muscle atrophy

And I love what you are pointing out, what you see in patients.

The acceleration of weight loss, of muscle loss in one week of bed rest, they could easily lose five pounds of muscle in one week of bed rest.

Versus when you're younger, it might take 30 days.

You are much more resilient and your baseline is much higher.

And that leads to, obviously, significant weight loss, right? But at the same time, it also creates perhaps unhealthy in a, in different situations, unhealthy weight loss where you have almost spiraled into eating disorders.

And, you know, where I would say people should be, you know, saying enough is, number one, you also have to worry about muscle loss, which is a very big issue because getting that skinny and not maintaining muscle is very dangerous in of itself.

And so that's again why I feel so strongly that a medical expert should always be advising those individuals.

It shouldn't be that you get the GLP and you're given a, you know, 12 months and come back in a year from now.

How are we going to keep a body fat percentage that is going to keep us living long, our insulin levels stable, and our metabolic health feeling good, while simultaneously keeping our mobility, resisting falls, keeping our ability to live life to the fullest independently as long as we can? Your ability to live independently as you age is directly tied to the muscle loss that you are experiencing.

If you experience significant amount of muscle loss, you are less resilient to illness around you.

This specific type of fat and where it's stored being a huge marker in whether or not you will suffer a major cardiovascular event in the future.

You have the ability to gain more body fat and lose muscle at the same time.

All that being said

... all that being said, muscle gain versus fat loss is what we're gonna talk to you about.

And honestly, guys, this is such a hot button topic, and I love that it is because there has been so much different information and different emphasis specifically for women, and when it comes to, um, when it comes to fat gain, and then so m- much less information when it comes to muscle loss.

And I think that we're doing such a wild disservice without actually comparing the two and looking at what that means for our health and longevity and actually looking at, you know, from what we, what we should be paying attention to.

We don't see them.

OK, so let's go back to the first one you mentioned, which is muscle loss.

So we hear this word that some women are starting to even come into clinic and say, which is great sarcopenia.

So what do we mean by that and what is the association with that and menopause hormones?

And, you know, oestrogen in this story is a very integral part of the story.

So I think more and more people are definitely becoming aware of that.

So does menopause actually speed up the muscle loss? And does taking oestrogen or testosterone or hormones, do we know what it does to improve that situation?

Yeah, I think we've actually got quite a bit of data that looked at women from, you know, time from menopause as opposed to chronological age and measured their sort of muscle function.

So some of the same people who came at me early [laughs] are now pres- prescribing them.

There's no muscle loss happening directly from the GLP-1, and I did a whole podcast episode about this, but I'll give you the summary.

I hypothesized early on, and I asked everybody I could get my hands on early on when they kept talking about lean mass, I'm like, "Well, muscle's only part of lean mass." This lean mass loss number, this 40% muscle loss, that was incorrect.

It was 40% lean mass loss, anywhere between 25 to 40% lean mass loss.

Lean mass makes up everything that isn't fat and bone on DEXA, so that's all your soft tissues.

Should it be in the conversation? Absolutely not.

Muscle loss as we age is an epic fail of the system of education of prioritization.

And I don't know how many of my, you know, clients 50, 60 years old are really damn good at riding a bike of long ass time.

Yes.

Because if you looked, and again, this is really important.

I got to stress this about metabolic adaptation.

Because everybody's going to point the finger at sarcopenia, muscle loss.

which definitely occurs.

But there are muscle condition scores that you can print out and look at your pet and see where you're noticing differences.

And are they having muscle wasting and where is it at? It gives you a good baseline to know, are they having some muscle loss and where is it? So where can I focus our treatments and our rehab at? All right, what I'm going to talk to you about today is, Definitely cannot take the place of an in-person rehab appointment.

I have watched these.

They are amazing.

So we're going to get a lot more instability.

We're going to get a lot more pain.

And we also know that muscle loss is directly correlated to a shortened lifespan.

So it's extremely important to make sure that we're trying to maintain their muscle mass to the best of our abilities.

And so GLP-1s are a huge part, I think, microdosing and all that.

But with those, you have muscle loss and bone loss.

I mean, probably more muscle loss than bone loss, but how do you counsel your patient?

To be clear...

Okay, I'm a board certified physician and I'm not obesity medicine certified, which would be the best person to see, but I feel that I know enough to do this safely.

program are like, you're going to lose muscle and bone.

We know from the data from gastric bypass that you are much more likely to end up with significant bone loss after massive surgery because they cannot eat enough with their new gastrointestinal configuration.

They're losing weight, but they are suffering downstream from bone loss and muscle loss.

Without enough protein and regular strength training, we will lose muscle, we will lose strength, and that compromises our balance, and honestly, it compromises our independence.

So this age-related muscle loss, there's a name for it, it's called sarcopenia, and it is a huge threat to our health outcomes in later age.

Maintaining muscle is not just about looking good or looking fit and toned.

Muscle is more about your resilience and your longevity and your independence.

Does menopause impact your protein requirements? Excellent question.

I'm sure a lot of you are wondering.

The hormonal changes that occur during perimenopause and menopause, especially the declining estrogen levels, can increase muscle loss and reduce your muscle strength over time.

During this time, you may also experience more abdominal fat, reduced bone density, slower recovery from exercise.

well? I mean, We don't advocate for that to happen.

Because, like I said, we want to be mitigating the muscle loss.

And you want

prevention more than cure, right?