South Asian Metabolic Protocol
Early Architecture Repair for a High-Risk Phenotype
This protocol is designed for South Asian adults who carry the characteristic metabolic phenotype:
- Type 2 diabetes or "pre-diabetes" at relatively low body-mass index (BMI).
- Disproportionate visceral and liver fat ("thin outside, fat inside").
- High triglycerides and low HDL-cholesterol.
- Family histories of early diabetes, heart disease, or stroke.
- In women, polycystic ovary syndrome (PCOS) that clearly tracks with insulin resistance.
The goal is not cosmetic weight loss. It is early architecture repair—reshaping how the body stores fat, handles glucose, and produces energy—so that a high-risk phenotype behaves more like a lower-risk one under the same life load.
The Protocol Architecture
The protocol builds in tiers. Each tier depends on the one below it.
| Tier | Focus | Core Tools | When to Add |
|---|---|---|---|
| 0 | Lifestyle Scaffold | Nutrition, Sleep | Mandatory Foundation |
| 1 | Metabolic Reprogramming | Retatrutide + NAD⁺ | After Tier 0 established |
| 2 | Mitochondrial Support | MOTS-c | Once Tier 1 tolerated |
| 3 | Anabolic Protection | Tesamorelin | If high VAT + low muscle |
Tier 0: Lifestyle Scaffold
This tier is mandatory. Pharmacology sits on top of it. Without this scaffold, higher tiers will feel like pushing on a locked door.
Nutrition
- Carbohydrate Quality: Unrefined (lentils, chickpeas, whole grains) over white rice, refined flour, and sweets.
- Protein: 1.6–2.0 g/kg/day. Deliberate planning required for vegetarian diets.
- Timing: Evening meals lighter and earlier to reduce nocturnal glucose/TG load.
Activity
- Resistance Training: 2–3× weekly focused on large muscle groups.
- Zone-2 Cardio: 2–3× weekly (brisk walking, incline treadmill) to support fat oxidation.
Tier 1: Metabolic Reprogramming
Objective: Reduce caloric and glucose load into a system with limited β-cell reserve. Shrink hepatic and visceral fat. Ensure mobilized fat is fully oxidized.
| Compound | Dose | Frequency | Notes |
|---|---|---|---|
| Retatrutide | 1.0–4.0 mg | Weekly (SC) | Very slow escalation. Caution to avoid muscle loss. |
| NAD⁺ | 100–300 mg | 2–3× weekly (IM) | Or equivalent oral precursor. |
Why Retatrutide?
Triple agonism (GLP-1/GIP/glucagon) maps directly onto South Asian failure points: it reduces calorie load, shrinks hepatic fat, and maintains oxidative drive.
Tier 2: Mitochondrial Support
Objective: Raise mitochondrial capacity so that diet and Retatrutide-driven flux feel sustainable. Improve metabolic flexibility in a low-muscle phenotype.
| Compound | Dose | Protocol |
|---|---|---|
| MOTS-c | 5–10 mg | 2–3× weekly (SC). 4–6 weeks on, equal time off. |
MOTS-c acts as an exercise-mimetic bridge. It does not replace training, but makes training and daily life less punishing for a system already near its limit.
Tier 3: Anabolic Protection
Objective: Preferentially reduce visceral adipose tissue while supporting lean mass. Maintain functional strength while deep depots shrink.
| Compound | Dose | Monitoring |
|---|---|---|
| Tesamorelin | 0.5–2.0 mg | Nightly (SC). Monitor IGF-1. |
Tesamorelin is not a first-line tool for everyone. It becomes relevant when visceral fat is clearly elevated and muscle is limited.
Special Focus: PCOS
For South Asian women with PCOS, central adiposity, and NAFLD, this protocol is a cardiometabolic intervention, not just for fertility.
- Tier 1: Flattens extreme insulin/glucose swings driving ovarian dysfunction.
- Tier 2: Makes lower-carb/TRE patterns tolerable.
- Tier 3: Protects lean mass while selectively shrinking VAT.
Timeline & Expectations
Weeks 1–4
Establish Tier 0. Introduce Tier 1. Expect GI tolerance, appetite shift, and reduced snacking.
Weeks 5–12
Layer MOTS-c. Training volume increases. Early reductions in waist circumference and liver enzymes.
Weeks 12–24
Evaluate Tier 3. Emphasis shifts from scale weight to body composition (lower VAT, preserved muscle).
Safety & Monitoring
- Glycemia: Watch for hypoglycemia if on glucose-lowering meds.
- Liver: Monitor enzymes and imaging as interventions progress.
- Contraindications: Active malignancy, proliferative retinopathy, pregnancy, severe CVD.