Recent studies have raised alarms about GLP-1 drugs, like Ozempic, Wegovy, and Mounjaro, highlighting that a significant portion of the weight lost may come from lean muscle mass. In fact, some studies report that reductions in lean mass range between 40% and 60% as a proportion of total weight lost.
However, Dr. Darshan Shah, board-certified surgeon, health and wellness specialist, makes it clear: It’s not the drug, it’s what people do (or don’t do) while taking it that makes the difference. This muscle loss isn’t an inevitable side effect of the medication itself. Instead, it’s often due to patients in many of the published studies not being properly educated on maintaining muscle during their weight loss journey. “People in these studies are given GLP-1s without any guidance on protein intake, strength training, or metabolic health. Of course they’re losing muscle,” says Dr. Shah.
Muscle loss doesn’t have to be a given. If you use GLP-1s strategically, you can lose fat while keeping—and even gaining—muscle. For women, the stakes are even higher.
Dr. Jessica Shepherd, a board-certified OB/GYN, points out that aging already predisposes women to muscle loss and declining bone density, making it even more crucial to preserve lean mass during weight loss.
“Women should be aware of this potential effect and stay on top of it with their healthcare providers; regularly monitoring muscle mass can ensure that weight loss doesn’t compromise overall health, particularly as women navigate the physical changes that come with aging,” she says.
Dr. Shepherd adds that maintaining a healthy diet with adequate protein intake and incorporating strength training exercises can help mitigate muscle loss. “By integrating targeted strength training, women can protect their bones, maintain mobility, and support long-term health.”
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Dr. Shah explains that people are losing muscle on GLP-1s for one primary reason: “They aren’t eating enough protein and calories.” The extreme appetite suppression causes many to unknowingly consume too few nutrients to sustain muscle tissue.
On top of that, there’s another factor at play: Many people on GLP-1s become less active. While not yet widely studied, Dr. Shah sees this trend in patients. “I believe people on these drugs often feel lower energy and, as a result, they move less, work out less, and ultimately lose more muscle mass than they need to.” Plus, he adds, without the stress from muscles on bones, bones will have more breakdown versus building. “So you’ll absolutely lose bone mass as well,” he says.
Dr. Arnold Avendano is a metabolic health expert and a former ER doctor with 20 years of experience. Avendano, who now focuses on functional medicine, says that mineral deficiency is yet another rising issue. Lower food intake means lower mineral intake, decreased gut biodiversity, and lower absorption rate. “The mineral status of patients on GLP-1s may swing out of balance, which in turn can have a negative impact on lean mass and bone mineral density,” he says. “Without key minerals like magnesium, calcium, and potassium, muscle function and bone health take a hit.”
myskin/Shutterstock
Doctors like Dr. Shah, and Dr. Avendano, who work in the functional medicine space, have a battle-tested protocol for patients using GLP-1 drugs without sacrificing muscle. Here’s what you need to do:
They recommend five key supplements that may help maintain muscle and metabolic health while on GLP-1s:
Your gut microbiome plays a major role in your metabolic function. To help the body become more efficient in increasing its levels of endogenous GLP-1, Dr. Shah recommends taking a probiotic strain called Akkermansia muciniphila. It’s been shown to support healthy glucose metabolism, gut barrier function, and GLP-1 secretion. “There’s a lot of research behind it,” he says, adding, “I’m a big believer in Akkremansia as just a maintenance supplement. So, I keep my patients on it.”
Neither Avendano nor Shah believes GLP-1 drugs should be a long-term crutch. Avendano says that with long-term use, patients can plateau when using these medications. “That’s why I recommend cycling on and off to promote healthy adaptations without becoming dependent on the drug,” he explains.
Dr. Shah adds that “we use them as a jump-start to help people reset their metabolism and relationship with food, but they shouldn’t be a forever solution.” He said his approach also includes tracking several blood biomarkers such as APOB levels, LDL, triglyceride, C-reactive protein (CRP), homocysteine, and serum insulin levels. Plus, he advises many of his patients to use continuous glucose monitors to assess metabolic improvements.
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The health industry needs more research to fully understand how these GLP-1 agonists impact long-term health. Dr. Avendano says he’s curious to see what future results will reveal once we have 10+ years worth of data on patient health and metabolic function.
But for now, research shows that these drugs, much like many prescription medications, do offer benefits but not without trade-offs. So if you think you need a little nudge on the weight loss department, instead of using them as a quick fix, be smart about it.
Take them with the intention to help wean off of processed foods and alcohol, improve your relationship with food, and build sustainable habits that support long-term metabolic health. Prioritize protein intake, resistance training, and key nutrients to protect your muscle mass and bone density. Monitor your progress with regular checkups and work with a healthcare provider to ensure you’re losing fat—not strength.
Continue reading...
