GLP-1 Medications: Muscle Preservation, Metabolic Resilience, and What Every Practitioner Must Know

What’s Inside This Episode

• Why weight loss is not the same as metabolic restoration
• How GLP-1s affect appetite, digestion, and nutrient intake
• Protecting muscle and functional strength while on these medications
• Key labs and markers to track metabolic resilience
• How diet, protein, fiber, phytonutrients, and exercise fit in
• Risks of nutrient depletion, slowed digestion, and functional decline
• How to help clients transition off GLP-1s without losing metabolic gains
• Practical steps for integrating GLP-1s into a systems-based metabolic strategy

Resources and Links

• Download the full transcript here
• Get your FREE guide: Beyond Protocols: A Practitioner's Guide to Root Cause Pattern Recognition for a structured framework to integrate symptoms, systems, and sequence in complex cases
• Access the Genetic Pathway Mapping Workshop Replay to learn a clinical framework for identifying genetic patterns and applying targeted epigenetic strategies. Approximately 2 hours of training.
• Join the Next-Level Health Practitioner Facebook group here for free resources and community support
• Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results. 
• Check out other podcast episodes here

 

---

Transcript

 

Dr Ritamarie 

What if GLP medications are not the metabolic miracle some people claim they are, and they're not the metabolic disaster that other people warn against? What if the real issue is that they're often being used without a strategy to protect muscle, preserve nutrient status, support digestion, and rebuild true metabolic resilience? 

 

In today's episode, we're going to look at GLP-1 conversation through a functional practitioner level.

 

Weight loss is not the same thing as metabolic restoration, and appetite suppression isn't the same thing as true healing.

 

GLP-1 medications have become one of the most talked-about interventions in metabolic health today. They're being used for type 2 diabetes, weight loss, appetite regulation, and increasingly discussed in relationships to cardiovascular risk and long-term metabolic outcomes. 

 

Like almost every big health trend, the conversation has become very polarized. Some people talk about them as if they're a miracle solution, and others talk about them as if they're automatically harmful. As practitioners, we need to be more discerning than that. 

 

GLP-1 receptor agonists can be very powerful tools when used correctly. They do influence appetite, glucose regulation, gastric emptying, insulin secretion, and satiety signaling. They can help people lose significant amounts of weight and also improve markers of cardiometabolic risk. 

 

The problem isn't that they exist or that they're being utilized. The problem is what happens when they're used without a plan, when they're not used in the proper context. If somebody loses weight while also losing a lot of muscle and lowers their protein intake, reduces nutritional density, and slows digestion, it worsens constipation and becomes more disconnected from the signals that their body has been trying to get across. This doesn't create metabolic health.

 

Dr Ritamarie (02:40)

We may have created a smaller body with much less capacity, because we're automatically reducing appetite and thus caloric intake and nutrient intake. That's a very different outcome than what I think that most people really need. Why do we, as practitioners, need to pay attention when you prescribe GLP-1s, or if their doctor has pre-prescribed GLP-1s or peptides, that are GLP-1 agonists?

 

Whether they're in your scope or not, people are going to ask you about them, and they may already, they probably are already, asking about them. 

 

They're probably already coming in and saying they've started to take them. So what do we as practitioners need to be aware of in terms of what to suggest that people do to get the best out of it or to determine whether or not these medications, these GLP-1 receptor agonists, are actually good for the particular person? 

 

They may be getting them prescribed through a prescription or a med spa or a telehealth platform or even a compounding pharmacy or even off-label out of the country, not to anybody but a distributor. They may not be telling you that they're using them unless you ask, so make sure that you include that in their intake. Are you taking any GLP-1s?

 

If you work with metabolic health, which most of you do, you have to, because it's everywhere. It's 93% of the population, so if you don't work with metabolic health, you need to learn about it, and you need to start using it. 

 

If you do work with it, and you look at insulin resistance and cardiovascular risk and thyroid function and hormones, digestive health, or even just aging and longevity, this topic is already making its way into your practice. The question is not do I like GLP1s. The better question is how do I help this person protect metabolic function while appetite, intake, digestion, and body composition are changing? 

 

That's where functional practitioners play a critical role, because we look at function, not just effects. We look at the function overall, not just the immediate effects of weight loss.

 

Dr Ritamarie (04:57)

Recent literature continues to raise concerns about the lean mass loss during GLP-1 associated weight loss, and some suggest that soft tissue can represent a meaningful portion of the total weight loss. Then when people go off and gain weight back, what they're gaining back is not the lean weight that they lost, it's fat. 

