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20 kg weight loss in 17 weeks: A doctor recounts his journey with Mounjaro, says it killed his craving
A radiologist and healthcare management specialist, Dr Sandeep Kawlra failed the discipline he advocated for others just 10 days after his diabetes diagnosis in 2016. His refrigerator had a 48-bar Snickers pack, which he had hoped to get rid of. But such was his craving that he gave in and finished all the bars within the next 10 days. 'That was the turning point. I knew that I needed help to control myself, especially at a time when my parameters were all over the place,' he says.
Now, thanks to a new class of weight loss drugs, both his weight and appetite are under control. He has lost nearly 20 kg in the 17 weeks that he has been on Mounjaro and now weighs 87.5kg. 'Although I am still obese, I have lost a lot of weight in a sustained manner. People who meet me now say that I look nearly a decade younger,' says Dr Kawlra, adding that he feels more energetic as well.
At the time of diagnosis, Dr Kawlra's blood glucose levels were sky high — the random blood glucose level was 350mg/dL and the HbA1c (average blood sugar count of three months) was 13.5 per cent. The normal random blood glucose level should ideally be between 70 and 140 mg/dL and the HbA1c 5.7 per cent.
'I know what had led to it — my frequent hunger pangs. I was eating indiscriminately, was addicted to sugar. I was drinking frequently, a couple of times a week. And, I was not exercising regularly. All of this meant I not only had diabetes, I was at risk of other metabolic diseases, heart attack and stroke. So, I panicked. I started cutting down on sweets, have a more balanced diet. I also got a treadmill at home and started exercising regularly. But things didn't seem easy,' says Dr Kawlra.
That was an indicator that the levels of his blood sugar-regulating hormone, insulin, were dropping. And since insulin is interconnected with the hunger hormone ghrelin, falling insulin automatically switches up ghrelin, making the person hungrier. He needed something to turn the latter off and chose liraglutide, a GLP 1A receptor agonist that mimics gut hormones and helps the pancreas release the right amount of insulin when blood sugar levels are high. This is a daily injectable, which decreases appetite, promotes satiety and reduces calorie intake, leading to subsequent weight loss.
The other weight loss drug in its category, semaglutide, generally leads to more weight loss and better HbA1c reduction, but Dr Kawlra tolerated liraglutide better.
When he started the medicine, Dr Kawlra weighed around 117.5 kg. Then he lost about 8-10 kg. His diabetes became manageable as his HbA1c reduced to around 6.7 per cent.
He had heard that semaglutide worked better for weight control and was being used off-label for the purpose although it had been approved for treatment of Type 2 diabetes. 'While the injectable drug was unavailable in India back then, oral semaglutide pills were available. So I made a switch. However, I could not tolerate the nausea and vomitting that came with semaglutide. So I switched back to liraglutide all over again because my body tolerated it better,' says Dr Kawlra.
He started looking for alternatives when liraglutide went off patent last November. 'As soon as the patent expired, the market was flooded with several generic versions. It became difficult to procure the drug that I was using. So, I started looking for alternatives,' says Dr Kawlra.
The availability of weekly injectables such as Wegovy (semaglutide) and Mounjaro (tirzepatide, which combines GLP1 RA with the insulin-stimulating GIP hormone) in India changed his goals. He opted for Mounjaro 2.5 mg, which costs Rs 14,000 per month. 'With the drug available in India, my doctors are slowly increasing the dose. Not only has Mounjaro helped me lose significant body weight, it has also had an impact on what I eat,' says Dr Kawlra.
He no longer craves sweets. Now, he eats eggs for breakfast, millet roti and vegetables for lunch and chicken broth or other proteins such as soya or boiled chickpeas for dinner. He has two cups of tea or black coffee without sugar. 'I have not had anything sweet in a long time. I have not had a drop of alcohol in over four months. To tell you the truth, I don't even have the craving,' he says.
This is one of the happy side effects of the GLP-1 receptor agonist drugs such as semaglutide and tirzepatide. 'Not only do these drugs increase satiety and reduce appetite, they also reduce cravings for sweets and rich, fried foods. For people who constantly think about what they are going to eat meal to meal, their food noise goes down significantly,' says Dr Ambrish Mithal, Chairman, Endocrinology and Diabetes, Max Healthcare, who has also been treating Dr Kawlra.
So how does Mounjaro change your appetite? 'When injected into your system, it mimics two hormones (GLP-1 and GIP) that are naturally produced by the body. These trigger receptors in your brain that tell you you're full and tricks your brain into suppressing your appetite. It also slows the passage of food through your digestive system, making you feel fuller for longer,' adds Dr Mithal. However, while making you feel less hungry, it may not help with stress eating or emotional eating, that is driven by psychological factors, and you could still feel tempted by unhealthy foods. That would need addressing emotional and behavioural aspects alongside Mounjaro.
Mounjaro users usually notice a drop in appetite within a few days of taking their first dose, though for others it could take a few weeks to feel real change as the medication stabilises your system.
There is some evidence to suggest that these drugs may help with alcohol, substance and tobacco use disorders. There are some laboratory studies, and now clinical trials in humans, that suggest that GLP-1 RAs can reduce the intake as well as the craving for these addictive substances by lowering the reward response of the brain. These drugs are already approved for the treatment of type-2 diabetes, obesity, cardiovascular diseases and obstructive sleep apnoea. The effects of the drug on chronic kidney disease and non-alcoholic fatty liver disease are being studied. 'They have also demonstrated some protective effect against neurodegenerative diseases such as Parkinson's and Alzheimer's,' says Dr Mithal.
Now Dr Kawlra feels motivated enough to maintain his diet and exercise regime and resume his favourite pursuits, travel and photography. 'Mounjaro gave me the push I needed. Now the journey ahead is mine to keep. And that will always need human effort, my effort,' he says.
Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government's management of the Covid-19 pandemic and closely followed the vaccination programme.
Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports.
Dutt also takes a keen interest in the country's space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan.
She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University's Dart Centre. Dutt has a Bachelor's Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times.
When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. ... Read More
