Latest / Wits & Weights | Strength & Fat Loss Over 40 / The Latest GLP-1 Science on Muscle Loss, Fat Loss, and Weight Regain | Ep 461

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The Latest GLP-1 Science on Muscle Loss, Fat Loss, and Weight Regain | Ep 461 · Wits & Weights | Strength & Fat Loss Over 40

• 0:00
  Philip Pape: If you're on a GLP1 drug like Ozempic or Monjuro, or you're thinking or curious about it, there are a few different narratives out there.
• 0:07
  Philip Pape: And I wanted to get into all the aspects of the science today, especially the body composition data from very, very recent research.
• 0:16
  Philip Pape: What happens when you stop taking these?
• 0:19
  Philip Pape: The cardiovascular and inflammation findings beyond fat loss, and then a framework to keep your muscle while the drug does its thing.
• 0:27
  Philip Pape: And then for those of you struggling with appetite and eating enough protein, stick around to the end.
• 0:31
  Philip Pape: I'm going to share some tips for that.
• 0:37
  Philip Pape: Welcome to Wits and Weights, the show that puts a popular piece of fitness advice under the microscope, finds the hidden reason it doesn't work, and gives you the deceptively simple fix that does.
• 0:47
  Philip Pape: I'm your host, Philip Pape, and this episode was directly requested by two listeners.
• 0:53
  Philip Pape: And I want to give them a shout out up front.
• 0:55
  Philip Pape: Daryl T wrote in and said, I'm mainly wanting to know if it's safe to take GOP1s and a deep dive into the long-term effects as well as its role in other indications beyond weight loss, like inflammation and heart health.
• 1:08
  Philip Pape: I'm also a nurse practitioner who's worked in urology for 11 years.
• 1:11
  Philip Pape: So, Daryl, we went back and forth a lot, and we're going to get into all of those things today.
• 1:16
  Philip Pape: I know you can evaluate this stuff with clinical eyes.
• 1:20
  Philip Pape: Obviously, I don't give medical advice, but I'm going to go deep on the evidence, and I think you're going to appreciate that.
• 1:25
  Philip Pape: And then our listener, Brianna N, asked for, quote, a podcast about GLP1 weight loss drugs and how to eat enough food and protein while taking them.
• 1:33
  Philip Pape: And so, Brianna, this is definitely a gap, definitely a challenge that I've seen.
• 1:37
  Philip Pape: The practical side of, well, they don't have as much of an appetite, which has seemed to be helpful for losing weight, but now it actually becomes a challenge when you're trying to get things like more protein or higher satiety foods.
• 1:48
  Philip Pape: So we're going to cover that as well.
• 1:49
  Philip Pape: And then stay tuned to the end for three specific high protein meals that I think you could use that are under 300 calories, over 35 grams of protein.
• 1:59
  Philip Pape: One of the challenges is protein density.
• 2:02
  Philip Pape: And this will help, I think, when you don't have quite as much of an appetite.
• 2:06
  Philip Pape: So in this episode, what are we covering?
• 2:07
  Philip Pape: You're going to learn the actual lean mass loss percentages from the major GLP1 trials.
• 2:13
  Philip Pape: You're going to learn about how lifestyle modifies those, because really that's what it comes down to.
• 2:19
  Philip Pape: So we're not fear-mongering.
• 2:20
  Philip Pape: We're not going to say, oh, you just lose your muscle on these things.
• 2:23
  Philip Pape: You're going to learn what happens to body composition, your heart, your inflammation when you take these drugs, and a practical five-part framework to keep your muscle, whether you're currently on a GLP1 or considering one, or honestly, or not, because the principles are universal.
• 2:41
  Philip Pape: All right.
• 2:41
  Philip Pape: So there are a couple narratives out on social media around GLP1 drugs right now.
• 2:48
  Philip Pape: And one narrative is hey, these are really great.
• 2:50
  Philip Pape: People have food noise.
• 2:52
  Philip Pape: People are using them to lose a lot of weight that were affecting, that was affecting their health and had trouble getting started.
• 2:58
  Philip Pape: We had uh guys like Jamie Sellzer on the podcast where it's been, you know, I mean, let's be honest, it's like a miracle drug.
• 3:04
  Philip Pape: This is not something that's ever existed before.
• 3:07
  Philip Pape: And yet he's doing it the right way by changing lifestyle at the same time.
• 3:10
  Philip Pape: And that's where we get into some of the thorny things here.
• 3:13
  Philip Pape: But that's that's the first kind of narrative, and and often there's a pushback because people want to judge people for taking these and so on.
• 3:19
  Philip Pape: I even did an episode a while back called Ozempic Envy about that phenomenon.
• 3:23
  Philip Pape: And then the second narrative here is hey, you lose all your muscle when you take these things, or it's cheating, or hey, you're gonna gain everything back the minute you stop.
• 3:32
  Philip Pape: And you've probably seen some truths to all of this stuff in a way.
