Introduction to Muscle Preservation on GLP-1s

Philip Pape 0:01

If you're one of the millions of people using weight loss drugs or thinking about them , you've probably heard about the impressive results on the scale or are experiencing them yourself . But you've also heard that there's a chance for massive muscle loss without the right lifestyle in place . So today I'm going to share with you some practical strategies to preserve muscle while maximizing fat loss on these medications , including how to adjust your nutrition , training and lifestyle , and then , if you choose to , you can maintain those results after you stop . Welcome to Wits and Weights , the show that helps you build a strong , healthy physique using evidence , engineering and efficiency . I'm your host , philip Pape , and today we are talking about how to optimize your lifestyle , nutrition and training when using GLP-1 medications . And this is both if you are considering them or you're currently on them , and , if you're on them , whether you want to continue using them or come off of them . So I'm very open-minded to all the different scenarios here , and this is not at all going to be a judgment on the medications or your choice to use them , but rather how to make the best use of your lifestyle in the process . I want to start by thanking Michael Kay . He's a fellow coach who we've been chatting for a while now . I actually did another episode in response to his sending me a question a while back , but today he sent me an email that helped inspire this episode . Or I should say he sent me the email a while back , working with clients on these medications , which very much reflect what I have seen as well , and he said quote we have a great opportunity to shed light on this subject and keep our clients safe and well informed . And , quote he emphasized the importance of the various lifestyle changes that must be made alongside these medications , and we are going to refer to some research as well . All of this perfectly aligns with what the evidence tells us and is also counter to some of the fear mongering like hey , you're just going to lose a ton of muscle , so why go on these meds ? When the reality is you will lose a ton of muscle when you crash diet , whether or not you are on the meds , and so the principles of how to counteract that are going to be the same .

Philip Pape 2:25

Now , before we get into it , if you are looking for personalized guidance on your approach , whether you are considering GLP-1s or currently using them or you're transitioning off , I've worked with all of these scenarios . We have folks in our Physique University and one-on-one clients who are in these various scenarios and what I do is I offer these free calls . They're called rapid nutrition assessments and it's a 15 minute fast paced call where we identify what is your biggest challenge right now , why ? Why are you reaching out for help , and can we come up with two or three specific plans to address it . That's it . No sales pitch , it's just some advice . I'm playing more of those on the podcast . In fact , we're going to have one of those calls coming up soon that I did with Sam . She was a more advanced person , experienced with nutrition and training , wondering if she should build , maintain or lose fat . So you're going to hear that soon . But if you want your own version of that and you want to talk to me on a Zoom call and just get some clarity , click the link in the show notes to schedule that , or go to my website , witsandweightscom , and click the big button for the rapid nutrition assessment , and that could be pretty much just what you're looking for to optimize your approach if you feel like you're stuck .

Understanding GLP-1 Medications and Body Composition

Philip Pape 3:34

So I want to talk about the medications , their impact on body composition , first , and then we'll set the stage for what's to come . So we're talking about GLP-1 receptor agonists like semaglutide , which is Ozempic , or Wagovi , or terzepatide , which is Manjaro , and of course , this class of drugs continues to expand and get more potent , and they work mainly by reducing appetite . The way they do that is a little complicated , but effectively they can slow your gastric emptying , they can increase your feelings of fullness , and then they act on brain centers that control hunger , and that's critical , because we know how important brain related genetics are to hunger and appetite and is why so many people struggle with overeating , even when they know that that's the issue , and it's difficult to overcome , and that's often why some people are prescribed these meds . If you then are able to control those mechanisms , you then can have significant calorie reduction without the willpower struggle that many dieters experience , and that is why the results are so impressive . Across the board . We see clinical trials showing average weight losses of 15 to 20% of total body weight in about 68 to 72 weeks . So it's fairly aggressive and way more effective than previous weight loss medications and , like bariatric surgery outcomes , things like that and the numbers are even higher for some of the more advanced , like terzapatide , is higher than semaglutide , and there are new classes of drugs as well , and it's effectively like doing a very rapid or aggressive diet on your own , but people tend to be able to stick with it and see it through because of the reduction in hunger and so on .

