My general framework: Start with semaglutide if cost is a significant concern, or if there is no strong reason to expect poor tolerance Start with tirzepatide if the patient has tried semaglutide before and struggled with side effects, if faster initial response matters clinically, or if the patients goals require larger total weight loss Switch to tirzepatide if a patient on semaglutide is experiencing persistent nausea or has plateaued and escalation options are limited One pattern worth noting: men I see a consistent pattern with male patients who struggle to tolerate semaglutide nausea and GI disruption can be particularly disruptive for them, and theyre often less willing to push through it
From there your dose may increase gradually over time, but theres no single right pace or target
Evidence suggests it may promote weight loss by increasing calorie expenditure.6 Taking an L-Carnitine supplement daily has been proven to increase the blood and muscular concentrations of this amino acid-like compound, which could enhance fat metabolism as a result with increased muscle carnitine concentrations.6 2
One older study on Byetta (exenatide) showed minimal transfer, but there are no studies on semaglutide, tirzepatide, or liraglutide in breast milk, and no data on infant outcomes when exposed via breast milk
Rich in powerful antioxidants such as resveratrol and vitamin E to protect the skin from oxidative stress and give it a healthy appearance