Ancient wisdom comes to the rescue
While my primary focus for healthy weight management has always been on lifestyle interventions, I have also explored pharmacological options for those who need them. One of the more interesting ones was Phentermine, which I have discussed in several case studies.
Recently, I noticed that some weight loss specialists have been combining Phentermine with a new class of drugs called GLP1-RAs, or incretin-mimetic drugs (IMDs), which I will cover in this article. I covered GLP1-RAs in a previous story, so I will not repeat their benefits and other factors.
GLP1-RAs: After Diabetes, Tirzepatide & Semaglutide Give Hope for Osteoarthritis & Dementia…
Incretin mimetics show beneficial pleiotropic effects, such as immunomodulation, antiinflammation, and neuronal…medium.com
In recent years, these new drugs like semaglutide and tirzepatide have emerged to help obese or overweight people lose weight. These medications, part of the incretin-mimetic drug class, are highly effective for treating obesity, which is an epidemic globally.
Many doctors and patients are excited about them because they can lead to significant weight loss without the constant feeling of hunger. However, there is growing concern that the rapid adoption of these drugs has outpaced the updating of medical guidelines, leaving some patients at risk of side effects and unknown long-term outcomes.
So, what’s the concern? While losing weight can greatly improve overall health, one unexpected side effect is that some people are losing muscle mass and fat.
Losing muscle too quickly can be harmful because muscle isn’t just for strength — it plays a big role in how our bodies burn energy and stay healthy. This is especially critical for older adults, as muscle loss (sarcopenia) is a major risk as we age.
If we lose too much muscle, it can affect our ability to stay active, maintain a healthy metabolism, and enjoy a good quality of life. While it is natural to gradually lose muscle with age, people on these medications may lose muscle at an accelerated rate.
A recent review published by Obesity Reviews in September 2024 found that people taking these drugs for 68 to 72 weeks (about 1.5 years) may lose 10% or more of their muscle mass — equivalent to 20 years of age-related muscle loss. That’s a rapid change for the body, which could lead to weight cycling (losing and regaining weight) and other health problems.
Although the review only focussed on protein and exercise, from my experience, sleep and stress management are the key factors, so I emphasize their importance in my story.
Here’s the title of the review and the standard public access to it: “Strategies for minimizing muscle loss during use of incretin-mimetic drugs for the treatment of obesity” https://doi.org/10.1111/obr.13841
Why Does This Happen, and How Can It Be Prevented?
When we lose weight quickly — especially with the help of medications — our bodies don’t just burn fat; they can also break down muscle if we are not careful with our nutrition, exercise, and sleep. So ancient wisdom comes to the rescue.
Here is a summary of the three key factors to remember for preserving muscle mass when using these weight-loss drugs:
1 — Nutrition: We must pay attention to what we eat. Although all macronutrients are important for health, protein is especially critical for muscle maintenance. Protein is crucial because it activates mTOR, a key pathway for maintaining muscle. Everyone’s protein needs are different, so it is important to ensure you’re getting enough from high-quality sources like meat, fish, dairy, or plant-based alternatives. In some cases, supplements may be necessary.
2 — Exercise: Physical activity is essential, but resistance training—like weightlifting or bodyweight exercises known as calisthenics such as push-ups, pull-ups, squats, etc. is particularly effective for preserving muscle as it activates mTOR. Alongside protein, strength training is one of the most important ways to maintain muscle during weight loss.
3 — Sleep: Muscles grow and recover during rest and sleep whcih vary from person to person. While some may thrive on 7 hours, others may need closer to 9. However, according to current research, both too little (less than 6 hours) and too much (more than 10 hours) sleep can pose problems.
. While some may thrive on 7 hours, others may need closer to 9. However, according to current research, both too little (less than 6 hours) and too much (more than 10 hours) sleep can pose problems.
Conclusions and Key Takeaways
The main point here is that using these new weight-loss drugs is not just about shedding pounds — preserving muscle mass is just as important for maintaining long-term health.
Metabolic health specialists recommend combining drug therapy with a comprehensive lifestyle plan that includes eating enough protein, getting the right vitamins, doing regular strength training, and having quality rest. This way, you can lose weight while staying strong, active, and healthy.
While medications like semaglutide and tirzepatide can be powerful tools for weight loss, they come with potential risks — especially regarding muscle loss. The good news is that with the right approach, you can protect your muscles and improve your overall health.
Remember, weight loss isn’t just about the number on the scale — it’s about staying strong, functional, and healthy. Combining these medications with a balanced approach to the right nutrition, exercise, and quality sleep, we can lose weight without sacrificing muscle mass or quality of life.
If you are using weight-loss drugs like semaglutide or tirzepatide, here are a few practical steps to discuss with your healthcare provider:
Get enough protein from bioavailable sources
Pay attention to micronutrients like vitamins and minerals
Perform regular resistance training such as weightlifting bodyweight exercises or high-intensity interval training.
Remember, muscle repair happens during sleep, so aim for the right amount of quality sleep, rest, and downtime.
Personal Experiences with Weight Management
In my younger years, intermittent fasting, periodic fasting, and ketogenic were the most effective ways to address abdominal obesity. They might not work for everyone, but they do for many people, and there is significant evidence about the value of fasting and keto diets for weight management.
I covered these points in several stories that you may gain insights into.
Perfect Storm in a Teacup: Can Intermittent Fasting Increase Heart Disease Risk by 91%?
A low-carb diet keeps me in ketosis and also helps with my brain health.
A New Clinical Trial Found a Low-Carb Diet Better Than the Dash.
β-Hydroxybutyrate: 2 Vital Role of Ketogenesis in the Brain for Dementia Prevention / Treatment
You can learn about the biochemistry of ketogenesis in the attached story. I have been in ketosis for over three decades now. Sometimes, my BHB is over seven nmol.
Biochemistry of Ketosis Simplified with Nuanced Perspectives and Personal Experiences
When I moved from sugar to fat-burning metabolism, all my metabolic disorders, including metabolic syndrome, insulin resistance, prediabetes, and abdominal obesity, naturally disappeared.
Here’s Why and How to Shift from a Sugar to a Fat-Burning Metabolism
Fats are valuable in our diet, and they are essential, unlike carbs, but not all fats are equal. Here is what you need to know about healthy and unhealthy fats. Nuances of Healthy and Unhealthy Fats with Practical Tips
In terms of exercise and remember remember that:
I wrote many articles about weight loss and muscle gain, which you can find in the attached list.
Weight Loss / Muscle Gain
Edit descriptiondr-mehmet-yildiz.medium.com
I invite you to check out β-Hydroxybutyrate: 2 Vital Role of Ketogenesis in the Brain for Dementia Prevention / Treatment. This information can be a lifesaver for some people suffering from cognitive decline. How to Slow Down Subjective and Objective Cognitive Decline. I leave you with Six Tips for a Youthful and Healthy Life as We Age.
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