Bathroom scale, measuring tape, and tirzepatide injection pen beside the headline "Why am I not losing weight on tirzepatide,"

Why Am I Not Losing Weight on Tirzepatide

You started tirzepatide expecting the scale to move, but weeks or even months later, you’re asking yourself: “Why am I not losing weight on tirzepatide?”

If that sounds familiar, you’re not alone. 

While tirzepatide has helped many people achieve significant weight loss, not everyone experiences the same results at the same pace. 

Some people lose weight quickly, while others see slower progress or hit frustrating plateaus along the way.

The good news is that a lack of weight loss doesn’t necessarily mean tirzepatide isn’t working. 

In many cases, there are specific factors that can slow progress, and identifying them can help you get back on track.

 

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Quick Answer: Why Am I Not Losing Weight on Tirzepatide?

If you’re not losing weight on tirzepatide, common reasons include being on a starting dose, consuming more calories than expected, not getting enough protein, lack of exercise, poor sleep, chronic stress, underlying hormonal imbalances, medication interactions, or experiencing a normal weight loss plateau. 

Some people may also need additional time or dosage adjustments before seeing meaningful results.

 

How Does Tirzepatide Help With Weight Loss?

Tirzepatide works by mimicking two naturally occurring hormones called GLP-1 and GIP. These hormones help regulate appetite, blood sugar levels, digestion, and energy balance.

As a result, tirzepatide can:

  • Reduce hunger
  • Increase feelings of fullness
  • Slow stomach emptying
  • Reduce food cravings
  • Improve blood sugar regulation
  • Help lower overall calorie intake

Because it targets multiple pathways involved in weight management, tirzepatide can be highly effective. However, it still works best when combined with healthy lifestyle habits.

 

How Effective Is Tirzepatide for Weight Loss?

Clinical studies have shown that tirzepatide can produce substantial weight loss when used consistently under medical supervision.

Many participants in clinical trials lost significant percentages of their body weight over time, with results continuing to improve over several months. Importantly, the greatest weight loss was typically not seen during the first few weeks but rather after sustained treatment.

This means that if your progress seems slow early on, it doesn’t necessarily indicate that tirzepatide is failing.

 

How Long Does Tirzepatide Take to Work?

One of the biggest reasons people become discouraged is expecting immediate results.

While some individuals notice appetite suppression within days of starting tirzepatide, meaningful weight loss often takes longer.

Typical Tirzepatide Weight Loss Timeline

Time on Tirzepatide What You May Notice
Weeks 1-4 Reduced appetite, fewer cravings, mild weight loss
Months 1-3 Consistent weight loss begins for many patients
Months 3-6 Continued fat loss and improved body composition
6-12 Months Significant weight reduction for many individuals
12+ Months Long-term weight management and maintenance

Everyone responds differently, so comparing your results to others can be misleading.

 

Signs Tirzepatide Is Working Even If the Scale Hasn’t Changed

Sometimes tirzepatide is working even when the number on the scale isn’t moving.

Common signs include:

  • Feeling full sooner during meals
  • Reduced food cravings
  • Less snacking between meals
  • Improved blood sugar levels
  • Looser-fitting clothing
  • Increased energy levels
  • Smaller waist measurements
  • Better control over eating habits

If you’re noticing these changes, progress may be occurring beneath the surface.

 

12 Reasons You May Not Be Losing Weight on Tirzepatide

Let’s look at some of the reasons you may not be losing weight on tirzepatide:

1. You’re Still on a Starting Dose

Most providers begin patients on a lower dose to reduce side effects and allow the body to adjust.

The starting dose often isn’t intended to produce maximum weight loss. Significant results frequently occur after dosage increases.

2. You’re Eating More Calories Than You Realize

Even with appetite suppression, calorie intake still matters.

Hidden calories often come from:

  • Restaurant meals
  • Sugary beverages
  • Specialty coffee drinks
  • Alcohol
  • Large portions
  • Frequent snacking

Many people unknowingly consume enough calories to prevent a meaningful deficit.

3. You’re Not Eating Enough Protein

Protein helps maintain muscle mass while losing weight and supports feelings of fullness.

Without enough protein, you may experience increased hunger, slower recovery from exercise, and reduced muscle preservation during weight loss.

4. You’re Not Strength Training

Exercise isn’t required for tirzepatide to work, but strength training can significantly improve results.

Building and maintaining muscle helps support metabolism and improve body composition.

5. You’re Losing Fat but Gaining Muscle

The scale doesn’t distinguish between fat and muscle.

If you’ve started exercising regularly, you may be gaining muscle while losing fat at the same time.

Pay attention to:

  • Body measurements
  • Clothing fit
  • Progress photos
  • Energy levels

These indicators often reveal progress that the scale misses.

6. You’re Not Sleeping Enough

Sleep affects nearly every hormone involved in appetite and weight management.

Poor sleep can:

  • Increase hunger
  • Increase cravings
  • Reduce energy levels
  • Make healthy choices harder

Even the best weight loss plan becomes more challenging when you’re chronically sleep deprived.

7. Stress Is Affecting Your Progress

Chronic stress can influence weight loss through hormonal changes and behavioral habits.

Stress often leads to:

  • Emotional eating
  • Increased cravings
  • Poor sleep
  • Reduced motivation to exercise

Managing stress may help improve overall results.

8. You Have an Underlying Hormonal Imbalance

Certain health conditions can make weight loss more difficult.

Examples include:

  • Hypothyroidism
  • Insulin resistance
  • PCOS
  • Menopause-related hormonal changes
  • Low testosterone

If you’ve been struggling with weight loss for years, underlying hormonal issues may be contributing.

9. Another Medication May Be Working Against You

Some medications are associated with weight gain or difficulty losing weight.

Examples may include certain:

  • Antidepressants
  • Steroids
  • Antipsychotics
  • Diabetes medications

Discuss any concerns with your healthcare provider before making medication changes.

10. You’ve Reached a Weight Loss Plateau

Plateaus are a normal part of nearly every successful weight loss journey.

As you lose weight, your body requires fewer calories. The calorie deficit that initially caused weight loss may no longer be large enough to continue producing the same results.

11. You’re Missing Doses

Consistency matters.

Missing doses can reduce appetite control and make it harder to maintain progress.

Taking tirzepatide as prescribed gives you the best opportunity for success.

12. Your Expectations May Be Unrealistic

Social media often highlights dramatic success stories, but weight loss doesn’t happen at the same rate for everyone.