 

So how do we help people to protect against this? How do we help if they are going to use these GLP-1s in the context of a framework that promotes overall metabolic health, not just lowers their appetite, which makes them eat less. That does work for weight loss temporarily, anyway, so we need to make sure that they're getting enough protein, that they're doing enough resistance training, that they're getting enough phytonutrients to support their body in the wake of reduced calorie intake, and that takes some planning. That takes some strategy, and that's where we come in and can help support people. 

 

Weight loss isn't the same as metabolic restoration. These medications were created for metabolic health. They were created with the idea of using them for people with type 2 diabetes, or insulin resistance, to help restore that functionality. That's not how they're being used these days. In some cases, they're being given to people as a weight loss drug without really helping the person change the way they eat, the way they think, the way they move, and that's where big mistakes come in. 

 

One of the most important clinical distinctions is how are people using these drugs? Are they using it as a crutch? Are they using it just as a, “I need help losing these last 20 pounds, and this is going to make it easier and reduce my appetite?” Or are they using it as part of an overall metabolic health restoration program? And that's totally different.

 

When somebody loses weight, they can still have poor mitochondrial function, and that's not good. They're not going to make energy. We can lose weight and still have low muscle mass. A lot of times that's what's happening. Most of the time, in fact, if the practitioner prescribing is not also prescribing a strength training program, a diet that's rich in phytochemicals, protein, good fats, and enough carbohydrates to prevent them from going into starvation mode, but not so much that they are putting on weight and increasing their insulin. 

 

So when a person loses weight, they can still have insulin resistance. It doesn't mean that they automatically reverse their insulin resistance. They can still have inflammatory drivers, and those are things we need to look at: toxic burden, poor sleep, dysbiosis, micronutrient depletion, all of these play in, and that leads to thyroid imbalance and adrenal dysregulation.

 

If we don't help people to recognize and solve these underlying problems, then all the GLP-1s in the world…, we'll create a lean body, but at what cost? At what cost? 

 

Weight loss can reduce risks in many cases. Obviously, it's taking a lot of strain off the body. I agree with that, but losing weight at all costs is not something that we should be promoting. It can lower the mechanical burden on the joints, so people feel better.

 

It can improve some of the cardiometabolic markers and reduce visceral fat. Those are all important things. It can improve glucose regulation for many people, but weight loss alone doesn't tell us whether the body is becoming more metabolically resilient, and that's what we want. We want metabolic flexibility. That takes a deeper look. 

 

It's not that people shouldn't be taking these medications, it’s that if they are taking them, they're doing it in the right context, in the context of also doing the things that they need to do to restore metabolic resilience, to restore metabolic health, to restore and keep and maintain and even grow lean body mass. 

 

We have to look at things like, Is their fasting insulin improving? Yes? That's great. Is the glucose variability improving? Are they having these big swings, or are they getting a more steady up, steady down kind of curve [on a CGM] which indicates metabolic balance. 

 

Is their muscle being preserved? We can easily test that with the various tests that at home scales do that, go to the gym and get bioimpedance done. Those are ways we can look at that. We can do a DEXA scan to see what the belly fat, the visceral fat is, and how's the strength? That's an easy marker. 

 

If you're on these medications and you're losing muscle, you're not going to be able to lift as heavy. You're going to find yourself straining to do simple things, tasks that you used to be able to do. How's energy, right? Are they having more energy or less? I hear from a lot of people who are doing this. I'm just going to say in quotes “The wrong way,” that they have no energy. They feel really tired all the time. They feel weak. They feel tired. 

 

Then when we look at weight, …, the whole point of these medications is to help with that satiation, that getting rid of that noise in the head that says eat more, eat more, eat more. 

 

Just eating less, unless you're eating less and still maintaining high nutrient density, the weight may go down, but the health may also go down. They need to get enough protein and minerals and fiber and phytonutrients, and fiber is one of the best things for feeling satiated without overconsuming calories.

 

What about inflammatory markers? We need to be measuring inflammatory markers. Are they improving? Are the liver enzymes, gallbladder function, thyroid markers, nutrient markers stable? Do we have GGT going up, because of reducing the weight and eliminating toxins from the tissue, but then the liver can't keep up with the load. What is happening here? Are they becoming smaller? Or are they also becoming more capable as a human body?

 

These are really, really important distinctions for us as practitioners to be looking for, because our job is not to help people change the number on the scale. Our job is to move the needle on moving them into a healthier, more protective lifestyle, helping them restore function, helping them get into a state where they're able to prevent the onslaught of degenerative diseases and the normal diseases of aging, which I don't think are normal at all. 

