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Microdosing Ozempic? Why some people are playing doctor with weight-loss drugs

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Microdosing Ozempic? Why some people are playing doctor with weight-loss drugs

Shauna Bookless never imagined she’d become her own pharmacist. But after gaining more than 20 pounds during undergraduate and graduate school and feeling unhappy with her weight, the Hollywood resident found herself mixing vials in her kitchen to create her own doses of a popular weight-loss drug.

“I’m playing doctor,” Bookless said, describing her foray into the world of do-it-yourself GLP-1 medication, injections developed to control diabetes and now also used for weight loss.

Her journey began conventionally enough. She’d first heard of Wegovy, a GLP-1 made by Novo Nordisk, from a friend’s success story. Bookless then talked to her own doctor, who told her it wasn’t medically necessary and insurance wouldn’t pay for it because her body mass index wasn’t high enough to qualify her for coverage (without insurance, the cost can be $1,300 a month). So Bookless took matters into her own hands. And it led her to the fringes of a booming weight-loss drug market.

First, she considered her alternatives. She could go to a med-spa, but that would cost about $1,000 a month, still too much for the new therapist. Then, another friend at work told her about getting it directly from a laboratory that produces the product. Bookless wasn’t sure about this method — it meant having no doctor to turn to if she had questions — but a friend of hers assured her it was a legitimate, and a much cheaper route. She put her order in, paid $130, and two days later, in August, a package with a vial of white powder, sterile water, and needles arrived in the mail. It was semaglutide, a drug sold under the brand names Ozempic (for diabetes) and Wegovy (for weight loss).

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Following instructions provided in the packaging, she mixed the powder and water and put it in the fridge, taking out one-fourth to one-half a milligram to inject herself in the stomach once a week.

Instead of consistently stepping up the dose to a target dose of 2.4 mg as the manufacturer’s instructions and FDA’s guidance recommend, she’s been sticking close to the amount she started with. Even at these lower-than-recommended levels, her appetite soon winnowed and she began to shed weight. Bookless has used two months’ worth of the semaglutide over three months of jabbing herself weekly.

Twenty-three pounds of weight loss later, she’s figuring out how low of a dose she can use.

“I don’t want to lose any more weight,” she said. “But I also don’t want to gain the weight back. It’s going to be an experiment to go off of it.”

As demand for popular weight-loss drugs like Wegovy and Zepbound skyrockets, Bookless’ DIY approach highlights the lengths some are willing to go to slim down while saving money. Some patients, with or without the help of doctors, are experimenting with “microdosing” weight loss drugs — using smaller-than-recommended amounts — in order to stretch limited supplies, reduce costs and even potentially curb side effects.

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Meanwhile, medical experts are raising concerns, saying that there are not enough data about the effects of such weight loss drugs on those with lower BMIs and that the consequences of such off-label use remain largely unknown.

“We don’t have any clearly identified risks of people using it if they don’t meet criteria,” said Dr. Alyssa Dominguez, a specialist in endocrinology, diabetes and metabolism at the USC Keck School of Medicine. “But we don’t know because we haven’t been looking at those people in the scientific way.”

When the semaglutide medication Wegovy first hit the market in 2021, it became the first weight-loss drug to get FDA approval since 2014 and immediately became the go-to weight-loss treatment. At the heart of these medications are two key hormones, depending on the drug: GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). These naturally occurring hormones play crucial roles in regulating insulin, appetite and metabolism.

At first, these medications were used to treat diabetes. But when the FDA finally gave pharmaceutical companies approval to use these same drugs for weight loss, demand for them skyrocketed.

The enthusiasm wasn’t just about dropping pounds. A landmark study in 2023 found that semaglutide reduced major cardiovascular events by 20%, even in patients without diabetes. Perhaps most striking was a 19% lower death rate from any cause. With more than 70% of American adults affected by obesity or overweight — conditions that increase risk for heart attack, stroke and premature death — these findings suggested that injecting oneself with Ozempic, or any number of the other brands semaglutide are sold under, could offer significant long-term health benefits.

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The popularity led to sky-high prices, supply shortages and, in some cases, desperate measures by those seeking to lose weight.

“No one size fits all.”

— Dr. Vijaya Surampudi, associate director of the UCLA Medical Weight Management Clinic, on microdosing weight-loss drugs.

