GLP-1/GIP induced muscle loss

GLP-1 and GIP are two known incretins, which are hormones produced in the GI tract and partially account for the postprandial insulin secretion.

Common FDA approved GLP-1 and dual GLP-1/GIP receptor agonists (RAs) are:

• GLP-1 RAs: dulaglutide (Trulicity), liraglutide (Victoza), semaglutide (Ozempic)

• Dual GLP-1/GIP RAs: tirzepatide (Mounjaro & Zepbound)

GLP-1 and dual GLP-1/GIP RAs have been approved by the FDA for the treatment of diabetes and weight management.

These GLP-1s don't just treat the weight, there is clinical evidence showing benefits for other chronic conditions:

• Sleep Apnea

• Osteoarthritis

• Pre-diabetes

• Fatty Liver

• Hypertension

• Dyslipidemia (Low HDL and high Triglycerides)

Risk of Muscle Loss from GLP-1/GIP treatment

Sarcopenia (progressive loss of muscle mass) is associated with negative health outcomes: 

• muscle weakness, reduced strength and endurance

• increased risk of falls and injuries

• immunosuppression and increased risk for infections

• reduced metabolic rate and increased fat tissue

• increased risk for chronic disease

• increased morbidity and mortality

• overall compromised quality of life, decreased life expectancy

Incretin mimetic drugs stimulate insulin release, slow gastric emptying and suppress appetite leading to caloric restriction.

Any kind of caloric deficit would also cause some muscle loss, the question is how much. In a study (STEP-1 Trial), the participants lost 10% of muscle mass in 68 weeks when treated with Ozempic, which is expected to take place in about 20 years of natural aging muscle loss.

It is not only GLP-1/GIP induced muscle loss, it is mainly profound rapid weight loss from significantly reduced caloric intake. The muscle loss associated with incretin therapy was determined to be similar to the muscle loss after bariatric surgery.

Strategies to prevent GLP-1/GIP induced muscle loss

1. Nutritional strategies

   • Protein Intake: Aim for a minimum of 1.2-1.6g/kg body weight daily.

   • Meal Timing: Distribute protein intake throughout the day.

   • Supplements: Consider (with caution) protein shakes or amino acid supplements.

   • Micronutrients: Ensure adequate vitamins and minerals intake for muscle health.

   

2. Exercise

   • At least 60 minutes of resistance training per week, two 30-minute sessions, non consecutive days, focused on major muscle groups.

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3. Stress Management

   • Mindfulness Practices: 4-7-8 breathing technique / 5-minute daily meditation sessions.

   • Nature Exposure/Engagement: 30-120 minutes of outdoor time daily with a purpose (gardening, forest bathing, hiking, yoga, walking).

   • Emotional Processing: journaling for emotional eating triggers.

     

Overall key message is to develop a balance between fat loss and muscle preservation.