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Debate on starvation mode and managing side effects in long-term restriction

77 replies33 peopleJul 28, 2026☆ Follow
Summary

does starvation mode exist and how can side effects like fatigue and pain be handled during extended restriction

participants distinguish true starvation mode from measurable drops in energy expenditure driven by reduced thermogenesis, inactivity from fatigue, and prolonged restriction. some report worsened fibromyalgia symptoms and other effects at higher doses, leading to strategies such as split dosing or switching compounds, while others note benefits from added compounds for appetite control and energy. individual variation in results, maintenance at lower doses after major loss, and limits imposed by medical conditions are highlighted as key factors. pinning location and source quality are also raised as variables affecting outcomes.

What this discussion establishesWhere people disagree

whether observed metabolic slowdown constitutes starvation mode or simply the combined effects of thermogenesis, inactivity, and restriction

Still open

optimal stacking approaches, water retention management, and safe titration under medical constraints

Nothing here is advice.

77 replies · 33 people · page 1 of 2
SteadyQuill85archiveopening postJul 28

Started looking into Reta back in November and went from 250 pounds down thirty so far. Just over fifty with fibromyalgia and chronic fatigue. Took the slow route with dosing but hit a three-month plateau. Stayed at 4 mg for a stretch with gradual drops, then did 5 mg across ten weeks, and four weeks ago moved to 6 mg with still no movement. Wondering if I should just jump straight to 8 mg instead of following the every-four-weeks schedule because of my health background. Small steps feel like they're costing more without getting anywhere. Any thoughts from folks who've been through it?

RustKettle57archiveJul 28

First thing I'd check is whether you're actually tracking calories. Too many and weight won't move, but too big a deficit can also stall things because the body thinks it's starving and holds onto fat. Your existing conditions might be playing a role too. Regular bloodwork would show what's going on inside. If calories look reasonable and bloods are fine, no reason not to try 7 mg and see how it goes from there.

CopperMeadow65archiveJul 28

How's your food intake looking? Have you swapped to better choices, cut back on snacks and sugars, and focused more on protein? Is food noise still an issue? You could try switching to Tirzepatide or stacking Reta with Tirz. Also explain how the Retatrutide is hitting you on hunger, eating habits and the like.

SteadyQuill85archiveJul 28

Food-wise I was stuck in a loop of fibro crashes followed by grabbing high-calorie quick fixes. That stopped once I started Reta. My condition still makes me skip meals from sheer tiredness, so breakfast at 2 pm then overeating once hunger hits. Been working on that and made progress. Upped protein and mostly snack on chicken. Stay as active as I can. Don't track calories because it stresses me out and I lose count. Some weeks the pin brings on overwhelming hunger but I manage not to clear the cupboard.

CopperMeadow65archiveJul 28

Starving isn't ideal either. Maybe look at ready-made protein drinks or shakes since mixing one when tired is probably tough. It might be hard to stick with right now, but what worked well for me on Tirzepatide was eating every three to four hours with around 20 g of protein each time. I tweak the protein a bit depending on the gap between meals and add a little more early on to help hold muscle.

SteadyQuill85archiveJul 28

Just picked up some of that meal-replacement shake powder. Still trying to figure out if I'm wasting time with the slow titration and should just move up to 7 or 8 mg.

SlowAnchor55archiveJul 28

My weight stalled on Tirzepatide for a couple of months. Had berberine sitting around so I added it. Weight started dropping again at a steeper rate than it had in months. Dropped twelve pounds since adding it. Berberine gets called the poor man's GLP-1. It's over the counter, helps with blood sugar and can lower blood pressure a little.

CopperFenwick10archiveJul 28

Take a look at that video, the guy shares decent info on reta, stalls and other compounds that can help.

KeenPebble33archiveJul 28
↳ replying to @SteadyQuill85 (opening post)

People on 8 mg of reta lost a little over 20 percent bodyweight in a year while 12 mg got above 25 percent. Start by asking what your target weight is and go from there. Remember they hit those numbers over 48 weeks so patience matters. Took me about a year and a half to reach 30 percent bodyweight loss on tirz and sema. Good luck.

