As an Obesity Medicine Specialist for 18 years, I have always been keenly aware of the importance of monitoring muscle during the weight loss process. With the introduction of weekly GLP-1s to the field with Semaglutide in 2015 and Tirzepatide in 2022, excessive muscle loss is now one of the biggest issues we see in our clinic.
Weekly GLP-1s are so powerful that at high doses, many patients have no appetite whatsoever. Patients end up losing extraordinary amounts of muscle in some cases putting them in a starvation state. This makes one prone to infections and makes weight loss very hard to sustain. There is a 50% abandonment rate in these meds for a reason.
Fortunately, with a high protein nutrition plan and careful follow-up using a Bio Physical Profile (a scale that breaks weight down into fat, muscle, and water), it is easy for us to catch and modify the plan so this no longer happens. For those who are not following a healthy nutrition plan or being seen regularly by a medical team, it’s another story. This seems like an appropriate time to brush up on techniques of maintaining muscle during the weight loss phase, and even building it during maintenance.
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ToggleStep 1: Protein
I can’t emphasize enough how important protein is for maintaining muscle mass. Protein provides the basic building blocks your muscles need to repair and grow. If you are doing some strength training, the two complement each other beautifully. The quantity, quality, and timing of protein are all important in the delicate balance of losing fat and maintaining muscle.
- Quantity. To maintain muscle mass during weight loss, it is recommended that you take in 1 gram of protein per kg of body weight (or half your weight in grams of protein per pound of weight). If you weigh 200 pounds, that’s 100 grams of protein minimum. If you work out, then the formula is ¾-1 grams per pound of weight. That’s 175-200 grams of protein for that same 200-pound individual.
Remember to titrate your exercise to your hunger. Taking in this many calories during the weight loss phase may make it harder to lose weight. Remember also that we ramp up exercise as we get closer to our weight loss goal, and it becomes imperative in maintenance.
- Quality.
- Animal proteins. Animal proteins (chicken, turkey, beef, eggs, etc.) are very helpful because they are rich in essential amino acids—those we must take in with our diet, especially Leucine. Leucine is critical in stimulating muscle growth. Fish like salmon and tuna also provide Omega 3 fatty acids which help with muscle function. There are two main types of animal proteins:
- Whey. Whey is the liquid portion that remains after cheese is made (the part that can be strained out after the cheese is curdled). It helps rapid replenishment of muscle, especially after a resistance workout. It also tends to be more sensitive to the stomach.
- Casein. Casein is the main protein found in curdled cheese. It provides a slower release of amino acids over several hours, as it is digested slowly.
Many protein shakes available include a proprietary blend of whey and casein to take advantage of the properties of both. For an excellent assortment of high protein, medical-grade quality whey/casein-based shakes, check here.
- Plant proteins. Plant-based proteins such as pea and soy are available for vegans and vegetarians. While vegetarian and vegan diets can support muscle growth, it is a bit harder to get all the amino acids in, so often different plant sources must be used together.
3. Timing.
- While total daily protein intake is crucial for muscle growth, the timing of eating protein can also influence results.
- In general, during the weight loss phase, it is recommended to eat something with protein every three hours. The high-protein shakes we use at Medical Weight Loss of NY have 27-28 grams of protein and Leucine. This combo has been shown to optimally support muscle mass.
- With exercise, it is important to have a post-workout shake with high protein as this is a critical window for muscle repair.
Step 2: Strength Training
The strongest stimulant for muscle building isn’t protein intake—it’s resistance training,” says Dr. Shawn Arent, professor of exercise science at the University of South Carolina, Arnold School of Public Health. “Carbohydrates fuel those high-intensity workouts, helping you push harder and longer.”
This is more of a lesson in maintenance, as a very vigorous workout plan during weight loss can increase appetite and caloric intake. Just remember to titrate exercise to hunger as the weight loss does come from the kitchen, and light, repetitive weights are the best approach during weight loss if you want to strength train as you lose. Also- remember to save a high-protein shake for after your workout as mentioned above. As you get closer to maintenance, you have more calories to work with and can therefore increase the weight and intensity of your workout, helping to build muscle instead of maintaining it.
Step 3: Testosterone
Testosterone is a steroid hormone that stimulates the process of muscle building. In men, testosterone decreases with obesity and age. In women, testosterone decreases with age. As testosterone drives muscle, and muscle drives metabolism, we check both metabolic rates (through resting calorimetry) and testosterone levels and advise replacing it in both sexes. The safest way to do this is through bioidentical hormone therapy which is truly identical to what our body makes.
Step 4: Creatine
There are many supplements available to help build muscle mass, but many have not stood the test of time. Creatine, on the other hand, is one of the most effective, well-researched supplements available, and well worth the investment. Think of it in the same way you think of your daily multivitamin. In addition to helping build and maintain muscle, it is also helpful for brain health, protecting the nervous system, and strengthening our immune system. Creatine is found in the skeletal muscle of beef, chicken, fish, and other animals. Creatine helps increase the intensity of workouts, allowing heavier lifting and supporting greater muscle growth.
The recommended daily supplement dose is typically 5 grams daily. For an excellent Creatine supplement, check out Creatine UP from Metagenics.
Step 5: Fish Oil
Fish oil, especially when high in EPA, supports lean tissue growth and muscle repair. EPA, or eicosapentaenoic acid, is an omega-3 fatty acid known for its anti-inflammatory properties, which can help reduce muscle soreness and joint pain.
Check out our favorite fish oil recommendation here.
The Formula to Maintain Muscle Mass During Weight Loss
In summary, protein is key in maintaining muscle during weight loss, and building it during maintenance. During the weight loss phase, aim for at least ½ your weight (in pounds) in grams of protein or higher. If you exercise, this increases to ¾-1 gram per pound. Once you get into maintenance, increase the intensity of your strength training and stay closer to 1 gram of protein per pound of weight to increase muscle mass. Remember the timing of protein, and always have a shake after workouts to ensure optimum muscle repair.
In addition to protein, consider optimizing the muscle-building hormone testosterone to increase muscle and metabolism. Bioidentical hormone replacement therapy is the best way to do this as it is natural with an identical formula to what our body innately makes. Finally, strongly consider 5mg of Creatine and 1-2 grams of fish oil to build muscle, improve strength, and also improve your brain, nervous system, and joint health.
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