 

Rapid weight loss often leads to a loss of lean mass. If somebody is on these medications, not prescribed by you, but prescribed by somebody else even, then are you measuring them on a regular basis, their body composition, doing either a full body DEXA or bioimpedance scale or something along those lines, and watching that? Are they doing progressive weightlifting? Are they doing strength training as their body allows?

 

Dr Ritamarie (11:49)

Muscle is a metabolic machinery. Metabolic machinery. Good muscle, healthy muscle tissue is going to keep us in metabolic balance. It's going to be less insulin resistant, and it's going to give us the strength and energy in the body, balance to resist disease and long-term things. 

 

Healthy muscle helps us get rid of the extra glucose, helps us use the extra glucose, regulates the insulin sensitivity, so the glucose can actually get into the cells. It produces myokines. It supports mitochondrial density, protects functional capacity as people age, and typically the muscle mass goes down as the decades progress anyway. 

 

If we're doing these GLP-1s, and they're causing us to lose weight and that muscle is what's lost, then that's going to accelerate the natural aging. When we're exercising and doing strength training and keeping the protein intakes right, then that's going to decelerate that process of muscle loss. 

 

When we lose muscle, a lot of that metabolic capacity gets lost with it, and it's harder to maintain. It's harder to put back on. It's easier to maintain muscle than it is to build new muscle. That takes a lot of work. It takes a lot of strength training, especially. 

 

When people start these programs, they're typically coming from a history of gaining weight, and maybe some emotional eating, and bingey eating, and not necessarily the right kind of eating. If we just get them to eat less, as opposed to getting them to eat better, it's not going to really help their long term health. It's certainly not going to help with long term and longstanding insulin resistance. 

 

As practitioners, we need to be thinking about this from the beginning. As soon as you hear that a client, or patient, is on these GLP-1s, or if you've prescribed them yourself, we have to be looking at these at the beginning of the cycle, not after they've already lost 40 pounds, and 40% of that or 20% of that, or even sometimes 50 to 95% of that is muscle. 

 

Then, they suddenly develop coldness and constipation, and their thyroid function declines, and they are eating half of what they used to eat. Yes, they're losing weight, but at what cost? 

 

What does this mean to us as functional practitioners? It means asking about their protein. It doesn't mean eating steak, and it doesn't mean doing carnivore. You can eat plenty of protein. Plant protein is quite adequate if it's done properly, and the protein amount has to be regulated to the activity level.

 

Somebody who's a couch potato with kidney disease should not be eating anywhere near the amount of protein that somebody who's in the middle of weight training and is a bodybuilder. Those are very, very different, and we really need to be talking to people about strength training and recommending it, whether it be going to the gym or just getting some bands that they can use at home, doing body weight exercise, starting with push-ups against the wall, pull-ups, hangs, dead hangs, all of those things.

 

We need to look at the person's body composition. This is a critical part that I think is overlooked in many of the clinics that are prescribing GLP-1s. We have to look at functional strength. How well can they do things like reach up to that top shelf and get something down? Reaching down, and all the things that they need to do with strength on a functional level? 

 

We have to make sure that people can tolerate nutrient-dense food. That they're getting nutrient dense food and that their body can tolerate it, because sometimes digestive capacity has been impaired from years of chronic overuse of processed foods and creating dysbiosis and all that. 

 

We now have to make sure that the weight loss doesn't have a big cost, like loss of resilience, loss of muscle strength. One of the issues with appetite suppression is that people just eat less of everything, and when you eat less of everything, you're eating less of the good foods, you're eating less of those fiber-rich, phytochemical-rich foods that are supporting health. 

 

What really needs to happen is they need to be reducing the not so good foods. The ultra-processed foods, the high fat, high saturated, oxidized fat foods, and sugar. People are eating way too much sugar already, and if they just cut the amount they're eating, they still have the same high percentage of sugar in their diet. 

 

Dr Ritamarie (16:23)

Less overeating is definitely helpful, but also they're probably getting less protein, less magnesium, less potassium, zinc, B vitamins, omega-3s, fiber, and the bitter foods that stimulate digestive process, less fermented foods, and fewer phytonutrients. 

 

All of these can happen by simply just eating less. If you're eating less of the same not so good diet, you're just not going to get enough. You're not going to get enough calories, of course. Therefore you're going to lose weight, but you're not going to get enough of the good stuff either. 

 

The question then becomes, how do we make every bite count? When we're talking to people, and that should be the truth all the time, but more so when we're working with somebody who's on a GLP-1 or other appetite suppressants.