PatientQuill81archiveJul 29

Went all the way up to 12 mg reta once a week, stalled for a few months, then dropped back to 6 mg and added cagri. Better to hold onto the lost weight longer than push too hard. A few more pounds came off over the last six months. Slower loss is easier for the body to handle.

SteadyQuill85archiveJul 29

Goal weight is 182 lb or 13 stone. Currently at 220. Was dropping just under 2 lb a week and happy with that pace. This stall has been frustrating though. Just want to break through and get the scale moving again.

IronKettle95archiveJul 29
↳ replying to @SteadyQuill85 (opening post)

Before adding anything else I'd first try moving to 8 then 10 mg of Reta if needed. Plenty of people here run those levels with good results. If that still doesn't work consider adding some Tirz on a different day from your Reta. I'm doing 7.5 mg Tirz on Friday and 4 mg Reta on Tuesday. Haven't stalled more than a few days. Tirz kills hunger and Reta boosts fat burning. Seems like a solid combo but results vary.

QuietThistle70archiveJul 29

People often read the phase 3 data to fit their own story instead of taking it as a uniform cohort for safety and efficacy. Managing your own program is different from being in a study. I'd start looking at other options before going above 8 mg a week. In particular a small stack with Sema to strengthen GLP-1 effects, and maybe small amounts of Cag or Elora for extra appetite control while offsetting heart-rate rise. The data shows diminishing returns above 8 mg for things like liver fat, and the extension shows higher-dose benefits can still be used later if needed. Depends on your goals. If you want the weight off fast without worrying about other markers, follow the trial titration. If you're viewing Reta as

LevelThistle44archiveJul 29
↳ replying to @QuietThistle70

Where are the studies showing you should stop escalating Reta and add Sema plus Cag/Elora because of diminishing returns on liver fat? I could be unusual but I take Reta to lower overall fat, not just liver. A liver can only drop so much fat before it plateaus around 2-4 percent. DEXA shows my VAT down about 43 percent by weight and area from end of January to mid July. That period covers 54 lb of my total 77 lb loss. Overall weight down 27.3 percent in 32 weeks. Trial averages were 17.5 percent at 24 weeks, 24.2 at 48, 28.3 at 80. I also run more than 8 mg a week and see clear dose-dependent results.

CopperSignal27archiveJul 29

Without knowing the medical issues you're worried about with reta it's hard to say, but chronic fatigue and fibromyalgia don't seem like reasons to avoid higher doses. If anything reta may help fibromyalgia though nothing is proven yet. Being lighter should ease fatigue and general pain. Some people get anhedonia or fatigue from reta but most don't. I'd disagree with focusing hard on calorie intake. Strict restriction can work short term but is much harder to sustain long term. Makes more sense to raise the dose until hunger drops naturally so you're eating less comfortably. That approach is more sustainable and lets you keep going until the weight is off and stays off. Eating better and moving more is still good, but

GreyFenwick29archiveJul 29
↳ replying to @SteadyQuill85

Ultimately working out a lot or taking meds won't make up for poor eating habits. The basic math is clear intake has to stay below what gets burned if the goal is dropping pounds. After checking into it myself I grew used to selecting better options and keeping track of calories in a simple way. No need to fret about the process and it points out the exact tweaks that keep me moving forward.

SteadyQuill85archiveJul 29

Tried a fasting plan the chronic fatigue clinic suggested. Eating clean and fasting twelve hours from 8 pm to 8 am. That didn't work so we tried longer windows, 8 pm until about 2 pm. Ended up gaining a few pounds so they said they didn't know why and that was it.

BrightKettle28archiveJul 29
↳ replying to @SteadyQuill85

Looks like you've got plenty of advice to sort through. My experience was the body adapted to fewer calories after months of it plus daily sixteen-plus-hour fasting, and only when I went a couple hundred lower did the scale move again. But that felt like too few calories so I ate more for a week then went back to a five-hundred deficit. Bottom line is CICO. Good whole food, not the processed stuff we grew up on. Why sell us things we shouldn't eat? Why do doctors mostly hand out pills instead of telling people to change what they eat so blood pressure and other problems fix themselves? Best of luck figuring this out.

