Transcription
Your Reddit True Tide protocol was probably written by somebody who copied a titration schedule straight out of the clinical trials. And you all seen how the clinical trials produced phenomenal titration schedules for your other GLP ones, right? That worked out really well.
Trials weren't designed to find your optimal dose. They were designed to see how high of a dose they could push the drug before patients couldn't tolerate it, right? While they were getting meaningful results. Those are two different missions.
The last escalation step in that trial, going from 8 to 12 milligrams, added 50% more drug and only caused 1.4 additional percentage points of weight loss. And dropout rates from side effects at those upper doses were on the higher end of what we seen with GLP1 based therapies. That's what happens when your dose is built for a study population, not for your body when you're trying to put in the work.
What I'm walking you through today is a dosing system built around just one question. What's the lowest dose that actually produces the result? Not the trial end point, not the maximum tolerated, the dose that works without making you want to quit. And that can actually lead you down the path towards permanent weight maintenance if done correctly. And I don't take that statement lightly.
I'm Dr. Jones DC and I lead a nationwide GLP1 tele medicine clinic. And the patients who I work with are on these medications every single day navigating exactly what you're dealing with right now. So what I'm sharing in this video isn't pulled from a textbook. It's what we've built from watching real patients succeed and struggle on Reddit True Tide and figuring out what actually separates the two.
Reddit True Tide is completely different from every other GLP1 on the market. And understanding exactly how it's different and what that means for how you dose it is what separates the people who get results from the ones who quit wondering what went wrong. Now, you probably already know that Redat True Tide hits three receptors while most other GLP1s work on either one or two. But what most people don't fully understand is how that third receptor operates completely different from the other two and why that changes everything about how you should approach this medication.
Those first two receptors, the GLP1 and the GIP are doing the work that you'd expect. Appetite control, insulin sensitivity, blood sugar management. But the third one, the glucagon receptor, isn't playing the same game at all. The glucagon receptor signals the liver to release stored energy and promote the breakdown of stored fat through downstream metabolic pathways. That's the mechanism behind reatride's fat mobilization advantage. And it's why in the phase 2 trials, reatride produced weight loss results that rival or numerically exceed what's been reported with Tzepide in separate studies.
But that same receptor raises your heart rate. It puts demand on your system in a way that the other two don't. It essentially is asking your body to run a controlled metabolic burn around the clock. And at the right dose, that's a powerful tool. That's something that you might want to deal with, right? But at the wrong dose, it's like flooring the accelerator before the engine is even warmed up. Like we can't do that. I call this the triple agonist tax. Every additional milligram doesn't just increase the benefit, it increases the load. And unlike tzepatide where pushing higher mostly means more appetite suppression, pushing reatrite higher means more glucagon activation, more cardiovascular demand, more systemic stress on top of whatever your body is already managing. And for a lot of you, it's managing too much.
This is why cardiac screening matters, especially if you have any existing heart conditions, in particular arrhythmias or heart rate problems. That glucagon activation adds a workload that your cardiovascular system needs to be ready for. And it's why, in my opinion, the minimum effective dose principle is more important here than with any other medication in this category. Now, the upside, it's real. So is the tax. And the whole system that I'm about to walk you through is built around capturing the benefit without paying more than you have to.
Now, real quick, if you want me to make a dedicated video on the newest updated information on the pros and cons of some glutide, tepatide, and reachide, let me know in the comments because that one deserves its own full breakdown. on and if there's enough interest, I'll definitely slot that into the upcoming videos. Okay.
Now, most people assume the triple agonist tax only becomes a problem when the doses get too high. What I actually see clinically tells a different story because for a lot of people, the problem starts on day number one. I want to tell you about a patient who came to me a few months ago. She'd been on Retta for about 10 weeks. She started at 2 milligrams, escalated to six, and by the time she found us, she was exhausted, barely training, and convinced the medication just wasn't right for her body. She wasn't failing reatrat was failing her because nobody had started her off correctly.
Here's what 2 milligrams as a starting dose actually does. That glucagon receptor gets activated, right? And 2 milligrams is already putting a meaningful load on your system before your body has any time to adapt. What that looks like in practice could be fatigue that shows up in the first couple weeks and gets written off as just normal adjustment period except it might not go away. Compounds with every escalation afterwards.
Now the protocol that we use with patients starts anywhere between 1/2 to 1 milligram maybe a bit more depending on certain circumstances and where they came from. 4 weeks at a half then 1 milligram for another four weeks and then 2 milligrams where most clinics are starting people off from 2 milligs in day number one. By the time someone reaches 2 milligs on our protocol, their body has been on it for 4 to 8 weeks to build tolerance to that glucagon load. The side effect profile looks completely different. And if we decide to start at 1 milligram instead of.5, the outcome is still typically much better than starting off at two.