Philip Pape 5:14

Now , what's important to understand about body composition ? Okay , there was a step one trial for semaglutide where researchers found that 40% of the weight lost was lean tissue . Right , lean tissue includes is your lean mass and includes muscle . It technically includes bone and water as well , but the vast majority of this is what we're talking about is muscle tissue . And there was a similar finding in the Sermount 1 trial for terzepatide .

Philip Pape 5:40

Now , that does not mean these medications cause muscle loss . Very important to understand . Instead , it is just a natural consequence of rapid weight loss without doing something to preserve muscle . Very important Because , if we put this in perspective right , when you're not on these medications typical weight loss that we see with just your normal dieting approach a calorie deficit may also include some muscle loss . In fact , the average person losing weight without trying to hold on to muscle might lose 25 to 30% of their weight as muscle , right . So the main reason the percentage is a bit higher with GLP-1s is the rapid rate of the weight reduction . That's really all it is . If you did this on your own and lost weight that quickly , you're also going to experience a 30 or 40% loss as muscle .

Philip Pape 6:29

So the point isn't to be fearful or alarmed here , but understand this and then be strategic about it , just as we would implement specific strategies for any weight loss approach . And , in fact , if you're listening and you have no desire at all or need to go on these meds , principles we talk about today are still valuable to you , and so we want to have these targeted interventions , and it would be awesome if everyone on these drugs everyone on these drugs had to be in a sort of patient-centered approach that had nutrition and lifestyle and training built in , like you had to do those things , but the real world and healthcare doesn't necessarily work that way . So hopefully you're listening to this podcast and getting the power to do this on your own . So I want to talk now about protein and nutrition , and then we'll talk about other lifestyle factors , especially strength training

Protein Optimization Strategies

Philip Pape 7:16

, of course . So the first , I guess , intervention for preserving muscle here is optimizing your protein intake , and I start here because for most people , this is going to be , I'll say , an easier play , in that we all eat food already .

Philip Pape 7:28

You're already thinking in terms of weight loss and what goes in your mouth , and there are some things that make it a little more challenging on these medications because a lot of people experience reduced obviously reduced appetite , appetite overall , but sometimes an aversion to protein rich foods . Others have an aversion to fat rich foods , right Like processed foods , which isn't the worst thing in the world when you just don't like to eat those things . But when it's protein rich and you all of a sudden like kind of like a pregnant woman , all of a sudden like craves or hates a certain food , I've had clients tell me they suddenly can't stand the taste of chicken or eggs or something that they enjoyed and and , and we have to understand that . So you have to be more deliberate and strategic about getting your protein . So , based on the research I've talked about this many times before I recommend aiming for 0.7 to one gram per pound of body weight per day . So if your goal weight is and again , this is goal weight , ideal weight , whatever you want to call it and if you're on these drugs , you're probably trying to lose weight . So if your goal weight is like 150 pounds , then that's say 110 to 150 grams of protein a day , and this is not a bodybuilder level protein intake . This is very solid amount , shown in research , to preserve muscle mass . When you are in significant calorie reduction because we have to make that assumption when you are in significant calorie reduction because we have to make that assumption I'm going to assume on GLP-1s , that you're going to be going at a rapid rate of loss . However , however , we want to make sure that loss is controlled and we're actually eating enough food to prevent it going so fast that we still lose muscle even despite these interventions .

Philip Pape 8:59

But anyway , back to protein . All right , simple strategies If you have protein at every meal . Back to protein . All right , simple strategies If you have protein at every meal . Prioritize protein at every meal . Start with protein before moving on to other foods , because not only do you want to have the protein , you want to get ahead of your hunger signals that are less than someone else would have , and it ensures that you get the protein before you fill up .

Philip Pape 9:19

Um , the second thing is , if you need liquid sources of protein , like protein shakes or Greek yogurt smoothies , right , it could still be whole food , like Greek yogurt , where you're smoothing , you're blending it , uh , even bone broth , like it's got to have a decent amount of protein , though , and it can sometimes be easier to consume . And then you want to distribute protein throughout the day , and this is not because science says that's so much better for building muscle . It's mainly to , um again , be able to get it all in right and not feel too stuffed or too full , and and there might be a tiny optimal advantage for muscle building , but I'm not asking you to do that for that reason . Uh , and then the next thing is , of course , you know , if you have an aversion to a specific source of protein , like chicken . You got so many other options . You've got fish , shrimp , dairy eggs , plant-based options , you've got tofu , tempeh , all of that . Just make sure you get enough , right . Just make sure you get enough . There's also whey protein versus pea and rice protein if you need to supplement .