WryCompass65archiveJul 29
↳ replying to @RustKettle57

Building on that, are you exercising or weight training? Taking measurements beyond the scale? I've been stalled about six weeks. Weight training over fifteen years. Use calipers for fat. Net weight is flat but it's tied to calorie intake. Visibly leaner though, calipers and pants size confirm it. Reta seems to be doing the partitioning I need right now. Weight is only one number and lots of variables are involved. The more you track the clearer the direction. Down thirty pounds, was aiming for forty, now think five pounds of true sub-q fat left.

SharpThistle77archiveJul 29

CICO. Can't outrun the math. As weight drops the daily calories needed to hold steady also drop. A smaller body takes less energy than the larger one you had. Over several months a stall means you're eating exactly what's needed to maintain current weight. Must either cut intake, raise expenditure, or both. Reta helps with both but still needs your input later on. To cut intake, count calories and eat fewer. Eat lower-calorie-density foods high in protein and fiber to fill up and protect muscle. To raise expenditure, lift weights. Muscle burns more at rest than fat. Last point, maybe you're already doing all this. Leaner, more muscular, smaller body. Muscle weighs more than fat,

IronKettle95archiveJul 29
↳ replying to @SharpThistle77

Read another forum with lots of beginners. They hate and reject comments like this. GLPs are magic that melt fat with nothing else needed. Live on chips and sit on the couch. They say CICO is fake. Few weeks later they post that the drugs don't work and it's a scam. That's why I see GLPs as a tool not a cheat. You still have to handle diet and exercise if you want results.

SteadyQuill85archiveJul 29

Since getting ill in 2021 exercise dropped fast and weight went up. Can't work out much anymore because it triggers full-body crashes lasting days. Stay as active as possible with light walking and moving around the house. Food intake is way down and portions are small. Will admit to snacking on things I shouldn't a couple times a week like chocolate or soda. Overall think I'm handling it. More protein foods like chicken and protein yogurts. Lost four inches off the waist and a couple off the neck. Kept most muscle which is why I picked reta over the others. Calorie cutting is hit or miss because it can trigger a crash. Read a study saying fibromyalgia can stop weight loss by putting the body into panic mode.

SteadyQuill85archiveJul 29
↳ replying to @IronKettle95

Yes that's right, but most of those forums are full of gym rats who are healthy and cutting for different reasons. Basics are the same but the way they say it can put off people who are genuinely struggling with weight. Not an excuse though, I do try to limit calories as much as possible.

SharpThistle77archiveJul 29
↳ replying to @SteadyQuill85

Plenty of other factors including disease but they don't cancel CICO. They change your BMR, the calories your body burns just to keep going. More accurate to say fibromyalgia can lower BMR which stops loss unless you cut calories or raise BMR some other way. Sounds like you're working with your doctor on sustainable movement that fits. Reta at the right dose can raise that burn rate too. But 99 percent of weight comes off in the kitchen not the gym. Cut the sneaky calories and you'll get moving again.

SharpThistle77archiveJul 29

I've noticed personally that consuming foods with a low glycemic impact which deliver lots of bulk for few calories helps manage those sudden energy drops that came up. I also tried feeding a request into whichever AI model I prefer asking for examples of such items plus reasons they qualify along with effects on feeling full and supporting weight reduction. Pairing that method with protein sources has helped me avoid the drops while cutting back on total calories.

KeenQuill57archiveJul 29
↳ replying to @SteadyQuill85 (opening post)

Stalls are common and frustrating but I like to see them as practice for maintenance. Some of us have bigger challenges due to various factors. Some are low responders to the meds and there are always outliers in studies. The closer you get to goal the fewer calories the body needs. Do you feel you're getting decent appetite suppression and satiety? If you're still eating through the dose there's room to go up. Can be hard to tell after months on it. Thought I had good suppression but was stuck six months so ended up going higher than studied. Some data shows people with the most side effects lose the most. I've had almost none so I titrated until I got mild discomfort. Day after the shot I might get a touch of nausea but nothing bad. Suppression and satiety are now very strong and I have to watch

SteadyQuill85archiveJul 29
↳ replying to @KeenQuill57

Was thinking about switching to tirz because I've seen others with inflammatory issues get good results on both weight and inflammation. It's discussed a lot in fibromyalgia groups. Had gut issues with bad bloating since getting ill and recently stacked kpv with reta. That stopped the bloating especially after eating. Used to have three different clothing sizes depending on the time of day. Seeing success there. Noticed food noise growing even on jab days which is why I was thinking of going up. Not unhappy with slow loss but it's been completely stopped for a while. On the plus side it gives an idea of maintenance dose once at goal. Ideally thirty-one pounds down with another thirty-six to go. Next pin day is Friday so I'll probably just do 8 mg and check the scale at the end of the week. Maybe went a bit too slow and landed in maintenance mode.

