The Truth About GLP-1s & Muscle Loss | SOLO

Added: 2026-06-10

[00:00:00]You are tuned into the Dr. Tina Show with Dr. Tina Moore. For more, visit drtina.com.

[00:00:07]On this episode of the Dr. Tina Show, we're going to have a conversation about GLP1s and muscle loss and why the story you have been told is completely wrong.

[00:00:16]So, let's get into it. All right. So, I cannot listen to it anymore. I cannot listen to well-educated physicians throw around this 40% muscle loss misinformation. And it is absolute misinformation. And I'm going to tell you why. If you are a strength and conditioning coach, if you're a chiropractor, if you are anybody who studied the muscularkeeletal system, and I'm going to let MDs and naturopathic doctors off the hook because no disrespect, but they are notoriously terrible with their anatomy.

[00:00:46]If you're any of the prior that I just mentioned and you're going around throwing out that JAMAMA study stat of 40% muscle loss, you are spreading misinformation. And I want to set the record straight so that we all are on the same playing field. I hope everyone listens to this episode. I hope you send it literally send it to everybody you know. Send it to everybody because that information is not only totally wrong, but it's dangerous. And here's why. That was lean mass loss.

[00:01:18]Virtually every study that we look at is lean mass loss. Lean mass is all of your soft tissues in your body. It's your organs. It's part of your nervous system. It's your liver, which is a huge part of your organ system. It's your skeletal muscle, too. But your skeletal muscle makes up roughly 45 to 50% of your lean mass. So that 40% muscle loss, that is a misinterpretation of the data.

[00:01:45]And it is a stat that started way back when when a certain famous celebrity longevity doctor who happened to end up on the Epstein list as well recently was on the Megan Kelly show and he said 40% of my patients or my patients are losing 40% of their muscle mass. And then that myth was perpetuated by a couple other bigname doctors and a big maja leader and other people who just couldn't let that number go. That was lean mass loss, you guys. That's not muscle mass. That's just your muscle is but one part of your lean mass. So that would be roughly if you based on 45 to 50% let's just say 50% that would have been 20% muscle loss. Do you know what that's on par with? It's on par with any weight loss attempt. Any weight loss that you have whether it be from caloric restriction, beriatric surgery, GLP-1 use, keto, whatever. If you're not actively working to maintain that muscle mass, you're going to lose roughly the same amount.

[00:02:48]So, it's not some outlandish amount.

[00:02:51]GLP1s are not mysteriously chewing up your muscle. In fact, they are protective and beneficial to your muscle. And I'm going to tell you why if you get to the end of this episode with me.

[00:03:00]But we just have we got to let that number go. Like, shame on everybody who's continuing to spread it. And if you don't know and you're continuing to spread it, with all due respect to some of my scientific colleagues who are they they they didn't know, lean mass is not all muscle mass. It's only half muscle mass. So we have to talk about that and we have to talk about pathologic muscle that is present in those using GLP1s.

[00:03:27]Most folks dealing with type 2 diabetes and obesity have pathologic muscle. What does that mean? Pathologic muscle is fatty infiltrate muscle. Muscle that has been infiltrated by it's it's overloaded. It can't handle what the body's asking it to do anymore. The blood sugar's been too high too long.

[00:03:44]The insulin resistance has been too high too long. The muscles start to become marbled like prime rib. The liver becomes marbled and fatty like faux ra.

[00:03:52]I did a whole podcast about fatty liver.

[00:03:54]I hope you guys will go listen to it.

[00:03:55]I'll put it in the show notes in the description in YouTube. And make sure you guys check it out because it is underappreciated, undervalued. It's not sexy, but it's happening to virtually everybody. 94% of US adults are metabolically compromised. That means 94% of US adults probably have some marbling in their liver and muscle. And when you start to become metabolically sound, like forget GLP ones for a second. When you start lifting weights and you start eating well and you start actually doing all the things and you start becoming more metabolically sound and your insulin resistance starts to decline, your fatty infiltrate will start to dissolve faster than anything else. You want to get rid of the fatty liver, go lift weights. It will reduce faster there than anywhere else. And that reduction makes that mass weigh less.

[00:04:41]That's what's happening. And so, we have a couple studies. I'm very excited about an April 2026 paper out of the International Journal of Obesity. We've got a 2016 paper I'm going to talk about that has to do with anabolic resistance.

[00:04:54]We'll get to that. I got a whole story for you guys. You're going to want to watch this episode. You're going to want to listen. And then cell reports medicine March 2026. Nobody seemed to want to talk about this one. Weight loss with GLP-1 medicines does not result does not result in disproportionate loss of muscle mass or function in obese mice and humans. Now granted the limitation here is that part of the study was done on mice and the other part was done on humans and it was a small cohort of humans. They were middle-aged obese humans.

