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Hey, what's up guys? So in today's video, I want to talk about seven things that you should avoid or at least be conscious of if you're on retatrutide.
One of the things I notice is that as the popularity of retatrutide grows, especially on online forums and online platforms, a lot of my patients are getting their hands on it, whether it's through their own inquiries like the gray market or through medical spas or other providers who can actually prescribe it through compounding pharmacies. More and more of my patients are on retatrutide and I don't think they fully understand the difference between retatrutide and the other GLP-1s that they might currently be on and certain things that they should specifically watch out for when it comes to this medication. So I figured I'd make this video because I'm constantly talking to them about it. So this might be a good topic to cover in a broad sense so that everyone can have more knowledge on the situation. So let's get started.
For those of you who may be new here or don't know me, I'm Dr. Kevin Joseph. I'm an internal medicine physician and medical director, but most importantly, I'm a recovering food addict and binge eater. I've lost over 150 pounds on GLP-1 medications and peptide therapy and since then I've started this community to hopefully bring people together and you know, have a focus on lifestyle changes and improving our lifespan and quality of life. So if that is something that interests you, please you know, subscribe to the channel, join our free school community that I just started. There's a lot of great information that we cover over there, but let's keep going with the video.
All right, first up is corticosteroids. When you hear the word steroid, you you know, most people initially think bodybuilders, but that's a different type of steroid class completely. Corticosteroids are medications that are commonly prescribed to you most likely for breathing treatments, right? So think prednisone, Solu-Medrol, methylprednisolone. These are medications that help with overall inflammation. If you have a history of asthma or COPD or any sort of breathing issue, autoimmune condition or even just generalized inflammation or inflammatory issues, you may have been on a steroid. I can almost guarantee that most people have been put on a steroid at some point in their life.
I have a love-hate relationship with steroids. Steroids are a great medication for what they do, right? They really do help with inflammation. Um and they are a lifesaver for people who have severe inflammatory diseases, um such as COPD, um severe autoimmune issues, um or, you know, even severe pain from impinged nerves or other inflammatory um muscle conditions. So, I love steroids because they offer people true treatment and relief, but I hate them because of the side effect profile. With steroids, the side effect profile is is it's extensive, especially depending on how long you've been on a steroid for. The longer you've been on a steroid, the more damage it does to your body.
A lot of people's bodies become reliant on steroids um because steroids or corticosteroids is a hormone that your body actually naturally produces. The adrenal glands naturally produce this hormone, and it's regulated throughout your body. When you take prednisone or you take a pill steroid, what it does is it tells your adrenal glands, "Hey, you don't need to keep producing steroids. The body, you know, we're getting steroids from a pill." And once that kind of cycle happens, your adrenal gland slowly starts shutting down because there's no reason for them to produce steroids. You're getting it from another source. And then eventually, you know, over a course of months to years, even a low dose of steroids for a long time, you can't just abruptly stop it. Your adrenal glands have shut down by that point, and you need to, you know, slowly come off of the medication, and some people can't come off of it. So, I I really dislike steroids um because of the side effect profile, but, you know, when it comes to retatrutide and GLP-1s, the side effects that matter the most are twofold.
One is peripheral insulin resistance. So, steroids increase your insulin resistance throughout the different cells in your body. So, if you do have type 2 diabetes and you're on insulin, you may notice that your blood sugar is much more difficult to control on your current insulin regimen or just by diet alone. Um we see this in the hospital all the time. Actually, we try to proactively get ready when we put patients on steroids by closely monitoring their blood sugar and adjusting their insulin needs pretty abruptly. Um you know, I don't want to let my patients' blood sugars randomly spike up to 300, 400 and then react to it. We try to be kind of proactive. But, that is one thing that you will notice with if you are started on steroids is that your blood sugar will be much more difficult to control because of the peripheral insulin resistance that this medication causes.
