Muscle Loss / Sarcopenia / Decreased Muscle Mass
Users on Reddit discuss muscle loss as a potential side effect of GLP-1 medications, often attributing it to rapid weight loss and insufficient protein intake or exercise rather than a direct effect of the drug itself. They recommend several strategies to mitigate or prevent this, primarily focusing on diet and exercise.
Experiences with Muscle Loss:
Another user on Trulicity, a competitive powerlifter, mentioned a "significant loss of strength," going from "benching 460 to barely hitting 315 in about 6 months. " However, they also noted this coincided with blood sugar issues, so the cause was multifactorial. [9]
A user on Ozempic for two years who lost 75 pounds stated, "I’m also noticeably weaker than before I lost the weight... I wish I’d known I’d lose that much or gotten counseling on what I should be doing to avoid loss of muscle mass. "[26]
Some users express concern about sarcopenia, especially in older adults. One comment highlighted, "Sarcopenia - when people lose weight, it's inevitable that some of it is muscle loss. The faster you lose it, the more of it comes from muscle. People on GLP-1s lose weight fast... I'm worried that there is a sub-population of de-conditioned, weaker older adults who become more frail and have greater risk of falls and fractures after GLP-1s. "[15]
It's often debated whether the muscle loss is directly due to the drug or a consequence of rapid weight loss and caloric deficit. One user commented, "I keep reading about muscle loss with GLP-1 Is this one of those correlation causation type things where the medication doesn't actually directly cause muscle loss, but losing 60 lb in 4 months because you're eating a 1200 calories a day does cause muscle loss? "[1] Another shared a similar sentiment: "I haven't seen any studies, however, it logically follows that muscle loss from GLP-1s is a side effect of overall weight loss. "[3]
Some research cited by users suggests that muscle loss with GLP-1 drugs might be higher than with calorie restriction alone. "Research suggests that muscle loss with GLP-1 receptor agonist drugs such as semaglutide (Ozempic) and liraglutide (Saxenda) can range from 25% to 39% of total weight lost over 36 to 72 weeks... By comparison, restricting calories typically results in losses of free-fat mass ranging from 10% to 30%. "[6]
However, other users report minimal muscle loss or even gains when combining medication with appropriate lifestyle changes. One user on Zepbound who incorporated resistance training and high protein intake shared DEXA scan results: "I have lost 40 lbs of fat and gained nearly 10 lbs of muscle. "[18]
Another user on semaglutide for 9 months stated, "I've lost 40 lbs and never been stronger. "[4]
Remedies and Preventions Recommended:
"Protein consumption is good but it’s useless without any form of resistance training. "[2]
"everyone absolutely needs to lift heavy weights, 2-4x per week. "[2]
"In a calorie deficit, your body has to gain the energy from somewhere. If you're not using your muscles, then your body will pull from muscle and fat, but if you resistance train you're telling your body that you're using that muscle and not to break it down for energy. "[2]
"All you need to add to this regimen is resistance training and you won’t loose much muscle mass. "[11]
"The key is while resistance training. A good number of people on these meds don’t do any exercise (cardio or weights) - and they’re the ones at risk for losing large amounts of muscle mass. "[18]
One user mentioned, "I resistance trained before and while on Zepbound if anything it's actually helped me build muscle faster since the glps have an anti inflammatory effect. "[18]
Adequate Protein Intake: Consuming enough protein is crucial.
"This is why GLP-1s need to be monitored and supported by trained dieticians. Someone to tell you to 'please remember to eat this much protein'"[7]
"I think this drives home the point that if you have adequate protein intake and perform resistance training, your losses will mostly be fat. "[18]
A user on Mounjaro who strength trains aims for "about 140g of protein per day. "[5]
Another user on Zepbound eats "about 2000-2200 calories a day, of which I try to reach 200g protein and 40g fiber. "[18]
Combining Diet and Exercise: A holistic approach is emphasized.
"The ability to maintain muscle mass during caloric restriction-induced weight reduction is influenced by two key factors: nutrition and physical exercise. Nutrition therapy should ensure adequate intake and absorption of high-quality protein and micronutrients... Additionally, concurrent physical activity, especially resistance training, has been shown to effectively minimize loss of muscle mass and function during weight reduction therapy. "[2]
"The medications can be a wonderful choice, but if you want lifelong success you absolutely need to also get your lifestyle habits in place. Additionally with GLP1s people tend to lose a lot of muscle if they are not actively working to maintain it—meaning adding consistent strength training and getting enough protein. "[22]
Monitoring Body Composition: Using tools like DEXA scans can help track muscle vs. fat loss. [2, 18]
Slower Weight Loss: Some suggest that very rapid weight loss contributes more to muscle loss. "One issue is that people are abusing GLP-1s to lose weight faster than is healthy and thus are losing more muscle than they would with traditional weight loss methods or if they used a GLP-1 to only lose 1-2 lbs per week. "[5]
Supplements: Some users mention supplements, though this is less common.
"I plan on taking one. I will take essential amino acid supplements & am excited to try it. "[25]
One user on Mounjaro incorporates "Thorne Greens & Fiber Supplements, Magnesium Bis-glycinate, Creatine, Pendulum Glucose Probiotic, Timeline Urolithin A, Berberine... Basic 2X Daily Vitamin, Vitamin D. "[10]
Carb Cycling and Alternate Day Fasting: One user suggested more complex dietary strategies: "you can either resistance train and have a very high protein diet. Or you can carb cycle while still maintaining your caloric deficit... The other alternative is alternate day fasting. "[2]
It's also noted that "muscle memory is a real biological process that means if you start resistance training, you’ll quickly regain the lost muscle much faster than it would take to build it from scratch. "[2]
Some users believe the concern about muscle loss is overstated if proper measures are taken. "I strongly believe if you use the opportunity to not only lose weight but make lifestyle changes and stick with them, GLP-1 products can add significant HealthSpan and Lifespan. "[10] A new study was shared suggesting "Minimal Lean Mass Lost During Weight Loss with GLP-1 and GIP Receptor Agonists" when participants received education on medication use, resistance training, and protein intake.
Experiences with Muscle Loss:
- Some users report experiencing muscle loss.
Remedies and Preventions Recommended:
- Resistance Training/Weight Lifting: This is the most frequently recommended strategy.
It's also noted that "muscle memory is a real biological process that means if you start resistance training, you’ll quickly regain the lost muscle much faster than it would take to build it from scratch. "[2]
Some users believe the concern about muscle loss is overstated if proper measures are taken. "I strongly believe if you use the opportunity to not only lose weight but make lifestyle changes and stick with them, GLP-1 products can add significant HealthSpan and Lifespan. "[10] A new study was shared suggesting "Minimal Lean Mass Lost During Weight Loss with GLP-1 and GIP Receptor Agonists" when participants received education on medication use, resistance training, and protein intake.