Intro
GLP-1 drugs promote major weight loss — but some of that loss can include lean muscle, especially in adults over 40. This guide explains how to prevent sarcopenia while using Ozempic, Wegovy, or Mounjaro.
Key Points
- GLP-1 drugs reduce appetite so much that protein intake drops.
- Without resistance training, 20–40% of weight lost can come from muscle.
- Strength training + high protein = the antidote.
- Creatine is safe, supported by decades of data, and highly useful.
- Muscle preservation is crucial for healthy aging and long-term metabolic health.
GLP-1 Medication Safety Warnings
- Do not use during pregnancy or within 2 months of planned conception.
- Avoid if you have a history of medullary thyroid carcinoma.
- Seek urgent care for severe abdominal pain (possible pancreatitis).
- Be cautious if you have severe reflux or gastroparesis.
- Rapid weight loss increases the risk of gallstones.
- Use alcohol carefully — nausea may worsen.
- Combine with strength training to prevent muscle loss.
Background
Muscle is metabolically active tissue essential for:
- glucose control
- balance & falls prevention
- metabolic rate
- healthy aging
GLP-1 drugs don’t target muscle directly; muscle loss comes indirectly from:
- lower protein intake
- lower calorie intake
- reduced mechanical loading
How to Protect Muscle (Evidence-Based)
1. Protein Target
Aim for 1.6–2.2 g/kg/day of body weight.
If appetite is low, prioritise:
- protein shakes
- Greek yogurt
- eggs
- lean meats
- cottage cheese
Consider front-loading protein earlier in the day while appetite is higher.
2. Resistance Training
Minimum:
- 3 sessions/week
- Focus on compound lifts: squats, deadlifts, pressing, rows.
- Progressively overload (heavier, more reps, or slower tempo).
Key principles:
- Train close to technical failure
- Use full range of motion
- Allow recovery days between heavy sessions
3. Creatine
- 3–5 g/day, no cycling needed
- Improves strength and reduces muscle loss during caloric deficits
- Mix with water, juice, or a protein shake
4. Daily Movement (Steps)
Baseline: 8,000–10,000 steps/day.
This maintains NEAT (non-exercise calories burned) and supports insulin sensitivity.
5. Supplements (Optional)
- Vitamin D (if low)
- Omega-3 (anti-inflammatory effects, joint support)
- Magnesium (sleep and recovery)
- Electrolytes (important with low appetite or GI side effects)
| Feature | GLP-1s (Ozempic / Wegovy / Mounjaro) | Metformin |
|---|---|---|
| Weight loss | 10–22% body weight | 2–4% (mild) |
| Mechanism | GLP-1 satiety hormone, slows gastric emptying | Improves insulin sensitivity, lowers hepatic glucose output |
| Best suited for | Obesity, metabolic syndrome, fatty liver | Prediabetes, mild metabolic dysfunction |
| Side effects | Nausea, constipation, reflux | GI upset, B12 depletion (rare) |
| Cost | High | Low / generic |
| Ideal pairing | Resistance training and high protein | GLP-1s or lifestyle changes |
Risks / Signs of Muscle Loss
Watch for:
- Rapid weight drop (>1 kg/week)
- Weakness or fatigue during daily activities
- Declining strength on familiar lifts
- Poor recovery from normal workouts
- “Skinny-fat” appearance (smaller but softer)
If these occur:
- Increase calories slightly (especially protein)
- Reduce the pace of weight loss
- Confirm that you’re lifting with enough intensity
- Discuss potential dose adjustments with your prescriber
FAQ
Q: Can I build muscle while on Ozempic?
Yes — if protein and training are sufficient. You may need to be more deliberate about calories and strength progression.
Q: Is creatine safe with GLP-1s?
Yes. There are no known direct contraindications. As always, check with your clinician if you have kidney disease or other concerns.
Q: Should older adults train differently?
Yes — focus on:
- slower, controlled lifts
- balance and coordination
- fall-prevention exercises
- slightly longer rest periods
Q: How fast is “too fast” for weight loss?
More than 0.5–1% of body weight per week increases the risk of lean mass loss.