How to Handle a Medication Pause Without Losing Progress

What do you do when you have to take a break from your GLP-1 medication—whether for a medical procedure, travel, or an unexpected setback? One patient recently wrote in, frustrated after going off their meds for a colonoscopy and feeling completely off track.

It’s easy to panic, feel like you've lost progress, or worry that getting back on track will be impossible. Your body’s natural instincts are working against you, and without a plan, you can quickly spiral into all-or-nothing thinking: I’ve blown it, so what’s the point?

In this episode, I break down the "ladder" approach to reintegration—starting with hydration, structured eating, and realistic goals—so you can ease back in without burnout. Because this isn’t just about bouncing back after a procedure; it’s about knowing how to plan for any time life throws you off course. 

Audio Stamps

00:00 - The April round of The 30/30 Program is now open for enrollment.

03:40 - Dr. Rentea reflects on a recent business retreat, emphasizing the importance of mind-body balance through practices like Qigong and sound baths

07:18 - Dr. Rentea shares a patient’s question about pausing their GLP-1 medication before a colonoscopy and how it can impact hunger, weight, and cravings.

09:27 - While off your medication, focus on drinking water, eating protein, and managing cravings. Hunger and weight gain are temporary—things will even out once you're back on track.

13:52 - Use a ladder approach to get back on track: start with hydration, add protein and fiber, then focus on structured meals. 

16:00 - This period is a powerful reminder of how much support the medication provides. Use it as motivation to stay consistent with nutrition and habits.

Quotes

“I don't even care if some weight comes back because here's the first thing I want you to realize: These medications are incredibly anti-inflammatory.”

“I would try to really make sure that you're hitting hydration and protein. Those would be the two that I would really focus on.”

“You're going to do the best you can. It's not going to be perfect. You're going to get that procedure and then afterward, you're going to get back on track.”

“You're not going to be scared by how quickly your hunger comes back because remember, it is super hard to keep fat off. Our body always wants to fight us.”

“You're going to try to hold on the best you can. You're going to try to do the things you can do that are allowed by the physician prior. And then afterward, you're going to ease yourself back in with simple steps. And you're going to al

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Premium Season 1 of The Obesity Guide: Behind the Curtain -Dive into real clinical scenarios, from my personal medication journey to tackling weight loss plateaus, understanding insulin resistance, and challenges with GLP-1s. Plus, get a 40+ page guide packed with protein charts, weight loss formulas, and more. 

