Returatide

I took Returatide (reta) because it led to the most weight loss, most visceral fat loss, least muscle loss, and most improved liver health of the GLP-1RAs I looked at.

I went from obese to overweight on it. I cannot recommend it, though, because since then, it’s been shown to have an association with Major Adverse Cardiac Events, so it may be best to use tirzepatide instead (or look into cagrilintide, the latest hotness). But if one disregards this risk, to monitor heart rate and discontinue if it gets high. I personally have not noticed any issues of this sort, but then I’ve always had a lower heart rate.

Many people have taken some form of GLP-1 agonist, and its well-proven weight loss, and risks are known. I will not duplicate that, but propose a theory and what I see as a best practice of using it.

GLP-1 agonists slow down gastric emptying and the conventional wisdom is that this is the main mechanism of weight loss, an acarbose-like effect but for all the macros at a different interdiction point. I don’t believe this as it doesn’t explain no appetite for days at too high doses. And any obese person can tell you that having full stomach doesn’t stop you from feeling ravenous. For a more likely mechanism, see here:

There is some similarity, and I wonder if like acarbose it exacerbates small intestine bacterial overgrowth in those who are prone. In fact, I’d guess this is the main mechanism for the reported side effects of nausea, bloating, and diarrhea. A slow drip of nutrients from the stomach, rather than a feast-famine cycles, is ideal for bacterial growth. Add to that the reported side effects of slower intestinal motility, and you have perfect conditions to bring out SIBO.

I had several episodes of bloating, gas with a strong sulfur smell, and diarrhea. To counter that, I took cascara sagrada to increase motility. I like to stack that with TUDCA, coconut oil, and activated charcoal, because I figure I ought to take advantage of the motility to get rid of some bile and bound toxins.

I watched what I ate and found that fatty meals caused trouble for me. Cutting some things out and reducing overall volume led to much better results. I don’t think this would necessarily be the case with someone else. Bacteria can and do eat fat, sugar, starch, and protein; everyone with SIBO has a different mix of gut bugs and will respond to food differently.

Eventually, amid episodes of diarrhea, I passed a big mucousy thing, and I did much better after that. A novel use of GLP-1RAs: upregulate SIBO to get a clearer signal of what is causing it. One weird thing after all this: hamburgers, the patty, seem really gross to me now.

I have developed a slight allergy, manifesting as a bump and redness (about 2-inch diameter) at the injection site. To counter this I take an antihistamine tablet and apply topical antihistamine. Inevitable result of injecting proteins, I suppose.

Weight loss has hazards, and GLP-1RAs enhance the ability to lose weight, so we see more evidence of it. Visual signs of it are saggy grey skin and sunken eyes. A sign of chronic calorie restriction that I’ve noticed is thin papery skin. I’d guess there is a age-metabolic health thing that determines how much dieting you can do and look good.

My own guidelines, developed before GLP-1RAs became a thing:

Losing 5% of body weight is free of risk.

Then cap weight loss at 1-2 lbs per week, depending on baseline size.

Since you are eating less, make sure the nutritional value of the food you eat is high: milk, eggs, meat, potatos, and beans are all high-nutrition foods. Add vegetables and such to taste at every meal. If you aren’t going to that trouble, a good multivitamin is better than nothing. If it has several things as 1000% RDA, I would be skeptical of it.

Exercise is a must to preserve muscle. Weightlifting with volume focus instead of loading focus.

Finally, it may be good to pause at significant milestones and let your body adjust. 25% weight loss is not uncommon on reta, so maybe every 5%. Oddly for me, after I had regained 5 pounds at a pause, was then I got comments from people that I had lost weight.

My next move is to increase to the dose associated with the most visceral fat loss. 8mg/wk. and see how SIBO yogurt does with reta. I may have to force myself to eat to keep weight loss below my thresholds.