Hi, it's Helaine.
Quick update before I go in. Over the weekend, I published the longest, most-researched piece I've written so far. It's about the question that has been keeping me up at night, and that almost everyone reading this newsletter is asking some version of:
I dug into the clinical trials, the real-world data, the messy middle of microdosing and tapering, and where I am personally landing on it.
Read it here on Substack (and please subscribe 😊)
If you haven't filled out the survey yet, please do. Two minutes, fully anonymous, and every response shapes what I write about next.
OK. Onto this week.
Myth I wanted to bust: "you have to refrigerate your shot"
I travel a lot. As I threw my KwikPen in my bag heading up to New York last week, I thought to myself, "Am I breaking the rules?” I kind of hoped I was.
Turns out the FDA-approved label for Zepbound says single dose pens and vials can be stored at room temperature, up to 86°F, for up to 21 days. KwikPens for up to 30 days. (GoodRx)
So, sadly I am not a rebel. I am within manufacturer tolerance. (Always check your own medication's official label. This is the published guidance for Zepbound.)
Why does refrigeration matter at all? Because tirzepatide is a peptide, a protein-like molecule with a delicate structure. Heat above 86°F and freezing both break that structure down and make the drug stop working. Refrigeration just keeps it stable longer.
The actual risk cases to avoid:
A hot car or beach bag in summer (over 86°F)
Freezing in checked airline luggage (cargo holds get cold)
Letting it sit out for more than 21 days
Any extreme temperature, hot or cold
If you are under 86°F and using each pen within 21 days of taking it out of the fridge, you are fine.
I am going to need to find a new rule to break.
Storage rules vary slightly by drug. Wegovy and Ozempic (semaglutide) can also be stored at room temperature up to 86°F, but only for up to 28 days once removed from the fridge. (Novo Nordisk Wegovy storage info.) Always check your specific medication's label, because the windows are different.
Quick win: 30 grams of protein, fast
Ok, yes, let’s talk about protein. A study from San Raffaele Hospital in Milan (presenting at the European Congress on Obesity in May) found that people on GLP-1s eat a "critically low" amount of protein and skip meals more often than non-users. (NBC News summary.) The actual gap is about 10 grams less per day than non-users. Real, but the bigger truth is most people aren't hitting their target in the first place.
The simple framing: aim for 25 to 30 grams at every meal. (GoodRx on the "30/30/30" approach.) Breakfast is the hardest one for many on GLP-1s to hit because your appetite is suppressed and nausea is real for some people.
Favorite breakfasts that hit 30+ grams from me and a few friends finding success on this journey:
Greek yogurt + berries. A full cup of plain nonfat Greek yogurt is 20 to 23 grams of protein. Lean into berries instead. Fiber is just as important to get early in the day, and often forgotten. Bonus if you add a little chia or flax.
Smoothie. Almost always wins because you can sneak a lot in. Frozen banana, unsweetened almond milk, scoop of protein powder of your choice, tablespoon of nut butter, handful of spinach. Easy to drink on a low-appetite morning.
Cottage cheese. A full cup is about 25 grams of protein. Pair it with berries, or do it on a piece of above average toast for extra fiber.
Coffee hack. A lot of people sneak protein into their morning drink. I add flavorless collagen in hot coffee and I have a friend that swears by chocolate protein powder in iced coffee for a homemade mocha. Don't drink coffee? Same trick works in a matcha.
(The internet also suggested I try savory miso protein soup in the morning. That is just not something I can consider.)
Reply and tell me what you eat. I am going to do a roundup soon, and I want yours included.
What I tried: Mel Robbins' "Pure Genius" protein shot
23 grams of protein in a tiny bottle. Convenient. Marketed hard. I was INTRIGUED.
Honestly? Not for me. Way too sweet. It brought me back to my college days of bad shots at Good Time Charlie's in Ann Arbor. I could only get down two small sips and it made me really appreciate real food.
The brand DM'd me back when I posted about it on Instagram and said you can dilute it in larger drinks, which... thank you?
Funnily enough, half of the people who answered my Instagram poll when I shared I was going to try this (the ones who weren't yelling at me for eating fake food) said they were curious to try it. Which tells me people are hungry for protein solutions, and I do not blame them. I am always on the lookout too.
Also, now have ten extra bottles. If anybody is curious and wants to try it, reply and I will send some your way.
This is certainly not the last time I’ll try something Instagram recommends so strongly 😅
What I'm watching
Medicare and GLP-1s hit a wall this week. This is a much longer conversation because it affects costs not just for people on Medicare, but across the board. CMS shelved its BALANCE program after the major Part D insurers (UnitedHealthcare, Aetna, Humana, Cigna, Anthem) declined to opt in. (Axios coverage.) The short version: even at negotiated prices, the upfront cost was too high relative to when insurers would see the savings, so they walked. It shows one of the many ugly sides of insurance companies not caring about actual health, only their short-term economics. Eligible Medicare beneficiaries still get $50 a month coverage through end of 2027 via a federal stopgap.
Lilly's Foundayo beat oral Wegovy in the first head to head trial. ACHIEVE-3, published in The Lancet earlier this year, showed orforglipron delivered better A1C and weight loss results than oral semaglutide in adults with type 2 diabetes. The two pills are not equivalent.
Pfizer is running ten Phase 3 trials in 2026, including a once monthly maintenance shot. Early Phase 2b data showed continued weight loss after switching from weekly to monthly dosing. (Pfizer release.) If this works, it changes the maintenance conversation entirely.
Retatrutide ("Reta") Phase 3 data keeps getting wilder. 28.7% body weight loss at 68 weeks. (PR Newswire.) Projected for FDA approval in 2027. And listen, Zepbound is not exactly gentle. The next chapter of this drug class is going to make Zepbound look gentle by comparison.
If something in here landed, hit reply and tell me. If you have a topic you want me to dig into next, drop a comment or send a note. I am building a running list, and your replies are shaping where this goes.
Coming up on Substack: a deeper look at GLP-1 stigma (it's real, but it's lifting fast) plus the Medicare and insurance fight ahead. Subscribe over there to get future pieces the day they drop.
See you next week.
Helaine
Helaine Knapp is the founder of CityRow, a fitness company she built and scaled for a decade before selling in 2024. She is also the author of Making Waves, host of the Step Into Next podcast, and an executive advisor and coach working with founders and leadership teams navigating growth and transition. She has been on her own GLP-1 journey for nearly two years and is building something for everyone navigating this one.