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Transcript

0:33

Welcome back to another episode of the podcast. I am a little bit under the weather, but I got a great topic to talk about today and I just want to go ahead and record this because I feel that this topic I think is going to help a lot of patients and podcast listeners. Just to give you a little bit of background with me, I always give a little bit of update at the beginning of the episode. I am back from a three day business trip. It was absolutely amazing. It was in Dallas and it was other women physicians that have clinics and that are really looking how to solve different challenges in their clinics. And it was just an incredibly amazing experience and something that the person that led this trip did just absolutely amazing is that,, They had a lot of different parts throughout the day where we, we call this somatic work where you really get into your body. So something that I want to bring up to a lot of professionals that are listening to this, or if you're in a career where you're using your brain a lot, it's very, It's something that's very common that I see with patients when I work with them clinically, that if you're in your head all day long, and this is, this is actually, I don't know, it's kind of everyone that works with me, but if you're using your intellectual brain often, you are usually not very connected to your body. The problem that this creates is that you're not familiar with hunger signaling. You're not familiar with what the needs of your body are because you're so disconnected from it. One of the things that this business coach knew was that if we're going to sit there and do three days of work with planning 2025 and doing all these things, that sounds all fine and great. But if you get all in your head, What ends up happening is, when you leave these trips, suddenly you have a crash, or suddenly you hit the wall. There's all these different things that happen if you're not also handling the body at the same time. So it was beautiful because, on my own, of course, you know, I got up and took a walk. Now, the area that it was, was not great for taking a walk outside. It was just sort of a questionable neighborhood. What was funny is a mile over there was the most cutest, most amazing town, but right there, it's not something where alone in the morning I would have gone and taken a walk, but I just got up in the morning for an hour and literally just walked a little loop around the house. It was perfect around the bottom floor. But the thing that this person did is that we started out each morning with 10 minutes of Qigong, which was just excellent. And on the second day of the retreat, we had an hour sound bath. If you've not had this done before, it's absolutely incredible. So apparently, and I'm going to do more reading on this, but I looked into how I can get this done more at home here in Indianapolis. Apparently with sound baths, it's really, An opportunity for your parasympathetic nervous system to be more on. So instead of being in this fight or flight or kind of reacting, being high stress all day, when you get a sound bath, it really sort of, let's just say in a very easy, basic way, really calms you down. And this was super incredible for that to be on that day. And then, Sunday went home. So coming home from all of that, of course, with the travel being there, all those things, I'm, you know, I feel I'm probably getting sick. I feel incredibly tired and like something might be coming on. Here's the funny thing. I cannot remember the last time I've been sick. And this is a really big deal if you've listened to this podcast long enough. I used to get sick constantly. I mean, I'm talking probably once a month, if not more often. And it was super disruptive to my work life and just everything. And I can't remember the last time I'm sick. And I was thinking, wow, I always used to get sick around, you know, the December holiday time or Thanksgiving in November or when the kids would be on break in October. I mean, I just, it was always a given that half the trip, that half the time I'd be sick and the other half I wasn't. So I don't know what I can attribute this to, if it's taking better care of myself, the hydration, the protein, the fiber, the multivitamins, the vitamin C, I don't know. But apparently, knock on wood, I'm very grateful right now for how things are. So. When I came back from this trip, I got an email from a patient and they actually said a very nice line at the end. They said, of course I give you permission to use this information or email in your podcast. And I thought, wow, that was great. Okay. Because normally If you write in a fan mail question, I might answer that on the podcast, but I'm not ever using patient information without permission. So this person had a question for me. This person got a colonoscopy and if you look at the new updated guidelines, they'll say, again, I'm not giving medical advice on this podcast, but you can look them up. They have a joint. position piece on this and basically you either don't need to stop it depending on your risk profile or stopping it one week ahead of time or there's different recommendations if also your nutrition gets adjusted for example maybe you'll do what we call like a lower residual diet like less fiber and things like that a day or two prior or maybe clear liquids or maybe a double prep there's just so many different things that can be done now i personally you still like people to be off of it for two shots. Meaning that it's a full two weeks that you're off of it. The reason being there's just too many people on the other end that when they get a colonoscopy, it will not be entirely clean and then they'll have to go back in six months and get the same thing done. So, you know, Yes, it's painful that additional week being off and I'm going to go through why that's such a big deal and why we're going to dedicate a whole episode to not only how to handle that period, but also afterward, because this is something that a lot of people struggle with. This episode is really for anyone that is headed into an elective procedure and they're having to hold their medication. So what ends up happening, even if you're holding it for a shorter period of time, these medications have a certain half life. And depending on the cadence to which you've been taking the medication, of course, if you're holding it, Things are gonna change for you that either one week or two weeks, right? So