It also stimulates a process called gluconeogenesis. This is a process by which the liver breaks down different substrates and molecules and makes glucose. So, this process is necessary, right? It's a evolutionary benefit during times of fasting and times where food may not be readily available. And your blood sugar drops too low, your body immediately says, "Hey, let's regulate that blood sugar. Let's bring it back up. Let's tell the liver to break down things like protein and turn that into sugar so that it can stabilize your blood sugar." So, it's a constant balancing act, right? We have gluconeogenesis on one side, which kind of brings up your blood sugar and helps stabilize it. And then you have insulin, which your body naturally produces also to kind of bring down your blood sugar. So, it's a constant seesaw, basically. But, when you have something that pushes the balance to one side and makes everything uneven, such as a steroid, which kind of really upregulates that gluconeogenesis, and it really throws everything off balance, then your blood sugars are going to be significantly higher than they should be. Even if you don't have anything like diabetes or insulin resistance. Um your blood sugars will just naturally be much higher than you would expect.
And the problem with this is that with retatrutide, it acts on glucagon. That's what makes retatrutide so special as a as the latest GLP-1, right? It acts on three receptors, GLP-1, GIP, and the glucagon receptor. However, when you activate the glucagon receptor, it increases, once again, gluconeogenesis. And it helps it pushes a increase in your blood sugar level. And this is done in a glucose-dependent manner. So, you know, retatrutide's not going to overshoot and put your blood sugar into the 200s, but what it will do is slowly, you know, increase it, give it a bump up. And some people need that. Uh some of my patients who were on tirzepatide or semaglutide, I've seen their, you know, glucose monitors, they their blood sugars drop significantly lower than they should. Not, you know, to a scary level, but lower than they should. So, like around like, you know, 80s or 70s. And for some people they get symptomatic from that, and they may experience light-headedness or dizziness. So, retatrutide is a good option for those people who get low blood sugars on tirzepatide or semaglutide because it kind of has that glucagon receptor, which will help bump up that blood sugar a little bit more, keep it in the 90s to 100 range. But, when you add steroids on top of it, it overwhelms the body. It overwhelms the GLP-1 and GIP receptors that retatrutide also activate, which help with insulin sensitivity. So, it blunts that response, and it forces the body into a very hyperglycemic or very high state of having a lot of circulating blood sugar. Just keep an eye on that if you are started on steroids, even if it's a short course, just keep an eye on your blood sugars, especially if you're on retatrutide. Just check them constantly. If you have a CGM, I always recommend a lot of my patients get like a continuous glucose monitor when they are on GLP-1. Um, it just helps kind of track your glucose trends throughout the day. Adjust your dose if needed, especially if you're microdosing or split dosing. But, definitely keep an eye on it if you're on steroids.
Number two is thyroid hormone excess, whether that's from, you know, excessive thyroid hormone supplementation or from untreated thyroid disease or hyperthyroidism. So, the benefit of retatrutide is when it activates that glucagon receptor we talked about, it puts your body into a metabolic overdrive. It increases your metabolic rate, which is great if that's the only factor that's really affecting your metabolic rate. When you have excessive thyroid hormone or your your thyroid gland is hyperactive and it's producing too much thyroid hormone, that in and of itself puts your body into a metabolic overdrive as well. You'll see actually some bodybuilders will take synthetic thyroid hormone to kind of help boost up their metabolism and hopefully increase their resting metabolic rate and burn some excessive or excess fat that they may have prior to a show. This has a lot of side effects. I don't recommend anyone ever do this, but it has been done before.
The thing is nowadays a lot of people are on thyroid, you know, hormone replacement because of a few reasons. One, your thyroid may be underactive, or you may also have had your thyroid removed if you have nodules or if you have a history of thyroid cancer and you had your thyroid removed, there's no way your body's going to be able to produce any thyroid hormone. So, you have to take a medication that supplements that. But, the important thing is when you are on a medication that is supplementing for the thyroid hormone, you need to have your thyroid levels closely monitored. Please keep an eye on your TSH, your T4, and your free T3 as well. Um, those are all very, very important thyroid markers to keep an eye on to see how your thyroid levels are functioning. Because if the medication is overdosed and you're taking too much of it, that plus retatrutide or the metabolic benefit of retatrutide will put your body into such a metabolic overdrive that it's not just burning fat, it starts eating at muscle, it starts eating at bone, it starts eating at everything else because it just constantly is starving for nutrition and calories. So, please keep an eye on that.