[00:05:25]this uh April 2026 paper out of the International Journal of Obesity titled GLP-1 agonist and changes in body mass and composition in adults with overweight or obesity with or without type 2 diabetes a systematic review and meta analysis. I'm going to go through these with you today. I printed them out. There's a lot here, but we're going to rub through it because I don't want to take all day for you. I just need you to understand that that 40% number, it's lean mass loss. That does not mean skeletal muscle. So, please, if you jump off the podcast right now, stop spreading misinformation. If you are a chiropractor or strength and conditioning coach or somebody who should know better, then truly shame on you because if you are continuing to perpetuate that number, it is because you have an agenda. You have something else you're trying to sell people is my best guess. That is my opinion. And uh it's got to stop. It's dangerous. It's dangerous because you're scaring the be Jesus out of people who might really need these peptides. You can hate on them all you want. If you're hating on them, you're not paying attention to the data. You're not paying attention to the recent data that came out and the data that came out 2 years ago that said basically the same that multiple obesity induced cancers were being protected against when people use JLP1s. It's not fighting cancer. It is keeping you potentially from getting it or having it potentiate in your body because a metabolically sound body is a healthy body. I think the coolest thing about GLP1 ones and maybe why I'm so excited about them, aside from them being like one of the coolest things that we've ever seen happen to human beings so far as the mess that we're in right now as a a species, is the fact that it proved what my ultimate hypothesis has been, the drum I've been beating since 2016, since I've come online, which is metabolic dysfunction is the root cause of all illness. And people didn't want to believe me. People didn't want to hear it. people. It it was too it w it it just it required too much work. I don't know the amount of grief I've taken from my colleagues in the naturopathic profession. The amount of grief I've taken from my chiropractic colleagues, the amount of absolute grief I've taken from MDs when I spoke at medical conferences trying to beat this drum. And my other part of my main hypothesis of my entire career was that you have to strength train in order to maintain optimal metabolic health. And we're seeing that play out in real time.

[00:07:38]And I'm so glad I'm still alive to witness it. But it is so frustrating to watch people jump on to numbers that they don't have backed up and then scaring people with them. So, let's just end that right now. I I mean no harm. I I mean no shade to anyone who's taking this the wrong way, but like that it truly it has to stop. It's just it's just bad science. And the part that's frustrating is that it's leaving people feeling defeated. And that's the opposite of what we want to do. We're not trying to make anyone feel defeated.

[00:08:12]People have the absolute right to embark on a journey that is successful for them. And if a GLP1 is a tool that we use to help that journey be successful while they're putting in all the work, then I absolutely see no shame in that.

[00:08:25]Now, the folks that are using it as a monotherapy and that's the only tool that they're using, um, I don't know what to say to those folks because that's just not going to end well. I don't think that's a great idea and metabolically that's not going to end well because they are potentially losing a lot of muscle. But we're going to talk about all of that. We're going to talk about why muscle in an obese diabetic is pathologic muscle. what that actually means, what lean mass actually means, what the limitations of DEA are, what these new papers say, why obesity itself damages the muscle and how we can switch that up, what anabolic resistance is and how it's a player here. Um, why exercise and specifically strength training, the load, the hormetic hit of strength training, the load, the volume, the intensity matters more than you would think. And why I say ultimately that strength training is non-negotiable.

[00:09:16]We're going to get into all of it. And what are the real issues and limitations of GLP1 ones, right? Like I'm not here saying they don't cause some level of muscle loss, but they are not any more extreme than any other weight loss. So, let's talk about that first. When you lose weight, if any of you have been avid gym goers, so you gym rats out there, you hear me, you know this is true. If you have lost weight during a cut, you know you got weaker, right?

[00:09:43]You got weaker. your muscles got smaller.

[00:09:47]You know this. So that's what's happening with GLP1s. That's about the extent of it. In fact, GLP1s are changing the proteomics of muscle in a favorable way. I'm going to talk about it because it's doing really great things for our muscles. And obese muscle, diabetic muscle is pathologic muscle. It's it's it's diseased tissue.

[00:10:06]It is infiltrated with fatty infiltrate which is pro-inflammatory which is creating a cytoine and inflammatory environment within the muscle. And guess what guys in the liver and also the bones. No one talks about that. We get fatty infiltrate in the bones. Your bone marrow is made in your bones. And so all of this culminates into a really toxic soup. The muscularkeeletal system is a system. It works together. What's happening to your bones and to your muscles are happening together. They're BFFs. Your ligaments and tendons and joints are also BFFs in there. So, the insulin resistance is happening inside the bones. I've always said this, I have a whole podcast episode about it that osteoporosis is really diabetes of the bones. Osteoarthritis is diabetes of the joints and it's happening to the muscles adjacent. It's happening to the ligaments and tendons and the the joint tissue inside the capsule, the sinovium, the cartilage, all of it is going through the same processes. And this is a dire situation and people either don't understand it or they don't want to talk about it or they don't want to address it. And GLP1's address it beautifully. It is truly the root cause of so much disability and pain and illness and disease in this world and GLP1's treat it beautifully. Now GLP1s are but a tool in a toolbox, a comprehensive toolbox and you have to do all the things when you're on them. So if you are not strength training and you're on a GLP1, you best get to it. I'm going to tell you why in in a few minutes. If you are on a GLP1 and you think it's a get out of jail free card and you don't have to strength train and you don't have to optimize your nutrition, you're in you're wrong. You're very wrong and it's not going to go well for you at the end of the journey because ultimately if you do obliterate all of your muscle mass from just malnourishment and lack of use, then you are going to be in a much more precarious metabolic state than when you came in metabolically compromised. You're going to go from bad to worse. And I I am very concerned about that. I know that's what a lot of people who hate on JLP1s are concerned about too. So I hear you and I understand. I empathize with your frustration.

