Recharge Podcast Mitchel Schwindt, M.D. | author | online courses | coaching | consulting

What is your definition of wealth? Could there be another version?
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There are several strategies that can help prevent or manage muscle mass loss associated with GLP-1 agonist treatment:
## Resistance Training
Incorporating resistance or strength training exercises is one of the most effective ways to preserve and build muscle mass during weight loss[1][2]. This counteracts the catabolic effects of caloric deficit by stimulating muscle protein synthesis.
## Adequate Protein Intake
Ensuring sufficient dietary protein intake, ideally 1.6-2.2 g/kg of ideal body weight per day, can help minimize muscle loss[2]. Protein provides amino acids needed for muscle maintenance and repair.
## Combining with Myostatin Inhibitors
Myostatin is a key negative regulator of muscle growth. Blocking myostatin with investigational drugs like apitegromab (SRK-439) from Scholar Rock may enhance muscle growth and prevent muscle loss when combined with GLP-1 agonists[1]. Early clinical trials are underway to test this approach.
## Using Activin Receptor Inhibitors 
Activin receptor inhibitors like those being developed by companies like Regeneron can block activin signaling and potentially increase muscle mass when used alongside GLP-1 medications[3].
## mTOR Activators
The mTOR pathway regulates muscle protein synthesis. Drugs that activate mTOR, such as the PPAR agonist enobosarm being tested by Veru, may preserve muscle when combined with GLP-1 treatment[5].
## Adequate Vitamin D and Calcium
Ensuring sufficient vitamin D and calcium intake is important for preserving bone mineral density, which can be impacted by the weight loss and muscle loss induced by GLP-1 agonists[2].
The key is utilizing a multi-modal approach combining GLP-1 agonists with resistance exercise, optimal nutrition, and emerging muscle-preserving medications to maximize fat loss while minimizing the loss of metabolically active lean muscle mass[1][2][3].
Citations:
[1] https://pharmanewsintel.com/features/addressing-muscle-loss-associated-with-glp-1-medication-use
[2] https://www.medscape.com/viewarticle/994030
[3] https://www.tctmd.com/news/dont-worry-about-muscle-loss-glp-1-inhibitors-viewpoint-asserts
[4] https://www.uclahealth.org/news/article/rapid-weight-loss-can-lead-loss-muscle-mass
[5] https://www.drugdiscoverytrends.com/glp-1-impact-lean-mass/

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Mindset Monday - Just because you can, doesn't mean you should.
https://mitchelmd.thinkific.com/
Let's talk about hustle culture gone mad.
You, the entrepreneur, the maverick, the one who built a damn empire from scratch. You can wrangle investors, write code that would make Einstein weep, and probably even fix your leaky faucet. But here's the thing, mate: just because you can doesn't mean you should spend your precious time wrangling screwdrivers and braving the fluorescent purgatory of Home Depot for a measly wall sconce.
Your time is your currency.
Delegate that sconce duty! Focus on the big picture, the revolution you're building, not the revolution of a light fixture. Let someone else play handyman while you conquer the day.

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The Keys To Accelerating Results
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Filling The Confidence Bank
Three takeaways from the opening of Dr. Zinsser's book on Confidence.

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The primary concern with using glucagon-like peptide-1 (GLP-1) agonist drugs for weight loss is the potential loss of muscle mass (lean body mass) along with fat mass. Clinical studies have indicated that a significant portion of the total weight loss achieved with GLP-1 agonists like semaglutide (Ozempic) and tirzepatide (Mounjaro) results from a reduction in lean body mass, which includes skeletal muscle.
In the STEP 1 and SUSTAIN 8 trials for semaglutide, about 39-40% of the total weight lost was due to a decrease in lean mass, primarily muscle. A 2021 meta-analysis of 18 randomized controlled trials also found significant reductions in fat-free mass (lean body mass) with the use of GLP-1 agonists.
The loss of muscle mass is concerning for several reasons:
1. **Metabolic Health**: Muscle is crucial for metabolism, insulin sensitivity, and glucose uptake. Significant muscle loss can negatively impact metabolic health and increase the risk of insulin resistance and type 2 diabetes.
2. **Physical Function**: Maintaining adequate muscle mass is essential for physical function, mobility, and independence, especially in older adults who are already at risk for age-related muscle loss (sarcopenia).
3. **Quality of Life**: Excessive muscle loss can lead to weakness, fatigue, and a decreased ability to perform daily activities, potentially impacting quality of life.
4. **Bone Health**: Muscle mass is closely linked to bone health and strength. Significant muscle loss can increase the risk of osteoporosis and fractures.
While some degree of lean mass loss is expected during weight loss, the extent of muscle loss observed with GLP-1 agonists is concerning, particularly for individuals with low muscle mass or those at risk for sarcopenia.
To address this issue, researchers and pharmaceutical companies are exploring strategies to preserve muscle mass while using GLP-1 agonists for weight loss, such as combining them with muscle-preserving agents or targeting specific pathways like myostatin inhibition. Additionally, incorporating resistance training and ensuring adequate protein intake are recommended to help mitigate muscle loss during GLP-1 agonist treatment.

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