• 3:37
  Philip Pape: Uh, not truths to judge judging people.
• 3:38
  Philip Pape: I'm not talking about that, but really like what happens when you take these drugs.
• 3:42
  Philip Pape: So just to say it up front, I'm definitely not anti-medication.
• 3:45
  Philip Pape: I think if any tool is the right tool for your situation, use it.
• 3:51
  Philip Pape: Use the tool if it helps.
• 3:53
  Philip Pape: Obesity is pretty well established now as a medical condition that has actual physiological drivers, things like brain-related genes and many other things.
• 4:03
  Philip Pape: It's very complicated.
• 4:04
  Philip Pape: These drugs do work.
• 4:06
  Philip Pape: Yes, there is a behavior and lifestyle component, but it's one of many, many components.
• 4:11
  Philip Pape: And the weight loss we've seen from these drugs is not only clinically meaningful, but just real life meaningful, you know, lots and lots of pounds lost.
• 4:20
  Philip Pape: And you know, we talk about it's not always about the scale, but it often is about the scale when you're carrying a lot of excess and dangerous body weight and body fat.
• 4:29
  Philip Pape: The body composition side of that, meaning how much of your weight that you're losing comes from fat versus muscle, this it's not a fixed thing.
• 4:38
  Philip Pape: It's not like you have this side effect and it happens this way.
• 4:42
  Philip Pape: It depends almost entirely on two things that you actually control.
• 4:46
  Philip Pape: Number one is do you lift weights?
• 4:47
  Philip Pape: And number two is do you eat enough?
• 4:49
  Philip Pape: I'll say enough protein, but there's other things you can have malnutrition with when you are in such a huge deficit that's often caused by these.
• 4:56
  Philip Pape: But protein is kind of the leader of all of these.
• 5:00
  Philip Pape: And so the difference between what I'll call unmitigated GLP1 use and optimized GLP1 use is the difference in what we're seeing with some of those numbers, like when you hear the 40% of your weight loss from lean mass, versus I've talked about it recently, losing close to zero from lean mass, just like if you weren't taking the drugs because you're doing the things.
• 5:20
  Philip Pape: And that's a big gap between those two populations.
• 5:23
  Philip Pape: And I guess the problem is today there's so many people taking these drugs that are then not doing the lifestyle thing that we hear about this more and more, and it gets fear-mongered and all that.
• 5:31
  Philip Pape: So I want you to be strong.
• 5:32
  Philip Pape: I want you to be metabolic, metabolically strong and resilient.
• 5:38
  Philip Pape: I want you to be leaner if that's what you want.
• 5:40
  Philip Pape: I want you to be healthier, all of those things together.
• 5:43
  Philip Pape: So that's what this episode is about.
• 5:45
  Philip Pape: It's not whether you should take the drug, that's between you and your doctor and your goals.
• 5:49
  Philip Pape: This is about what the evidence says you should do alongside the drug to get the best possible outcome.
• 5:55
  Philip Pape: So let's start with numbers because numbers always tell the nuance.
• 5:58
  Philip Pape: They tell us the stuff, the reading between the lines of all these headlines.
• 6:02
  Philip Pape: The step one trial, I've mentioned it several times.
• 6:05
  Philip Pape: This is referenced a lot.
• 6:07
  Philip Pape: It's foundational data on semaglatide, which is the drug behind Wagovi, and Ozempic.
• 6:12
  Philip Pape: And in this study, it was on body composition.
• 6:15
  Philip Pape: Participants lost about 15% of their weight over 68 weeks, and about 39 to 45% of that was lean mass.
• 6:22
  Philip Pape: So just every 10 pounds you lost, about four were coming from muscle.
• 6:26
  Philip Pape: Not something we want to do, right?
• 6:27
  Philip Pape: We don't want to do that.
• 6:28
  Philip Pape: And it sounds scary, but the context always matters.
• 6:32
  Philip Pape: So we've talked about the quarter rule in body composition research, where we've seen for over decades of research when anyone loses weight through any method, about a quarter of the weight loss on average is typically lean mass.
• 6:44
  Philip Pape: And that's your physiology.
• 6:46
  Philip Pape: Your body doesn't just say, I'm only gonna burn fat.
• 6:49
  Philip Pape: It's going to burn whatever it can, and I hate to use the word burn, but it's gonna draw energy from wherever it can.
• 6:54
  Philip Pape: And when we talk about muscle, it's not like eating away at your muscles, it's simply not rebuilding them, it's not preserving them.
• 7:00
  Philip Pape: And that's kind of the way to think about it.
• 7:02
  Philip Pape: So it, you know, this percentage right off the bat is not great, and that affects anyone who's just not lifting weights.
• 7:09
  Philip Pape: For semaglotide in step one, the question in the step one trial, the question has always been recently is it higher than the average?
• 7:20
  Philip Pape: The answer is yes, but you also have to think about the rate of weight loss, also is higher than average.
• 7:27
  Philip Pape: So we're still teasing out the data.
