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The familial form of ALS is due to gain of functional mutation in the gene encoding Cu/Zn superoxide dismutase1 (SOD1) an antioxidant enzyme (Rosen et al., 1993)

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Months 1-2 (Initial Titration): Maintain weights from before starting medication Focus on consistent training despite side effects Priority is showing up, not pushing intensity If you miss workouts due to nausea, dont compensate by training harder Months 3-6 (Adaptation Phase): Attempt modest strength increases (2.5-5 pounds on upper body, 5-10 pounds on lower body every 3-4 weeks) If strength stalls, thats acceptable maintenance is success Increase reps before increasing weight (if you can do 12 reps with good form, add weight) Months 7-11 (Maintenance Phase): Continue training at maintained strength levels Accept that weight loss velocity is slowing Focus shifts to body composition refinement Consider adding 1 additional set per exercise if recovery permits MY UNCONVENTIONAL RECOMMENDATION I actually tell patients to stop tracking their one-rep maxes during Retatrutide treatment