let's say that you take the medication weekly, but you are holding it for two doses. So that second week, the week before you're doing the procedure, you likely will get more hungry, you will likely have weight regain. I'm gonna explain why in a second here. So all of that's gonna happen. Increase urges and cravings, all of that. Let's talk first about why that's happening, strategies that you can mitigate that. But I don't even care if some weight comes back because here's the first thing I want you to realize. These medications are incredibly anti inflammatory. So some of this weight, even if you say, okay, I'm increased hunger, but I'm sticking to the exact same foods I'm eating. I'm doing all the exact same things. Even if you do that, I still see some gain. Usually So thing number one, I need you to realize that this is likely a lot of inflammation. And so I want you to not freak out about that. Meaning I want you to say, listen, this is a super brief period and. This is something where I just need to keep my head screwed on right during this time that in the grand scheme of things months and months and years and years and decades managing overweight and obesity We have to go through these periods where med gets held for different things or you get put on a steroid and some weight comes On we need to be able to navigate these ups and downs and this is one of the examples Okay, so number one inflammation is is part of this. Number two, these medications, remember half life for terzepatide, which is zepam and manjaro, the half life is five days. So imagine if you don't take that next shot at the seven day mark, imagine by 10 days, you would get like, you keep having these half lives breaking down, right? So you have less and less medication around. Semaglutide, the half life is seven days. So that's going to be your ozempic wagovi. Okay, so I often find the people that are on somaglutide do not experience this as profoundly as those on terzepatide. This is just observational. So in this time period, you're going to realize, listen, I don't have the support, not only for the appetite part, but also the part that's going to the hypothalamus and saying you're satisfied, you're good your taste buds being changed, all these things. are not the same anymore. So you are going to try to continue to do the things that have supported you, the water, the protein, the fiber, if they're allowing all that right now, the monkey wrench here is that this person said that I had to stop my GLP one two weeks in advance of the colonoscopy tomorrow. And the last week, my doctor recommended I eat low fiber foods and no fruit or veggies. As a result, I'm up six pounds. I am amazed by how fast my appetite returned. But then also they said, Hey, can you do a podcast on this on the, in the future, which was extremely nice. By the way, I just need to say, I'm so impressed with my patients because they actually care about everybody learning and it's not just them learning. So I, again, I'm always blown away. Okay, so you're trying to do those things, but look they said to her we don't want you having fruits and veggies So imagine that's usually most people veggies are a pretty big part of what you're doing you can be doing all the hydration and the protein and all those kind of things But you're still gonna struggle with less met around plus you're not able to get the fiber So I just want to bring up You're gonna do the best you can. You're going to do the best you can. I would try to really make sure that you're hitting hydration and protein. Those would be the two that I would really focus on. And it could even be as simple as number one,, that might also be a time when you're really going to need to start to implement some of these emotional eating urge techniques where you are allowing, The urges and cravings to pass this is really hard work that normally I suggest you're working on this all the time because then when these type of scenarios come up, you really have that muscle build up, but realize you're going to do the best you can. It's not going to be perfect. Okay, so everybody repeat after me. You're going to do the best you can. It's not going to be perfect. What you're going to do is you're going to get that procedure and then afterward, you're going to get back on it and you're going to get back on track. So within a month, okay. Within four weeks from the time when you stopped to the time when you weigh yourself again, those are the two points I want to look at. I don't care in between if the weight went up and then came back down. Does it have to be perfectly down at the two week mark after? No, but just give yourself a framework like, Hey, we're sitting this month out. It's kind of like when the holidays, are, Crashing tidal waves on us. Yes. We try our best. We realize, look, it's a day like no other, and I'll do one meal and not the whole day overeating. And you know, we go on and on. But if you've listened to my podcast long enough, maybe you say, Hey, if I have three birthdays that month plus three holidays, and I'm outta town two weeks and I'm this and I'm that, maybe that's not the time you push for weight loss. Right. So what I would say then is you get your colonoscopy and again, based on your doctor's recommendations, maybe you get right back on it afterward. Then the question becomes, how do you quote unquote, get back on track after that? And what I want to say is you need to create a ladder when you're getting back on track. So this is not just pertaining to after colonoscopy time. This is in general, when you feel like life has fallen apart, This is normal, by the way. This is going to happen in life. We're not robots. I really say that a lot. We're not robots in the sense that things are not perfect all the time. And we have to get out of perfectionism. Otherwise, we're always like, well, I blew it. It's over. So part of quote unquote getting back on track is what does the latter look like to you to get back to that? Typically, the things that I find help the most, we get back to number one, hydration. If that's happening, you At every meal and snack, can we get some protein and some fiber? Now it doesn't need to be the perfect, well, you know, 30 grams of protein and 25 grams of fiber per meal. If I'm a woman or 38, if I'm a man, it doesn't need to be that perfect to start out with. It's just, Hey, can I hydrate period? It's not that I'm perfect and can I get any protein and veggie at each meal? So when I say this ladder, usually I'm like the