Philip Pape 10:14

So the other thing that happens beyond protein is , of course , your nutrients , and I don't mean nutrition like your food , but your actual nutrient , micronutrient sufficiency , because when you're losing weight rapidly and you're not taking up in as much food or calories , you're then reducing your intake of essential vitamins and minerals , and so you may need to supplement more than you would in the past and you may lead to a deficiency if you don't right . And so what are we talking about ? Well , I like multivitamins as a catch-all vitamin D if you need it , calcium if you need it , omega-3 supplements , magnesium , for sure . But you may have other needs . Vitamin C , you know , you may have other needs , that , even iron , sometimes for women , but again , that's between you and your medical practitioner , based on your specific needs , based on your history . And then I alluded to this already but you've got to be mindful of your actual calorie intake .

Philip Pape 11:05

If anyone's taking GLP-1s and not tracking their food , I think they're doing themselves a disservice , because you're going to have significantly reduced appetite and could potentially eat way too little . Yeah , you're losing weight Great . But you're also going to lose muscle and you're going to have additional nutrient deficiencies . You're going to be low on energy . It's going to be this kind of vicious cycle . It's not going to feel great .

Philip Pape 11:27

So , actually , you know , determining your appropriate calorie target , which , in my opinion , would be no more , no more than 1% of your body weight a week maximum . Okay , for most people that are not on these drugs , a half a percent is usually reasonable , maybe 0.75 . When you're on the drug because you have so much less appetite , you end up going more aggressively , but sometimes too extreme . So track it . Use Macrofactor . Use my code Wits and Weights to get two weeks free . Try it out . Link in the show notes . Use Macrofactor and track your food so that you know how much you're eating and how much you should be eating to continue at that rate . By the way , that's the only app that will do that for you , because it can calculate your metabolism and tell you true calorie targets for you .

Philip Pape 12:10

All right , so if protein is the foundation of preserving muscle from a food perspective , then resistance training is what actually makes that

Resistance Training for Muscle Preservation

Philip Pape 12:19

possible . So listen up , I could have put this as number one , but I wanted to start with the food side , because it's very unique to these meds . But resistance training has been clearly demonstrated time and again as the most effective intervention to maintain muscle mass during weight loss and then when you're not losing weight . Of course , it's how you build muscle , and this becomes even more critical when using these meds , mainly because the meds get you to go at a more extreme rate of loss , like we've talked about , but not too extreme , right , okay . So in practical terms what this looks like is probably a minimum of two , but ideally three strength training sessions per week , potentially four once you get into it and you're like , hey , this is a lot of fun , I'm getting strong , et cetera , but three days a week , full body , mainly compound lifts and use progressive overload .

Philip Pape 13:10

Now we're not going to get into great detail on how to do all that in today's episode . If you're not sure what I'm talking about . I've got plenty of episodes on this . I did one recently called strength versus hypertrophy . I think it's going to be a classic . It's a really good overview of this , of all the principles , and then from there you can branch off into other episodes or reach out to me .

Philip Pape 13:27

But I think the most effective approach , just at a high level , includes compound movements that engage multiple muscle groups . So we're talking about squats or , if you can't do squats , leg presses for your lower body , deadlifts for your hamstrings and back and posterior chain , bench presses for your chest , for your triceps , overhead presses for your shoulders , and then like rows or pull downs for your back , for your biceps , things like that , and then you could throw other fun stuff in there if you've got the time and inclination . But for those new to resistance training , I think a very simple three-day full body using these basic lifts is super solid , something like starting strength . We've got workouts in our Physique University that will get you started and then you can move up into more intermediate programs . Definitely , working with a coach is super recommended early on , even if it's just a few sessions to get your form dialed in . Or again , if you're working with us or in our Physique University , you can submit videos anytime for free as part of the program and get a form check and you're going to get where you need to be .