 

For someone on these, the diet needs to be way more intentional, not less intentional. Not just, okay, we just eat when we're hungry, stop when we're full, and maybe they just had their unhealthy meal, or they had a snack on the way home from work and then they're not hungry for a good dinner, because they're full. 

 

These are all the things we need to be taking care of: diet diaries or taking pictures of their foods and using some sort of AI app to be able to analyze what's in it. This is really, really important. We have to make every single meal count to support muscle, mitochondria, blood sugar digestion, liver, bile, satiety, all these things. 

 

A lot of times, people get into this problem with the extra weight, because they have this food noise in their head, and it's hard to stop the food noise. Therefore, the GLP-1s help to stop that food noise, but we have to also retrain that. Now they don't have the food noise that says constantly let's eat. How do we train it so that when we do eat, every morsel counts? 

 

Forcing large meals is not going to help when the appetite's low, but we have to strategically balance those meals, so that they're healthier, more phytonutrient-rich, fiber-rich, and all that. Smaller protein-forward meals, yes, that's good, but it doesn't mean going carnivore and eating nothing but steak. That may give you the results short term, but long term is certainly not going to give you those results. 

 

Dr Ritamarie (18:43)

Smoothies with plant-based protein and mineral-rich greens in them, those are things that can be nutrient dense and good foods at least temporarily. Digestive support may be necessary, enzymes, bitters, probiotics, things like that. Electrolytes, fibers, bowel support, making sure the bowels keep moving.

 

Add resistance training, before they feel ready. That doesn't mean trying to lift things that are way beyond their capacity. It means that we just start a little bit at a time. Light weights, resistance bands, short duration, and then we build up to it slowly. 

 

There's a lot of things to think about in terms of digestion and gallbladder when we're on these medications. They slow gastric emptying. That's why people feel fuller. What does that mean? Well, that's part of a poor digestive track. When there's slow gastric emptying, we're not getting the food through, and we're not getting the transit time to be what it needs to be. That can feel full, but it could be that they feel nauseous. They have some reflux, because the stomach contents aren't emptying. They may feel constipation, or bloating, and other things like that. They may even develop food intolerances, because the food is not getting digested as well and is sitting in the system longer than it should.

 

When food intake stops, bile secretion may also decrease, which means they're not going to be handling the fatty foods, as well. We have to be careful about fatty food intake. Rapid weight loss puts stress on the gallbladder. We know that people who lose weight very quickly tend to develop some gallbladder stagnation. 

 

We need to ask all the practical questions, all the questions we always should be, but even more important are things like: how often are you having a bowel movement?

 

Even if you're having a bowel movement every day, are you pooping out the stuff you ate within the last 24 hours, or is it three-day old fecal matter? Those things can be done by doing a carefully constructed bowel transit time. I find that that happens a lot. I have bowel movements every day, but if we actually do a transit time, we're seeing that the transit time might be three days. 

 

What about skipping meals? What about not getting enough nutrients? That's really important.

 

Dr Ritamarie (21:03)

Some are avoiding fiber sometimes, because they feel full. They may be avoiding eating high fiber foods or drinking enough water. Getting enough minerals? All of these questions we need to ask them, but also ask by looking at their food diaries.

 

What about showing signs of slow bile flow or sluggish detox? Shoulder pain, right-sided shoulder pain, can be a sign of problems with the liver and gallbladder. We have to look at that. Seeing stools that have undigested fat in them that glisten or that float, that can be a problem as well. That can show that there's a problem. All of these things have to be considered. It's all part of metabolic health.

 

When we suppress the appetite without supporting digestion, elimination, nutrient volume, and nutrient absorption, we miss the deeper picture.

 

A simple framework that you can use when someone's using, or considering, coming off of a GLP-1. First assess their baseline. Look at their fasting glucose, fasting insulin, hemoglobin A1C, liver markers, HS-CRP, triglyceride:HDL ratio, kidney markers, thyroid, vitamin D, all of these markers are super important to identify where they're at to start, then work at protecting the muscle.

 

Prioritize protein adequacy, resistance training, and functional strength, not just lifting weights, but functional strength. Grip strength is really good indicator. Having a little grip strength meter, an inexpensive device they can have at home. 

 

What about walking capacity? How far can they walk without getting wounded? How can they get up from the floor, stair climbing, fatigue? All of these things are things we can measure, before they start, towards the middle, and then as they're nearing an end. 

 

If there's something that is not right, protect it. Not just eating less, but more nutrient dense. Every single bite matters when you're eating less. 

