Is my patience the real problem?

My read is that the difficulty of stopping the regain or losing more comes down to something quite simple: over 30% of your body weight is already gone, from ?185 to 125 lbs, and you sit at 135 now. Even at 135 lbs that beats the average result expected from 15mg of tirz. You also have solid evidence about what your maintenance drug and dose ought to be — tirz 15mg is what got you there, and from your own account holding that weight wasn't a struggle; the struggle was side effects, which is what you were trying to solve, or perhaps you were hoping reta's somewhat better effectiveness would let you use smaller doses and get fewer side effects. And you already know 10mg of tirz isn't enough to stop the regain.

Physiologically, being down 30% is a completely different proposition from starting on glp drugs, because essentially the entire job of the drug becomes fighting the regain.

I don't think there's an easy, simple answer here. What you want to find out is whether some maintenance dose of one or more GLP drugs can deliver the effectiveness of 15mg of tirz with fewer side effects, and tirz is probably the one with the lowest side effect rates of the lot. Since you've already made the switch to reta, carrying on and raising the dose until you either hit too many side effects or it gets you where you want to be makes the most sense. If that fails, or side effects bite before you get there, elora or cagri at low doses is an option — but finding your maximum tolerated dose of reta first seems sensible, because that in itself tells you something useful for working out the best long-term choice. Otherwise you'll never know for certain whether reta or tirz suits you better. Working out the optimum is going to take patient experimentation over a long period. It might turn out that sub-maximum doses of reta or tirz plus 3mg or so of elora is what works, which in theory should be one of the most effective combinations with the fewest side effects, though the data on elora is very thin so far.

Health-wise, none of this greatly matters. At a BMI of 23, getting thinner won't improve your health, though I do understand the pull of reaching the weight you want — given where you started, feeling in control of the situation can carry real psychological weight. It may be that you simply can't tolerate doses high enough to hold you at 125 lbs, if 15mg of tirz wasn't tolerable or comfortable for you over the long haul, but experimentation is the only way to find out, because with this kind of issue individual variation in response is everything. Worst case you end up stuck at over 25% below your start weight, in or near the normal range, which is still a considerable success.
 
eternalyouth2 said:

Stace_wow said:

When someone is obese the weight drops off 'more easily', and I heard this said yesterday…no idea who by, but the point wasn't that weight loss is easy, only that small changes produce bigger, faster visible results in obese people. At a lower body weight, and the nearer you are to goal, the more meticulous everything has to be.

At 135 you may just have to be patient, and accept that progress will come slowly. Cag might help…but you're only 7 weeks into Reta with a fast dose escalation…it could still be building in your system…I'd give it time.
Click to expand...
The reality check is appreciated, particularly that last paragraph. I'll stay the course and ease off a bit. A few more weeks on Reta, then I'll decide on the cag. We'll see how it goes.
Click to expand...
Wishing you the very best of luck!!! 😌
 
Seasonal1 said:

Assuming the meds are working and you're training, what remains is diet. Are you logging what you eat? Weighing it? Accounting for every bite? CICO has not gone anywhere. And can you honestly say you're running a steady deficit?
Click to expand...
^^ THIS!

This has nothing to do with the drug. It's about diet and patience.

You've also gone from 2 mg of Reta to 7 mg in only seven weeks, which bears no resemblance to the titration schedule that was studied. In the phase 2 trial, doses went up every four weeks. Each dose has barely had time to show what it does before you've written it off and moved up.

I'm the same height as you, I started at 135 lb, and I held at 1, 2 and 3 mg the whole way to goal. Our biologies aren't the same, so my dose isn't automatically going to be yours, but racing through milligrams at this rate can add side effects and eat up your dosing runway without fixing what's actually wrong.

And now you're weighing another Reta increase or bringing Cag in. That's impatiently stacking more experimental pharmacology on top of a problem you haven't yet shown to be pharmacological.