The other thing is also, like I mentioned, untreated thyroid disease, uh, most commonly Graves' disease. Um, that's a disease where your thyroid is overactive and a lot of people don't notice it until they start having side effects from it. So, if you have heat intolerance where you're constantly hot, um, if you have like palpitations, racing heart rates, just things to keep an eye on and make sure that, you know, your thyroid is functioning properly. I always recommend that when my patients get their blood work done, whether it's every 6 months or every year, they always get a thyroid panel added on because you do not know what you may find. And these things can pop up out of nowhere. So, definitely keep an eye on it. But, yeah, um, you know, overactive thyroid along with too much thyroid medication plus retatrutide can send your body into a meta- metabolic overdrive, which sounds good, but it really isn't because once your body starts needing more calories and you're already your appetite's already reduced because of the GLP-1 activity, it's going to just start eating at muscle and bone because there's nothing else to feed it. So, please keep an eye on that.
All right, number three is insulin secretagogues. I hate insulin secretagogues. I think they are an archaic medication, but they're cheap. And unfortunately, insurance companies love cheap stuff. It sucks and they don't care about the patient because I've unfortunately seen so many side effects on these medications, but you know, some people are still on them, especially the older population and you know, older generations. I'm talking about medications like sulfonylureas. These medications basically force the pancreas to secrete insulin. And initially, you think that's good, right? need exogenous insulin, you're not putting more stuff into your body, but you're helping optimize your body's natural processes. And in theory, it's good. Your pancreas is secreting more insulin, that should help drive your blood sugar down, especially in type two diabetics. However, the problem is that there's no regulatory mechanism when it comes to this medication. Unlike the activity or the insulin benefits that GLP-1s provide, which are blood sugar and glucose dependent, the activity of sulfonylureas are independent of anything. So, basically what happens is when you take this medication, if you are not keeping a close eye on your blood sugar, your blood sugar can tank. I've had patients come into the ED whose blood sugars were in the 30s and 40s on these medications. And it's just a simple pill. Like people don't even notice it. Like it's not like you have to inject anything. You just take a pill and it drops your blood sugar. So, I think they are scary medications. I try to take all my patients off of it, but unfortunately, like I mentioned before, they are cheap. They are an alternative to insulin because a lot of people don't like to inject themselves.
But, if you are on retatrutide and a sulfonylurea, please keep an eye out for hypoglycemia or severe lower blood sugar. Um retatrutide, just like the other GLP-1s, have GLP-1 and GIP activity, which helps stimulate the pancreas to release insulin. Like I said before, that's in a glucose dependent manner, so it's much healthier. But that stimulation of insulin plus the sulfonylurea will just tank your blood sugar. So, please if you're on a sulfonylurea or other even even if you're on insulin, I would speak to your medical provider about lowering your dose or coming off of it completely because a lot of my patients were able to significantly drop their insulin needs or come off of insulin completely. So, please please talk to your medical providers because you may be doing more harm than good sometimes.
Next up is prescription stimulants, specifically a medication called phentermine. If you've been trying to lose weight in the past, you've probably been told about this medication. It's phentermine is a medication that's been around for a long time and like most old medications, they're outdated and the side effect profile significantly outweighs any benefit that it provides. Once again, another medication I personally hate. The problem here is that in order for me to get GLP-1 coverage for a lot of my patients, they need to have shown that they failed other medications. This this is you know, it's obviously insurance plan specific, but for some of the insurance plans, they need to they specifically say "Patient should have been tried on phentermine first." I hate phentermine.