Philip Pape 14:29

You're going to get stronger , you're going to build muscle and then , if you're on these drugs , what this will look like is maintaining all that muscle so that you prioritize fat loss . That is how you lose fat . It's not cardio right . It's not cardio ever . It's not cardio right . It's not cardio ever . It's lifting weights , building muscle , holding onto that muscle so that you lose fat , and so that's how we improve our body composition and you don't get skinny fat , frumpy , weak , low energy , all of that .

Philip Pape 14:55

Speaking of energy , energy can sometimes be quite a bit lower while you're on GLP-1 meds because of the lower calorie intake , especially if you're going more aggressively . So it's kind of ironic not ironic , but like you've got this ability to eat less because your appetite's less , but then there are other negative consequences if you do it too aggressively . So many of my clients who are on these drugs , I still don't want them to go at the full level of aggressiveness because of the negatives to their other biofeedback , like their energy , like their recovery , their sleep , their stress , all of that stuff . So you want to have realistic expectations around your workout intensity , right your training intensity , because it could be compromised a bit if you're going really aggressively and you don't have much energy . And so I really focus on consistency right , getting to the gym three days a week and doing the program and trying to progress right . You're not necessarily going to chase all time maximum personal records , but if you're listening to this podcast and you're not and this is all new to you anyway you're probably going to have some growth regardless . Just get in the gym three days a week and do it , do the training right , focus on slowly progressing and do the training .

Philip Pape 16:02

The timing can also help , depending on your injections . So this is specific to the meds . Some clients find that training shortly after their injection , when appetite is most suppressed , actually allows them to maintain their energy level , but others prefer training right before their injection or their meal , when energy might be slightly higher . Right , so it's very personalized , but you need to track this stuff and figure it out . Um , and then you you don't need to be a power lifter , a bodybuilder , whatever . It's just moderate resistance training with barbells , maybe dumbbells and machines , depending on what you have access to is going to give you massive , significant benefits compared to just not doing it . You've got to train , you've got to resistance train and then do it for the rest of your life . There's so many benefits to that .

Philip Pape 16:47

We're not they're outside the scope of today's episode , but I have plenty of other episodes that get into that and then I think the final piece of the puzzle here is planning for what happens when I'll say if and when you decide to reduce or discontinue GLP-1 therapy and I say it in that subtle way because some people might feel like they want to stay on it for a while . They're asked by their doctor to do so . There could be metabolic or health reasons for doing so . Maybe you've come off of them and found that it's very difficult for you to continue maintaining your habits even when you've done everything right , and it's just your brain and your genetics are that way . Again , I'm not here to judge .

Philip Pape 17:29

A lot of folks , though , want to try and then eventually get off of the drugs and discontinue them , and they understand that this is a lifelong thing , that we need to do this the right way and set yourself up for success , because the research is clear that weight regain is very common after stopping these meds . In the Step 1 Extension Study , participants regained two-thirds of their lost weight within a year after discontinuation . But guess what ? This does not have to be your outcome . It's also a very typical outcome , even when people are not on these drugs and go through weight loss , and I think that's actually an empowering statement I just said , because what it means is it's not really the drugs , it's the fact that the drugs allow you to have a calorie deficit , and then the lifestyle is not in place at the same time to allow you to come off the drugs and maintain it , just like somebody who's not on these drugs loses weight the wrong way and loses muscle and then regains their weight that way , it's the same thing really . So the wrong way and loses muscle and then regains their weight . That way , it's

Planning Your Exit Strategy

Philip Pape 18:25

the same thing really . So if you can plan properly , you can maintain your results , and this planning begins months before you stop the medication .

Philip Pape 18:30

So here is my approach to this . I've done this with clients . It works really well . I can refer you to individuals who've done this . It works okay .

