Dardarbinks said:
lessthanhalf said:
Dardarbinks said:
Hey everyone,
I began reta in feb, but over the past 2 months, my gallbladder and liver enzymes have all come back elevated. Do I have to quit the meds to resolve this, or does anyone have ideas for bringing these enzyme levels down and cutting the risk of bile blockage?
Has a physician actually reviewed this? Reta and other GLP medications are capable of triggering severe liver toxicity—rare, but it does happen. Far more often, what shows up is a milder rise in enzyme levels, and the response may be either to discontinue the drug or in some cases to keep going and watch whether things normalize. That kind of decision really needs a specialist's input. You haven't said how far above normal the values are, or which enzymes are affected, so there isn't much to work with. Mild elevations above the reference range tend to be unremarkable, whereas 3-5 times normal is a real concern.
In Victoria, Australia, there were 6 recent cases of liver toxicity thought to stem from a contaminant in grey market reta. No additional details emerged about what that contaminant was. Since you appear to be in the US, a connection seems unlikely, though it may still be worth noting.
Liver enzyme irregularities generally fall into 2 patterns. One is cholestatic, where bilirubin rises—which sounds like what you're describing—but that pattern isn't usually driven by gallbladder or bile duct problems directly; rather, it reflects damage and leakage from the cells lining the small ducts where bile is produced. The other pattern involves enzymes more typical of generalized liver cell toxicity. Drug toxicity can produce either pattern. I'm not certain which one GLP's usually cause, but it shouldn't be hard to find out.
Jfrick11 said:
Dardarbinks said:
Hey everyone,
I began reta in feb, but over the past 2 months, my gallbladder and liver enzymes have all come back elevated. Do I have to quit the meds to resolve this, or does anyone have ideas for bringing these enzyme levels down and cutting the risk of bile blockage?
Indeed, when weight comes off fast this kind of thing can show up, and Reta might play a part too. Problems with the gallbladder or stones forming are a recognized danger during quick weight reduction, so blaming Reta alone for liver trouble isn't something I'd jump to.
What matters most is pinning down which enzymes came back high. Elevated AST/ALT tells a different story than high alkaline phosphatase/GGT plus bilirubin, and the latter pattern leans more toward a bile or gallbladder problem.
Two months is a long stretch for this to continue, so rather than tinkering with numbers or trying to sort it out on your own, I'd push to get it evaluated. A pretty straightforward first step is an abdominal ultrasound, and it can clear up a lot of uncertainty fast.
Permanent Reta cessation may not be necessary, but if you haven't done so yet... while you're working out what's happening, definitely bring your doctor into the loop for their 2 cents, particularly when weight is dropping very fast. Also, don't go on a crash diet in the meantime..... that can actually make the gallstone problem worse.
Right now I'm not in a deficit and I'm not trying to lose weight. My reason for using Reta is the constant food noise, plus it keeps my binge eating in check — this matters a lot after the hard cut I did in jan!
Total bilirubin: 20 umol/L
Potassium: 5.4 umol/L
Gamma Glutamyl Transferase: 46 umol/L (normal range: <44)
ALT: 57 umol/L (normal range: <36)
AST: 53 umol/L (normal range: <30)
Amylase and lipase are both at the upper end of the range, though neither goes above it
My diet is high protein and has no fried foods. On weekends I usually take in much more sugar, but weekend bingeing has been a long-standing pattern for me. I'm female, not overweight, and my BF% is 15. Fat intake is roughly 53-60g
Those readings sit at the upper end of normal or only slightly beyond it, so this is not something requiring emergency care. In my own case, when a few liver values came back mildly elevated without a clear pattern (GGT at 1.5x the normal limit, albumin a touch under normal), my doctor's response was simply to disregard it and possibly recheck in 3 or 6 months.
Gallstones rank as the least probable explanation. They do show up often alongside weight loss, yet they tend to hurt when they shift position or lodge somewhere they should not, and frequently they just remain in the gallbladder causing no trouble at all. Abnormal enzyme readings can come from them, but that happens when they move and become stuck, and the picture is typically more dramatic.
Age, overall health, starting weight, current weight and any other drugs would all matter here, since plenty of medications can push liver enzymes upward. It would also help to know whether testing happened before reta or before any weight loss. Should enzymes have already been abnormal back then, MASLD becomes the likely explanation and a liver ultrasound or fibroscan could be worthwhile. Should they have been normal previously, reta moves much higher on the list of suspects.
Tirz and sema, plus unidentified contaminants found in grey market products, are recognized as occasional causes of liver enzyme irregularities and, less often, genuine liver disease. Whether this has been documented for reta specifically is not something I can recall, but given how tirz and sema behave and how closely reta resembles them, assuming it is possible seems reasonable.
Across the board, the leading reason for raised ast/alt is Metabolic dysfunction-associated steatotic liver disease (MASLD). It is extraordinarily widespread among people eating a western diet - ( as many as 1/3 of the population has it ) - and the rate climbs further with age and with overweight or obesity. Your particular enzyme pattern is about as non specific as such a pattern can get; it does not match the classic ast/alt picture of masld, yet masld cannot be ruled out either. Drug toxicity, meanwhile, is fully capable of producing cholestatic style liver enzyme elevations.
Reta itself remains a real possibility. Situations like this are exactly why medical supervision alongside GLP therapy matters. A typical doctor might not be well versed in liver enzyme shifts caused by GLP drugs, but they are generally skilled at researching unfamiliar topics or consulting a specialist, and crucially they possess the hands-on experience to judge whether continuing is safe.
What I would advise is obtaining an expert medical opinion on the next step, preferably from someone likely to recognize this pattern and have encountered it before ( at minimum with other GLP drugs if not reta ) , for instance an endocrinologist or gastroenterologist. After that comes your family doctor, and 4th best is chatgpt in research/scholar mode. Mildly elevated enzymes, whether pancreatic or liver, will not create problems by themselves; the signal is merely that a tiny number of cells have died and spilled their contents, or are unwell and leaking slightly. Still, you would not want that low grade damage or inflammation to persist for years without being treated or diagnosed.
If no test results exist from before you began reta, or if results exist and were normal, my best guess is to halt the reta, then retest a month or two later to see whether things return to normal. Should they normalize, a reta rechallenge with repeat testing could follow, and if the values rose once more that would be fairly convincing proof of causation. At that point you would need to steer clear of it permanently. Since the enzyme shifts are only borderline abnormal, the risk in doing this is minimal. It is a bit frustrating, as reta is a good drug and, while not yet proven, likely the best option nearing availability for treating MASLD. If levels remain elevated after stopping reta, then investigating your liver further may be needed, perhaps with ultrasound or fibroscan.
The other path is to continue and repeat the tests in a couple of months. Realistically, this sort of judgement call belongs with a doctor. My guess is they will lean toward stopping, partly because the drug is not yet approved, meaning far less is known about adverse effects than for tirz or sema, so they would err on the side of caution and advise discontinuation. Without expert guidance on whether staying on reta is safe given those results, I would suggest the only safe approach is to stop it. And recheck liver function to make sure it goes to normal after stopping it.