• 7:28
  Philip Pape: We're not 100% sure that there's an independent factor with these drugs, and it really doesn't matter because if you're doing the right thing, you don't have to worry about it.
• 7:36
  Philip Pape: Now, if we look at terzepatide, that's the drug behind Manjaro and Zeppound.
• 7:41
  Philip Pape: There was another study, the Surmount 1 body composition substudy, and that's February 2025.
• 7:47
  Philip Pape: So you can look that one up.
• 7:49
  Philip Pape: Participants lost 21% of their body weight, and lean mass accounted for about 25% of what was lost, which is more in line with other weight loss methods and that held across different doses, different sexes, or both sexes, and all age groups.
• 8:04
  Philip Pape: Now we don't quite know what the difference is between the two.
• 8:07
  Philip Pape: It may have to do with the terzepicide being a dual receptor agonist hitting both the GLP1 and the GIP receptors.
• 8:15
  Philip Pape: And maybe that gives some additional lean mass protection, but nothing is compare the two side by side.
• 8:20
  Philip Pape: They're different studies, different potentially methodologies and populations and all that.
• 8:24
  Philip Pape: Okay.
• 8:25
  Philip Pape: Now, the lean mass includes more than skeletal muscle.
• 8:29
  Philip Pape: I think we forget that in the discussion as well.
• 8:32
  Philip Pape: It includes your organ mass, your connective tissue, your bone, and your water.
• 8:36
  Philip Pape: And the fat tissue you have, what we call adipose tissue, believe it or not, is also 15 to 20% lean mass itself.
• 8:44
  Philip Pape: I don't know if you realize that.
• 8:45
  Philip Pape: It's something we don't talk very often, but there is some lean mass, quote unquote, in fat tissue, and that's water and protein in your fat cells.
• 8:53
  Philip Pape: So when you lose a lot of body fat, you're automatically going to lose some measured lean mass, even if you haven't lost actual muscle.
• 9:01
  Philip Pape: And now, of course, you're like, well, wait, one time I gained lean mass.
• 9:04
  Philip Pape: Well, yes, if you gain enough muscle to offset that during a fat loss phase, like if you're a brand new lifter, that can offset it for sure.
• 9:11
  Philip Pape: A very recent study, 2026, combined pre-clinical data with a human proof of concept trial and looked at lean tissue loss on submagotide, where and they found that liver mass decreased more than muscle mass.
• 9:28
  Philip Pape: So that's an organ, right?
• 9:30
  Philip Pape: So now we're saying, oh, maybe some of that lean mass loss is coming from organ mass loss.
• 9:36
  Philip Pape: Interesting.
• 9:37
  Philip Pape: And then there's a third piece here, and that's what we call muscle quality.
• 9:41
  Philip Pape: So there was a surpass three MRI substudy published last year, 2025, and it found that while muscle volume decreased on tur's epitide, intramuscular fat infiltration.
• 9:53
  Philip Pape: Now that's the fat marbled within the muscle itself, decreased significantly more than you would expect from weight loss alone.
• 10:01
  Philip Pape: So now less fat inside the muscle means better muscle quality, insulin sensitivity, better function.
• 10:08
  Philip Pape: And the researchers called these adaptive changes, not pathological, just adaptive changes.
• 10:14
  Philip Pape: And finally we had the step up trial, and that tested the new higher dose of maglatide of 7.2 milligrams, found the same pattern.
• 10:22
  Philip Pape: And they used MRI instead of DEXA.
• 10:25
  Philip Pape: They measured about 16% of weight loss coming from lean tissue, and then the muscle function as they measured it with sit-to-stand testing was preserved.
• 10:34
  Philip Pape: I don't know what to make of that piece of it, honestly, because it it's a low bar, but I guess it's important.
• 10:40
  Philip Pape: But the the summary is this, right?
• 10:42
  Philip Pape: The initial numbers from the step one, that's like the full-on, unmitigated scenario.
• 10:48
  Philip Pape: First study they did on this, or the first big study that I guess we can rely on.
• 10:52
  Philip Pape: And really, in practicality, the lean mass fraction of the muscle lost ranges from anywhere from you know zero to like eight percent in people who do train and eat protein.
• 11:03
  Philip Pape: Remember that some of that lean mass is good.
• 11:05
  Philip Pape: It's from, you know, fat what what I should say, fat cells.
• 11:10
  Philip Pape: And then some of it is non-muscle tissue anyway, and then some is all the way up to say 45%, and people just don't do anything they're supposed to do, and they're losing tons of weight really fast.
• 11:19
  Philip Pape: All right, so that is body composition.
• 11:21
  Philip Pape: I think we're all caught up.
• 11:22
  Philip Pape: Now we're gonna shift to what Daryl was talking about, which is the non-weight loss indications.
• 11:29
  Philip Pape: There was a trial back in 2023 called SELECT, over 17,000 adults that had heart disease, a high BMI over 27, but no diabetes.