Steady, sustainable progress is often more realistic than rapid transformations.

 

Why Am I Not Losing Weight on Tirzepatide Even Though I’m Eating Less?

This is one of the most common questions people ask.

Even if you’re eating less food overall, weight loss may still be affected by:

  • Hidden calories
  • Low physical activity
  • Hormonal issues
  • Fluid retention
  • Weight loss plateaus
  • Insufficient protein intake

In some cases, your body may also be adjusting to changes in calorie intake, causing temporary slowdowns.

 

Can Tirzepatide Stop Working?

Many people worry that tirzepatide has stopped working when weight loss slows.

In reality, true medication failure is relatively uncommon.

More often, the issue is related to:

  • A plateau
  • Lifestyle factors
  • Metabolic adaptation
  • Changes in activity levels
  • Inconsistent use

If appetite suppression has completely disappeared and weight loss has stopped for an extended period, it’s worth discussing your treatment plan with your provider.

 

What If Tirzepatide Isn’t Working at All?

If you’ve been taking tirzepatide consistently for several months and have experienced:

  • No appetite suppression
  • No reduction in cravings
  • No weight loss
  • No body composition changes

it may be time for further evaluation.

Potential explanations include:

  • Dosage issues
  • Medication storage issues
  • Underlying medical conditions
  • Hormonal imbalances
  • Individual differences in response

A healthcare provider can help determine whether changes to your treatment plan are appropriate.

 

Why Has My Weight Loss Stalled on Tirzepatide?

A weight loss stall happens when progress slows or stops despite ongoing treatment.

This can occur because:

  • Your metabolism has adapted
  • Your calorie needs have changed
  • Physical activity has decreased
  • Food intake has gradually increased

Stalls are common and do not necessarily mean you’re doing anything wrong.

 

How Long Do Tirzepatide Weight Loss Plateaus Last?

There is no universal timeline.

Some plateaus last a few weeks, while others may persist longer.

You may still be making progress during a plateau if:

  • Measurements are decreasing
  • Clothing fits differently
  • Energy levels are improving
  • Strength is increasing

Patience and consistency are often important during these periods.

 

How to Break a Weight Loss Plateau on Tirzepatide

If your weight loss has stalled, consider the following strategies.

Reevaluate Your Nutrition

Tracking food intake for a week can reveal hidden calories and portion increases.

Prioritize Protein

Protein supports muscle maintenance and satiety.

Add Resistance Training

Strength training can improve body composition and metabolic health.

Improve Sleep

Aim for seven to nine hours of quality sleep each night.

Reduce Stress

Managing stress can improve both physical and behavioral factors that influence weight loss.

Speak With Your Provider

Your provider may recommend adjustments to your overall treatment plan based on your progress.

 

When Should You Talk to a Healthcare Provider?

Consider scheduling an evaluation if:

  • You’ve been on tirzepatide for several months without results
  • Appetite suppression never occurred
  • Weight loss has stopped for an extended period
  • Side effects are affecting your quality of life
  • You suspect an underlying medical issue

A comprehensive assessment may uncover factors that aren’t immediately obvious.

 

How PRIME Medicine Can Help

At PRIME Medicine, we understand that successful weight loss involves more than simply prescribing medication. 

Factors such as hormones, metabolism, nutrition, sleep quality, exercise habits, and overall health all play a role in your results.

Our team develops personalized medical weight loss plans designed to identify obstacles that may be slowing progress and help patients achieve sustainable results. 

Whether you’re just beginning your weight loss journey or trying to overcome a plateau on tirzepatide, we work closely with you to create a strategy tailored to your individual needs.

 

CONTACT US

 

Final Thoughts: Why Am I Not Losing Weight on Tirzepatide 

If you’re wondering why you’re not losing weight on tirzepatide, the answer is often more complex than simply taking a medication and waiting for results.

Starting doses, calorie intake, sleep, stress, activity levels, hormonal health, and weight loss plateaus can all affect your progress. 

The key is identifying the factors that may be slowing you down and making targeted adjustments.

With patience, consistency, and the right medical guidance, many people who experience slow progress are able to restart weight loss and continue moving toward their long-term goals.

 

SCHEDULE A CONSULTATION

 

FAQs: Why Am I Not Losing Weight on Tirzepatide 

How to make tirzepatide work better?

To help tirzepatide work more effectively, focus on habits that support weight loss. Eating enough protein, staying physically active, strength training regularly, getting adequate sleep, managing stress, and taking the medication consistently can all improve results. Following your provider’s recommendations regarding dosage and lifestyle changes can also help maximize the benefits of treatment.

Is it normal to not lose weight some weeks on tirzepatide?

Yes, it’s normal to have weeks where the scale doesn’t move, even while taking tirzepatide. Weight loss is rarely linear, and factors such as water retention, hormonal fluctuations, muscle gain, and normal metabolic adaptation can temporarily slow progress. Looking at long-term trends rather than week-to-week changes provides a more accurate picture of your results.

How long does it take to lose 20 lbs on tirzepatide?

The timeline varies from person to person depending on factors such as starting weight, dosage, diet, activity level, and overall health. Some people may lose 20 pounds within a few months, while others may take longer. Sustainable weight loss is generally more important than rapid weight loss, as gradual progress is often easier to maintain long term.

How to break a stall on tirzepatide?

Breaking a weight loss stall often requires identifying factors that may be slowing progress. Tracking food intake, increasing protein consumption, incorporating strength training, improving sleep quality, managing stress, and staying consistent with treatment can all help. If the stall continues, speaking with your healthcare provider may help determine whether adjustments to your treatment plan are needed.

Do higher doses of tirzepatide increase weight loss?

Higher doses of tirzepatide are often associated with greater weight loss in clinical studies because they can provide stronger appetite suppression and metabolic effects. However, higher doses are not appropriate for everyone and should only be used under medical supervision. Providers typically increase doses gradually to help minimize side effects while optimizing results.

How long does it take for tirzepatide to work?

Many people notice reduced appetite and fewer cravings within the first few days or weeks of starting tirzepatide. Weight loss itself may take longer, especially during the initial dose-escalation phase. Most patients begin seeing more noticeable changes within the first few months of consistent treatment.

Does tirzepatide burn fat?