Now, you might be thinking, Dr. Jones, why does the starting dose matter if you're going to end up at the same place anyways? It's a great question because the starting dose shapes everything downstream. Someone who hits that fatigue wall early doesn't just feel bad. They start undereating. They stop training potentially. They lose muscle instead of fat possibly. By the time they escalate further, the medication looks like it's failing when it's actually the protocol that failed them. This is why we call it foundation first. Getting the starting conditions right before the medication goes to work isn't just being conservative. It's what makes everything that comes afterwards actually land.
Every person who comes to us already at four to six milligrams and struggling, the first question I ask them is the same. Hey, where did you start? and how fast did you get here? And that answer tells me almost everything that I need to know. So if the starting dose is the foundation, the escalation decision is where most people fall apart and the tool that most providers are using to make that decision. Now the trial titration schedule was never designed to answer the question that you actually need answered.
In my opinion, if you're on Red True Tide right now and you're not confident in your protocol, how it was built the way that I just described, that's exactly what our team works through every single day. the free discovery call. You can hit that link below or text number on the screen. Our patient educators will review your current protocol, identify what potentially needs to change, and walk you through exactly how we'd approach your situation where you can then decide if you'd like to work with us, me, my medical team. Again, link or text number on the screen.
Okay, so the trial titration schedule pushed patients from two all the way up to 12. And on paper, the data looks freaking amazing. Higher doses produced more weight loss. That's the number everybody points to. But when you actually sit with the data, something jumps out that needs to be highlighted. Going from 8 to 12 milligrams, a 50% increase in dose produced a meaningless 1.4 additional percentage points of weight loss. So you already know that number and here's what it means. Clinically, if someone is losing say 15% of their body weight at 8 millig, pushing to 12 gets them to roughly 16.4%. Meanwhile, the side effect burden at 12 milligs is significantly higher. And within the trial, discontinuation rates were highest in that 8 to 12 milligram group, particularly during the escalation.
There's already a body composition study worth mentioning here. Okay, so it looked at 8 versus 12 millig specifically for fat mass reduction. And the result will surprise you. The 8 milligram group actually showed slightly greater fat loss than the 12 milligram group. Now, that research was done entirely in the diabetic population. So, it doesn't translate universally, but it's one more signal that higher doses isn't automatically better, and anybody citing 12 milligs as the target for maximum weight loss is working off of the wrong data.
So, the real problem isn't the data itself. It's that prescribers are using that titration schedule as a target instead of a ceiling. There's a meaningful difference between the trial with the 12 milligs and your optimal dose is 12 milligs. Most people will never need to get anywhere close to that number in our experience, especially when you implement lifestyle.
So, how do you actually know when you found your dose? Because the answer isn't a number on a chart. It comes down to one primary signal and two things that I watch closely alongside it. Primary signal is appetite control, not appetite elimination. I want to be clear about that distinction. We're not chasing zero hunger. We're looking for controlled hunger. You're able to eat enough to hit your calorie targets. You're not white knuckling through cravings. Food isn't dominating your mental bandwidth the way that it was before. When that's happening consistently, your dose is working for you.
The two things that I watch alongside are protein and training. Can you hit your protein goals on this dose? Because if your appetite suppression is so aggressive that you're struggling to get adequate protein in, that's not optimization. That's the medication working against your muscle mass. And are you still able to train? Not perfectly, not at peak performance, but are you showing up and putting in the work? If your training has collapsed, your dose is creating more systemic stress than your body can absorb. And when appetite is controlled, protein is being hit, and training is preserved, that's when I tell someone, "This is your dose. Stop here." You see, the dose escalation trap is exactly what happens when people keep pushing past that point, chasing a number on a chart or just chasing nothing because nobody's telling them otherwise, right? That's just these what happens with these large tele medicine clinics where there's very little doctor oversight and interaction and you got one individual signing off on a thousand different prescriptions.
Now, let me know in the comments. Tell me whether your appetite is controlled and whether you're still hitting your training. And I'll jump in and share with what I'd look at first based on what I see in our clinic.
Now, there's one more layer to this that catches a lot of people off guard. And it has to do with how rated true tide actually binds in your system because those three signals that I just described, they don't show up on day one. And mistaking that lag for failure is one of the most common reasons people escalate before they should. Redat true tide has a long half-life. Like other once-w weekly injectables, the levels they build up over multiple weeks of consistent dosing before the medication reaches its full working concentration. The first couple of weeks on a new dose can feel like nothing is happening. Appetite control arriving gradually over the following weeks rather than immediately.
Now, for a lot of people, that silence reads as the dose isn't working. Let's go up. Let's go up. Right? I get the excitement, but it's not the situation here. That's accumulation. Your body is building towards the therapeutic level. And what you're feeling in week number one is not what you're going to feel in week number three and week number four. In many cases, this is one of the most important things to understand about this medication. And almost nobody explains it before handing someone their freaking vial.
