From the other side of the consultation, briefly. There is a difference between no evidence and evidence of no effect, and this subject is one where the two get swapped freely in both directions.
Dr.EndoIndy said:There is a difference between no evidence and evidence of no effect, and this subject is one where the two get swapped freely in both directions.
That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.
Dr.EndoIndy said:There is a difference between no evidence and evidence of no effect, and this subject is one where the two get swapped freely in both directions.
There is a second half to this that has not been said yet. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.
Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
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Shop Reference StandardsAdding the numbers, since they settle part of this. Worth knowing that the injection site changes very little. Abdomen, thigh and upper arm are bioequivalent for semaglutide, so a site change is not a plausible explanation for a bad week.
One thing that is still open after Dr.EndoIndy’s answer:
How much of the between-person variation is pharmacokinetic and how much is just adherence measured badly?