[00:12:22]But if you are in any type of health field where you are helping or working with folks who are dealing with obesity and or metabolic dysfunction, which by the way 94% of US adults are metabolically compromised.

[00:12:37]That's data from 2018 that was published in 2021. And if that's if you're if you're working with folks in that cohort, which is basically everyone, and you're not paying attention to the real data around JLP1s and the real science around them and how they work and how you can help your patients who are on them, because like what one in six, one in eight people last time I looked, literally like just past week, that's how many Americans are using GLP-1s. That's how many American adults are either have or will use GLP1s. And so I think it's pretty prudent that all of us in the healthcare field understand this. And at the very least, if you jump off this podcast right now, just know that 40% number is not muscle loss. It's lean mass loss. Totally different beast.

[00:13:19]So, what is lean mass? It's your organs.

[00:13:24]It's your glycogen storage in your liver. It's your and your muscles. It's your connective tissue. It's your nervous system, at least part of your nervous system, which is also part fat.

[00:13:32]It's your blood volume. It's your extracellular water. It's your inflammatory substrate. And it's your skeletal muscle. That's what lean mass is. That 40% loss is all of that. Now, part of my hypothesis back in 2023 when I started talking about the benefits of GLP1s was that if you are in a metabolically compromised state and or obesogenic state and if you're if you're in the obese state and you are healthy metabolically right now, it's just a matter of time. It's not it's not a matter of if, it's when the metabolic compromise will come. And I have been saying this for well over a decade.

[00:14:07]People again wanted to argue with me, but we now have the data. Those folks ultimately become metabolically compromised as well. It's because of macroofage switching. You have these immune cells called macrophagages, and they live in your fat. And when they switch from an an somewhat anti-inflammatory type to a more pro-inflammatory type, and that seems to happen around middle age as well, things go off the rail. So, I call it fat cells going rogue. Once they go rogue, your im immune system goes sideways. Your metabolic health goes sideways. Everything just kind of goes off the rails and goes sideways. And it's really hard to turn that around.

[00:14:39]It's really hard. And guess what switches the macrophagages back to their anti-inflammatory younger state? Trisepatide.

[00:14:49]There's studies on that. I can link them or you can look them up.

[00:14:53]That's freaking miraculous. It's very cool. Not only do GLP1s bind your immune cells like directly bind your immune cells, that's why years ago I was telling people, hey, if you have mass cell activation syndrome or you have mass cell issues or histamine issues, it I told every doctor I knew who dealt with patients like that, would you please try micro doing GLP-1s and see if you can stabilize their mass cells? And lo and behold, it worked. And now we have studies on it. So there's a lot of immune activity happening in a favorable way with GLP-1 use. And then on top of it, we get this macroofage switching. Trisepide literally switches your macroofage from an M1 back to an M2, which is what we want, which is ultimately favorable. So an M1 macrophag is pro-inflammatory, and an M2 is essentially anti-inflammatory.

[00:15:42]It's not that simple, but just for the sake of this podcast, think of it that way. And so Trespatite is going to give you an M1 to an M2 switch back. It's pretty cool. It's really cool. It's it's one of the most remarkable medications I've I've ever seen. Humans are in a lot of trouble right now and uh we need all hands on deck. So, at the very least, if you're going to hate on GLP1s or you have an aversion to them or you don't like them or whatever it is, at least get your facts straight and stop stop with this 40% muscle loss. That's not what's happening. Okay. So lean mass is going to be this inflamed fatty infiltrate liver and it's going to be the sarcopenic inflamed fatty infiltrate muscle as well. And so when you lose that fat because of the use of the GLP-1 that lean mass is going to be a loss and it's going to look like a loss on dexa because a dexa cannot distinguish between a fatty liver and a regular liver. It just distinguishes overall mass. And so things are moving in a really favorable direction in the way that we want and yet they're screaming it's a loss in a bad way and it's not. So that's a huge piece of this argument. This new cell paper, this was the uh cell reports medicine. Basically what it looked at was all these different GLP1s in mice and in humans. It looked at skeletal muscle, their strength, their endurance, their treadmill performance, immobilization, which is not nice, but they did immobilize the mice. And they looked at proteomics, body composition, and functional outcomes. And what they found was that lean mass does not equal muscle. First of all, they found that the loss of the liver mass, the liver shrank more than the muscle did, than the skeletal muscle, proportionally more than skeletal muscle. So that very likely proves my hypothesis that we're losing fatty infiltrate in the liver. The liver is shrinking. The skeletal muscle was also shrinking, which means we're losing fatty infiltrate, which is what I was speculating about years ago. And I I think we can say safely that that is a good thing. Overall, DEXA is still going to count that as lean mass loss, the DEXA scan, but overall it's very favorable. It's what we want. We want good quality contractile muscle tissue that is not full of fatty infiltrate and inflammation. And so we're going to see that overall as a lean tissue loss and and that's a win. If you guys want more information about that specifically, go look at Greg Tinsley's work. He is a PhD scientist, really smart guy. He has been on the Nadolski Brothers uh podcast, Docs Who Lift, and he talks about this.