At 5'4" and 135 lb you're already on the light side. “Eating healthy,” exercise and an 80/20 rule are no proof that you're in a consistent calorie deficit. Do you weigh and log all of it? If not, you genuinely don't know whether your diet is dialled in.

Are you willing to say no, for now, to alcohol, processed foods, snacks, sugar, restaurant meals, and nights out or dinners with friends and family? Eliminating every carbohydrate or dairy product may not be necessary, but you do need to find where the calories are leaking through and become far more structured.

If an athletic body is the goal, that body has to be built. It takes accurate nutrition, enough protein, progressive resistance training, hard conditioning, recovery and consistency. Medication can blunt hunger; it can't stand in for structure or cancel out an energy surplus.

Stop introducing variables. Keep the dose where it is, audit the diet honestly, track weekly averages and measurements, and judge body composition instead of chasing every five-pound swing with another compound. A DEXA scan would be worth it — ideally a package of two, so you have a comparison over time. At your size it's worth knowing lean mass from fat mass, because the number on the scale is only a number.
 
DunningKruger said:

Seasonal1 said:

Assuming the meds are working and you're training, what remains is diet. Are you logging what you eat? Weighing it? Accounting for every bite? CICO has not gone anywhere. And can you honestly say you're running a steady deficit?
Click to expand...
^^ THIS!

This has nothing to do with the drug. It's about diet and patience.

You've also gone from 2 mg of Reta to 7 mg in only seven weeks, which bears no resemblance to the titration schedule that was studied. In the phase 2 trial, doses went up every four weeks. Each dose has barely had time to show what it does before you've written it off and moved up.

I'm the same height as you, I started at 135 lb, and I held at 1, 2 and 3 mg the whole way to goal. Our biologies aren't the same, so my dose isn't automatically going to be yours, but racing through milligrams at this rate can add side effects and eat up your dosing runway without fixing what's actually wrong.

And now you're weighing another Reta increase or bringing Cag in. That's impatiently stacking more experimental pharmacology on top of a problem you haven't yet shown to be pharmacological.

At 5'4" and 135 lb you're already on the light side. “Eating healthy,” exercise and an 80/20 rule are no proof that you're in a consistent calorie deficit. Do you weigh and log all of it? If not, you genuinely don't know whether your diet is dialled in.

Are you willing to say no, for now, to alcohol, processed foods, snacks, sugar, restaurant meals, and nights out or dinners with friends and family? Eliminating every carbohydrate or dairy product may not be necessary, but you do need to find where the calories are leaking through and become far more structured.

If an athletic body is the goal, that body has to be built. It takes accurate nutrition, enough protein, progressive resistance training, hard conditioning, recovery and consistency. Medication can blunt hunger; it can't stand in for structure or cancel out an energy surplus.

Stop introducing variables. Keep the dose where it is, audit the diet honestly, track weekly averages and measurements, and judge body composition instead of chasing every five-pound swing with another compound. A DEXA scan would be worth it — ideally a package of two, so you have a comparison over time. At your size it's worth knowing lean mass from fat mass, because the number on the scale is only a number.
Click to expand...
No side effects on Reta for me — other than an elevated heat rate, which is to be expected. I came over from 15mg Tirz. That's 4.5 years on glps. I don't believe you read my other replies: the appetite suppressant no longer works the way it did, and that's my actual issue. What I wanted was advice on the next step.

Edit to add: alcohol went when I started sema in February 2022.
 
If appetite suppression fades after 4 years on GLP-1s, we don't unfortunately have solid evidence-based ways of bringing it back. It's common among long-term users, and at the moment it's an open question rather than something with a proven answer.

Cagri is worth a try, but titrate conservatively. Blowing your receptors out even further doesn't strike me as the solution.

You're also meant to have an appetite. Do pay attention to when you're hungriest, though. Under stress? Straight after a call with a partner, a family member, a high-maintenance friend? In your luteal phase? Following a hard workout? And what had you eaten that day, or the day before, when the hunger was worst? I notice myself drifting to the fridge subconsciously when my bf rings, or when a work project is dull or demands too much brain. Noticing it put a stop to the pattern.

