The GLP-1 Exit Strategy: Preventing Regain When You Stop Medication

Thinking about stopping your GLP-1 medication and wondering what that means for your progress? Whether it’s affordability, pregnancy planning, or personal choice, stepping away from a medication that’s helped you feel in control can bring up a lot of anxiety. What if the cravings come back stronger than ever? What if all your hard-earned progress starts to slip?

In this episode, I answer a heartfelt listener question about coming off a GLP-1. We unpack what to expect physically and emotionally, how to taper without shocking your system, and why added support—nutritional, medical, and emotional—is non-negotiable during this phase.

Tune in to learn how to step down strategically (rather than go cold turkey), what nutrition shifts can help ease the transition, and how to manage that all-too-familiar surge of insatiable hunger. You’ll walk away with three core strategies to minimize rebound effects, tools to reshape your food and movement routines, and a grounded approach to protecting your progress.

Audio Stamps

00:30 - Dr. Rentea addresses a listener question about discontinuing GLP-1 medication and explores various reasons people might want to stop.

01:40 - The importance of gradual dose reduction to prevent sudden, intense hunger increases.

02:45 - Reintroducing volume-based eating techniques when food no longer stays in your stomach as long.

03:27 - The physiological changes that occur when stopping GLP-1s and why lifestyle factors become even more crucial.

05:46 - Overview of alternative medication options like generic Contrave that can help bridge the transition, though they're less effective than GLP-1s.

07:05 - Dr. Rentea shares the common pattern of patients who stop medication abruptly returning months later after regaining weight.

08:48 - Despite our desire to be the exception, most people struggle to maintain weight loss long-term without adequate support.

