Reta washout timeout

My AF is asymptomatic and resting heart rate sits around 50 bpm, up only slightly from 47-48 before retatrutide. This is not the first episode; two years ago severe dehydration from gastroenteritis triggered it without any GLP-1 use. Recent diarrhea episodes likely lowered blood pressure and caused dehydration this time, so retatrutide is only indirectly involved. Five milligrams weekly seems the highest dose I tolerate without side effects, same as with tirzepatide. My cardiologist actually recommended GLP-1 therapy and saw no AF link.

Washout periods or cycling look counterproductive for lasting GLP-1 benefits and weight-loss results. One study showed cycling induces therapeutic resistance and raises adiposity. What are you hoping to achieve with the break when the AF does not appear tied to ongoing peptide use?

Anyone considering a GLP-1 should read that study first to grasp the long-term commitment. Retatrutide users expecting to cycle are finding there really is no off-ramp; stopping leads to a difficult rebound and restarting does not work the same way.

Main aim is to clear up the diarrhea completely before resuming GLP-1 drugs. Even though it occurs only a couple of days a week it seems to have triggered the electrolyte and blood-pressure shifts behind the AF.

Thanks, that study is useful. Would be good to have a section in the group for science-based papers.

Thread has gone in several directions. Split dosing, lowering the dose, staying consistent, and possibly adding supplements have all been mentioned for easing symptoms.

Not sure cycling has much support for larger users. People focused on cutting might respond differently.

Psyllium husk, one spoonful morning and evening, improved the diarrhea a lot but did not stop it entirely; it still occurs in a milder form. Low blood pressure over recent weeks seems related. I want the diarrhea gone before restarting GLP-1 at the same effective point as before. Cycling may not be ideal, yet how else to resolve the loose stools?

Fiber is worth trying. I use PHGG instead of psyllium. Earlier dose increases caused noticeable urgency; stepping back briefly then continuing helped. Now at 18 mg weekly my GI function is actually better than before the peptides. What works for one person may not for another, and cycling still runs counter to steady weight-loss goals.

Highest tirzepatide dose was 7.5 mg weekly before dropping to 5 mg because of diarrhea. Switched to retatrutide starting at 2 mg and going up to 6 mg, again with significant loose stools, so returned to 5 mg. Weight loss then stalled, so I tried 5 mg every five days and added a small amount of Cagri for six weeks. Five milligrams every five days became the best balance and was used for two months until the AF prompted stopping.

Have you tried splitting the dose further, say every 3.5 days? It keeps the same average exposure while lowering peaks that often trigger symptoms.

Dose splitting reduced the diarrhea but did not eliminate it.

Doctor agreed that diarrhea alone probably would not cause AF but a sudden blood-pressure drop could. Online information indicates GLP-1 agonists are generally linked to lower atrial-fibrillation risk through weight loss and metabolic improvements.

At 7.5 mg tirzepatide or 6 mg retatrutide the diarrhea became severe with cramps. At 5 mg retatrutide stools stay loose; psyllium makes them more formed. Still need to lose another 15 kg and would like to stay at the manageable 5 mg every five days once the AF and residual loose stools are sorted.

Apixaban 5 mg twice daily.

Ablation is one option I am considering and have a cardiology appointment booked. Did you use GLP-1 medications while the AFib was active?

I did not. I monitored heart rate closely on the medications and had some early tachycardia that later settled.

Apixaban is only an anticoagulant and does not treat the AFib itself. Discuss adding a beta blocker such as metoprolol or an antiarrhythmic like flecainide with the cardiologist. AFib tends to progress with age.

Beta blockers and most antiarrhythmics are unsuitable because resting heart rate is already low at 50-55 bpm. Plan is catheter ablation to try to resolve the AFib permanently. Heart-rate screenshot from smartwatch added.