Who This Is For

First-time peptide users who want:

Clear structure with minimal complexity
Predictable weight loss without energy collapse
A foundation for more advanced protocols later

In comparison to GLP-1 monotheraphy, the goal is not aggressive weight loss at the expense of overall health. It is metabolic recalibration—restoring the body's ability to burn stored fuel without the fatigue, cravings, and rebounds—and physical withering that accompanies GLP-1 monotheraphy.

Why These Two Together

Retatrutide creates the conditions for fat loss through three receptor pathways:

GLP-1 quiets appetite and slows gastric emptying
GIP improves insulin sensitivity and nutrient partitioning
Glucagon maintains hepatic oxidation and prevents the metabolic slowdown typical of caloric restriction

The result is a deficit that feels natural rather than forced. Hunger quiets. Metabolic rate holds.

But mobilized fat still needs to be burned. That's where NAD+ becomes essential.

In a deficit, cells lean heavily on β-oxidation—the pathway that converts fat to ATP. This pathway is NAD+-hungry. When NAD+ runs short, fat is mobilized but not efficiently converted to energy. Fatigue sets in. Cravings return. Progress stalls.

Maintaining NAD+ keeps the fat-burn → ATP chain moving. Energy stays stable while the deficit does its work.

Dosing Protocol

Retatrutide
Dose	0.5–4 mg weekly
Frequency	Weekly or q3d
Route	SubQ
Note	Allow 4+ weeks before increasing

NAD+
Dose	100–200 mg
Frequency	5x per week or EOD
Timing	Morning
Route	IM or SubQ
Note	Inject slowly

Weekly Schedule (Example)

Compound	MON	TUE	WED	THU	FRI	SAT	SUN
Retatrutide	—	—	1–4 mg	—	—	—	—
NAD+	100–200 mg	100–200 mg	100–200 mg	100–200 mg	100–200 mg	Rest	Rest

Adjust to your chosen Retatrutide frequency. Consistency matters more than the specific schedule.

Timeline: What to Expect

Weeks 1–4

Weeks 1-4
Adaptation	Appetite suppression begins within 48–72 hours
Early signals	Reduced snacking, flatter glucose curves, 2–4 lb loss (some water/glycogen)
Side effects	Mild nausea possible; smaller protein-first meals help
Energy	May fluctuate initially; NAD+ smooths this out

Weeks 5–8

Weeks 5-8
Steady progress	Fat loss stabilizes at 1–2 lb/week
Appetite	Becomes mechanical rather than emotional
Energy	Often better than baseline with consistent NAD+
Challenge	May need reminders to eat enough protein

Weeks 9–12

Weeks 9-12
Consolidation	Scale progress may slow; body composition keeps improving
Measurements	Waist circumference drops, clothes fit differently
Metabolic state	Hunger control effortless, energy stable
Decision point	Continue, maintain, or advance to Intermediate

Lifestyle Foundation

This protocol works on top of, not instead of, basic metabolic hygiene.

Component	Target
Protein	1.0 g/lb body weight daily
Training	2–4 resistance sessions/week
Movement	Walking on non-lift days (7–10k steps)
Cardio	Zone 2 (conversational pace) while adapting
Sleep	7–9 hours; NAD+ often improves sleep architecture via calmer glucose dynamics
Hydration	3+ liters daily; Retatrutide can blunt thirst signals

When Progress Stalls

Step	Action
1	Re-check protein, steps, and hydration. Ensure you're not under-eating to the point of rebound cravings.
2	If nausea is minimal and you've held 4+ weeks at current level, raise Retatrutide by +0.5 mg/week.
3	Move NAD+ to 200 mg per dose or add one additional NAD+ day.
4	Keep new settings for 4+ weeks before any further changes.

Managing Side Effects

Issue	Primary Mitigation	Secondary Options
Nausea	Hold dose; smaller protein-first meals	Ginger tea; move injection away from largest meal
Constipation	Fiber + fluids	Magnesium citrate at bedtime
Headache	Hydration	Add electrolytes
NAD+ injection sting	Buffered NAD+, slower push	Split volume; IM instead of SC
Fatigue	Increase NAD+ to 200 mg or add extra day	Check protein and sleep

Monitoring

Timepoint	What to Track
Baseline	Fasting glucose, fasting insulin, HbA1c, lipid panel, blood pressure
Weekly	Weight (same conditions), waist measurement, energy (1–10), hunger (1–10)
Bi-weekly	Progress photos (front/side/back), clothing fit
Week 8–12	Repeat baseline labs; expect improved glucose, TG/HDL ratio, blood pressure

What Comes Next

After 12 weeks, two paths:

Maintenance: Reduce Retatrutide to 1–2 mg/week. NAD+ at 100 mg on training or high-stress days. Continue lifestyle foundation.

Progress to Intermediate: Add L-Carnitine and MOTS-c to increase fat oxidation capacity and preserve lean mass during deeper recomposition.

Contraindications

Personal or family history of medullary thyroid carcinoma or MEN2 syndrome
Active pancreatitis
Pregnancy or breastfeeding
Severe GI motility disorders

Discuss with a physician if you have a history of gallbladder disease, diabetic retinopathy, or are on glucose-lowering medications that may need adjustment.

References

Jastreboff AM, et al. Triple-hormone-receptor agonist retatrutide for obesity. New England Journal of Medicine 2023. https://doi.org/10.1056/NEJMoa2301972
Yoshino J, et al. NAD+ Intermediates: The Biology and Therapeutic Potential. Cell Metabolism 2021. https://doi.org/10.1016/j.cmet.2020.11.007
Covarrubias AJ, et al. Senescent cells promote tissue NAD+ decline during ageing via the activation of CD38+ macrophages. Nature Metabolism 2020. https://www.nature.com/articles/s42255-020-00305-3