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

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Transcript

0:29

Welcome back to another episode of the podcast. I recently got a fan mail question here that really broke my heart because someone was saying, look, I'm gonna have to come off of a GLP one. It was for affordability reasons, and they were basically saying, Hey, what's the best strategy for this? And remember, nothing on this podcast is medical advice, but I do think that we do need to have our eyes open and realize that affordability and access, these are. Factors that will play a role in if someone will be able to remain on a medication? So let's talk about if you have to come off of it. And there are many reasons, right? So for example, a very common one that I encounter, a lot of women will come work with me prior to attempting pregnancy, and they will work with me for that preconception. Really working on their optimal health so that they know that they will handle a pregnancy better and the health of their future baby will be better as well. So they might work with me for a year or two, or sometimes even six months. It depends on where they're at in their biologic timeline and how much time we have. And they might work on first optimizing their weight and then they say, okay, and now I'm ready to try to get pregnant. So. The recommendation would be that they're not on the medication. Now, I typically don't say, okay, we're gonna stop the max amount that you were on right now, and then, next week you don't take anything. I find it ends a lot better that there's not this rapid regain. If we can each week, slowly go down on the dose and what this is going to allow, as you're slowly decreasing the dose. You will at that same time that you're doing that. Number one, it will not panic your brain because you won't have sudden increased hunger. It will be gradual. You'll notice, you know what it wasn't as easy to say no to that urge or craving, I was more hungry for lunch before I could eat half of that and be okay, and now I notice I need the whole thing. Things like that. But you're not gonna have this overnight insatiable hunger. I don't know if any of you have ever experienced this, but it is. Truly otherworldly. When you can't quench your hunger. It's very much so not a fun feeling to have, and I'm talking like physical hunger that cannot be quenched. I'm not talking about emotional hunger, where you want different things and so when we're going down, slowly less of that is going to occur because you are going to, at the same time, step number two, you are going to increase volume-based eating. Remember all those little diet tips, tricks, hacks, where you had the biggest amount of food for the lowest calories, and can you believe that all of this is, you know, only 200 calories you're gonna have to bring back in some of those tricks. You might need to make the big cucumber salad. You might need to make sure that everything has a low calorie veggie base to it. You might need to really figure out how can everything, some of the techniques that we use anyway really have a good amount of protein but you that there's an aspect of volume-based eating that's likely gonna have to reenter the equation because food's not gonna be sticking around as long in your stomach anymore. When we are getting rid of this metabolic help, we're getting rid of. A lot of the physiologic help. Now, insulin resistance is coming back into play. Remember, GLP ones were helping you with insulin sensitivity, so you don't have that around. Your blood sugars are more wonky. You are more hungry. You have to imagine you're gonna have to solve for all of that. And there's a level to which you can do that, right? So you're okay, you're increasing volume-based eating, things like that. But here's the other part. You also need all the other areas of life really in check. Meaning that you are not undersleep, that you're getting all the sleep you need. You're not overworking, you're not overstressed. You just need this bandwidth to be able to give a lot of energy to what is happening with your health and. This level of focus is usually not sustainable long term, and I'm talking about people that have struggled with this for decades. I'm not talking about the person where for six months they put on some weight with something and then they use a GLP one and now you know, oh, and I was fine. Then off it's like, yeah, you never really had a weight struggle to begin with. It didn't ever really enter the land of. Severe metabolic derangement where your blood sugars were off and cholesterol and all these other things. For tho the people that never really struggled long term, they're in a different metabolic land compared to other people when their weight set point potentially has been very elevated for a long period of time. It's like the thermostat's broken, right? Okay. So let's say that you have to come off of it because. You, there's an affordability issue or you're, trying to get pregnant, things like that. So again, down, try titrating, nice and slow. Weekly would be one of the first things that I would typically work on with a patient. Number two, returning back to volume-based eating. And that's completely different than what you were doing when you were on a GLP one. So this is gonna take time for you to mentally calibrate again and physically in your home and all those kind of things, what you're doing. The third aspect is that, again, you're really gonna need to look at, am I really staying on top of the exercise, the movement that I'm doing? I'm not just talking about strength training. You're also really gonna need to make sure, is it running, is it steps that you're doing? Is it swimming? How are you getting in your movement? You can't afford not to do these things anymore because again, you don't have the resources anymore that are going to help with any of that error. Like it's, you don't have the support The thing that I think is the most helpful in an ideal world, if you have to come off of one thing, is there something else that you could go on that could bridge you in the, either in the meantime or in the long run? And these things will not ever be as powerful as the GLP ones. Okay? So this is the fallacy. I'll give you an example. I have someone in the clinic that due to cost reasons, doesn't wanna be on a GLP one long term, by the way, I completely respect this. This is valid. Okay. So not wanting to do that, I said, okay, great. One of the options that we could do is to use something like generic contrave, which is Wellbutrin, naltrexone, and that will help with urges and cravings and potentially hunger, you know, things like that. But it's not as strong a tool as a GLP one. So the reason I say this is it