No matter the drug, microdosing is an inexact art. The weight-loss drug users and doctors whom The Times spoke to for this story all had slightly different takes: staying closer to the starting dose of 0.25 milligrams, cutting down to as low as 0.1 milligrams or simply refraining from injecting the medication every seven days as recommended. While “microdosing Ozempic” joins the lexicon on gentler-sounding beauty terms like “baby Botox” and “mini face lift” that make procedures seem more approachable, the reality is that some people do see benefits from lower doses.

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Even as this approach gains popularity, pharmaceutical companies advise patients against adjusting dosages.

“We do not condone these practices and it’s important to understand that for Ozempic, only the marked doses on the pens (0.25, 0.5, 1.0 and 2.0 mg) are approved for use (with 0.25 mg only approved for initiation and not maintenance),” a Novo Nordisk spokesperson said in an email. “The approved doses are the only dose strengths that have been studied as maintenance doses in our phase 3 clinical development program.”

“The products are not interchangeable and should not be used outside of their approved indications,” the spokesperson added.

Dr. Vijaya Surampudi, associate director of the UCLA Medical Weight Management Clinic, works with patients who want to stay at lower doses. She emphasizes that patient responses to these medications vary widely and the need for higher doses doesn’t necessarily correlate with how much weight someone needs to lose. Instead, she carefully monitors each person’s reaction to the medication, tailoring the approach based on their body’s unique response.

“No one size fits all,” she said.

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But there are practical limitations in microdosing weight-loss medications, she said. Brand-name GLP-1 medications come in fixed-dose pen injectors, making personalized dose adjustments impossible.

Bookless found a way around this roadblock by acquiring a compounded version of the medication, a copy of brand-name medicines. Federal law normally bans pharmacies from making copycat versions of commercially available drugs. But when medications are in short supply, regulators don’t consider them “commercially available” — opening the door for pharmacies to create and sell similar products.

Dr. Tasneen Bhatia, better known as Dr. Taz, an integrative medicine physician and wellness expert, offers compounded GLP-1 to clients at her Los Angeles office, where she estimates about 10% to 20% of clients are microdosing the medication.

Bhatia sees microdosing as an option for clients who come to her office with the goal of losing 20 pounds or less or patients who have proved to be sensitive to the side effects of GLP-1, which include nausea, constipation, lack of energy and diarrhea.

Because early research shows many patients regain weight once they cease use of GLP-1, Bhatia says many doctors expect patients to use these medications for the rest of their lives. Bhatia, however, sees a future where people microdose the drug on and off as needed, something she acknowledges is not yet conventional wisdom.

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“I think by switching it up, you’re challenging the metabolism a little bit, and so using it more, maybe once a quarter, to get back on track,” she said. “The goal should never be that someone has to be on something forever.”

Dr. Suzanne Trott, a Beverly Hills board-certified plastic surgeon, started a microdosing clinic after her patients had used the medication to reach their goal weight and hoped to maintain it. She works only with tirzepatide — the drug behind Zepbound that uses both GIP and GLP-1 — which, in her experience, has fewer side effects. She sources the drug from a compounding company that has facilities in Southern California. Trott said she works with her patients to figure out the amount and schedules injections as needed.

“Not all of medicine is science; some of it is an art.”

— Dr. Suzanne Trott, Beverly Hills-based plastic surgeon

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“They can try to microdose however they want it,” she said. “Not all of medicine is science; some of it is an art.”

The microdosing works so effectively that she said it’s cutting into the plastic surgery side of her business. She recommends it as a safer alternative to liposuction for some patients.

No matter how effective doctors and patients say microdosing weight-loss drugs are, this form of medical experimentation may be short-lived. Once shortages ease, companies peddling these alternatives could face a crackdown. Last week, the Food and Drug Administration announced that the shortage of Eli Lilly’s Zepbound was over, though Wegovy remains scarce. Eli Lilly then sent cease-and-desist letters to many companies offering compounded versions of tirzepatide.

Shortly after being sued by the Outsourcing Facilities Assn., a compounding trade group, the FDA reversed its decision and said it would allow pharmacists to continue making compounded versions of the drug while it reexamines the shortage.