So, phentermine is a medication it's it's a sympathomimetic medication basically. So, what it does is it puts your nervous system into a overdrive situation. This increases your resting heart rate, this increases your metabolic rate. It helps boost up your metabolic rate, but it comes with a lot of side effects like insomnia, jitteriness, restlessness, palpitations, tachycardia, or irregular heart rhythms. Phentermine is a horrible medication, but unfortunately, it has to be or at least for some of my patients, I have to try them on it before they can even get approved for a GLP-1. The problem here is when you may already be on phentermine and this is mostly for patients who maybe do it trying retatrutide on their own without any medical supervision. I'm hoping that a medical provider would not keep a patient on phentermine if they're on a GLP-1 agonist, but who knows nowadays. The concern is if you're taking retatrutide while you're already on phentermine, retatrutide also because of the improvement in your metabolic rate and that increase in metabolic rate, it overstimulates your nervous system and your sympathomimetic system and it'll cause significant more side effects similar to what does, but kind of on a more severe level. So, think uh restlessness, insomnia, um palpitations. Retatrutide's already known for increasing your heart rate because of this um glucagon activity, but with phentermine on top, I mean, your heart rate could be hitting in the hundreds or even higher. So, please keep an eye on that because the two medications really should not be used together.
So, as we've seen, unfortunately, a lot of these interactions aren't obvious until the side effects start popping up. So, I think as retatrutide becomes more popular, we will start seeing more and more interactions and you know, learning from the different clinical situations. So, real quick, what's something on this list that surprised you the most? Or what's something that you might already be taking while on retatrutide? Comment below. Uh like like I mentioned before, I read every single comment, and they really guide my future videos, but I love to hear what you guys, you know, are thinking about and what you think about this video. So, let me know.
Next up is over-the-counter stimulants. Think fat burners, pre-workouts, yohimbine, um synephrine. These honestly fly under the radar because they become so mainstream, and you could just buy them at any uh vitamin shop, but they still have significant side effects even though they don't need a prescription. These stimulants act very similar to phentermine, which I just talked about. They activate your sympathetic nervous system, and they increase energy expenditure. But that comes with side effects, right? Uh like obviously reduced appetite, which is the benefit, but it puts some stress on your heart, it increase palpitations, increase heart rate. Um it puts stress on your central nervous system. You may notice some jitteriness, restlessness, shakiness. So, overall, these medications act in a similar way to a you know, high-dose stimulant. And when you're throwing in retatrutide on top and activating that glucagon receptor, which also increases your metabolic rate, and it stresses different organs in the body, um this glucagon receptor's on the heart, which increase heart rate, increase the uh force at which the heart is squeezing at, called contractility. So, these stimulant over-the-counter supplements along with retatrutide activity will actually put way too much stress on your nervous system as well as your heart. Um that's the biggest thing I notice is the cardiac issues with a lot of my patients who are on these stimulants along with retatrutide. They've noticed significant increases in their heart rate, sometimes feeling it to the point where they feel palpitations and even arrhythmias. I'll get EKGs on my patients during certain visits and sometimes they start noticing that if they have a history of arrhythmias or abnormal heart rhythms, sometimes their heart goes back into that abnormal rhythm because of retatrutide or the stimulant that they could be on. So, you know, definitely keep an eye on that. This is not something to be taken lightly even though you can get it over the counter. Just keep a close eye on your you know your dosing, the ingredients that are in the pre-workout or fat burner because sometimes mixing too much of a stimulant can really do your body more harm than good.
All right, next up is heavy alcohol use. I mentioned this in my previous video on things to avoid when you're on semaglutide or tirzepatide, but because there's a lot of receptor overlap, this is also something that should be avoided on retatrutide. Retatrutide also acts on the GLP-1 and GIP receptors which is located on your pancreas, right? We talked about this before. These receptors help the pancreas or stimulate the pancreas to release more insulin, which is good. But that puts a little bit of stress on the pancreas. Another thing that puts a lot of stress on the pancreas is alcohol. So heavy alcohol use like chronic alcohol use or heavy binge drinking can really put a lot of stress on the pancreas. I've had a lot of patients come in with acute pancreatitis caused by heavy alcohol intake. It's actually the number one cause of pancreatitis. So please please keep you know keep an eye on that. If you're on a GLP-1, please limit your alcohol use. A lot of my patients actually have significantly decreased or eliminated alcohol from their diet after starting a GLP-1 just just naturally without even thinking about it. But if you are thinking about you know consuming alcohol or if you are consuming alcohol, please keep a close eye on it because it can definitely kind of stress your pancreas to a point where it can do more harm.