Tirzepatide does not directly burn fat in the same way exercise increases calorie expenditure. Instead, it helps create conditions that promote fat loss by reducing hunger, lowering calorie intake, improving blood sugar regulation, and helping people maintain a calorie deficit. Over time, this can lead to significant reductions in body fat when combined with healthy lifestyle habits.

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Does Tirzepatide Lower Blood Pressure?

Tirzepatide may lower blood pressure in some people, especially adults with obesity, excess weight, insulin resistance, or other metabolic health concerns.

Clinical research has shown that people taking tirzepatide experienced meaningful reductions in systolic blood pressure, which is the top number in a blood pressure reading.

But tirzepatide is not a replacement for blood pressure medication.

Blood pressure is affected by many factors, including weight, diet, stress, sleep, hydration, heart health, kidney function, medications, and genetics.

If your blood pressure improves while using tirzepatide, your provider may need to monitor your readings and decide whether any medication adjustments are appropriate.

PRIME Medicine takes a personalized approach to medical weight loss and metabolic health.

That means looking beyond the number on the scale and paying attention to markers like blood pressure, blood sugar, cholesterol, inflammation, and long-term cardiovascular risk.

 

SEE HOW TIRZEPATIDE CAN HELP YOU

 

Quick Answer: Does Tirzepatide Lower Blood Pressure?

Yes.

Tirzepatide may lower blood pressure in some adults, especially those with obesity, excess weight, or metabolic health concerns.

Research has shown average systolic blood pressure reductions of about 7.4 to 10.6 mm Hg after 36 weeks of treatment.

However, tirzepatide should not be used as a replacement for prescribed blood pressure medication unless a healthcare provider makes that change.

If you already take medication for high blood pressure, your readings should be monitored during treatment.

Question Short Answer
Does tirzepatide lower blood pressure? It may lower blood pressure in some people, especially when weight loss occurs.
How much can it lower blood pressure? Research has shown average systolic reductions of about 7.4 to 10.6 mm Hg after 36 weeks.
Is tirzepatide a blood pressure medication? No. It is not used as a stand-alone hypertension medication.
Can tirzepatide cause low blood pressure? It may contribute to low blood pressure in some patients, especially those on blood pressure medications or diuretics.
Should blood pressure be monitored? Yes. Home readings and provider follow-up are important during treatment.

 

Does Tirzepatide Lower Blood Pressure?

Yes, tirzepatide may help lower blood pressure in some patients.

The strongest evidence comes from one study that followed adults with obesity or overweight.

In a blood pressure substudy, tirzepatide was associated with lower 24-hour systolic blood pressure compared with placebo after 36 weeks of treatment.

This matters because systolic blood pressure is the top number in a blood pressure reading.

For example, in a reading of 130/80 mm Hg, 130 is the systolic pressure.

It reflects the pressure in your arteries when your heart contracts.

High systolic blood pressure is closely tied to cardiovascular risk, especially as people get older.

So when a treatment plan helps lower systolic blood pressure, it may support better cardiometabolic health.

That said, tirzepatide is not simply a “blood pressure medication.”

Its main effects are tied to appetite regulation, blood sugar response, insulin signaling, delayed gastric emptying, and weight loss.

Blood pressure improvement may happen as part of a broader metabolic shift.

 

Why Might Tirzepatide Lower Blood Pressure?

Tirzepatide may lower blood pressure largely because of weight loss and improved metabolic function.

Excess body weight can increase blood pressure by raising inflammation, affecting insulin resistance, increasing fluid retention, and placing more strain on the cardiovascular system.

When a person loses weight, the heart and blood vessels often do not have to work as hard.

This can lead to lower blood pressure over time.

Tirzepatide works by activating GIP and GLP-1 receptor pathways.

These pathways help regulate appetite, fullness, insulin response, blood sugar control, and digestion.

When appetite and cravings decrease, many patients are better able to reduce calorie intake and lose weight.

Weight loss appears to be a major reason blood pressure improves with tirzepatide.

However, researchers are still studying whether there may also be additional effects related to vascular function, insulin sensitivity, kidney function, or other metabolic changes.

The practical takeaway is simple: tirzepatide may help lower blood pressure as part of a broader improvement in metabolic health, but it should not be viewed as a stand-alone hypertension treatment.

 

Does Tirzepatide Lower Systolic and Diastolic Blood Pressure?

Tirzepatide appears to lower both systolic and diastolic blood pressure in some patients.

Systolic blood pressure is the top number.

It measures the pressure in your arteries when your heart beats.

Diastolic blood pressure is the bottom number.

It measures the pressure in your arteries when your heart rests between beats.

The most discussed finding from tirzepatide blood pressure research is the reduction in systolic blood pressure.

However, diastolic blood pressure may also improve in some patients, especially when weight loss and metabolic health improve.

For patients, this means tirzepatide may affect overall blood pressure patterns, not just one isolated number.

Still, home readings and in-office readings can vary.

A single low or high reading does not always tell the full story.

Trends over time are usually more helpful.

 

How Long Does It Take Tirzepatide to Lower Blood Pressure?

Blood pressure changes may happen gradually as weight loss and metabolic improvements occur.

In clinical research, meaningful blood pressure reductions were measured after 36 weeks of treatment.

Some people may notice blood pressure changes earlier, especially if they lose weight, reduce sodium intake, improve sleep, increase activity, or drink less alcohol.

Others may need several months before their readings change.

It is also possible for blood pressure to fluctuate during treatment.

For example, if you are eating less, drinking less fluid, or experiencing nausea, vomiting, or diarrhea, your blood pressure may temporarily drop because of dehydration or lower fluid volume.

That is why it is helpful to monitor blood pressure consistently, rather than judging progress from one reading.

 

Can Tirzepatide Cause Low Blood Pressure?

Tirzepatide may contribute to low blood pressure in some situations, especially if blood pressure is already being treated with medication or if a person becomes dehydrated.

Low blood pressure, also called hypotension, can cause symptoms such as dizziness, lightheadedness, feeling faint, weakness, blurry vision, fatigue, nausea, confusion, or fainting.

This does not mean everyone taking tirzepatide is at risk for low blood pressure.

But it does mean monitoring is important, especially for patients who already take blood pressure medications, diuretics, heart failure medications, or medications that affect fluid balance.

If your blood pressure drops too low during treatment, do not adjust medications on your own.

Contact your healthcare provider so they can review your readings, symptoms, hydration, weight loss rate, and medication list.

 

Who Should Be Extra Careful With Tirzepatide and Blood Pressure?