• 11:39
  Philip Pape: And smagletide reduced their major cardiovascular events by about 20%, with a hazard ratio of 0.8, and it reduced all cause mortality by 19%.
• 11:52
  Philip Pape: And I think from what I can read, the cardiology community was a bit surprised because there was an analysis in the Lancet in 2025 that found a third of the heart benefit, only a third of the heart benefit, was explained by the reduction in waste.
• 12:09
  Philip Pape: In other words, they lost weight, they got a benefit to the heart, but there was more of a benefit than you would expect.
• 12:14
  Philip Pape: And the cardiovascular protection seemed to be consistent regardless of how much weight people lost.
• 12:20
  Philip Pape: And so it's not just, hey, lose weight, help your heart kind of thing.
• 12:24
  Philip Pape: Something else must be going on.
• 12:26
  Philip Pape: So fast forward, or not fast forward, but same year, 2025, last year, for terzepatide, the surpass CVOT trial, compared it to dulaglutide, which apparently already has proven heart benefits.
• 12:39
  Philip Pape: And terzepatide met what's called non-inferiority, meaning it's at least as good.
• 12:45
  Philip Pape: And against a theoretical placebo, they estimated a reduction in major heart events by 28% and 39% reduction in all-cause mortality.
• 12:56
  Philip Pape: These are huge numbers.
• 12:58
  Philip Pape: And then the inflammation data probably explains some of this cardiovascular data.
• 13:04
  Philip Pape: It's all connected, right?
• 13:05
  Philip Pape: So across the STEP trials, going back to those semaglatide trials, they found a reduction in C reactive protein, CRP.
• 13:13
  Philip Pape: That's a key inflammatory marker we can measure in our blood pretty easily.
• 13:16
  Philip Pape: And it dropped by 38% over two years.
• 13:20
  Philip Pape: It dropped 12% at just four weeks, and that's before there was any meaningful weight loss.
• 13:25
  Philip Pape: They only lost like 2-3% of their body weight by that point.
• 13:28
  Philip Pape: So that's really strong evidence for a direct anti-inflammatory effect that's independent of weight change.
• 13:34
  Philip Pape: At least that's my understanding and reading of the evidence.
• 13:37
  Philip Pape: Another review last year in the Journal of Clinical Investigation looked at a neural pathway where GLP1 receptor activation in the brain reduces circulating TNF alpha, and it does so just within a few hours.
• 13:53
  Philip Pape: Just a few hours.
• 13:54
  Philip Pape: This is before really anything else has changed.
• 13:56
  Philip Pape: So that's pretty clear potential cause and effect going on.
• 14:01
  Philip Pape: Now let's talk about the brain.
• 14:03
  Philip Pape: And this is maybe a little bit less exciting than what we know so far.
• 14:06
  Philip Pape: There's some large observational studies where GOP1 users had 40 to 70% lower risk of developing Alzheimer's, and it generated a lot of headlines at the time.
• 14:18
  Philip Pape: But then when Nova Nordisk tested oral semaglitide directly in people who already had mild cognitive impairment or early Alzheimer's in the evoke and evoke plus trials, it failed to make a difference versus placebo on things like cognitive scores.
• 14:35
  Philip Pape: And there was another trial of laraglide in Alzheimer's that also didn't seem to have an impact, but it did show 18% slower cognitive decline and it preserved brain volume on MRI.
• 14:48
  Philip Pape: There was another study that showed no benefit for Parkinson.
• 14:51
  Philip Pape: So, you know, things are being tested out.
• 14:53
  Philip Pape: Who knows where we're going to end up with all this?
• 14:55
  Philip Pape: I'm not claiming anything here.
• 14:56
  Philip Pape: I'm just sharing what seems to be known so far from whatever studies have been done.
• 15:01
  Philip Pape: And I guess the emerging interpretation here, and for Daryl, our listener who asked about those things, I think it's that GLP1 drugs may help prevent some neurodegeneration through anti-inflammatory metabolic effects.
• 15:16
  Philip Pape: They may not treat the disease, you know, maybe a prevention thing.
• 15:20
  Philip Pape: And honestly, I again, I'm not giving you medical advice here.
• 15:23
  Philip Pape: This is just my reading of evidence as a lay person when it comes to this stuff.
• 15:28
  Philip Pape: So I hope that's helpful and at least gives you a thought to look into some of these things.
• 15:32
  Philip Pape: So we've just covered why body composition on GOP1 drugs is it's not a fixed static thing.
• 15:39
  Philip Pape: It highly depends on your training, your protein intake.
• 15:43
  Philip Pape: And if you're thinking, okay, how do I actually set up my protein?
• 15:46
  Philip Pape: How do I structure my training?
• 15:47
  Philip Pape: How do I know if I'm losing weight too fast or if my plant is working?
• 15:51
  Philip Pape: That is what Eat More Lift Heavy is built for.
• 15:55
  Philip Pape: This is my 26-week coach program.