CopperSignal27archiveJul 30
↳ replying to @SharpThistle77

None of the diet or exercise advice is wrong and I believe CICO is how the body works. Went from 145 kg to 75 kg on a very high-protein, low-calorie-density, very low-fat, zero high-glycemic highly palatable food diet. Know from that and earlier attempts that the approach can work. Even that carefully designed satiating diet didn't solve the maintenance problem. Keeping the weight off the first year was hard and I was hungry most of the time. Only after adding GLP drugs two years later did it start to feel possibly sustainable long term. What I don't agree with is that diet and exercise actually work in real life as a long-term obesity solution, especially severe obesity. It works short term but long-term success rates are poor for big losses because hardly anyone sticks to a tough program forever once they've been obese. With

IronLantern24archiveJul 30
↳ replying to @SlowAnchor55

There's a container tucked away in my storage area that slips my mind whenever I should use it. Placing it near my everyday belongings could help me remember and gain from it.

SharpThistle77archiveJul 30
↳ replying to @CopperSignal27

I share the view on nearly everything mentioned. Maintaining my reduced weight after losing it naturally proved impossible, which is why I'm using these medications now to control my daily calorie consumption, and perhaps raise my resting metabolism as well. From tracking every single calorie each day over twelve months, I gained extensive knowledge regarding nutrition and meals. This round, I skip that process since I understand my energy needs and nutrient balance without the daily task. Since overeating isn't possible even when desired, my focus on unprocessed foods like vegetables, beans, and lean meats should help achieve the goal. I dislike all physical activity aside from strolling, yet my extended workdays limit how much I can do that. Therefore, I'm incorporating some mild strength training to maintain muscle and skeletal health. However, this isn't sufficient for adding size, even without the calorie restriction. Using only the medication can work if food consumption drops sufficiently. My motivation stems from wanting better health and longer life for my loved ones, so building positive routines during this process allows me to shed fat while improving overall wellness, unlike my previous state of being thin but unfit. Solid thoughts!

CopperSignal27archiveJul 30

Actually think diet and exercise are extremely important for health. Saw a study last year where fit obese people were two to three times less likely to have heart attacks than skinny unfit ones, so below about BMI 30 fitness probably matters more than fatness. But tolerability and sustainability are the biggest factors because obesity consequences play out over decades and keeping weight off long term is what reduces risk. Ideally eat better and exercise too, but I tend to think diet and exercise alone don't solve the weight part of the problem while GLP drugs largely do. If it's even mildly hard to stick to long term the chance it won't be maintained goes up, so making it as easy as possible matters.

WarmSparrow92archiveJul 30
↳ replying to @SteadyQuill85 (opening post)

Titrate up if the scale stalls, up to 12 mg. Obesity is worse than temporary side effects from Reta. Then stay on 12 mg while also fixing habits. Keep 1. Imodium, 2. Pepto Bismol, 3. Zyrtec on hand for side effects that will probably show up when going to 12 mg. After maintenance taper down and you're set.

PlainAlder11archiveJul 30
↳ replying to @WarmSparrow92

I experienced nothing negative from taking 10 milligrams, neither did my spouse. Any problems stopped long ago, with the sole issue being slight indigestion during evening on the injection day. It was probably around four milligrams but I forget exactly.

SteadyQuill85archiveJul 31

Pinned 8 mg today. See how it goes. Wish me luck.

IronKettle95archiveJul 31
↳ replying to @SteadyQuill85

Best of luck and update the thread if it works or not.

SharpWillow45archiveJul 31

Finishing my fifth month now at a weekly dose of 12 milligrams. Along with regular cardio sessions this has started the weight dropping once more. However I'll begin lowering the amount during October. Then I intend to stop entirely for several winter months while attempting a lean bulk phase through March. Should the pounds return too quickly a minimal amount might get added back yet I believe taking a break to build muscle and refresh my metabolic rate will benefit me over time. My current weight is 205 pounds after starting from 295 though the losses have occurred in yearly cycles and these medications were introduced only recently. A decade back I managed to shed everything within twelve months yet clearly that approach failed to last.