[00:18:23]He's done a couple episodes, but he talks about how roughly lean mass is not synonymous with skeletal muscle loss, first of all, and that most weight loss includes some lean tissue. And that's to be expected. And that's something that I think we can all agree on. Going back to what I said earlier, no matter how you lose the weight, you're going to lose some lean mass and you're going to lose some skeletal muscle with it. And so, basically, it's the the rule of the quarter, I think it's called. It's 25% comes from fat- free mass when you lose weight and 75% comes from fat. So that's very normal physiology and that's right on par with GLP-1 use as well. Obesity itself damages muscle. Like it doesn't just make it pathic, it damages it. It damages the mitochondria. It's pro-inflammatory. It leads to uh anabolic resistance. It's full of insulin resistance. It potentiates insulin resistance throughout the rest of the body. It leads to mitochondrial dysfunction. It leads to chronic inflammation. It leads to fat accumulation. Impaired force production, that's very dangerous, you guys. If you have impaired force production, you're not going to respond quickly. Your muscles are not going to respond quickly when you step off the curb or when you twist weird or when you go to fall.

[00:19:35]You're not going to have good force production and you're not going to have quick responses. And that's how we end up with broken things. And that's not good. You end up with impaired muscle quality. Quality is more important than quantity when it comes to muscle. We have multiple studies showing that strength is more important than mass. So when I tell you guys to build muscle, I mean just build the base, right? Build the base level muscle. Build that nice meat suit on your skeleton so that you have insurance going forward. But it doesn't have to get huge and you don't have to build for bulk. You have to build for strength. We want you can have senue muscle and we want if it's strong, we're good. We want strong muscle. We want strength. That is good healthy muscle. And we want good glucose disposal. At the end of the day, your muscles and your liver are your biggest glucose sinks. They hold and store glucose as glycogen and for your body to use later as needed. That's why they end up with fatty infiltrate because they get overwhelmed. It just becomes too much. And when you have fatty infiltrate and toxic soup going in your muscles basically from inflammation, you have really impaired metabolic flexibility in that muscle. So it's just not going to respond nearly as well biochemically, physiologically. It just gets messy. So now GLP1's actually remodel tissue to a degree as far as the proteins and the mitochondria and the behavior of the muscle. I'm going to talk about that towards the end. It is beneficial. JLP1 ones are beneficial to the muscle for a lot of reasons. And again, I'm not saying we are not going to lose some muscle mass, but that's normal and it's not always a bad thing. For one, what I just said, we're losing potentially size because we're losing the fatty infiltrate, which is better. The outcomes are better at the end of that.

[00:21:25]But also, a little bit of muscle loss does not mean you're losing strength.

[00:21:29]And if we're preserving strength and we're improving mobility and we're improving stamina and we're improving all these markers, it's not such a bad thing. And going back to what I mentioned to you meattheads, you gymgoers, you know, you've lost weight before and you've lost strength. There is a break-in period where it's a recalibration period where that muscle needs to recalibrate and your central nervous system needs to recalibrate. And once that happens, you're able to regain that strength back. For the most part, I have always been able to I've lost weight. I've lost strength with it or I wasn't able to lift as much on the barbell and then all of a sudden, you know, I continue to train with progressive overload and with intelligence and with intention and boom, I'm back. I'm back to where I was and it's just a little bit of a recalibration period that takes place. I am crazy strong when I have excess fat on me. And we've all seen that too if we're avid gymgoers. We know people who've come in just cold with a lot of obesity on their body and they have never picked up a barbell and they just pull, you know, 220 lbs off the floor, no problem. And you're like, whoa. So, there's something to that mass that leads to strength. And when you lose that mass, you will lose some of that strength, but overall in proportion to your new body size, your relative strength has either maintained or in some cases improved if even for a time.

[00:22:51]The other thing I want to mention is gravity. We've all heard about the oh your bones are going to turn to dust.

[00:22:57]It's such nonsense. I heard a big PhD pretty famous doc. She's like your bones will turn to dust. And I was like I'm done listening to her. It's such an ignorant statement to make. Let's just think about physiology for a second.

[00:23:08]When you lose fat and you lose weight, period, all of the things that come with it, you lose gravity on the bones and on the muscle.

[00:23:18]So, as pathologic and and damaged as that muscle is, as pathologic as those bones are from being metabolically compromised, they still have a lot of gravity on them when we have a lot of weight. And you take that weight away and you lose the benefit of that gravity pushing down.

[00:23:33]And so now you're going to have less force on both and they are going to diminish if you're not actively working to keep them healthy and keep them building. So osteoblasts are the cells of your bone that build bone and osteoclass are what break it down. And as we get older and we become more inflamed and we get more metabolically compromised, the osteoclass sort of win the battle and the osteoblast may go a little bit dormant or not be as active.

[00:24:00]And so now you're just living with increased bone loss exceedingly year after year after year. So we h this is reason number 10,000 that we have to strength train because we have to fight that that is happening no matter what.

