Creatine loading vs maintenance on GLP-1 — optimal protocol

MikeFit_NJ said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

MikeFit_NJ has the substance of this right. The condition it depends on is worth stating. Extending the interval and reducing the dose are pharmacologically different. Reducing the dose lowers the whole exposure curve evenly; extending the interval keeps the peak and drops the trough. Since the appetite effect tracks the trough, interval extension tends to give you good days and bad days rather than a uniformly smaller effect, which most people find harder to live with.

I would rather be corrected than agreed with, if it comes to it.

MikeFit_NJ said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.

This one has a reasonably settled answer, so here it is. STEP 4 is the study that answers this and it is blunt. Participants who continued kept losing; participants switched to placebo regained about two thirds of what they had lost within a year, and the metabolic improvements faded with the weight. That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

NeuroNate said:

Extending the interval and reducing the dose are pharmacologically different.

Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.