However, Dr. Darshan Shah, board-certified surgeon, health and wellness specialist, makes it clear: It’s not the drug, it’s what people do (or don’t do) while taking it that makes the difference. This muscle loss isn’t an inevitable side effect of the medication itself. Instead, it’s often due to patients in many of the published studies not being properly educated on maintaining muscle during their weight loss journey. “People in these studies are given GLP-1s without any guidance on protein intake, strength training, or metabolic health. Of course they’re losing muscle,” says Dr. Shah.
Muscle loss doesn’t have to be a given. If you use GLP-1s strategically, you can lose fat while keeping—and even gaining—muscle. For women, the stakes are even higher.
Dr. Jessica Shepherd, a board-certified OB/GYN, points out that aging already predisposes women to muscle loss and declining bone density, making it even more crucial to preserve lean mass during weight loss.
“Women should be aware of this potential effect and stay on top of it with their healthcare providers; regularly monitoring muscle mass can ensure that weight loss doesn’t compromise overall health, particularly as women navigate the physical changes that come with aging,” she says.
Dr. Shepherd adds that maintaining a healthy diet with adequate protein intake and incorporating strength training exercises can help mitigate muscle loss. “By integrating targeted strength training, women can protect their bones, maintain mobility, and support long-term health.”
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Why Do GLP-1 Drugs Cause Muscle Loss?
Dr. Shah explains that people are losing muscle on GLP-1s for one primary reason: “They aren’t eating enough protein and calories.” The extreme appetite suppression causes many to unknowingly consume too few nutrients to sustain muscle tissue.
On top of that, there’s another factor at play: Many people on GLP-1s become less active. While not yet widely studied, Dr. Shah sees this trend in patients. “I believe people on these drugs often feel lower energy and, as a result, they move less, work out less, and ultimately lose more muscle mass than they need to.” Plus, he adds, without the stress from muscles on bones, bones will have more breakdown versus building. “So you’ll absolutely lose bone mass as well,” he says.
Dr. Arnold Avendano is a metabolic health expert and a former ER doctor with 20 years of experience. Avendano, who now focuses on functional medicine, says that mineral deficiency is yet another rising issue. Lower food intake means lower mineral intake, decreased gut biodiversity, and lower absorption rate. “The mineral status of patients on GLP-1s may swing out of balance, which in turn can have a negative impact on lean mass and bone mineral density,” he says. “Without key minerals like magnesium, calcium, and potassium, muscle function and bone health take a hit.”
myskin/Shutterstock
How To Lose Fat, Not Muscle, on GLP-1 Drugs
Doctors like Dr. Shah, and Dr. Avendano, who work in the functional medicine space, have a battle-tested protocol for patients using GLP-1 drugs without sacrificing muscle. Here’s what you need to do:
- Prioritize protein
- Strength train
- Supplement wisely
They recommend five key supplements that may help maintain muscle and metabolic health while on GLP-1s:
- Creatine: Supports muscle retention and recovery.
- Vitamin D + K2: Crucial for bone and muscle health.
- Omega-3s: Helps with inflammation and recovery.
- Magnesium: Supports muscle function and insulin sensitivity.
- A high-quality multivitamin: To cover any micronutrient gaps.
Improve your gut health
Your gut microbiome plays a major role in your metabolic function. To help the body become more efficient in increasing its levels of endogenous GLP-1, Dr. Shah recommends taking a probiotic strain called Akkermansia muciniphila. It’s been shown to support healthy glucose metabolism, gut barrier function, and GLP-1 secretion. “There’s a lot of research behind it,” he says, adding, “I’m a big believer in Akkremansia as just a maintenance supplement. So, I keep my patients on it.”
Cycle your GLP-1 use and track progress
Neither Avendano nor Shah believes GLP-1 drugs should be a long-term crutch. Avendano says that with long-term use, patients can plateau when using these medications. “That’s why I recommend cycling on and off to promote healthy adaptations without becoming dependent on the drug,” he explains.
Dr. Shah adds that “we use them as a jump-start to help people reset their metabolism and relationship with food, but they shouldn’t be a forever solution.” He said his approach also includes tracking several blood biomarkers such as APOB levels, LDL, triglyceride, C-reactive protein (CRP), homocysteine, and serum insulin levels. Plus, he advises many of his patients to use continuous glucose monitors to assess metabolic improvements.
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The Bottom Line
The health industry needs more research to fully understand how these GLP-1 agonists impact long-term health. Dr. Avendano says he’s curious to see what future results will reveal once we have 10+ years worth of data on patient health and metabolic function.
But for now, research shows that these drugs, much like many prescription medications, do offer benefits but not without trade-offs. So if you think you need a little nudge on the weight loss department, instead of using them as a quick fix, be smart about it.
Take them with the intention to help wean off of processed foods and alcohol, improve your relationship with food, and build sustainable habits that support long-term metabolic health. Prioritize protein intake, resistance training, and key nutrients to protect your muscle mass and bone density. Monitor your progress with regular checkups and work with a healthcare provider to ensure you’re losing fat—not strength.
Continue reading...