Some patients need closer blood pressure monitoring while taking tirzepatide.

This includes people who already take medication for high blood pressure, heart failure, kidney disease, or fluid retention.

You should also be cautious if you have a history of dizziness, fainting, dehydration, very low blood pressure, heart rhythm concerns, or rapid changes in weight.

Patients taking diuretics, also called water pills, may need extra monitoring because these medications affect fluid balance.

If tirzepatide reduces appetite or causes nausea, vomiting, or diarrhea, dehydration may become more likely.

Dehydration can make blood pressure drop too low.

This is one reason a personalized plan matters.

Your provider should know what medications you take, what symptoms you are experiencing, and how your blood pressure changes over time.

 

Can You Take Tirzepatide If You Have High Blood Pressure?

Many people who are interested in tirzepatide also have high blood pressure, insulin resistance, elevated cholesterol, prediabetes, type 2 diabetes, or other metabolic health concerns.

In many cases, high blood pressure and weight gain are connected.

Tirzepatide may be appropriate for some patients with high blood pressure, but it depends on the full medical picture.

A provider should review your blood pressure history, current medications, cardiovascular risk, kidney function, and overall health before recommending treatment.

It is especially important to tell your provider if you take ACE inhibitors, ARBs, beta blockers, calcium channel blockers, diuretics, heart failure medications, diabetes medications, or any other medications that affect blood pressure, hydration, or blood sugar.

When weight and metabolic markers improve, your medication needs may change.

But those changes should be guided by a clinician.

 

Should You Stop Blood Pressure Medication If Tirzepatide Lowers Your BP?

No.

Do not stop, reduce, or skip blood pressure medication just because your readings improve while taking tirzepatide.

Lower readings may mean your health plan is working, but stopping medication too quickly can cause blood pressure to rebound.

On the other hand, staying on the same medication dose after significant weight loss may cause blood pressure to run too low in some people.

The right approach is to track your readings and review them with your provider.

If your blood pressure consistently improves, your provider can decide whether your medication plan should stay the same or be adjusted.

This is one reason PRIME Medicine focuses on personalized follow-up.

A safe weight loss plan should include more than prescription support.

It should include monitoring, education, and adjustments based on how your body responds.

 

Tirzepatide, Heart Rate, and Cardiovascular Health

Blood pressure is not the only cardiovascular marker to watch.

Tirzepatide may also affect heart rate.

Some research has shown that average heart rate may increase slightly during tirzepatide treatment, even while blood pressure decreases.

A small increase in heart rate does not automatically mean something is wrong, but it is something your provider may want to monitor.

Patients with palpitations, dizziness, chest discomfort, shortness of breath, or a history of heart rhythm issues should talk with their provider before or during treatment.

Cardiovascular health is not based on one number.

Blood pressure, heart rate, cholesterol, blood sugar, waist circumference, sleep quality, inflammation, and fitness level all matter.

 

When to Call a Healthcare Provider

Call your provider if you experience frequent dizziness, fainting, weakness, blurry vision, confusion, racing heartbeat, or very low blood pressure readings.

You should also reach out if your blood pressure stays high despite weight loss or lifestyle changes.

Tirzepatide may support blood pressure improvement for some people, but it does not replace a full cardiovascular evaluation.

Seek urgent medical care if you have chest pain, trouble breathing, severe weakness, signs of stroke, or fainting that does not quickly resolve.

 

CONTACT US

 

Is Tirzepatide a Good Option for Metabolic Health?

Tirzepatide may be helpful for some patients who are dealing with weight gain, insulin resistance, blood sugar concerns, or weight-related cardiovascular risk factors.

Research suggests it can support significant weight loss and may improve blood pressure in some adults with obesity or excess weight.

But the best results usually come from a complete plan.

That may include nutrition changes, resistance training, better sleep, stress support, hydration, protein intake, and ongoing lab monitoring.

At PRIME Medicine in Corona Del Mar, treatment is personalized to the patient.

The goal is not just to lose weight.

The goal is to improve how the body functions, reduce long-term health risks, and help patients feel better with a plan that fits their needs.

 

SEE IF TIRZEPATIDE IS RIGHT FOR YOU

 

The Bottom Line

Tirzepatide may lower blood pressure, especially systolic blood pressure, in some adults with obesity or excess weight.

In clinical research, participants taking tirzepatide had average systolic blood pressure reductions of about 7.4 to 10.6 mm Hg after 36 weeks.

For many people, this improvement may be related to weight loss and better metabolic health.

But tirzepatide should not be used as a substitute for prescribed blood pressure medication unless a healthcare provider makes that change.

If you already take blood pressure medication, have heart disease, have kidney concerns, or experience dizziness while using tirzepatide, medical monitoring is important.

PRIME Medicine is located in Corona Del Mar and serves patients throughout Orange County, including Newport Beach, Irvine, Costa Mesa, Huntington Beach, and surrounding communities.

If you are considering tirzepatide and want to understand how it may affect your blood pressure, a personalized medical evaluation is the safest place to start.

 

SCHEDULE A CONSULTATION

 

FAQs

Does tirzepatide lower blood pressure?

Yes. Tirzepatide may lower blood pressure in some adults, especially when it leads to weight loss and improved metabolic health. It should not replace blood pressure medication unless a healthcare provider recommends that change.

Can tirzepatide cause low blood pressure?

Yes, it may contribute to low blood pressure in some situations. This is more likely if you take blood pressure medication, take diuretics, become dehydrated, or experience vomiting or diarrhea.

Can I take tirzepatide if I have high blood pressure?

Some patients with high blood pressure may be candidates for tirzepatide, but they should be medically monitored. Your provider should review your medications, blood pressure history, cardiovascular risk, and overall health.

Can I take tirzepatide with blood pressure medication?

Some people may take tirzepatide while using blood pressure medication, but this should be supervised by a healthcare provider. If blood pressure improves, medication adjustments may be needed.

Should I stop my blood pressure medication if tirzepatide lowers my blood pressure?

No. Do not stop or change blood pressure medication without medical guidance. Your provider can review your blood pressure readings and decide whether any changes are appropriate.

Is tirzepatide used to treat hypertension?

Tirzepatide is not a stand-alone hypertension treatment. It may help lower blood pressure as part of weight loss and metabolic improvement, but high blood pressure should still be managed with medical guidance.

What is a good tirzepatide diet plan?

