CDear doctor, I’m 49 years old and I’ve been taking semaglutide to lose weight for three months. I’ve lost almost six kilos and my hunger has really decreased. But lately I feel less toned, I get tired faster and I read that these drugs can cause muscle loss. How should I eat so as not to arrive at the end of the journey leaner but also weaker and “softer”?
Weight loss and muscle loss: a misunderstanding to clear up
That you are asking yourself this now, three months after the start, is already good news, it would have been even better if they had guided you from the beginning.
Let’s start with a very common misunderstanding. Muscle loss during weight loss is not a specific consequence of semaglutide. It happens with any low-calorie diet, with bariatric surgery, with prolonged fasting. When the body loses weight quickly, it does not always precisely separate fat from lean mass: it just loses weight, while losing weight means losing excess fat. The most recent reviews estimate that between 25 and 40 percent of the weight lost during GLP-1 therapy may come from muscle mass. It is not a pathology. It is an adaptive response of the body to a very often wrong way of eating. Ignoring it would be a big mistake.
Who is most at risk of losing muscle mass
Who is most at risk? Women and those over 45. So: you.
Proteins: the main lever to protect the muscle
The main lever is not a supplement. It is dietary protein, distributed well throughout the day. With the drug the appetite is lowered, the portions are reduced, and if you are not careful the first thing that disappears from the plate, almost without realizing it, is the protein portion: you eat a bit of the first course, you feel full and you leave the table. The body in caloric deficit, at that point, begins to use muscle as fuel.
How much protein do you really need (and how to distribute it)
To protect lean mass during a journey with GLP-1, the protein requirement rises: at least 1.2-1.5 grams per kilo of body weight per day, present at breakfast, lunch and dinner. Not just in the evening! Always. Eggs, Greek yogurt, ricotta, fish, chicken, tofu, legumes. Even when there is nausea, which is quite common in the first few weeks, it is better to focus on light, cold sources, in small quantities and at closer intervals. A few spoonfuls of Greek yogurt with dried fruit is often handled much better than a hot second course.
Strength training: why it is essential
The other element that no diet can replace is strength training. Two or three times a week, even with moderate loads. The muscle, in fact, needs a mechanical stimulus to maintain itself: walking alone is not enough. The most recent evidence, also discussed on Diabetes Care, indicates that during treatment with GLP-1 drugs, an adequate protein intake associated with resistance exercises is essential for improving body composition, promoting the loss of fat mass and limiting the loss of muscle mass as much as possible. This is not an “accessory” strategy, but an integral part of the path: what the scientific literature confirms and daily clinical experience makes clear.
Supplements: when they can help
Where there is a personalized indication, some molecules, creatine monohydrate, leucine, omega-3 and vitamin D, can give concrete support. They are not universal solutions. They are tools that must be calibrated to the person.
Semaglutide: a powerful tool, to be used with awareness
Semaglutide is a powerful tool. Using it without structured nutritional support is like driving a fast car without knowing how to brake.
Lose weight without becoming more fragile
Losing weight while preserving muscle is not an aesthetic issue. It’s the difference between a healthier body and a more fragile one.
Doctor Federica Almondo
Doctor Federica Almondo.
Specialist in Nutrition Science, trained at the Dietology and Obesity Center of the San Raffaele Hospital in Milan, Doctor Federica Almondo is a point of reference in personalized nutrition, preventive medicine and anti-aging pathways.
After founding and directing Cerva 16 – Nutrition & Anti-aging Center, he is now responsible for the Nutrition and Longevity areas of Image Regenerative Cliniccenter of excellence and international point of reference for Regenerative Medicine and Aesthetic Medicine with offices in Milan and St. Moritz.
It deals with tools such as genetic tests (DNA), assessments of the state of the intestinal microbiota, analysis of oxidative stress, body composition, indirect calorimetry, ANS Analysis to build highly personalized diets with a holistic and scientifically validated approach, suitable for even the most complex needs.
With excellent training and skills ranging from nutrigenetics and nutrigenomics to nutraceutics, metabolomics and epigeneticsAlmondo is also recognized for her work on intestinal health, menopause, chronic stress management and optimization of psycho-physical energy. Particular attention to ketogenic therapya nutritional approach now totally validated by scientific literature such as effective intervention in many complex pathologiesincluding type 2 diabetes, PCOS, fibromyalgia and lipedema and much more.