first, four or five days, we get back to looking if that's there, we get back to what I'm going to say is structured eating, meaning, hey, can I try to eat three times a day so that maybe at night I'm not wanting so many, you know, Snacks or that it's not the scenario where suddenly I'm wanting all the things in the house.'cause you know how this goes when you're like, I'm not hungry for breakfast, I'm fine. And then things kind of cascade on you throughout the day. So we get back to what's the ladder for what we can follow. I'm sorry for hearing construction in the back. I think I've told you guys that I'm getting a new home office, which is great, but there's a lot of work that's going into that. So you're going to focus on this ladder. What's the first thing I'm going to do? What am I going to do next? How am I going to know that I reach that next thing before I do the next thing up in the ladder? So I had a patient the other day, and whatever thing it was, we were writing out a ladder for them for, again, it's the same thing, how to get back on track, or how to sort of, what looks like kind of ramping things up for them. And my whole thing was, how do you know it's time to go to the next step in the ladder? So don't just, Make a plan for yourself. I need you to know, how do you actually know it's time to go to the next step in the plan? To kind of wrap this up, you are going to realize that this is part of normal life, that procedures are going to happen, that you're going to forget your med when you go on vacation, something's going to happen where there's going to be an interruption in the universe. You're going to realize that If, you're, you're not going to be scared by how quickly your hunger comes back because I want to tell you, remember, it is super hard to keep fat off. Remember that our body always wants to fight us, that's why it makes sense that these medications, the way I typically teach it, there's rare exceptions, but most people need these medications for life because the body's physiology wants to fight back. So it's very evident that second week when you're not on it, you suddenly say, wow, that's the level of hunger that I would have been dealing with. You would have slowly gained it back over time, but I'm not shocked by that, right? So there's that, there's inflammation. You don't have the typical support that you have. You're going to try to hold on the best you can. You're going to try to do the things that you can do that are allowed by the physician prior. And then afterward, you're going to ease yourself back in with simple, simple, simple steps. And you're going to allow that to be enough. You can always crank the intensity later. There is no need when you go from no medication support with that second week with a lot having washed out to right away back to every single thing in the universe. Give the medication time to kick back in. So for example, you're going to take it. It might take two three days for you to feel like you have anything around. It might only be week two or three after that when you're back on it where you feel like you're back to what we call quote unquote steady state where you're back to where the levels feel consistent from week to week, how you're feeling throughout the week. So you need to give yourself time. I can't stress this enough. Okay, that is all I wanted give today. Of course, again, I really need to stress in this episode, always listen to what your physician is saying. These are just some general thoughts that I've seen this be disruptive to patient's journey when they have a procedure. And then they really get in their head with, well, somehow this is really going to mess them up or that they're going to not be on track for a really long time after that's optional. Remember, this quote unquote getting back on track. I want to call that kind of the reintegration period. We've talked a lot about this when you come back from vacations, right? And we'll say, Hey, make sure that you have the foods in the house or there's like a food delivery that happens that night when you get home on the plane, right? That we want to make sure that things are ready to go for you when you get back that you have a plan of even if I've been. Eating differently, all vacation. When I get back, here's what I want to get back to. Here's the structured eating. Here's the food in the house. Here's what I want to do. Just make a plan for after. And then realize it is a bit of a roller coaster that usually the days leading up to the procedure because you don't have as much support and you don't need to feel like you're out of control. I'm doing something wrong. Oh my gosh. This is what it feels like for the disease to be untreated. And thank the Lord that we have a tool or that we're working towards strategies where every day doesn't feel like that. I want you to remember past you had to deal with that every single day. You did not have a minute of relief before, and now you have a reality where that's not a battle every single minute of every single day. I'm not saying you don't have times of struggle, right? Because we know this,, even if you're on the meds, it can still be a struggle at times and all these things, but Let it be just a really nice reminder of, wow, it is a different place when I'm on the meds. Because I do find, this is my last comment, I do find that people get to a place of, not complacency, but they don't appreciate anymore how heavy a lift these medications are helping them with, like how much medications are helping. And so oftentimes I find this is such a nice opportunity to just say, yeah, it really does a lot, and I'm gonna be grateful when I'm back on it, and I'm gonna make sure to not squander the opportunity and really be grateful for the help and do my part to make sure that I'm then getting the nutrition that I need. So I'm going to leave it with that. I'm sure I could share so many other things, but I think that this is good for today. I would love, love, love. If you are really enjoying this podcast, please leave me a review where you are listening. It means so much to me. It helps me. Other people that are really struggling to find the podcast. So please leave a review wherever you're listening, whether it's iTunes, Spotify, Audible, Pocket Cast, you name it. There's so many amazing places and I love to get your feedback and your hopefully five star reviews, but I love to hear what you have to say. All right. I hope you have an amazing rest of the week here and we'll talk soon.