A good tirzepatide diet plan usually focuses on lean protein, high-fiber vegetables, whole-food carbohydrates, healthy fats, and steady hydration. Because tirzepatide can reduce appetite, it is important to prioritize nutrient-dense meals instead of simply eating less. A provider can help personalize your plan based on your weight, blood pressure, blood sugar, digestion, and overall health goals.

Does tirzepatide burn fat?

Tirzepatide does not directly “burn fat” like a stimulant. It may help the body lose fat by reducing appetite, improving fullness, supporting blood sugar control, and making it easier to maintain a calorie deficit. Many people lose body fat during treatment, especially when tirzepatide is combined with protein-focused nutrition, resistance training, and healthy lifestyle habits.

Retatrutide and Alcohol: Can You Drink While Taking Retatrutide?

If you are using retatrutide or learning about it as part of a medically guided weight management plan, you may be wondering whether alcohol is still okay.

The short answer is that alcohol may not be off-limits for every person, but it can make retatrutide side effects more likely and may feel different than it did before.

Retatrutide acts on hormone pathways involved in appetite, digestion, blood sugar, and metabolism.

Alcohol also affects digestion, hydration, sleep, blood sugar, appetite, and decision-making around food.

When the two overlap, some people may notice stronger nausea, lower alcohol tolerance, worse hangovers, or less interest in drinking.

This does not mean everyone will react the same way.

It does mean alcohol is worth discussing with a medical provider, especially if you are increasing your dose, having side effects, drinking frequently, or managing blood sugar, liver, gallbladder, or digestive concerns.

 

SEE IF RETATRUTIDE IS RIGHT FOR YOU

 

Quick Answer: Is Alcohol Safe on Retatrutide?

Some people may tolerate an occasional drink while taking retatrutide, but alcohol should be approached carefully.

Alcohol can worsen nausea, reflux, dehydration, dizziness, blood sugar swings, and poor food tolerance.

It may also make weight loss harder by adding calories, disrupting sleep, and increasing the chance of late-night snacking.

The safest approach is to avoid heavy drinking and ask your provider what is appropriate for your health history, side effects, medications, and goals.

 

What Is Retatrutide?

Retatrutide is a triple hormone receptor agonist, meaning it acts on GIP, GLP-1, and glucagon receptors.

These pathways are involved in appetite signaling, food intake, blood sugar regulation, energy balance, and body weight.

In phase 2 clinical research, retatrutide was studied for obesity and produced significant weight reduction over 24 and 48 weeks.

Because retatrutide affects appetite and digestion, many of the most common side effects are gastrointestinal.

Nausea, vomiting, diarrhea, constipation, bloating, reflux, and reduced appetite may occur, especially during dose changes.

Published phase 2 research reported that the most common adverse events in retatrutide groups were gastrointestinal, dose-related, and mostly mild to moderate in severity.

That matters when talking about alcohol because alcohol can irritate the stomach, worsen dehydration, disrupt sleep, and make nausea more likely.

 

Can You Drink Alcohol While Taking Retatrutide?

Some people may be able to have an occasional drink while taking retatrutide, but alcohol is not something to ignore.

A single glass of wine with food may feel very different from multiple drinks on an empty stomach, especially if your appetite is reduced or you are still adjusting to treatment.

Alcohol may be more difficult to tolerate if you have nausea, vomiting, reflux, dehydration, dizziness, poor food intake, or blood sugar changes.

Your usual alcohol tolerance may also change if you are eating less, losing weight, or drinking less often than before.

You should be especially cautious if you have a history of pancreatitis, gallbladder disease, liver disease, diabetes, frequent low blood sugar, heavy alcohol use, or medications that should not be mixed with alcohol.

 

Retatrutide and Alcohol: Common Concerns

Alcohol Concern Why It May Matter on Retatrutide What to Consider
Nausea or vomiting Retatrutide can cause digestive side effects, and alcohol may irritate the stomach. Avoid alcohol if you are already nauseous or having trouble keeping food down.
Reflux or bloating Alcohol can worsen reflux and may feel worse when digestion is slower. Carbonated drinks, beer, and sugary cocktails may be harder to tolerate.
Dehydration Alcohol can increase fluid loss, and reduced appetite may mean you are drinking less water. Hydrate before and after drinking, and avoid alcohol if you are vomiting or having diarrhea.
Dizziness or low tolerance Eating less, losing weight, or drinking less often can make alcohol feel stronger. Do not assume your old tolerance still applies.
Blood sugar swings Alcohol can affect glucose regulation, especially with low food intake. Be cautious if you have diabetes, hypoglycemia risk, or symptoms like shakiness or confusion.
Weight loss slowdown Alcohol adds calories and can disrupt sleep, appetite control, and consistency. Frequent drinking can work against metabolic and weight management goals.

 

Why Alcohol May Feel Different on Retatrutide

Many people using GLP-1 or related metabolic therapies report that alcohol feels different.

Some say they lose interest in drinking.

Others say alcohol tastes worse, causes nausea faster, or leads to worse next-day symptoms.

There are a few possible reasons for this.

First, retatrutide may affect digestion and appetite.

If you eat less than usual, alcohol may feel stronger or more irritating.

Drinking on an empty stomach can increase the chance of dizziness, nausea, and poor coordination.

Second, changes in digestion can make the timing of alcohol’s effects feel less predictable.

You may not feel the same response at the same pace you used to.

 

Retatrutide and Alcohol Side Effects

Alcohol may make retatrutide-related side effects worse.

This is one of the main reasons many clinicians advise limiting or avoiding alcohol, especially early on or during dose changes.

Nausea and Vomiting

Nausea is one of the most common side effects associated with retatrutide and similar metabolic therapies.

Alcohol can irritate the stomach lining and may make nausea worse.

Drinking on an empty stomach can add to the problem.

If you are already dealing with nausea, reflux, or vomiting, alcohol is more likely to make you feel worse.

Reflux, Bloating, and Indigestion

Retatrutide can affect digestion and fullness.

Alcohol can relax the lower esophageal sphincter, irritate the stomach, and trigger reflux.

Together, that may lead to more burping, burning, bloating, fullness, or discomfort after drinking.

Carbonated alcoholic drinks may be especially uncomfortable for people who already feel bloated or overly full.

Dehydration and Headaches

Alcohol can contribute to dehydration.

Retatrutide-related nausea, vomiting, diarrhea, or reduced food and fluid intake can also increase the risk of dehydration.