 

Protein, minerals, fiber, magnesium are super important. Zinc is super important, and we see it low in so many people. Colorful plant foods with all their phytochemistry. 

 

Finally, support digestion and elimination. Track their bowel movements and make sure that they're eliminating on a regular basis. Make sure that as they're detoxing, which often happens with a lower intake, that they're actually able to eliminate whatever they're pulling out. 

 

The last part is to monitor that transition. Many people gain weight. If they're going off of it. You have to look at what's happening as they go off. Sometimes it's slow and steady. You can't just jump right off and then suddenly gain all the weight back. It's not a good idea. 

 

We need to have a plan. It really comes down to having a plan, and it's improving their metabolic capacity, not just decreasing their weight.

 

Dr Ritamarie (23:55)

Let's switch to talk about the bigger clinical message. GLP-1 medications change appetite. We know that for most people. They also change weight. We know that for most people. They also do improve blood sugar for some people, not all, but for a lot of people. 

 

They don't teach people how to nourish their bodies. If they go into it on a poorly balanced diet, not nourishing their body properly, and now they're just eating less, they're not getting the nutrients they need to support overall health. That's where the downside happens when people go off. 

 

They're not going to automatically rebuild muscle if they've lost muscle. That would be a process of proper food, proper protein intake, proper enzymes to digest the protein, proper chewing, proper state of eating. All those things are important. If we just take somebody off, and we just say keep going, it’s not going to be the same. 

 

We have to help them to restore this, and we have to help them to correct the micronutrient imbalances that might have been corrected during this process. 

 

They don't restore sleep, so we have to make sure that people are sleeping properly. Just being on GLP-1 isn't going to heal the gut, so we have to look at all of this. We have to solve the chronic stress chemistry, which is lifestyle factors.

 

We need to help them with inflammatory drivers, because they're not automatically going to get support with that, just being on a GLP-1. Being on a GLP-1 doesn't teach somebody how to listen to their body. They may hear the appetite signals, but they're not going to learn how to address when the body's calling and asking. 

 

Skilled practitioners are needed here to guide them if they're going to be on them, especially if they're not under the care of a doctor, and they've just got them off label, or off prescription. 

 

Functional nutrition is not becoming irrelevant in the GLP-1 era. It's becoming more relevant, more important, because it's super important. If somebody is using a tool like this, and for some people it's absolutely a lifesaver, then they have to be doing the rest of it.

 

Dr Ritamarie (25:58)

The FDA has continued to warn about the unapproved use of GLP-1s. They were approved, by the way, for people with diabetes and insulin resistance, not for weight loss. That's the way they're being used. It's kind of off-labeling right now. They're warning about the off-label use and the compounded semaglutide, tirzepatide, and pterostilbene, including reports of adverse events, some people even going into the hospital. This doesn't mean that all the compounding is automatically inappropriate, but it does mean that we need to take this seriously and look for quality and make sure that we're not just getting it off the shelves in a foreign country and not really aware, and not be really subject to all the drug safety. 

 

GLP-1s are not a hero, but they're also not a villain. When used properly, they can be good tools, but used properly is the key part. All tools require good context. 

 

For practitioners, our deeper question is not is this person losing weight, is  this person becoming more metabolically resilient and healthy? Are they stronger? Are they becoming better nourished? Are they becoming more insulin sensitive? We can measure all of these things. All of these things are measurable with the tools that we have available. 

 

Dr Ritamarie (27:15)

How well are they digesting and eliminating? We need to ask, are they building a foundation that can sustain health long after the medication, the injection, or the trend? Are they creating the habits that are going to give them lifelong health? Is this being used as a tool to help them bridge the gap into that eating, because they've been trying to do it all along? 

 

As practitioners, we have the ability to reinvent health care as it's being done now. 

 

If you like this kind of thinking approach, and you want to move beyond chasing symptoms and grabbing the newest intervention, and really start thinking through these complex cases, then I ask you to download my new guide, my free guide, Beyond Protocols, a Practitioner's Guide to Read Cause Pattern Recognition, to show you how to look at symptoms, systems, terrains, sequence, and strategy, so you can stop relying on cookie cutter protocols and start building personalized plans that really, truly help people. You'll find the link in the show notes.

 

Dr Ritamarie (28:08)

If this episode helped you to think differently about GLP-1 and the interaction with metabolic health, make sure to share, like, subscribe, and share it with other practitioners who are trying to navigate this conversation.

 

If you want to go deeper, check out our resources at inemethod.com. And until next time, shine on.