[00:24:12]that just that osteoblast osteoclast war is happening no matter what. So we have to fight that through strength training and this is one of the reasons I'm a fan of getting comfortable in and learning the skill well enough that you can lift somewhat heavy because we need that force on the bone. Force on the bone is how the bone maintains or grows or stays healthy. So we can't have bone that has nothing happening for it. Lately, there's this new sort of drive to get women to jump quite a bit. I think that's great. Uh I just jump out of my G Wagon every day and it's quite a ways down. So, I think I'm I think the studies are like 8 inches off the ground. I'm like I'm definitely 8 inches I'm like 12 inches off the ground. I'm like get out of that thing all day. Like boom, there's my jump. But I like jumping just for athleticism. I think it's fun. I like box jumps. I I just I love all that stuff because it's good times. But the actual force that we and the torque that we put on the bone through strength training, particularly heavier weights, I think does a really great job as well.

[00:25:14]It's it's equally, if not more important in my opinion. And there's, you know, the American College of Sports Medicine came out recently and gave us some really great parameters. And it was the first time they had come to a conclusion in like 17 years where they actually put out a um you know a paper on this and they I think it was really reasonable.

[00:25:34]It was like do 10 to 12 sets a week for every body part. If you want to maintain if you want to grow it's like 12 plus.

[00:25:43]Make sure that you're consistent. That's probably the most important thing is consistency. And then you can really use any tool you want. barbells, dumbbells, bands, it doesn't matter as long as you're consistent and you're hitting those body parts at least 10 times a week and that you don't necessarily have to lift heavy. And I think that's really approachable for people and it's doable and those are some parameters that we can like say, okay, and we can and we can aim towards those goals. But I will say that there's a lot of benefits to lifting heavy. And strength training is a skill and you need someone to teach it to you so you don't hurt yourself, especially if you're older or you have some orthopedic limitations. And that is truly why we want to hire some help if we can. I think that's the first best thing you can do. If you can't afford that, there's so many options out there on the internet. There's machines which I think will keep you relatively safe.

[00:26:30]Although I see people lifting too light on machines most of the time. I don't see him putting enough effort in. Volume matters, load matters, intensity matters. Those all matter at the end of the day. And your central nervous system, you can wear it out. You can pick up, you know, a I see these women at the gym with like five pound dumbbells just all they're doing is fatiguing their muscles. And that fatigue, you see this in like bar and Pilates a lot. You'll see the sort of shake, the shakes you get. That's fatigue. That's equally as much your central nervous system as it is your muscular skeletal system. But I'm looking to like wamp the central nervous system for a quick second with some with a hormetic insult, which is a heavy training session and then resting it. And so I'm a big fan of the ladder.

[00:27:20]I think we get a lot more bang for our buck that way because we want our central nervous to be system to be responding quickly and flexibly to the demands that we put on it with our bodies so that we can catch ourselves if we fall off the curb at the end of the day. That to me is so much more important. So lifting heavy is probably something that scares a lot of people.

[00:27:41]Your heavy is different than my heavy.

[00:27:42]So every time I post a video of me doing any kind of strength training, people are like, "What weights are you using?"

[00:27:47]That doesn't matter. It has. It matters not at all to you because those are the weights that I'm using right then. I can't swing those weights around as much as I could before. A couple years ago, if you saw me swinging 16, 18, 20 kilo kettle bells, I can't swing those today.

[00:28:04]I'm in a different place now. I've had a lot of injuries that I'm recovering from. And so, I'm back to the baby, you know, smaller weights. But that's fine.

[00:28:12]Like, we all, you know, that's the journey. We're just in it. trying to get stronger every day, 1% better every day, right? So, just know that you're following people on social media who probably used to be able to also lift a lot more weight than they can now. And as they've aged, they've gotten smarter. They realize they don't need to put such a load on their joints. So, heavy doesn't mean so heavy that you're destroying yourself.

[00:28:34]It just means enough to really get that hormetic warm to your central nervous system. I really think that's best done under the guidance of a strength and conditioning coach who knows how to help you. I do have a program if you're just looking to get started and you don't know where to start. I have a program called the Strength Vault. You can find it. I'll put it in the show notes first thing. You can grab it. It's very affordable. You do not need to go to the gym. You just need a couple dumbbells and you can do it from the comfort of your own home. You can get some bands very inexpensively. You can get a suspension trainer very inexpensively that you know like a TRX, but you don't have to spring for a spendy TRX. You can get a similar thing for like 25 bucks and you can work out from home and you can get started safely in strength training. I have a strong background in rehab. So, I just make sure it's very simple. I give you videos for every single exercise and I just make sure that you are lifting intelligently and that you are being cognizant of your joints and where they are in space. I do make sure that there's a couple different modifications for some of the moves so that they are approachable and that they are available to virtually anyone. I think anyone of any age, of any limitation, can find a way to strengthen the parts of their bodies that they can move. And I think they will find that if they start to move the parts that they think they can't move because they're uncomfortable, I think that they'll find that that's available to them, too.

[00:29:56]It's, you know, obviously sharp pain we don't want to move through. We want to get the help of a professional with that. But if that's not something you can do or you live out in an area where you're not going to find a strength and conditioning coach readily or there's not a gym nearby or you don't want to go to the gym or you don't have the finances or whatever it may be, the strength vault is a great place to start. An equally important part of of preserving and taking good care of your muscle. So you're you're hitting the protein macros, you're doing the gym, you're lifting the weights, like say you're doing all of that. I think the part that nobody talks about is the rest and refeed. We have to incorporate recovery into our day-to-day. Otherwise, we do not get beautiful muscle building and we don't get good muscle preservation if we're just always breaking it down. And you're breaking it down through being overly stressed.