Philip Pape 18:40

The first thing you're going to do is gradually transition to maintenance calories . You're coming out of a deficit . You're increasing your calories to maintenance while you're still on the medication , and this gives your body time to adapt to higher food intake while the appetite suppressing effects are still present , with the caveat that you might want to reduce the dose . So you do this in conjunction with your doctor and you talk to them and you say , hey , I've been working with Philip , where I've been listening to his podcast , I've been training , I've been tracking my food , I've been eating plenty of protein . Right , I'm active , I'm an athletic fitness lifestyle individual , not like I was before , when I first came to you , doc , but now I am , I've got my lifestyle in place and I want to eventually get off these drugs . So maybe I'm going to titrate down by a fraction of the dose while you then increase the calories , all right .

Philip Pape 19:35

The second thing is and this should go without saying , but I want you to make sure that your resistance training program , by this point , is consistent and progressive , because by the time you start tapering off the meds , this is going to be like a well-established habit . It's just part of your lifestyle . Strength training above all , okay . Third , I want you to learn and practice mindful eating strategies while you're on the meds , that you're just going to continue , mindful eating strategies while you're on the meds , that you're just going to continue . And that could be a number of things that could be simply eating slowly , you know , uh , planning your meals in advance , meal prep , meal planning To me , that is a form of mindfulness as well . It could be , you know , learning to estimate your foods visually so you you eat reasonable portions , balancing your macros right . That's what I mean by mindful , not just the you know , put your fork down between each bite type of thing , but more of the mindfulness of the eating and the mindfulness of the planning , prep , logging , tracking , all of it , all right . And then I want you to connect . So this is number four I want you to consider a gradual tapering strategy . So I already alluded to this when I talked about going to maintenance .

Philip Pape 20:42

But people have success tapering . This is true of most things not all , but most types of dosing approaches where your healthcare provider can help design this for you so your body adjusts to the changing appetite signal because it is fairly proportional to the medication , right ? And so that way you don't just get a sudden rebound and all of a sudden feel like you're starving and you could eat anything . So for most of my clients , I'm gonna transition , or I'm going to recommend transitioning , not just to maintenance but actually slowly toward a slight caloric surplus that coincides with the tapering process and gets you into a really a building growth , a high energy state of thinking right , where you are now setting up structure and control about your eating , even when you're eating more enough to slightly gain weight . And it's a very different way to live than the reason you gained weight before , where it was uncontrolled , you couldn't control your appetite signals or whatever . Now we're going to direct your increasing appetite toward muscle growth rather than fat storage and towards something that benefits you right , and that's a beautiful thing in my opinion .

Philip Pape 21:56

So it's really about having a plan before you stop . I don't want you to just discontinue it and have no strategy and then , even worse , not having done any of these things to begin with . Anyway , right , you put the lifestyle in place , the training , the protein , the tracking very simple , right , just the simple pillars . Yeah , you can get increase your step count . Yes , you should focus on sleep and stress . All that's great .

Philip Pape 22:16

But the big ones are really training , protein , tracking , right , consistency , controlling your mindfulness or having a mindful approach to not only eating but planning , prep and so on , and then tapering your dose down as you bring the calories up and potentially bring the calories even more up , past maintenance to a slight building phase , and it all just lines up really well . After that you can see how you feel , not being on the meds , eating plenty of food , building growth . It should help manage the hunger really well at that point , because most people who are gaining weight to build muscle actually don't have much hunger . When they do , it's because they do need to eat more food , but it kind of mentally frees your brain from even having food noise because you don't get the hunger and you're off the medication , and it creates a nice positive association with food . Then , after you build muscle for , let's say , six months now you can go potentially into maintenance or another fat loss phase without the medications and that's like your next phase of your overall approach that you can experiment with . That's well beyond the scope of today's episode .

Key Takeaways and Final Thoughts

Philip Pape 23:20

So what's really cool about these medications is they present a unique opportunity for body recomp . That isn't possible when you're not in the meds . And I'm not telling everyone to go out and get your injections . What I'm saying is is if you're on these medications , because they so effectively manage hunger , they can create an environment where you can be in a calorie deficit without the hunger or even brutal hunger , depending on how you've done it that normally accompanies significant weight loss . Right , most people , when you're on these drugs , are not going to really be able to push at that 1% for very long , but when you're on the drugs , you kind of can .

