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ForumsExercise & Body CompositionCreatine loading vs maintenance on GLP-1 — my results so far

Creatine loading vs maintenance on GLP-1 — my results so far

DerekSJ_a1c Tue, Jul 9, 2024 at 7:47 AM 45 replies 2,756 viewsPage 1 of 9
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DerekSJ_a1c
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Jul 9, 2024 at 7:47 AM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

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 That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

Where I think it is weakest: the completion rate deserves as much attention as the headline, because a large effect among those who finished is a different claim from a large effect among those enrolled.

So the question, as narrowly as I can put it: whether extending the interval works as well as reducing the dose, since they are not the same intervention pharmacologically. I would rather have one careful answer than five confident ones.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
23 18adam_van, Dr.SurgeonPGH, rachel_ABQ and 20 others
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PurityPaulOR
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Jul 9, 2024 at 8:07 AM#2
DerekSJ_a1c said:
STEP 4 is the study that answers this and it is blunt.

Agreeing with DerekSJ_a1c, and the qualification matters more than the agreement. One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are. That subgroup is the most interesting unanswered question in the field and it is routinely flattened into the two-thirds headline.

22 17MikeNYC_runner and 19 others
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Dr.CardioMD
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Jul 9, 2024 at 8:27 AM#3
DerekSJ_a1c said:
STEP 4 is the study that answers this and it is blunt.

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.

Correct me if the detail matters more than I have assumed.

21 16tony_orlando, Dr.NephBHM_UK, kim_atl_prep and 18 others
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SleepDoc_PDX
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Jul 9, 2024 at 8:47 AM#4

Answering the narrow version, because the broad one does not have a single answer. 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.

Correct me if the detail matters more than I have assumed.

20 15sophie_paris, mel_PDX, Dr.AddMedPHL and 17 others
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wanda_boise
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Jul 9, 2024 at 10:37 AM#5
PurityPaulOR said:
One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution. Hydration status moves the lean compartment by a kilogram or more between scans, so any comparison of scans done at different times of day or different hydration states is noise.

19 14ben_calgary, patPC_UT, Dr.DermMIA and 16 others
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