[00:30:43]You're breaking it down through being inflamed. Like, there's all kinds of reasons why muscle will why it will be challenging aside from anabolic resistance, why it will be challenging to put muscle on. But I think the biggest driver is not resting it appropriately. And we don't want to just do recovery where we lay on our ass and do nothing. We want to do active recovery. So consider walking, some yin yoga, uh maybe some gentle Pilates. Like those are wonderful ways to have active recovery. But I will tell you hands down my favorite recovery tool is my sauna.

[00:31:14]It does not require anything of me except time and me laying down in it.

[00:31:18]And it does act to some degree as an exercise my medic. It is not replacing strength training, but it gives you that active recovery because it upregulates BDNF, which is miracle grow for your brain. It upregulates heat shock proteins. It gets your circulation going. Like, it's a really wonderful tool. If you're in a place where you can have a sauna in your home, I think it is one of the best investments you can make into your health. This is not like a biohacking thing where you need all the tools. This is truly something that people will use in your family. We have multiple studies showing cardiovascular benefits, multiple studies showing improvement in mood. Uh it moves lymph, it moves blood, cardiovascular health.

[00:31:58]It is a it is an all-around winner. And of course, check with your physician before you jump into one and start, you know, cranking the heat up. But I don't really go very high. I actually am much more interested in having all of the infrared wavelengths penetrating me. Not all sauna have all the infrared, but my sunlight and amplify does. I have a sunlight and signature model at my Oregon home. I love it. It's far infrared only. It does a bangup job. The only other thing I wished I had when I got that was more room. So, when I got the Arizona unit in my new house, I got the Amplify 3 so that I could have that's three person so I could have a place to lay down because I really just like to go in there and melt. That's my active recovery. And the amplify actually has the full spectrum. So we get near, mid, and far infrared. It heats up very quickly. It heats up so quickly that I used to, shame on me, I used to take my phone in my signature model. So sunlighten truly, I have done my research. I had a different model of sauna, a different company in my clinic and I ended up giving it to my mom.

[00:33:03]Lovely sauna, but sunlight and just they check the boxes. the low EMFs, they use non-toxic building materials because a lot of times when you're grabbing something from Costco or whatnot, you don't know what glues are in there. You don't know what the wood is offging.

[00:33:18]Sunlightening has done all of that work for us. beautiful models AC whatever one you choose beautiful models and they've got an array of price points and array of models and sizes you could get I've seen a lot of my friends have just the signature one or even one of the higher up models just the the oneperson unit which is a wonderful thing to put in your office put it in your home office put it in your bedroom like there's lots of ways to go about this you don't have to get a big old sauna have a big old space for it um and they're having a huge sale right now like one of the best sales I've seen of the whole year so and there's lots of bells and whistles that come with it. So, head to sunlighten.com/dtina and you can check it out right now and tell them that you came from the Dr. Tina Show podcast. Let them know you came from my show. You'll get the best deal that way. But that that Amplify 3, man, it's it's a beautiful unit. It looks beautiful in my backyard. I have kind of a resort-like backyard, very intentionally, and that is just the crown jewel of the whole space. I get in that thing for active recovery and it melts me and the infrared penetrates my tissue so that and I have a lot of muscular skeleal complaints. So when I go to the gym regularly like I can very quickly start to break down if I'm not taking good care of myself. I don't have time to be massaging and going to all the places and having other people do passive care to me. So I just do my mobility drills inside my sauna. It's plenty spacious. It heats up very quickly. The other thing about the Amplify that some of you may be interested in, some of you ask me about really high heat because some of the protocols that you see maybe Dr. Rhonda Patrick or Dr. Huberman talking about, they go, they are up to 170 and that is hot. I do not recommend that, especially if you don't have clearance from your doctor. But if you are one of the crazy people who likes it to get that hot, the Amplify 3 is one of the few models on the entire market that will get up to that heat. So, it gets hot fast. I usually rock it around 105 to 110. My phone will overheat at that temperature.

[00:35:11]It's a beautiful unit. So anyway, sunlighten.com/dtina.

[00:35:16]Tell them you came from the Dr. Tina Show podcast and they will give you the sweet deal. Remember, our quality of our muscle matters more than the quantity.

[00:35:23]the good, healthy, lean muscle that contracts well, that responds quickly to the the loads that we put upon it through our central nervous system matters much less than the size. And the strength of that muscle matters a lot.

[00:35:41]And if you want to talk about longevity, true longevity, I'm going to tell you the secret. Build your glutes because those are your biggest glucose sink.

[00:35:48]Focus on your glutes. My strength vault is very glutecentric. My all my workouts are very glutecentric. You are going to hammer your glutes out every week if you work out with me because it's all it's all about glutes for me because I'm always going for metabolic balance. That all I care about at the end of the day is that because as we get older, we will become more insulin resistant and we will become more inflamed. That's just the nature of aging. It's called inflammaging.

[00:36:14]I'm always combating that. And I think that you get the most bang for your bucks with your glutes. So all you ladies out there that are trying to get your demi more arms, first of all, that poor woman is emaciated and she's I I every time I see pictures of her and I see the the reals on Instagram where people are talking about like the social construct of how we're going back to this like wafy thin look. And then I see all these other actresses following suit that are supposedly micro doing GLP1s, but really they're just taking standard doses and they're all wasting away. but yet they all go to Pilates, so they have these like strong looking senuey arms.

