makes sense as your body doesn't have the sun to burn through the carbs (and starch) as efficiently.
I've actually been thinking about visiting a sauna, so this is timely advice, thank you.
I'm aware of the Randel cycle (not a cycle) and how the potato/mcdougal/rice diets can help some people reduce their insulin resistance. However, I don't think there is any necessity for a carbohydrate in human nutrition, at least not published in literature. In so far as some low glycemic carbohydrates can help a patient displace more glycemic carbohydrates I would agree it is a valid tool. If we look at type 2 diabetes as a state of carbohydrate intolerance (which it really is because of blood glucose being driven directly by carbohydrate consumption) then it is not advisable for any type 2 diabetic to incorporate carbohydrates in their protocol.
This is a interesting paper (and my notes) on the absolute requirements of carbohydrates in human nutrition: Paper - Confronting myths: relative and absolute requirements of dietary carbohydrates and glucose as metabolic fuels. - 2024
Fight fight!
Paper - The Carbohydrate-Insulin Model of Obesity - Beyond “Calories In, Calories Out” - 2018
I really need to move my notes off of lemm.ee this weekend. TLDR on the paper insulin is the driver of obesity, reducing insulin is the solution to obesity (allowing the body to enact its amazing homeostasis capabilites)
You can use any capacitive scale that estimates muscle mass to give you a broad indicator of progression or retention. Inbody scanners are fairly common at gyms, some places have dexa body composition scanners which are even more complete, but any measurement from any system is good enough here to milestone progression. It could even be weekly hand grip strength measurements.
I'm not familiar with any mechanism between sunlight and carbohydrate mobilization. Perhaps just warmer climates make being outside nicer so people are more active?
Start slow! and enjoy it (make sure not to take your glasses into the sauna, I melted mine).
Happy to talk at length and get into the details about any of the above.
This is interesting, thanks for sharing. Sadly a keto diet is beyond me as I suffer from KPD.
Always happy to share! I'm genuinely happy you read what i wrote!
KPD https://en.wikipedia.org/wiki/Ketosis-prone_diabetes ?
You might find this interesting Ketosis, ketoacidosis and very-low-calorie diets: putting the record straight - 2011
TLDR: DKA and Ketosis are distinct biological states, and eating carbohydrates does not provide a benefit in avoiding DKA. i.e. DKA is resolved with insulin and not injecting/consuming glucose.
Update - Above you said your on a SLGT2 inhibitor, which does decrease insulin levels, so there is a DKA risk with that medication by itself, with your KPD condition I agree its probably not great to combine SLGT2i medication and a strict ketogenic diet