AmberTimber37archiveJul 31

Calories in versus out does hold up overall. Still people dealing with ongoing exhaustion or gland troubles often lack usable strength once they cut back on food. That leaves them chilly even somewhere warm and unable to handle regular activities. Basically they turn into total layabouts. In my situation the power fades so fast I can't manage to take any steps.

SteadyQuill85archiveJul 31
↳ replying to @AmberTimber37

During my weight loss phase with that compound I end up feeling chilled to the bone regardless of warm weather. Yet this feeling has disappeared over the past several weeks. You nailed it about how cutting calories leaves you without usable stamina. So I set my intake at levels that let me function normally each day, probably above my basal metabolic rate. This requires constant adjustment.

SteadyQuill85archiveAug 3

I increased my dose to 8 milligrams last Friday from the previous 6. My fibromyalgia reacted poorly to this change. A big flare-up occurred, and only now am I starting to feel functional again. The discomfort was extreme. On the positive side, my waist measurement decreased by half an inch, suggesting possible weight reduction benefits ahead. It might have been worth enduring that discomfort. I'll check my weight again at the week's end.

CopperHarbour29archiveAug 3
↳ replying to @RustKettle57

That starvation mode concept is bogus. The body never halts its use of fuel for vital processes.

IronKettle95archiveAug 3
↳ replying to @CopperHarbour29

I saw another board full of beginners. Half of them credit the meds for finally sticking to a diet. The other half sit in recliners at the highest doses swearing they are in starvation mode.

NorthWillow72archiveAug 3
↳ replying to @CopperHarbour29

True enough, but you still get tired and move around less without realizing it. Without tracking calories you can stop losing because your actual burn drops. Nutrition and muscle loss matter too in big deficits. I ran 1200 calories daily for seven months to reach goal and never subtracted my steps from that number.

CopperHarbour29archiveAug 4
↳ replying to @NorthWillow72

There is a middle ground where the deficit still lets you feel decent and stay active. Push past that and you feel wiped out, move less, and burn fewer calories overall. The notion that your body suddenly cuts basic functions like walking or breathing down to half the usual calories is just wrong.

LevelCinder55archiveAug 4
↳ replying to @SteadyQuill85 (opening post)

Two changes sped up my fat loss the most. I started going to the gym and added tesamorlin on top of reta. I also cleaned up my diet, dropped fast food and processed items, and added some vitamins. The gym plus tesamorlin gave the biggest and quickest results.

SteadyQuill85archiveAug 4
↳ replying to @LevelCinder55

A gym is not an option with my health issues. I agree it helps a lot though. Right now I am using GHK-Cu and KPV, plus a short course of wolverine for a shoulder problem.

LevelCinder55archiveAug 13
↳ replying to @SteadyQuill85

If a gym is out, try a fifteen or twenty minute walk after your biggest meal. It helps more than most people expect.

QuietAnchor73archiveAug 13
↳ replying to @CopperFenwick10

That person is a fraud whose license was revoked years ago by the state board for unprofessional conduct.

PatientPebble79archiveAug 13
↳ replying to @SteadyQuill85

The food noise comment makes me think adding tirz could help since appetite control is usually stronger. I deal with similar health issues. Having easy grab-and-go protein like bars or canned salmon and yogurt helps on low-energy days. Be gentle with yourself; this is a tough fight. I am having a slightly better stretch right now and it feels good to have a few extra spoons. Good luck.

SlowLedger31archiveAug 13

A lot of my stalls broke when I drank more water and cut calories further. For a stretch I added heavy cardio. Recently motsc ended another plateau. Might try 5a1mq next. Thirteen pounds left and two months to do it. Fingers crossed.

PatientPebble79archiveAug 13
↳ replying to @CopperHarbour29

I am not sure what you mean by survival mode being imaginary. I can drop below three hundred calories for two weeks and see zero scale movement while feeling weak and unsteady. It feels like my body is just forcing things to keep going and sometimes I even gain a pound or two. Clearly some functions are being dialed back to stay alive.

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