[00:36:50]If they don't have a set of glutes on them, which most of them don't, they all have really flat butts and tiny little legs. I see a ton of these women walking around my gym in North Scottsdale.

[00:36:59]All I want to say is like, good luck with your hip fracture.

[00:37:03]That's not going to go well. That's that's not that's not a great insurance plan for longevity. If if I fall, I want a set of glutes to catch me, first of I don't want to land on bone and I need a strong set of glutes to get up off the ground. And you got to squat to get that. You got to squat. I I was telling my husband the other day, I'm like, I think a really good gauge of health and vitality should be, can you hover over a toilet and use a toilet in a public bathroom without sitting on the seat, without touching anything? Like, you're not holding on to anything. You're just literally hovering. Like I grew up going to punk rock shows and punk rock bars and those are some of the most disgusting bathrooms you'll ever go in.

[00:37:44]If you ever been to like a nasty dive bar, you know, and you just you don't touch anything. You go in the stall, you like use toilet paper to lock the door and then you hover. And now to add a layer to that, can you hover without peeing all over the toilet seat, right?

[00:38:00]That is a skill. That is something we should always be able to do. you should always be able to get down into a low aigrass squat like an Asian squat. Like these are things that we should just have in our culture to continue. Like that's how you know you're doing a good job by your training is if those are some of the markers that you aim for.

[00:38:18]And can you get out of that as grass squat without grabbing anything? I'll tell you this too, just cuz I'm on a rant. You know that study that was going around that everybody was on Instagram and they were crossing their ankles and sitting down without touching anything and then they were getting back up with their feet still crossed and standing and they were saying if you can do that without there was a study that came out if you can do that without touching anything or leaning on an elbow or putting a hand down you get more points and that this is linked to longevity.

[00:38:48]Well, I've gone through that study with a fine tooth comb, and the author of that study legitimately says in the middle of the study that it doesn't matter how you get back up. You do not have to come back up with your ankles crossed. I can't do that. I have some hip issues. My hips will not allow me to come back up in that position. I sure can just plant my feet down right up against my chest, like my knees up against my chest, plant my feet down, and stand up. I can do that without touching anything. And that's just fine.

[00:39:14]That for his purposes, that was fine, too. No one talks about that though on social media. They just want you to do it that way because it's fun to show off. And then there's other people out there doing the challenge, but they've got weights in front of them and you're thinking, "Oh, the weights make it harder." No, they're using the weights to leverage. It makes it way easier if you put some weights out in front of you. So, if you see girls out there with dumbbells in front of them and they're doing the crisscross down and the criss-cross up, it's so much easier to get back up when you have something leveraging out in front of you, even like eight pound dumbbells. So anyway, I just thought I'd share that cuz that challenge was driving me nuts. I was trying to call people out and people were like wanting to argue with me about it. I'm like, that's not what the study said. You don't have to get back up that way. And also, it's not he didn't have it was it was correlative. It was not positive. He just had correlative information. He followed these people and he saw that there was a lower rate of death for people who basically have mobility and strength. That's it. This grip strength thing, it's just a marker of strength overall. You can't, you're not going to train your grip strength.

[00:40:17]Tra, you know, squeezing something and getting stronger hands is not going to make you live longer. It's a proxy for overall body strength because you get grip strength by picking heavy [ __ ] up and putting it back down. So, if you have mobility and you have strength, you have longevity. That's the take. Okay, just a little added pearl there for you if you didn't know. Larger muscles can contain more fat. You've seen those cross-sectional thighs of like this is the 80-year-old athlete and this is the 80-year-old regular person who's sarcopenic and they've got all the fatty infiltrate and looks like a marbled prime rib. Bigger muscles are going to hold more fat and so we're going to have this overall lean mass loss depending on the size of these people's muscles originally. So again, it's just that DEXA scan is not a great marker for skeletal muscle loss. It is a marker of lean mass loss and that fatty infiltrate is in there. I'm just gonna keep saying that so we get it and we're going to understand that muscle quality is much more important than muscle quantity.

[00:41:23]All right. The human portion of this cell reports medicine was small. It was obese middle-aged people. They weren't necessarily frail. They weren't necessarily sarcopenic or older. They were just middle-aged, obese people on GLP-1s. And what they found was that muscle cross-sectional area decreased, but strength was largely preserved. And we've seen this in other studies that strength is largely preserved. This is great. That strength is a proxy for what's actually happening to the quality of the muscle. The muscle is working well. It's still working. Okay. Um I don't know about well, I guess it depends on how they go in. This strongly suggests that some of the tissue remodeling likely involved fatty infiltration, glycogen, fluid, inflammatory substrate rather than pure healthy muscle loss. Another review discussed MRI data from Turszepatide trials and they showed that reduced they had reduced muscle volume also, but they preserved fat-free muscle volume, they improved muscle quality and they had less fat infiltration. So this is pretty strong evidence that we have showing that GLP1s potentially are giving us improved muscle composition overall.