When these overlap, headaches, dizziness, fatigue, dry mouth, and next-day “hangover” symptoms may feel worse.

Dizziness and Lower Tolerance

Some people feel that alcohol affects them faster while taking appetite-regulating medications.

This may be related to eating less, losing weight, drinking less often, or being more sensitive to dehydration.

This does not mean retatrutide automatically makes alcohol stronger for everyone.

It does mean your usual tolerance may not be a reliable guide.

Blood Sugar Swings

Alcohol can affect blood sugar regulation, especially when drinking without enough food.

For people with diabetes, insulin resistance, or medications that affect blood sugar, this is worth taking seriously.

Symptoms such as shakiness, sweating, confusion, dizziness, weakness, or faintness after drinking should not be ignored.

 

Can Alcohol Interfere With Weight Loss Results?

Alcohol can make weight loss harder, even if it does not directly “block” retatrutide.

Alcohol can affect results in several ways.

It adds extra calories without much fullness.

It can lower food inhibitions and increase snacking.

It may worsen sleep quality, reduce workout recovery, increase dehydration, and make it harder to stay consistent with protein, hydration, and meal timing.

For many people, the bigger issue is not one occasional drink.

It is the pattern around drinking: skipped meals, late-night eating, poor sleep, reduced movement the next day, and more cravings.

If your goal is fat loss, metabolic improvement, or better appetite control, frequent alcohol use can work against those goals.

 

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Does Retatrutide Reduce Alcohol Cravings?

Some people taking GLP-1 or related therapies report that they simply do not want alcohol as much.

They may drink less, stop before finishing a drink, or feel less interested in the reward of alcohol.

This is an active area of research.

One clinical trial found that low-dose semaglutide reduced alcohol craving and some drinking outcomes in adults with alcohol use disorder.

The researchers noted that larger clinical trials are needed to better understand the role of GLP-1 receptor agonists in alcohol-related conditions.

Retatrutide-specific human research on alcohol cravings is still limited.

The available animal research suggests retatrutide may alter alcohol-related internal cues, but animal findings should not be treated as direct proof of how people will respond.

The practical takeaway is this: if you notice less interest in alcohol while taking retatrutide, you are not alone.

But retatrutide should not be viewed as a treatment for alcohol use disorder.

If alcohol use feels hard to control, that deserves direct medical support.

 

Does Retatrutide Make You Drunk Faster?

There is not enough human evidence to say that retatrutide directly makes someone drunk faster.

However, some people may feel alcohol more strongly because of related factors.

You may feel more affected by alcohol if you are eating less than usual, drinking on an empty stomach, losing weight, dehydrated, drinking less often than before, or taking other medications that interact with alcohol.

Digestive side effects can also make alcohol harder to tolerate.

If you already feel nauseous, bloated, lightheaded, or overly full, drinking alcohol may make those symptoms worse.

Because tolerance can change, it is smart to avoid assuming that your previous drinking habits will feel the same.

 

Is Any Alcohol Better on Retatrutide?

No type of alcohol is truly risk-free while taking retatrutide.

That said, some choices may be easier to tolerate than others.

For example, a small serving of wine or a simple mixed drink with food may be easier on the stomach than sugary cocktails, heavy beer, or carbonated drinks.

Drinks high in sugar may also make blood sugar swings, cravings, or next-day fatigue worse for some people.

The bigger factor is usually not the type of alcohol.

It is the amount, timing, food intake, hydration, and your current side effects.

If your provider says occasional alcohol is reasonable for you, it may help to drink slowly, have alcohol with food, hydrate before and after, avoid drinking during dose increases, and stop drinking if you feel sick, dizzy, flushed, or unusually impaired.

You should also avoid driving if alcohol affects you differently than expected.

 

When Should You Avoid Alcohol Completely?

Alcohol may be a poor fit while taking retatrutide if you are already having side effects or have certain medical risks.

You should be especially cautious and speak with a provider if you have persistent nausea or vomiting, severe reflux, abdominal pain, a history of pancreatitis, gallbladder disease, liver disease, diabetes, low blood sugar episodes, frequent dehydration, a history of alcohol use disorder, alcohol withdrawal symptoms, or medications that should not be mixed with alcohol.

Alcohol should also be avoided if you cannot keep fluids down, feel faint, or are having significant digestive symptoms.

 

When to Seek Medical Help

Most mild nausea or indigestion after alcohol may improve with hydration, rest, and avoiding further alcohol.

But some symptoms need medical attention.

Seek medical help if you develop severe or persistent abdominal pain, repeated vomiting, signs of dehydration, fainting, confusion, yellowing of the skin or eyes, dark urine with abdominal pain, chest pain, shortness of breath, severe dizziness, severe weakness, or symptoms of alcohol withdrawal.

Severe abdominal pain that spreads to the back, especially with vomiting, should be taken seriously.

 

What to Ask Your Provider Before Drinking on Retatrutide

Before drinking alcohol while taking retatrutide, it is worth having a direct conversation with your clinician.

You do not need to guess or rely on social media anecdotes.

Helpful questions include:

  • Is alcohol safe for me based on my health history?
  • Should I avoid alcohol during dose increases?
  • Are my liver, kidney, blood sugar, or gallbladder markers a concern?
  • Could alcohol worsen my current side effects?
  • Do any of my medications interact with alcohol?
  • How much alcohol would be considered too much for my situation?
  • What symptoms should make me stop drinking or call the office?

This is where personalized care matters.

Two people may take the same medication and have very different alcohol tolerance, side effects, lab results, and risk factors.

 

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Retatrutide and Alcohol: The Bottom Line

Alcohol and retatrutide can be a difficult combination for some people.

Alcohol may worsen nausea, reflux, bloating, dehydration, dizziness, headaches, and blood sugar swings.

It may also interfere with weight loss progress by affecting calories, sleep, appetite, and consistency.

Early research on GLP-1-related therapies and alcohol cravings is promising, but retatrutide should not be treated as a solution for alcohol use disorder.

If you are using retatrutide or considering a medically guided metabolic health plan, talk with a qualified provider about alcohol, side effects, lab markers, and your personal risk factors.

Occasional alcohol may be reasonable for some people, but heavy drinking is not a good match for a plan focused on metabolic health, appetite regulation, and long-term weight management.

At PRIME Medicine in Corona Del Mar, care is centered around personalized health history, symptoms, lab testing, lifestyle, and long-term goals.