I'm sorry the last stubborn pounds are stressing you out. They really are hard to shift.
 
ladyj779 said:

Running tirz alongside reta is my approach ♥️
Click to expand...
That's how it's done






a6ed7b4fd389e3b3492bbdee4bc64209307815409355da800a8d6595e4a2e619.gif
 
DunningKruger said:

If appetite suppression fades after 4 years on GLP-1s, we don't unfortunately have solid evidence-based ways of bringing it back. It's common among long-term users, and at the moment it's an open question rather than something with a proven answer.

Cagri is worth a try, but titrate conservatively. Blowing your receptors out even further doesn't strike me as the solution.

You're also meant to have an appetite. Do pay attention to when you're hungriest, though. Under stress? Straight after a call with a partner, a family member, a high-maintenance friend? In your luteal phase? Following a hard workout? And what had you eaten that day, or the day before, when the hunger was worst? I notice myself drifting to the fridge subconsciously when my bf rings, or when a work project is dull or demands too much brain. Noticing it put a stop to the pattern.

I'm sorry the last stubborn pounds are stressing you out. They really are hard to shift.
Click to expand...
There's a perfectly clear explanation for why the OP's appetite reduction is smaller. One is that the reta dose is lower than the previous 15mg of tirzepatide, and 2 is that a large share of the weight is already gone — 30%+. Holding weight steady in maintenance took 15mg of tirz, but side effects were a problem, so she's trying reta instead.

In a case like this, nearly all of what the glp drug is doing is counteracting the body's natural pull towards regaining the weight. It has effectively nothing to do with the drug losing potency over time, or receptors burning out — neither of those has any real evidentiary basis. (On the dose used to lose the weight, people on average stayed at that weight for another 4 years, and if tolerance were developing, regain would have shown up. It didn't.)

Finding a long-term maintenance dose, or combination of doses, that holds the weight off with the fewest side effects can be hard. To stay 55% below my starting weight I've ended up on tirz15mg/reta6mg /cagri0.5mg, which unfortunately isn't free of side effects, but it's the best I've managed so far.
 
eternalyouth2 said:

Glps have been part of my life since 2022, starting on sema under a dr's prescription, and I took off 50lbs across the first 1.5 years. Then insurance cut me off and I went grey. After reading up on the benefits I switched to tirz, hoping to shift another 10lbs. That switch took roughly another year to deliver, given I was already at the low end of the range — 135 down to 125, at 5'4 F. I pushed all the way to the top dose of 15mg, but the side effects were wearing me down. I dropped back to 10mg and began putting weight on. That was back in April and I climbed to 130; it sounds trivial, but 5lbs shows on a small frame. I figured maybe my body wanted a rest and made my peace with the extra 5lbs. Except it kept creeping, and between what life was throwing at me and simply being hungrier, I was back at 135. So 7 weeks ago I moved to Reta — 2mg for two weeks, then 4mg for 3 weeks, then 6mg for some weeks, and this week up to 7mg. Zero weight loss... I do exercise (walking, weights, large, yoga and versa climber) and while Reta actually seems to make me hungrier in some ways, my diet is dialed, following the 80/20 rule. Am I being impatient?? lolI

I've got Cag on the way and I'm wondering whether to add it or just raise my reta dose? Any feedback would be appreciated.
Click to expand...
Same here. I even put a pound on 6 weeks in. My protocol is 3mg 2-3 times a week, or every 3 days. In a couple of weeks I'll step up to 4mg. If that does nothing, it's back to Tirz for me. Reta just doesn't seem as good on food noise. I'm giving it a chance to run its course, but the skin issue is wearing thin, particularly with no weight loss to show for it. And yes — three different sources, and I paid out of my own pocket to have the one I'm on now tested.
 
Back
Top