will definitely be more helpful than going from a GLP one to cold Turkey. But it doesn't mean that you are going to feel as much support as you did on a GLP one. We have to manage expectations. So for that person, I would still do a slower down titration. While I'm starting the generic contrave and upping that dose over, one to three months, whatever the titration looks like, based on how that person's tolerating it. So again, cross titration as one goes down, the other one goes up, that's a cross titration. And so they then have a tool to support them. Or are there other medications that you can do? But the point is that there needs to be a strategy in place and it's not just, I yank the med and we just see what happens because I will tell you. 99.99999% of the time, people really think they can do it. They're confident about it. They just suddenly fall outta your world. And then they come back six to nine to 12 months later and they say, yeah, I thought I could do it. Then I started to regain. Here I am. Okay. I know you told me to go down solely or to do this, to do that. I didn't listen to you.'cause I thought, you know what? I don't wanna have to renew it one more time. Whatever the case was, they thought, ah, forget what she's saying. She doesn't know what she's talking about. And then they realize, okay, I need to do it in a different way. I really think that you should listen to an expert where we do this all day long because we know how to titrate you onto different medication or if it's gonna be off. How to do it in a way where it doesn't shock your system too much. It's not that it can't be done, I get it. There's some people that say, well, why would I wanna be on that for life? Well, again, I don't think that you're someone that ever really struggled with this. If you don't understand the impact of actually being able to treat something, we're not curing it, but we are helping with the treatment and making it be more accessible for you to do these lifestyle things. This is just like a whole philosophy. Difference on this, and I feel like we don't even need to get all that into it. But those are the things that I would say to really look out for is that you're not necessarily doing it cold Turkey if you can afford to titrate down on it. If you have guidance on that and that. When you're doing that nutritionally, you return back to volume-based eating because before volume was an issue and you really had to work on how to get in the protein and the fiber with a reduced volume. And then that you're really looking at, okay, are these other factors controlled? Am I making sure to still get my sleep? My movement is my stress controlled, all of that. So you're really staying on top of all of that. And usually I see people, maybe you can hold on for 1, 2, 3 years, but typically five years is the. Amount of time where I will see the damn break. This is just where I say like, I've just done this too long to just kind of know the pattern. And it's not that I'm wishing ill on people, in fact, it's really the opposite. I'm so hopeful when, when patients leave the clinic and I think amazing, okay, we're transitioning to your primary care doctor and, I'm really wishing the best, but if the plan isn't solid, I already, in my mind, I know that it's not gonna work out I can predict. Rather accurately who's gonna make it and who's not. And it's because the plan isn't sound, what they're going to. And so it's just like the longer you do it, it's frustrating because I think. We all have this side of us that doesn't wanna listen to science and the data and the numbers, and we, we wanna say, well, I can be the exception because you do see the person out there. I mean, I can literally name who these influencers are, where they have been the exception like they have been. The person that 15, 20 years ago lost the weight has kept it off all this time, and who knows why they're successful and not other people. But it's not the norm. It's not typical. And when we're just looking at thousands and hundreds of thousands of people in data sets, I feel like I trust that more than a one-off outlier. Yet we are very emotional as people, and we wanna say, well, if she could do what? I can do it. And why not me? And by the way, I'm all about a positive mindset. I'm all about this. But we also need to live within the realm of reality. I say we always stay within the four walls of reality. We don't plan things that we, we know we're gonna fail. We're setting ourselves up for it. So in this scenario, if you have to come up for different reasons, are there other medications that you can go to? Can you go down slower as you adjust other things? Can you, look to get additional support in other areas? I'm serious when I say this, so if you're gonna get rid of the medication, maybe you decide, okay, but I'm gonna. Get help and X, Y, Z area at work. So that work is not as stressful because I know that it's gonna be an increased burden on me. I only have so much energy and so much capacity and so much conscious control that if I need to make so many decisions in this other area, I'm not gonna be able to have it happen over here. So I'm gonna see, can I get more support over here? Where am I gonna bring in more support? Because we are removing a support. Be very clear about that. We are removing a massive support to you. So where else are you gonna? Remove some of the work that you've had to do so that you have the energy to bring it over here. Alright, I hope that this episode was helpful. If you have questions, again, make sure that you always leave it in the um, fan mail down below. You can submit it anonymously. If you ever do wanna hear back from us, make sure that you give us your email, something. We need to be able to reach out to you. Otherwise, we just get a random message. Remember, it's not something where we can just hit reply and get back to you. The whole point is that you could submit stuff anonymously. Hopefully this episode was helpful. I always feel like it's a little bit depressing when I do these episodes because I feel like think people don't want a world where they're on medication. I, I really, I really get that. But we need to think about what is the benefit versus the risk. If the benefit to treating. Means that you are very healthy and you get to move on with your life. That's very different than potentially the risk of cancers, developing blood sugar problems, blood pressure, cholesterol, all other things from insulin resistance, stuff like that. That is a heart disease. Oh my lord, I can't believe I almost forgot to say that those consequences are steep. Compared to potentially you being on a medication and getting help. Alright, I'm gonna leave it there. I hope you have a great rest of the week and we'll talk soon.