For patients throughout Orange County, alcohol tolerance, appetite changes, side effects, and metabolic health concerns are all important details to review as part of a thoughtful treatment plan.

 

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FAQs: Retatrutide and Alcohol

Can I drink alcohol while taking retatrutide?

Some people may be able to drink occasionally while taking retatrutide, but alcohol can increase the risk of nausea, reflux, vomiting, dehydration, dizziness, and poor food tolerance. It is best to ask your provider what is appropriate based on your health history, medications, goals, and current side effects.

What happens if you drink alcohol on retatrutide?

You may feel normal, or you may notice stronger side effects than expected. Some people report nausea, bloating, reflux, lower tolerance, worse hangovers, or less interest in alcohol. Alcohol can also make it harder to stay consistent with hydration, nutrition, sleep, and weight management goals.

Can retatrutide reduce alcohol cravings?

Some people report lower alcohol cravings while using medications that affect GLP-1-related pathways. Early research suggests this area is worth studying, but retatrutide-specific human evidence is limited. Retatrutide should not be treated as a stand-alone approach for alcohol cravings or alcohol use disorder.

Can alcohol make retatrutide nausea worse?

Yes, alcohol can make nausea worse. Retatrutide commonly affects the digestive system, and alcohol can irritate the stomach, worsen reflux, and increase dehydration. If you already feel nauseous, it is usually better to avoid alcohol.

Does alcohol affect retatrutide weight loss results?

Alcohol may interfere with weight loss progress indirectly. It adds calories, can disrupt sleep, may increase snacking, and can make it harder to stay consistent with meals, hydration, protein intake, and exercise. Occasional alcohol may have less impact than frequent or heavy drinking.

Is Tirzepatide a Peptide?

If you’ve been researching weight loss treatments, metabolic health, or peptide therapy, you’ve probably come across the question: Is tirzepatide a peptide?

The answer is yes.

Tirzepatide is a synthetic peptide medication made from a chain of amino acids that mimics naturally occurring hormones involved in appetite regulation, blood sugar control, and metabolism.

While tirzepatide is widely known for supporting weight loss and metabolic health, many people don’t realize that its effectiveness is directly related to its peptide structure.

Understanding what a peptide is and how tirzepatide works can help clarify why this medication has become such an important advancement in metabolic medicine.

In this guide, you’ll learn what peptides are, why tirzepatide is classified as a peptide, how it works in the body, and how it compares to other peptide therapies and weight loss medications.

 

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Is Tirzepatide a Peptide? The Short Answer

Yes, tirzepatide is a peptide.

Tirzepatide is a synthetic peptide composed of 39 amino acids.

It was specifically designed to mimic the actions of naturally occurring hormones that help regulate appetite, insulin secretion, blood sugar levels, and energy balance.

Because it is made from amino acids linked together by peptide bonds, tirzepatide meets the scientific definition of a peptide.

Its structure allows it to interact with specific receptors involved in metabolic health and weight regulation.

 

What Is Tirzepatide?

Tirzepatide is a medication that belongs to a class of drugs known as dual GIP and GLP-1 receptor agonists.

Unlike traditional GLP-1 medications that activate a single hormone pathway, tirzepatide works by targeting two important metabolic hormones:

  • Glucose-dependent insulinotropic polypeptide (GIP)
  • Glucagon-like peptide-1 (GLP-1)

These hormones play a role in:

  • Appetite control
  • Hunger signaling
  • Blood sugar regulation
  • Insulin production
  • Energy utilization
  • Metabolic function

By activating both pathways, tirzepatide helps support a more comprehensive metabolic response than medications that target GLP-1 receptors alone.

 

What Is a Peptide?

Peptides are short chains of amino acids linked together by peptide bonds.

Amino acids are often called the building blocks of proteins.

The primary difference between peptides and proteins is their size.

Peptides contain fewer amino acids, while proteins are generally larger and more complex.

Peptides naturally occur throughout the body and act as signaling molecules that help cells communicate with one another.

They regulate countless biological processes, including:

  • Metabolism
  • Growth
  • Tissue repair
  • Hormone production
  • Appetite regulation
  • Immune function

Many hormones are peptides, including:

  • Insulin
  • Glucagon
  • Oxytocin
  • GLP-1
  • Growth hormone-releasing hormones

Because peptides can target specific receptors and pathways, researchers frequently use them to develop therapies designed to support particular physiological functions.

 

Why Is Tirzepatide Considered a Peptide?

Tirzepatide is classified as a peptide because of both its structure and function.

Structurally, tirzepatide consists of a sequence of 39 amino acids connected through peptide bonds.

Functionally, it behaves like naturally occurring peptide hormones by interacting with receptors that regulate metabolism, appetite, and insulin secretion.

Unlike many traditional medications that are synthesized from small chemical compounds, peptide medications are designed to mimic biological messengers already found within the body.

This peptide-based design allows tirzepatide to communicate with specific receptors and trigger targeted metabolic responses.

 

How Tirzepatide Works in the Body

The effectiveness of tirzepatide comes from its ability to activate two hormone pathways involved in metabolic regulation.

GLP-1 Receptor Activity

GLP-1 is a hormone released by the digestive system after eating.

When GLP-1 receptors are activated, the body may:

  • Feel fuller sooner
  • Stay satisfied longer
  • Slow stomach emptying
  • Improve insulin secretion
  • Reduce appetite

These effects can help decrease calorie intake and support blood sugar management.

GIP Receptor Activity

Tirzepatide also activates receptors for glucose-dependent insulinotropic polypeptide, commonly known as GIP.

GIP plays a role in:

  • Glucose metabolism
  • Insulin release
  • Energy utilization
  • Nutrient processing

Researchers believe the addition of GIP activity may contribute to the enhanced metabolic effects seen with tirzepatide.

Why Dual Receptor Activation Matters

Most medications in this category activate only GLP-1 receptors.

Tirzepatide’s dual-action mechanism allows it to engage both GIP and GLP-1 receptors simultaneously.

This broader approach helps influence multiple pathways involved in hunger, satiety, insulin response, and overall metabolic function.

 

Is Tirzepatide a GLP-1 Peptide?

Not exactly.

Tirzepatide does activate GLP-1 receptors, but it is not considered a traditional GLP-1 receptor agonist because it also activates GIP receptors.

This distinction is important because tirzepatide works through two complementary hormone pathways instead of one.

