From the Guidelines
To prevent muscle mass loss associated with Glucagon-like peptide-1 (GLP-1) agonist therapy, it is essential to combine the treatment with resistance training and adequate protein intake, as evidenced by recent studies 1. When using GLP-1 agonists, such as semaglutide or tirzepatide, patients should prioritize resistance training 2-3 times a week, focusing on major muscle groups with progressive overload, as recommended by the 2025 standards of care in diabetes 1.
- Aim for 1.2-2.0 grams of protein per kilogram of body weight daily, spread across meals, to support muscle preservation.
- Supplement with creatine monohydrate (3-5g daily) to further support muscle preservation, as part of a comprehensive approach to maintaining muscle mass.
- Ensure sufficient calories to prevent excessive deficit, as extremely low calorie intake can accelerate muscle loss, and consider essential amino acid supplements, particularly leucine (2-3g per meal), to stimulate muscle protein synthesis.
- Maintain adequate hydration and ensure sufficient sleep (7-9 hours nightly) for recovery, as these factors are crucial for overall muscle health and recovery. The combination of adequate protein, resistance exercise, and strategic supplementation helps maintain nitrogen balance and stimulates muscle protein synthesis even during weight loss, as supported by the most recent and highest quality study on the topic 1.
From the Research
Preventing Muscle Mass Loss with GLP-1 Agonist Therapy
To prevent muscle mass loss associated with Glucagon-like peptide-1 (GLP-1) agonist therapy, several strategies can be considered:
- Pharmacological treatments: Several pharmacological treatments to maintain or improve muscle mass are being developed in combination with GLP-1-based therapies 2, 3.
- GLP-1 receptor agonists: GLP-1 receptor agonists themselves may have a role in ameliorating muscle wasting by suppressing myostatin and muscle atrophic factors and enhancing myogenic factors through GLP-1R-mediated signalling pathways 4.
- Combination therapies: Combination therapies involving GLP-1 receptor agonists and other agents may help mitigate muscle mass loss associated with GLP-1 agonist therapy.
- Monitoring and assessment: Regular monitoring and assessment of muscle health, including accurate and meaningful assessments of muscle quantity, composition, function, mobility, and strength, are important for optimizing treatment and minimizing muscle mass loss 2, 3.
Key Considerations
When considering strategies to prevent muscle mass loss with GLP-1 agonist therapy, the following factors are important:
- Individual patient characteristics: Factors such as older age and severity of disease may influence the selection of appropriate candidates for GLP-1-based therapies due to the risk of sarcopenia 2, 3.
- Drug-specific effects: Different GLP-1 receptor agonists may have varying effects on muscle mass and composition, and individual patient responses may vary 5.
- Weight loss and muscle health: Weight loss induced by GLP-1 receptor agonists may be associated with changes in muscle mass and composition, and strategies to maintain or improve muscle health during weight loss are important 2, 3.