So, how do you tell the difference between accumulation lag and actually being past your effective range? Both can actually look similar on the surface. Appetite isn't well controlled, results have stalled, something feels off. The distinction comes down to the timing and the trajectory. Now, if you're in the first couple weeks on a dose, say 2 weeks, and things feel quiet, that's lag. Give it time. Now, if you're at week four or beyond, and the appetite control still isn't there, that's a different conversation. That's a dose that may genuinely need to move up. And there's a whole conversation we have to have there.
Here's the pattern that I actually see most often. Someone hits week two, feels like nothing is happening, and then they escalate. And then at week four, the original dose finally reaches full effect. Now, on top of a higher dose that they just added, now they're overcorrected. Side effects spike. They blame the medication and the cycle that started with a too high starting dose repeats itself at the escalation level. Patients inside the four-week hold isn't passive. It's the active part of the protocol. The hold exists precisely because this medication needs time to show you what it's actually doing before you add anything more.
There's also something worth noting about what glucagon does at the lower end of the dose range. There's a working theory and I want to be clear this is still mechanistically plausible but not yet proven in the human dosing studies yet that at lower retati doses glucagon receptor activation may help the body counterregulate more efficiently producing cleaner fat loss with less systemic disruption. Now this is one more reason the lower end deserves more respect than it typically gets. Now what I want you to take from this section is simple. When the dose feels quiet the first two weeks that's normal. when it still feels quiet at week number four, then you have information worth acting on, not before.
Now, this kind of content that actually helps you navigate what you're on, be sure to hit that subscribe button because I put out two videos like this every single week. And the next one might be exactly what you need to hear in addition to what you're probably listening to right now saying the same thing. And be sure to turn on that bell.
Now, let's pull all of this into a single system so that you can take this into your next provider conversation and know exactly what you're asking for. Step one is the pre-start qualification. Before the first injection, two things need to be in place. Metabolic readiness, meaning your foundation is solid enough to handle what rotide is about to ask of your body and cardiac screening. If you have any existing heart concerns, it's probably a good idea to get screened regardless because of everything that we've covered about the glucagon load.
Now, step two is your starting dose. Half milligram, maybe one, not 2 milligrams. You hold that for at least 4 weeks before you ever consider moving up. I know that feels conservative, but that is deliberately conservative. Those four weeks are your body building the tolerance that makes every subsequent escalation cleaner, more sustainable, and you might not need it.
Step three is the hold cadence. Every dose increase gets its own 4-we minimum hold before you evaluate. No exception. This isn't about being cautious for caution's sake. It's about giving the medication enough time to show you what it's doing before you make any changes.
Now, step four is the functional checkpoint. At the end of every hold period, you're asking the same three questions. Is my appetite controlled? Not eliminated. Controlled. Am I hitting my protein targets? Am I able to get my ass to the gym and freaking work out? And if I can answer yes to all three, I'm at my dose. I'm going to stop right there. If appetite isn't controlled yet and the other two are intact, that's the conversation to have with your provider about whether you should move up or not.
Okay. Step five is ceiling logic. Now, most people that I work with find their effective ceiling well below 12 milligrams. Often in that 2 to four milligram range when the starting protocol is followed correctly. The ceiling isn't a number on a chart. It's the moment all three signals align. More drug doesn't buy you more results. It just buys you more side effects.
One more thing worth knowing for people who need stronger appetite support but don't want to push reetutide higher. There's an option on the table that we do all the time. Combining a low dose of retoutide with a low dose of trespatide lets you capture retoutide's fatty mobilization advantage metabolic profile while leaning on tzepatide for the appetite control peak. It's a strategy that we use in our clinic when retoutide alone just isn't doing enough for food chatter. Yet somebody doesn't want to go up on a higher dose of reatite.
Okay, so that's the system for reatite. Pre-star qualification half milligram or one to start four-week hold at every step. Functional checkpoints at each hold. Stop when the signals align, not when the chart says you're done. And if you're on Reddit true and your protocol doesn't reflect what we've covered today, that's worth fixing.
Okay, so the free discovery calls that I linked below is how we bring people in. Our patient educators will go through exactly where you're at, what your current protocols look like, and whether working with our team makes sense for you. And if it does, we'll build it for you the right way from the start or rebuild it if that's what's needed to get permanent weight maintenance. A lot of times we take patients on these higher doses of tzepide, put them through a medication reset, help them get off and get started on a low effective dose of reatine. You can check out the link in the description or just text the number on the screen.
Now, one last thing. If you made it this far, I want to know what surprised you the most in this video. Was it the starting dose, the escalation data, or something else entirely? Let me know in the comments. And now that you know how to dose it, the next thing worth understanding is what can actually undermine those results even when your protocol is exactly right. I've got a video on the most common mistakes that people make on Red True Tide. There it is right there. Check it out, guys.