Started Contrave

Two remarkable days on Contrave.




I first blogged about Contrave in March 2016 link

I first took Qsymia but had Atrial fibrillation and I was taken off of it.

Then I took Belviq but a couple of months ago they took it off the market. 

I took my first Contrave yesterday and soon felt bad  
after  I drank a glass of wine.
 I read later alcohol can cause side effects?
 I never new that before. 
 I knew I was not to take opioids with naltrexone.
However I also had my 2nd shingles shot 
which today has left me with a sore left arm and tiredness.
 I was not able to walk as fast as I did yesterday. 
 I have felt tired. 

Last night I skipped dinner.  
I never do that but I had no desire to eat. 
I also had no desire to drink anymore wine.
I guess Contrave really does reduce cravings and appetite. 
The lack of wanting alcohol continued all day on this second day of taking Contrave.  
I haven't done my usual routine of snacks after my 14 hour fast as I usually am very hungry or rather even though I am full after lunch the cravings to continue to eat before dinner continued but not today.

I miss wine and cocktails and I was tempted to stop the Contrave so I  could drink.  It is interesting my Obesity specialist didn't warn me not to drink. 
I put this in the category that no patient had told her of a alcohol reaction with Contrave. 
It is similar to my Endocrinologist not telling to avoid alcohol with metformin. 
The PDR will list virtually all side effects ever mentioned in the trials.  
I went home and looked up the side effects and was surprised to see the warning not to drink alcohol but also that Contrave will raise my citalopram level. 
Thus I decreased my antidepressant from 40 to 20 mg. 

Citalopram decision making link

DAY THREE on Contrave

I went from 216 lbs to 213 lbs. 
I'm sure it is mostly water. 
I did my usual mile walk but not my dumbbells.
No alcohol yesterday.  I didn't miss it at all.

I had avoided intermittent fasting in the past because I found if I missed a miss I was get so hungry that I would overeat at the next meal. 

After years of making three eggs and 3 slices of bacon I decided to skip breakfast and then hold off lunch till 2 PM.  

It was not difficult but I found even though I ate a satisfying lunch which made me full I still craved more satisfying snacks.

So I would have wine with cheese. Then some dark chocolate.  That would do the trick of satisfying my cravings. 

During the Covid 19 lock in I found it easier to stay on my diet and exercise program.

I got down to a very low weight of 202 pounds.  I had also been off alcohol for 20 days with intermittent fasting and walking. 

In the lowest right corner of this page I write:
No ETOH so I ate ice cream to overcome strong cravings after 21.5 hour fast.




This was my best weight.
No doubt 20 days of abstinence from ETOH helped me break through my plateau. 
Also no restaurant eating helped and a nice beach to walk on.





  Under the stress of COVID 19 lock down I finally decided to have some wine.  Wine does prevent me from eating desert.  






WHAT IS THE POINT?

I am 68 years old.  I was diagnosed with Alzheimer's in Dec 2017.

Why do such a regimented life? 

Intermittent fasting does involve hunger (suffering).
I deal with it by spacing out 2 cups of coffee, 2 diet sodas and 2 diet Snapple teas.
Then I go for a walk. 

I come home after a 14 hour fast and check my glucose and ketones. 
The astonishing thing is sometimes my glucose has not gone down!
I asked my Endocrinologist about this and he explained that with Diabetics the body figures out what is happening and will release glycogen from the liver even though I am in fat metabolism mode as 
demonstrated by my ketone levels. 

I have been on IM since Nov. 19, 2019.
I weighed 214 pounds and my fasting glucose was 134.
I have continued IM not because of weight loss but because my
 Hgb A1c dropped by 2 points and control of glucose is important for my Alzheimer's

Now I can't enjoy my bar anymore.  Why do it?
With Contrave, I don't enjoy ETOH. 
Why take that pleasure away from me?

I stopped Cialis for a week but I still have a headache. 
I am thinking the headache is not from Cialis but
 Post Concussion link may be causing the mild headaches.

I would like to know as I get beyond the half life of Cialis.

However my new diet pills can also cause headaches. 

It's called polypharmacy problems.

If the two new drugs allow me to lose weight I am willing to try it. 

I have a goal of getting below 200 pounds. 
I did it for my wedding with traditional low calorie diet in June 2007  I quickly gained 10 pounds due to Sponge syndrome with shrunken fat cells that never go away and the subsequent low leptin causes the brain to think the body is starving.  Thus the Rest Metabolism Rate is reduced as well as the exercise metabolism rate.  I am always cold. 
The only way to maintain weight loss is to stay on a sub-starvation diet of 1200 to 1700 calories.  I have maintained my weight to 220 from apogee of 280.  
That is with alcohol on low carb high fat diet on ketosis. 
Ketosis does not help with hunger once you become one of the reduced obese. 

This is a struggle. 
Low down with COVID 19 is a struggle. 
Having Alzheimers is a struggle. 

Why keep trying?
Getting back up to 250 pounds would make me very depressed. 

My main goal now is to slow the progression of Alzheimers.
Lowering my Hgb A1c is very important. 

Alcohol consumption does not affect my Hgb A1c.

Contrave prevents me from drinking alcohol. 

The author Cornwall wrote about a overweight British officer during the Napoleanic wars who was given an award.  In his acceptance speech he said he was "blessed to have a good appetite"

I never forgot that. 
Many sick patients lose their appetites and don't enjoy it. 
Here I am taking expensive medicine to lose my appetite?

I am switching from Victoza to Ozempic soon. 
I usually take only the DM dose of Victoza 1.8 mg unless my wife does not take her her Victoza, then I take the Obesity dose of 3.0.
Our supplemental will not cover the code for Obesity to pay for Victoza. 
Ozempic is covered for the highest dose for DM and it is for Obesity as well.
Retail price of Ozempic is $875 at Walgreens
My wife paid $56 with our supplement. 
I paid $320 as I was in the donut hole with Medicare. 

Important fact:
Loss of appetite is just before nausea and vomiting.

This is what many people on Victoza experience. 
It's amazing most work through it with lowering the dose. 
I also once stopped my Victoza because I thought it was making me feel sick.
Once I was in New Orleans and Victoza suddenly kicked and I could not finish my wonderful meals as I felt could not eat anymore.  My son said I was the only one who visits NOLA and loses weight. 

The people in National Weight Control Registry maintain the discipline over 5 to 10 years.  They are committed (compulsive/obsessive?) to do this. 

It's early days with Contrave. In 3 weeks I will be on maximum dose.

Next week I will switch from Victoza to Ozempic.

I hope the new diet medicines will help me stay on 1,000 to 1,500 calories a day so I can reach my goal of 200 pounds.