For that reason, many experts classify tirzepatide as a dual GIP and GLP-1 receptor agonist rather than simply a GLP-1 medication.

 

Tirzepatide Peptide Structure Explained

One of the reasons tirzepatide has attracted so much attention is its sophisticated peptide design.

Scientists engineered tirzepatide to mimic naturally occurring incretin hormones while remaining active in the body for extended periods.

Its molecular structure includes modifications that help:

  • Increase stability
  • Extend half-life
  • Resist rapid breakdown
  • Support once-weekly administration
  • Maintain receptor activity between doses

Without these structural modifications, the peptide would be cleared from the body much more quickly and require significantly more frequent dosing.

This engineered design is one of the key reasons tirzepatide can provide sustained metabolic effects throughout the week.

 

Is Tirzepatide Considered Peptide Therapy?

Many patients searching for tirzepatide also wonder whether it falls under the category of peptide therapy.

Technically, the answer is yes.

Because tirzepatide is a peptide-based medication, many healthcare providers include it within broader discussions about peptide therapy.

However, peptide therapy is a broad term that can include many different compounds with different purposes.

Some peptide therapies focus on:

  • Recovery and healing
  • Growth hormone support
  • Muscle development
  • Hormone optimization
  • Anti-aging strategies

Tirzepatide is unique because it primarily focuses on metabolic health, appetite regulation, and weight management.

 

How Tirzepatide Differs From Other Peptides

Not all peptides work the same way.

Different peptides target different biological systems and produce different effects.

Although these compounds are all peptides, they are designed to influence very different biological processes.

 

Tirzepatide vs Semaglutide

Tirzepatide and semaglutide are often compared because both are peptide-based medications used to support weight management and metabolic health.

However, they work differently.

Tirzepatide

  • Activates both GIP and GLP-1 receptors
  • Targets two metabolic pathways
  • Supports appetite regulation and metabolic function
  • Classified as a dual receptor agonist

Semaglutide

  • Activates GLP-1 receptors only
  • Targets a single metabolic pathway
  • Supports appetite regulation and blood sugar control
  • Classified as a GLP-1 receptor agonist

Both medications are peptides, but tirzepatide’s dual-receptor activity makes its mechanism of action distinct.

 

Why Are Peptides Used for Weight Loss?

Many people searching for weight loss peptides are surprised to learn that hormones involved in hunger and metabolism are naturally occurring peptides.

Researchers often develop peptide-based medications because peptides can interact with highly specific receptors throughout the body.

In the case of tirzepatide, its peptide structure allows it to communicate directly with pathways involved in:

  • Appetite control
  • Satiety signaling
  • Insulin response
  • Glucose regulation
  • Energy metabolism

This targeted activity is one reason peptide-based therapies have become increasingly important in the field of metabolic medicine.

 

Benefits of Tirzepatide’s Peptide Structure

The peptide design of tirzepatide offers several unique advantages.

Targeted Receptor Activity

Peptides can be engineered to interact with specific receptors, allowing for highly targeted biological effects.

Biological Compatibility

Because peptides mimic naturally occurring hormones, they work alongside existing physiological pathways.

Longer Duration of Action

Structural modifications help tirzepatide remain active for extended periods, supporting convenient once-weekly dosing.

Dual Hormone Support

Its unique peptide structure allows it to activate both GIP and GLP-1 receptors simultaneously.

Metabolic Regulation

The combination of targeted receptor activity and prolonged action helps support appetite regulation and metabolic health.

 

Who May Be a Candidate for Tirzepatide?

Tirzepatide may be appropriate for adults seeking medical support for weight management or metabolic health concerns.

A healthcare provider can evaluate factors such as:

  • Current health status
  • Medical history
  • Weight loss goals
  • Existing medications
  • Metabolic conditions

The best treatment approach will depend on an individual’s specific health needs and goals.

 

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Final Thoughts: Is Tirzepatide a Peptide

So, is tirzepatide a peptide?

Yes.

Tirzepatide is a synthetic peptide composed of 39 amino acids that was engineered to mimic naturally occurring hormones involved in metabolism, appetite regulation, and blood sugar control.

Its peptide structure enables it to activate both GIP and GLP-1 receptors, making it different from traditional GLP-1 medications and many other peptide therapies.

Whether you’re researching peptide therapy for weight loss, or learning more about metabolic health, understanding that tirzepatide is a peptide helps explain how it works and why it has become such an important tool in modern metabolic medicine.

 

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FAQs: Is Tirzepatide a Peptide

Is tirzepatide considered a peptide?

Yes, tirzepatide is considered a peptide because it is made from a chain of 39 amino acids linked together by peptide bonds. Its structure allows it to mimic naturally occurring hormones involved in metabolism, appetite regulation, and blood sugar control.

What type of peptide is tirzepatide?

Tirzepatide is a synthetic peptide and a dual GIP and GLP-1 receptor agonist. It was engineered to activate two hormone pathways that help regulate hunger, insulin release, and metabolic function.

Is tirzepatide a GLP-1 peptide?

Tirzepatide acts on GLP-1 receptors, but it is not solely a GLP-1 peptide. Unlike traditional GLP-1 medications, tirzepatide also activates GIP receptors, giving it a dual-action mechanism.

Why is tirzepatide called a peptide?

Tirzepatide is called a peptide because it consists of amino acids connected by peptide bonds. This structure fits the scientific definition of a peptide and enables it to function similarly to naturally occurring peptide hormones.

How does tirzepatide help with weight loss?

Tirzepatide helps regulate appetite and feelings of fullness by activating GIP and GLP-1 receptors. These effects can help reduce calorie intake and support healthy weight management when combined with lifestyle changes.

What is the difference between tirzepatide and semaglutide?

Both tirzepatide and semaglutide are peptide-based medications, but tirzepatide activates both GIP and GLP-1 receptors, while semaglutide targets only GLP-1 receptors. This difference gives tirzepatide a unique mechanism of action.

Are all weight loss peptides the same?

No. Weight loss peptides can work through different pathways in the body. Some target appetite regulation and metabolism, while others focus on growth hormone production, recovery, or body composition. Tirzepatide specifically targets GIP and GLP-1 receptors to support metabolic health and weight management.

Can tirzepatide be used for metabolic health?

Yes, tirzepatide was designed to support metabolic health by helping regulate blood sugar levels, insulin response, appetite, and energy balance. A healthcare provider can determine whether it may be appropriate based on an individual’s health goals and medical history.