Philip Pape 23:56

I mean , I've had clients who are like yep , I'm not hungry , yep , I'm not hungry , and here we are in this like pretty significant deficit . So then you can get some substantial fat loss in a short amount of time while preserving your muscle . If you do it with lifestyle , you've got to have the meds with the lifestyle , okay . And I've had clients who've got amazing body composition transformations , who were on the meds initially just to lose weight . We got them actually thinking in terms of fat loss and body comp training and nutrition and it helped them do it . I'll say faster , true , faster . Yeah . Let's just not beat around the bush , because they didn't have the hunger , but we didn't want to go so fast that it'd affect them in other ways and they got it over fairly quickly . So you know we're talking 40 , 50 , maybe 60 pounds of fat over . I don't know what are we saying ? A nine , 12 month period . I may have the numbers off . We don't want to go past 1% a week , but some clients come in and start there . You know they're 350 pounds , right , so it's all relative Um , and then they'll actually gain some lean mass in the process . So actually get some recomp , which is totally possible when you have a lot of weight to lose .

Philip Pape 25:01

And for many people that seems like an impossible thing to do without the appetite management benefits of the meds . And that's why I am very open-minded to what you need as an individual , even though I'm not out there being like , yeah , come , take these drugs and then join my program . It's not like that , it's hey , I want to help you do what you want to do with the drugs or without them . Okay , the I want to help you do what you want to do with the drugs or without them . Okay , the medications are not magic pills , although some would argue they're pretty close . The problem is they're . The magic that they do cause is misleading , because weight loss by itself isn't going to get you what you want to be . You want to have fat loss . So if you pair it with lifestyle , that's where you're going to get the great results . And then the habits and the muscle that you build during the process that becomes your foundation for the new you that doesn't need these meds anymore . Potentially , right , potentially . Again , I don't want to make anyone feel guilty Like , hey , I tried all this , I came off the meds . I felt like I couldn't control my appetite .

Philip Pape 25:55

There may be deeper or more genetically linked challenges for certain people . So main takeaways here GLP-1 meds are powerful tools to lose weight , but they work best when combined with lifestyle to optimize fat loss , body composition , holding onto muscle right . Otherwise you can lose up to 40% of your body mass as muscle . Number two you want to prioritize protein of 0.7 to one gram per pound of your goal body weight , even when you don't feel like you can eat it . And that's where you have to get creative . How do you get it in liquids , different timing , et cetera . Number three resistance training has to be a non-negotiable part of your routine . Resistance training , not just a YouTube workout , right ? Not just randomly going to the gym , but actually training with progressive overload to signal to your body that muscles should be preserved . Number I think I'm on number four here .

Philip Pape 26:44

You want to plan for transitioning to a lower or off of the medication well in advance . Come up with a plan to do it . Reach out to me , work with your medical practitioner . Now doctors , in my opinion , most of them don't understand , don't understand building muscle , losing fat , body composition , energy balance they really just don't . They don't have much training and nutrition in lifting . Some do right , more do now than in the past but many don't . And so , unless you have a really good feeling for that being the case with your practitioner , reach out to me , listen to the show , join us in Physique University . We'll help you do that . And so it's a strategic approach , right , where these meds are just objective tools to help with the appetite . They're catalysts , and if you do all the other things that's going to set you up sustainably for the rest of your life , all right . So I hope that clarified your approach to these meds .

Philip Pape 27:35

Whether you're thinking about them , you're on them . You want to come off them . You're unsure about the best strategy for a situation ? I off them . You're unsure about the best strategy for a situation . I'm not offering medical advice . I'm not recommending them one way or the other . I'm just trying to help you navigate them , if that's in your realm . So , if you want to talk about it , I offer a free 15-minute rapid nutrition assessment . Again , during this Zoom call , which is not a sales pitch at all , we're going to identify your biggest challenge right now and create a plan to address it . And if you want to talk through these meds maybe you're on them . You want to know what's my plan to get off ? We can talk about that . Just some advice that you can implement , starting right now . Click the link in the show notes to schedule it or go to witsandweightscom and until next time , keep using your wits lifting those weights . And remember it's not about losing weight , it's creating a strong , healthy body that you deserve . I'll talk to you next time here on the Wits and Weights podcast .