Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT
Protocol: standard weight management with niacinamide support Goal: Weight loss with enhanced cellular energy support Formulation: Semaglutide 2.5 mg/mL + Niacinamide 2 mg/mL Dose escalation schedule: Weeks 1-4: 0.25 mg semaglutide (0.1 mL) weekly Weeks 5-8: 0.5 mg semaglutide (0.2 mL) weekly Weeks 9-12: 1.0 mg semaglutide (0.4 mL) weekly Weeks 13-16: 1.7 mg semaglutide (0.68 mL) weekly Week 17+: 2.4 mg semaglutide (0.96 mL) weekly, or as tolerated Supporting measures: Protein intake: 1.2-1.6 grams per kg body weight daily (to preserve muscle) Hydration: minimum 2-3 liters water daily Consider additional oral niacinamide (250-500 mg daily) if fatigue persists, with provider approval Monitor energy levels, documenting changes weekly Blood work at baseline and every 3 months: metabolic panel, B vitamins, liver enzymes Expected timeline: Weeks 1-4: Minimal weight loss, adjustment period, possible nausea Weeks 5-8: Weight loss begins to accelerate , appetite suppression strengthens Weeks 9-16: Steady weight loss of 1-2% body weight per month Months 4-6: Continued progress toward goal weight Months 6-12+: Maintenance phase at optimal dose Protocol: enhanced energy focus Goal: Combat fatigue while maintaining weight loss momentum Same dose escalation as above, with these additional measures: Oral niacinamide supplement: 500 mg twice daily (with meals) to boost NAD+ beyond injectable dose CoQ10 supplementation: 100-200 mg daily (supports mitochondrial electron transport chain) Magnesium glycinate: 200-400 mg at bedtime (supports energy production and sleep) B-complex vitamin: daily, to support all energy metabolism pathways Track energy levels on a 1-10 scale daily for the first 8 weeks This enhanced protocol recognizes that the 2 mg injectable niacinamide dose alone may not be sufficient to meaningfully impact NAD+ levels
SURMOUNT clinical trials of brand-name tirzepatide showed patients losing up to 22.5% of their body weight, with 57% of participants losing 20% or morethose studies inform how the active ingredient is understood, but the safety, efficacy, and quality data from those trials do not directly apply to compounded preparations
Nothing else worked like this. I lost 18 lbs in 3 months and finally feel in control of my hunger
doi: 10.1016/j.cell.2008.01.046 91 YuPFHuangYXuCLLinLYHanYYSunWHet al
& Boyer, N