Semaglutide compounders could be next: Novo Nordisk has asked the FDA to bar compounding pharmacies from making compounds of its weight loss and diabetes drugs, arguing the medication is too complex for it to be manufactured by others safely.

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With the compounded versions still available (for now), Trott said her clinic is almost at capacity, with a couple dozen patients. She remains optimistic about the widespread appeal of these treatments.

“It’s something that’s become a part of a lot of regular people’s lives,” she said. “Kind of like the way plastic surgery used to be just something that celebrities did, and now this is something that is accessible to everyone.”

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Political stress: Can you stay engaged without sacrificing your mental health?

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Political stress: Can you stay engaged without sacrificing your mental health?

It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.

“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”

Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.

Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.

The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.

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That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.

In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.

“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”

Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).

The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.

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For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.

Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.

“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.

Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.

There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.

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“Politics is many forms of stress all rolled into one,” Ford said.

Weinschenk observed this firsthand the day after the election.

“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”

That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.

Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.

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“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”

Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.

“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”

On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”

“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.

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Genessa Krasnow has been seeing a lot of that since the election.

The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.

“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.

“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”

That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.

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“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.

Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.

“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”

Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.

“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.

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The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”

“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”

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Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight

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Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight

President-elect Donald Trump joined Elon Musk in Texas and watched the launch from a nearby location on Tuesday. While the Starship’s giant booster stage was unable to repeat a “chopsticks” landing, the vehicle’s upper stage successfully splashed down in the Indian Ocean.

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Alameda County child believed to be latest case of bird flu; source unknown

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Alameda County child believed to be latest case of bird flu; source unknown

California health officials reported Tuesday that a child in Alameda County tested positive for H5 bird flu last week.

The source of infection is not known — although health officials are looking into possible contact with wild birds — and the child is recovering at home with mild upper respiratory symptoms.

Health officials have confirmed the “H5” part of the virus, not the “N1.” There is no human “H5” flu; it is only associated with birds.

The child was treated with antiviral medication, and the sample was sent to the U.S. Centers for Disease Control and Prevention for confirmatory testing.

The initial test showed low levels of the virus and, according to the state health agency, testing four days later showed no virus.

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“The more cases we find that have no known exposure make it difficult to prevent additional” infections, said Jennifer Nuzzo, professor of epidemiology and director of the Brown University School of Public Health’s Pandemic Center. “It worries me greatly that this virus is popping up in more and more places and that we keep being surprised by infections in people whom we wouldn’t think would be at high risk of being exposed to the virus.”

A statement from the California Department of Public Health said that none of the child’s family members have the virus, although they, too, had mild respiratory symptoms. They are also being treated with antiviral medication.

The child attended a day care while displaying symptoms. People the child may have had contact with have been notified and are being offered preventative antiviral medication and testing.

“It’s natural for people to be concerned, and we want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious — and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said CDPH Director and State Public Health Officer Dr. Tomás Aragón.

The case comes days after the state health agency announced the discovery of six new bird flu cases, all in dairy workers. The total number of confirmed human cases in California is 27. This new case will bring it to 28, if confirmed. This is the first human case in California that is not associated with the dairy industry.

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The total number of confirmed human cases in the U.S., including the Alameda County child, now stands at 54. Thirty-one are associated with dairy industry, 21 with the poultry industry, and now two with unknown sources.

In Canada, a teenager is in critical condition with the disease. The source of that child’s infection is also unknown.

Genetic sequencing of the Canadian teenager’s virus shows mutations that may make it more efficient at moving between people. The Canadian virus is also a variant of H5N1 that has been associated with migrating wild birds, not cattle.

Genetic sequencing of the California child’s virus has not been released, so it is unclear if it is of wild bird origin, or the one moving through the state’s dairy herds.

In addition, WastewaterScan — an infectious disease monitoring network led by researchers from Stanford University and Emory University, with laboratory support from Verily, Alphabet Inc.’s life sciences organization — follows 28 wastewater sites in California. All but six have shown detectable amounts of H5 in the last couple of weeks.

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There are no monitoring sites in Alameda Co., but positive hits have been found in several Bay Area wastewater districts, including San Francisco, Redwood City, Sunnyvale, San Jose and Napa.

“This just makes the work of protecting people from this virus and preventing it from mutating to cause a pandemic that much harder,” said Nuzzo.

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