• 15:57
  Philip Pape: I created it in conjunction with Coach Carol.
• 15:59
  Philip Pape: So you get two coaches.
• 16:01
  Philip Pape: And it's a three phases over 26 weeks where phase one is where we get your tracking and your baseline dialed in.
• 16:07
  Philip Pape: Phase two is where most of the, I'll say coaching happens because now you have data that you can read and make decisions from for your protein, your progression, your hunger signals.
• 16:16
  Philip Pape: If you're on GLP1s, are you losing weight too fast or just right?
• 16:20
  Philip Pape: Are you holding on to your muscle?
• 16:21
  Philip Pape: How are you training the right way?
• 16:22
  Philip Pape: You know, and if you're on a GLP one, I think it's fantastic.
• 16:25
  Philip Pape: These are the same skills we want to build.
• 16:27
  Philip Pape: And if anything, you really want to come in and learn those skills.
• 16:31
  Philip Pape: So eventually you could potentially titrate off the drugs.
• 16:35
  Philip Pape: And whether or not you do that, you can live with them in a more sustainable way.
• 16:38
  Philip Pape: So there's a lot in there.
• 16:40
  Philip Pape: I'm not going to go over all the things.
• 16:41
  Philip Pape: You know, you've got calls, you've got one focus per week, we've got a community.
• 16:45
  Philip Pape: We've got all that fun stuff.
• 16:46
  Philip Pape: But the key is that you're going to build skills one week at a time so that you come out more confident on the other side.
• 16:52
  Philip Pape: EatmoreLiftheavy.com.
• 16:54
  Philip Pape: That's eatmoreliftheavy.com.
• 16:57
  Philip Pape: Link is in the show notes as well.
• 16:59
  Philip Pape: All right.
• 16:59
  Philip Pape: So the next question people often ask is what happens when you get off these drugs?
• 17:04
  Philip Pape: Speaking of stopping, what happens when you stop?
• 17:07
  Philip Pape: And again, we go back to the step one, they had an extension study where at the end of it, after 68 weeks on some magletide, participants lost about 17% of their body weight.
• 17:20
  Philip Pape: And then when they stopped the drug, a year later they'd regained two-thirds of the weight they lost.
• 17:27
  Philip Pape: And also the cardiometabolic improvements in their blood pressure, their lipids, their blood sugar, those all reverted toward baseline too, which kind of makes sense.
• 17:33
  Philip Pape: Obviously, if you're gaining weight and you're not getting the protective effects if these drugs have independent effects, that would you'd be expected to happen.
• 17:41
  Philip Pape: For terzepatide, the Surmount 4 trial had a similar outcome.
• 17:45
  Philip Pape: 70% regained their weight within a year of stopping.
• 17:48
  Philip Pape: And 82% of patients who stopped regained at least a quarter of the weight within 12 months.
• 17:53
  Philip Pape: And then we have a 2025 meta-analysis across 11 different trials that found an average regain of about 5.6 kilograms, which if I do the math in my head is something like 12 pounds or something, multiplied by 2.2.
• 18:05
  Philip Pape: And then even longer follow-up periods showed even larger regain of weight.
• 18:10
  Philip Pape: Now that sounds discouraging, but I'm all about reframing and understanding the context.
• 18:15
  Philip Pape: So think of it this way: no one would take blood pressure medication for a year and then stop and be surprised when their blood pressure went up if they didn't do anything else, especially.
• 18:23
  Philip Pape: That's the nature of a chronic condition.
• 18:26
  Philip Pape: The drug was managing a physiological drive inside your body.
• 18:29
  Philip Pape: You move remove the drug and the drive returns.
• 18:32
  Philip Pape: So GOP1 drugs do the same thing at a minimum with your appetite, let alone with these other metabolic things we're talking about.
• 18:40
  Philip Pape: Your body has this biologically defended set point.
• 18:43
  Philip Pape: Now, I I'm hot and cold on like set point theory, but when you've been doing something for a long time, many years, there does seem to be a reversion to the mean that your body wants to do in terms of your weight and your habits and everything else.
• 18:57
  Philip Pape: And the drugs are suppressing the appetite signals that would have caused you to eat up to that point and then some.
• 19:04
  Philip Pape: And so when you remove the drug, those signals come back, right?
• 19:07
  Philip Pape: And we talked to Jamie Sellsler on this podcast.
• 19:09
  Philip Pape: He was talking about being on this for life in his case.
• 19:13
  Philip Pape: And that doesn't necessarily have to be the case for everyone, it depends on the person.
• 19:17
  Philip Pape: But the the promising thing here is other research.
• 19:20
  Philip Pape: There was a Copenhagen trial published in the New England Journal of Medicine in 2021, and it showed that exercise actually changes this equation.
• 19:28
  Philip Pape: So patients who exercise on laraglide regained five kilograms less than those who just used the drug after a full year after the treatment stopped.
• 19:38
  Philip Pape: And they were seven times more likely to maintain at least 10% weight loss.
