Without reading anything the thread has mentioned. I am at 30mg of Tirzepatide, 2.5mg of Semaglutide, and 2.5mg of Cagralinutide a week and can still eat (as a reference) 2 In N Out burgers with a fry, 1 Chinese Lunch Special, 2lbs of BBQ Chicken and some Quest Chips, with a large bag of kettle corn. After 5 days of injection.
The first day I couldnt eat or drink, 2nd I could drink, 3rd was 1 bowl at Chipotle , 4th was a standard Bodybuilding Diet at 2100cals.
I have obvious binge eating disorder, undiagnosed medically. I've tried every single substance regarding weightloss to appetite suppression. Including but not limited to meth, DNP, nicotine, coke, GLP's, Benzo's, SSRI's, etc. It isn't the suppression of the appetite. As someone has once said in here, I will at times eat until I am physically going to puke, crying as my stomach feels as if it gets ripped open, then 2 hours later munch on something else. I can visualize it to the same fix a junkie needs when withdrawing from Drugs, is the same feeling I get after a few hours without food. And I don't like to over exaggerate, as the headaches, sweating, and literal fiending is real at times for me, I've spent probably 10k at least on overeating this year. For the first time in my life (day 3 of that dose) I had actually stopped eating a meal I enjoyed, and was satiated for 2 hours and was happy to eat again later. It evoked the same joy that you get when you find something out as a child. I wish I could find a way for that to be a reality.
Heighest weight was 465 lowest was 201.4, sitting at 285. I'll probably just get the Gastric Sleeve, but despite everything it's all about just being disciplined with a constant ring in your ear telling you to eat, and having to weigh every single gram of food and plan for the next day everyday as well as bad habits I need to break that I have before.
I can see you're desperate to turn this around. Before a gastric sleeve, if I was advising someone I know who was going through this, I'd recommend this approach:
Extreme GLP-1 resistance is mostly a genetic condition. The result (obesity, inflammation, fatty liver, insulin resistance) destroy whatever GLP-1 sensitivity remains. This results in a loss of the ability to experience satiety, and even the physical limitations the body uses as an eating "kill switch" like slowed gastric emptying to make it nearly physically impossible no longer work.
The GLP-1 RA doses you're describing should have made it physically impossible to eat regardless of psychologic factors and the fact it hasn't can only be reasonably explained by extreme GLP-1 receptor dysfunction. You can get genetically tested for this and I'd be shocked if you didn't have the code that causes this problem.
Extreme GLP-1 resistance also correlates with substance use disorder and addiction risk in people with this is many times higher than average.
Restoring the GLP-1 sensitivity you do have (everyone has at least some) requires fixing the underlying metabolic issues. That means losing weight to the greatest degree possible, A real chicken and egg problem.
Cagrilintide is an amylin. This is a secondary appetite inhibiting hormone that works directly on the brain, completely bypassing the primary GLP-1 appetite regulation system. The psychological reduction of appetite isn't as strong as GLPs (aka food noise) but the physical blocks to limit eating are.
On its own, as a second rate (compared to glps) weight loss drug Cagri's top dose is 4.5mg. But it was proven safe up to 10mg. they simply didn't bother going higher than 4.5 because most people in the studies couldn't eat anything beyond that point. It was so physically unpleasant to eat at higher doses, subjects didn't want to continue. That sounds like exactly what you need.
If I were you, I'd stop all the other GLPs. Increase Cagri to 4.5mg once a week. If that's not enough to stop you from overeating, increase it 1mg a week until your get to 10 if absolutely necessary.
The idea here is do drop weight, regain insulin sensitivity and lower inflammation. After that's taken place, you should have some GLP-1 sensitivity restored. Then you can start dropping the Cagri dose, and reintroduce Sema. The physical unpleasantness of high dose Amylin will lessen, and the GLP silencing of food noise will hopefully take place. Metabolic health will continue to improve thanks to now (at least partially) restored GLP-1 sensitivity, I can't tell you precisely what doses to use, we're in unexplored territory here, but you clearly know how to titrate given your current doses. Sema is safe up to 7.2mg.
I don't expect the initial Cagri only stage to be pleasant. It won't lessen your appetite much, but cause you to lose weight by brute force. You'll stop eating because you can't swallow and vomit at the same time. The goal here is to get GLPs to work again.
With any luck, you'll get to the point you can extinguish food noise, suppress addictive tendencies (which GLPs are known to do), and maintain this new, healthier state with a combo of Cagri and Sema.