Last but not least is blood pressure medications, specifically loop diuretics or thiazide diuretics. Blood pressure medications that help your blood pressure by getting fluid out of your body. So retatrutide like we've kept talking about, has the glucagon activity, and glucagon, what it naturally does is it helps your body lose fluid. It's a diuretic. It's actually more of a naturaletic, meaning that it helps your body get rid of sodium and water, not just water by itself. And in isolation, it's it has its benefits, but, you know, it kind of it keeps your body in a constant state of, you know, homeostasis or a well-balanced state. But, when you pair this glucagon activity with something like a thiazide or a loop diuretic, which help your which are these are blood pressure medications that help lower your blood pressure by getting rid of excess fluid and excess sodium or salt. The problem here is that when you combine these two, you're getting rid of one a lot of salt, which is, you know, for some people good, but a lot of times it's an electrolyte that you need to really help with, you know, your heart rhythm and your heart the electrical activity of your heart, as well as muscle contractility. But, the bigger issue is that you're getting rid of a lot of water. You're not just getting rid of water through the diuretic effect of the blood pressure medication, but also the glucagon activity of retrotide. This, along with the decreased oral intake that happens when you have the activation of the GLP-1 and GIP receptor, is a huge kind of recipe for dehydration.
So, you know, what I want you to really keep an eye on if you're on these medications is please, you know, stay hydrated. Make sure you're drinking enough water. Make sure you're on top of your electrolytes. I'm a huge proponent of electrolytes. I think a lot of people think that they're unnecessary or they're heavily marketed supplement, which I agree. I think they are overly marketed. I don't think you need the supplements or the the yeah, the electrolyte supplements that cause, you know, cost tens of hundreds of dollars. You can literally just, you know, get some salt, get some salt light, I think it's called, which is a potassium supplement, as well as you know, just magnesium on its own, and kind of make your own electrolyte drink from it. I would do this under the guidance of a medical provider just because you don't want to take too much of it. You also want to make sure your kidney function's okay, so that your kidneys balance your electrolytes. They they kind of excrete if you have too much salt, too much potassium, or too much magnesium, your your kidneys help excrete it and get get the excess out of your body. But, if you have kidney issues, you may hold on to electrolytes a lot more, and that could be another issue. So, I've definitely, if you're thinking about supplementing with electrolytes, if you um, you know, want to be more cautious, I would definitely speak to a medical provider about it. Make sure your kidney functions okay. But, unfortunately, that is a side effect that or I'm seeing more commonly with a lot of my patients on blood pressure medications and retatrutide, um, is severe dehydration. So, please, please keep a close eye on that.
So, there you have it. Seven things to avoid or try to keep a close eye on if you're on retatrutide. And don't get me wrong, I think retatrutide is the most potent metabolic medication that we have at the moment. Um, and I'm hoping that once it's FDA approved, a lot more people will have access to it and be closely monitored while they're on it. But, with this powerful of a medication, I think comes patient responsibility and more importantly patient education. I think ultimately my goal is always make sure my patients are as well informed as they as they can be so that they can make the best decisions for themselves. I will never tell you what to do, but I would teach you what I think should be done, and that's how you should approach your health in general. You should always get as much information as possible and make sure you make a decision that you can live with that night. But, I think when newer and newer medications come out, especially medications that are so popularized by the internet and different communities such as bodybuilders, biohackers, you know, it's it's hard to know what's real and what's not. So, just make sure you stay as informed as possible and that you're getting your information from legitimate sources. I'll see you next time.