• 19:43
  Philip Pape: And it increased the body's own natural GLP1 production.
• 19:47
  Philip Pape: So exercise during taking the drugs, it's not just a, I'll say transient support.
• 19:54
  Philip Pape: It's actually giving you long-term benefits, which really isn't that surprising, is it?
• 19:58
  Philip Pape: And now they say exercise.
• 20:00
  Philip Pape: I like to be specific: strength training, walking, all the types of activity we talk about on this show, especially lifting weights as being a huge game changer for the longer term.
• 20:10
  Philip Pape: But when you stop AGOP1, you are probably going to gain some initial weight anyway, like anyone would when you start to eat more.
• 20:18
  Philip Pape: Your body restores glycogen.
• 20:20
  Philip Pape: That's the stored carbs in your muscle and liver.
• 20:22
  Philip Pape: Glycogen binds with water.
• 20:24
  Philip Pape: So the first like three to five pounds on the scale on average are not body fat.
• 20:28
  Philip Pape: And that's always something when I tell people they're going to gain weight, you know, if they come out of a deficit and go to maintenance, is what's going to happen.
• 20:35
  Philip Pape: So you got to account for that as well.
• 20:37
  Philip Pape: And don't blame it on the drugs.
• 20:39
  Philip Pape: Okay, so where are we now?
• 20:40
  Philip Pape: We've covered body composition data, cardiovascular and inflammatory story regarding the drugs, and the weight regain piece.
• 20:48
  Philip Pape: Now, how can you use this data?
• 20:49
  Philip Pape: So if you're on or considering a GOP1 drug, there's five things the evidence says you should prioritize.
• 20:55
  Philip Pape: And the cool thing is, these are the same things this show Wits and Weights has always taught.
• 21:00
  Philip Pape: So this is a great refresher if you've already heard it, and it's a great new sense of empowerment and information that you can use if it's new to you.
• 21:09
  Philip Pape: Because the drug is not going to change the principles.
• 21:12
  Philip Pape: What I would say is it amplifies the consequences of ignoring these principles.
• 21:17
  Philip Pape: That makes sense.
• 21:18
  Philip Pape: Okay.
• 21:18
  Philip Pape: So number one is the protein.
• 21:20
  Philip Pape: We've got to have a certain amount of protein.
• 21:22
  Philip Pape: I'm just going to say the number again, at least 0.7 grams per pound, or like 1.2 grams per, or 1.6 grams per kilogram.
• 21:31
  Philip Pape: Some numbers you see out there advise less, but we are we're talking about lifting weights here and having enough, and we're talking about older population, maybe over 40.
• 21:39
  Philip Pape: I would just say going for, you know, 30 or more grams of protein for every meal so that it adds up to around 0.7 grams per pound of your body weight or more is solid.
• 21:48
  Philip Pape: And if you don't have an appetite, which is going to be the case, that's where you have to prioritize protein dense, low volume foods, where we normally talk about the opposite.
• 22:00
  Philip Pape: For most people, trying to have higher volume foods, but this is where you need it to be more uh dense.
• 22:03
  Philip Pape: And I'm gonna give you three specific meals at the end of this episode that do exactly that.
• 22:07
  Philip Pape: So I want you to stick around, but I want to get through these principles first because these are important to have before you go to tactics.
• 22:13
  Philip Pape: So number two is resistance training, non-negotiable.
• 22:16
  Philip Pape: This is the most evidence-supported intervention to preserve lean mass, period, let alone on GLP1 drugs.
• 22:24
  Philip Pape: And we talked about the exercise group in the Copenhagen trial.
• 22:27
  Philip Pape: There's also a case series in 2025 of patients who did resistance training while on some aglitide or terzepatide.
• 22:35
  Philip Pape: And I talked about this in a previous episode.
• 22:38
  Philip Pape: The amount of lean tissue they lost was low.
• 22:41
  Philip Pape: It was something like five to 10%.
• 22:44
  Philip Pape: It's very similar to anybody who would lose weight and hold on to muscle, remembering that some of that lean mass is not muscle.
• 22:52
  Philip Pape: And so your actual muscle loss is quite small.
• 22:54
  Philip Pape: And if you're doing it right, it kind of comes right back when you get back to maintenance or start building again.
• 23:00
  Philip Pape: So all you need at a minimum is two to three sessions per week hitting all major muscle groups with progressive overload.
• 23:06
  Philip Pape: So if you want further numbers than that, I would say try to hit major muscle groups for around 10 sets per muscle group per week.
• 23:14
  Philip Pape: And that could be direct or indirect.
• 23:16
  Philip Pape: That leads to a whole other discussion and many other podcast episodes about training and programming.
• 23:21
  Philip Pape: But heck, going from zero to one a week is itself a massive game changer compared to saying, no, no, I just can't do this and I'm not going to train.
• 23:30
  Philip Pape: You've got to lift weights.
• 23:31
  Philip Pape: All right, number three is monitoring your rate of loss.
• 23:34
  Philip Pape: So the GLP1 drugs, because they suppress your appetite by a lot, like 30 to 40%, it can push you into a very aggressive deficit without even trying.
• 23:45
  Philip Pape: I see it all the time.
• 23:46
  Philip Pape: Clients come in or members come in to eat more lift heavy.
• 23:49
  Philip Pape: And it's ironic because they the eat more in their mind is because they're actually not able to eat more due to the appetite while losing weight.
• 23:56
  Philip Pape: It's a very interesting place to be.
• 23:58
  Philip Pape: And so if your scale is dropping faster than 1% of your body weight per week, you are definitely in that zone where the lean mass loss can accelerate.
• 24:07
  Philip Pape: All right.
• 24:07
  Philip Pape: There's a lot of other variables behind it, like how much weight do you have to lose and how lean are you to begin with, et cetera.
• 24:13
  Philip Pape: But the fix here is just to intentionally eat more, starting with protein.
• 24:19
  Philip Pape: Don't be all excited about this rapid weight loss.
• 24:22
  Philip Pape: Like manage it and get control of it.
• 24:24
  Philip Pape: And this may also let you reduce your dosage of the drug, which I don't know if it's gonna save you money as well, maybe reduce side effects, those kinds of things.
• 24:31
  Philip Pape: Number four is to start early.
• 24:35
  Philip Pape: Now, what do I mean by this?
• 24:37
  Philip Pape: There is a study in 2026, semoline, it was called.
• 24:41
  Philip Pape: It found that lean mass loss was largest in the first three to six months and then it stabilized.
• 24:46
  Philip Pape: And they used hand grip strength and found that it improved.
• 24:49
  Philip Pape: And sarcopenic obesity, so so sarcopenia, which is the loss of muscle and function, actually reduced as well.
• 24:57
  Philip Pape: Like there was less of it from 49 to 33 percent.
• 25:01
  Philip Pape: But the loss of lean mass is really front-loaded.
• 25:05
  Philip Pape: So ideally, you're starting your training in protein optimization when you start the medication.
• 25:11
  Philip Pape: But if you haven't, the next best time to start is now, right?
• 25:14
  Philip Pape: That's obviously always the case.
• 25:16
  Philip Pape: Don't use that as an excuse.
• 25:17
  Philip Pape: Then number five is plan ahead for an off ramp.
• 25:21
  Philip Pape: Now, a lot of people aren't doing this.
• 25:22
  Philip Pape: A lot of you taking these drugs, I know it because I talked to you, you're just taking them, you're kind of in the middle, and you're like, all right, I'm just gonna keep taking them.
• 25:29
  Philip Pape: Well, if you plan to eventually stop or want to stop or want to reduce the dose, right?
• 25:33
  Philip Pape: Yeah, many people do, some people don't.
• 25:35
  Philip Pape: And it's okay to experiment and try coming off, seeing what happens, and maybe you do have to go back on.
• 25:40
  Philip Pape: That's fine.
• 25:41
  Philip Pape: The behavioral habits that you build while on the drug, that is the thing, that's the buffer.
• 25:47
  Philip Pape: That's like the insurance policy that will save you later on when you reduce or come off of these.
• 25:53
  Philip Pape: And at a minimum, they'll get rid of some variables that you need to fix anyway, right?
• 25:59
  Philip Pape: Your training and your nutrition, so that you can isolate whatever remains in terms of things like food noise or appetite.
• 26:06
  Philip Pape: So, this would be how do you structure your meal?
• 26:08
  Philip Pape: Do you plan ahead?
• 26:09
  Philip Pape: What are your training habits?
• 26:11
  Philip Pape: Do you get enough protein?
• 26:12
  Philip Pape: All of those things, the things that we teach and eat more live to have exactly those skills.
• 26:17
  Philip Pape: And then for those who are staying on these drugs long term, which is a totally valid option, and some people are probably gonna have to do this.
• 26:24
  Philip Pape: There is now an oral pill for cymagotide that they're starting to study.
• 26:29
  Philip Pape: And I guess it's pretty affordable as well.
• 26:32
  Philip Pape: There's a higher dose injectable somagide, and there are more options now than ever, is what I'm saying.
• 26:39
  Philip Pape: So, meaning you should kind of shop around and always be aware of what's available.
• 26:43
  Philip Pape: Talk to your doctor, of course.
• 26:44
  Philip Pape: This is not me giving you medical advice.
• 26:45
  Philip Pape: This is just be aware of the options as they continue to evolve and change.
• 26:49
  Philip Pape: You might find something that has less side effects or a lower dose or something like that, or it's more convenient to take, et cetera.
• 26:54
  Philip Pape: All right, last little thing here is I think Daryl asked about safety as well.
• 26:57
  Philip Pape: And this is where I could easily get into the medical side of things too much more than I'm comfortable with.
• 27:02
  Philip Pape: But if you look up, look up the studies, large cohort studies done as recently as 2026, made analysis done as recently as 2025 on thyroid cancer, on pancreatitis, on gastroparesis, on even things like suicidal ideation.
• 27:18
  Philip Pape: There's a lot of mixed data.
• 27:20
  Philip Pape: Generally, it seems like some things are getting overblown.
• 27:23
  Philip Pape: You know, there have been these like what they call like black box warnings that were on and then they were removed from the labels.
• 27:29
  Philip Pape: There's weird conditions like dysesthesia.
• 27:34
  Philip Pape: I don't even know how to pronounce it.
• 27:35
  Philip Pape: It's like an altered skin sensation.
• 27:36
  Philip Pape: So there's all these really weird little side effects and things.
• 27:40
  Philip Pape: And in studies that show some sort of risk increase for like a cancer, oftentimes they're confounded by other things like gallstone formation or the fact that you're losing weight rapidly, all that kind of stuff.
• 27:54
  Philip Pape: So I really don't want to make any claims or even get into that data here today.
• 27:57
  Philip Pape: I'll leave that for more of the medical podcasts.
• 28:00
  Philip Pape: But it's very interesting if you are taking them or thinking about taking them just to be educated on things like side effects and long-term effects, if you're able to tease that out, which is very difficult, I realize.
• 28:12
  Philip Pape: All right, before we wrap up, remember those three high protein meals that I promised you, each under each under 300 calories, over 35 grams of protein.
• 28:20
  Philip Pape: If you don't have an appetite, I'm gonna share those in just a second.
• 28:23
  Philip Pape: But if you know someone who's currently on a GLP1 med or thinking about starting one or curious about them or talking about them, send them this episode, please.
• 28:32
  Philip Pape: Share this episode.
• 28:33
  Philip Pape: We love to spread the word and get people educated and excited and curious.
• 28:37
  Philip Pape: Text them a link from your app, whatever's the easiest way to do it, because I doubt they're getting a lot of this information from their healthcare professional.
• 28:47
  Philip Pape: I'm just saying, I doubt they are.
• 28:48
  Philip Pape: The odds are low from what I've discovered.
• 28:51
  Philip Pape: And things like protein and training and whatnot, doctors generally are just not talking about those from a prescriptive standpoint because that's not really their job anyway.
• 28:59
  Philip Pape: So text this friend who needs to know, wants to know who you love and want them to know about it.
• 29:05
  Philip Pape: All right, here are some ideas for hitting a lot of protein in a very dense way without having as much volume.
• 29:12
  Philip Pape: So, meal one is take a cup of nonfat Greek yogurt, a scoop of whey protein, handful of berries.
• 29:19
  Philip Pape: I've mentioned this before.
• 29:20
  Philip Pape: This is like the perfect combination of low calorie, it's like 280 calories, 42 grams of protein.
• 29:26
  Philip Pape: And of course, you've got the fiber and the berries, and it tastes great.
• 29:28
  Philip Pape: You could add some cinnamon, add some sweetener in there, you know, either a calorie sweetener, which adds calories, or if you're okay with an artificial sweetener or like a stevia.
• 29:36
  Philip Pape: All right, meal two, let's go with the chicken breast, about four ounces of chicken breast, mixed with a tablespoon of mayo and squeeze a lemon on a bed of spinach.
• 29:44
  Philip Pape: So that's kind of like your chicken salad, if you will.
• 29:47
  Philip Pape: And of course, you could put that on like high fiber wrap or something like that if you want to add more fiber and maybe even a little protein that way.
• 29:53
  Philip Pape: So we're talking 250 to 300 calories and almost 40 grams of protein, super quick and easy, convenient.
• 29:58
  Philip Pape: And you could even use canned chicken.
• 30:00
  Philip Pape: And then meal number three is a protein shake where you've got one and a half to two scoops of whey.
• 30:05
  Philip Pape: You use something like skim milk or almond milk, and some peanut butter powder if you like peanut butter, so you don't get all the extra calories and fat from actual peanut butter.
• 30:13
  Philip Pape: So, again, that is about 290 calories, 43 grams of protein.
• 30:17
  Philip Pape: Just super simple, convenient ideas.
• 30:19
  Philip Pape: Three meals, protein forward, they're low volume.
• 30:22
  Philip Pape: That's the key.
• 30:22
  Philip Pape: They're low volume.
• 30:24
  Philip Pape: They shouldn't make you as full.
• 30:25
  Philip Pape: And you can rotate them through and get your protein.
• 30:27
  Philip Pape: All right, until next time, keep using your wits, lifting those weights.
• 30:30
  Philip Pape: And remember that the these GLP1 drugs, they definitely can affect your appetite.
• 30:35
  Philip Pape: But regardless of whether you're on them or not, it's the protein and the training and the lifestyle that are really going to make a difference for you in the long term.
• 30:42
  Philip Pape: I'm Philip Hape, and I'll talk to you next time here on the Wits and Weights podcast.