[00:42:37]They do not appear uniquely toxic to muscle, the GLP1s. And they've sorted this out with the mice. They immobilized them and they both were on low calorie intakes and both were immobilized. One group was given GLP1s. When they took the immobilization off, the atrophy that had occurred, we all atrophy when you know you've put a cast on and you atrophy significantly. The atrophy was the same between both groups. If the GLP1s were toxic to the muscle and were eating the muscle or eating the bone, that limb would have been much smaller than the group that was not on the GLP1s. So that is pretty good indication that they're not causing significant muscle toxicity or muscle wasting in excess of what immobilization, low calorie intake, etc. already do to you.

[00:43:24]A note on anabolic resistance because I did want to throw this paper in here.

[00:43:27]This is a 2016 paper.

[00:43:30]Does muscle protein synthetic response to exercise and amino acidbased nutrition diminish with advanced age?

[00:43:41]Basically, in a nutshell, what they found was that a older adults can build muscle, too, which I hope we all understand that. Doesn't matter what age you are. Doesn't matter what age you are. You can still build muscle. It's not going to be as robust as when you were 25, but you can still build muscle.

[00:43:54]You should still go on the journey. You should still make the effort. You should still do it. It's still non-negotiable for you. But the anabolic threshold is often higher, meaning the ability to induce muscle protein synthesis and get things moving is higher as we get older.

[00:44:08]So, this is you've heard me say like ladies, as we get older, this gets harder, right? We need more protein to actually get muscle protein synthesis up. We need to actually add we need to work harder. I I know we I hate to say it, but we got to work harder to induce muscle protein synthesis and get that anabolic threshold met. But, um it doesn't mean you still can't do it. We just we have to do it. But what they found was protein intake aside, leucine intake aside, leucine threshold, hitting that leucine threshold, that low exercise intensity, low exercise volume and not not loading the muscle is what's actually keeping the anabolic resistance in place.

[00:44:54]So it appears more commonly when people are obviously low protein or low leucine or low you know malnourishment.

[00:45:03]Basically the what happens when you take too much GOP1 and your appetite is suppressed but low exercise intensity and volume and load matter a lot probably more and other data is showing this. It's the strength training that gets the protein in the muscles to induce the muscle protein synthesis.

[00:45:24]It's not just eating the protein. Eating the protein is great. Taking the protein powder, taking the essential amino acids. I'm all for that. Those are tools. But the main driver of all of this is the gym. You got to go to the gym. It's you get a weak signal otherwise. We need a strong signal. We need a strong signal to overcome that anabolic resistance that we get as we age and we become more inflamed.

[00:45:46]Exercise is the primary driver of muscle protein synthesis. Period. Take that home. Write that down on your notes, too. Okay? I see a lot of people using Dr. Gabrielle Lion's work and saying protein, protein, protein. And I'm super excited about that. But her equal message in that book and in all of her content is gym, gym, gym. Go to the gym.

[00:46:08]Like she says it and she beats that into us, too. Just like I'm trying to. So, we don't want this anabolic signaling to fail because we failed to go to the gym and we just relied on ingesting protein.

[00:46:20]Yes, protein can give you better body composition, but I'm not looking for better body composition. I'm looking for strength. I'm looking for contractility.

[00:46:28]I'm looking for healthy muscle mass.

[00:46:30]Ideally, yes, we want body composition to shift in a favorable way. that we can't just lean on that and say, I mean, I know it's a full-time job sometimes to hit those protein macros, but we can't just hang on that and be like, "Oh, that's good enough." I hear this. I The reason I'm saying this is because I get messages from you guys all the time, and you're like, "I'm doing the protein. I'm doing the G GLP1. My life has changed forever. I've lost 50 pounds and now I'm going to go to the gym." And I'm like, "Oh, no, no, no, no, no. Gym first."

[00:46:58]Start with the gym first. let all the other lifestyle variables fall into place because you go to the gym. Trust me, you start going to the gym, you're going to hit your protein macros because you're going to be hungry and you're going to want to build beautiful muscle.

[00:47:12]You're not going to throw that hour away in the gym for some refined carbs and some garbage. You're going to make better food choices because you're an intelligent human being. You're going to hydrate because you're thirsty. You're going to sleep because you're tired.

[00:47:26]Everything will get better. Your hormones will get better. I have been going to the gym religiously for the past, I don't know, five weeks and I've been able to cut my progesterone dose in half and still get the same benefits. I just was needing to take extra progesterone to overcome the stress and the sleep disruption because I wasn't getting enough activity in my day. I wasn't getting enough of the right kind of activity. So, everything works better when you hit the muscles. The muscles are the main driver of everything. Keep that in mind. That's why I say this is non-negotiable. Focus on the strength. focus on lifting the weights, getting stronger, your nutritional choices, your hydration, your sleep, all of the things will fall into place. And plus, there's data out showing that people who strength train regularly do not respond to stress the same way that people who do not. They are calmer. They have a superpower. They quite literally do not have as much of a cortisol stress response. They don't get wigged out as easily, if you will, than people who strength train. And that's true. Everyone I know who strength trains regularly is so much calmer. and I am way calmer and happier and much more level-headed when I'm doing it regularly. Okay, so let's talk about this study. This is the one out of the International Journal of Obesity. I'm just going to read you the just the quick box here just to kind of drive it home.

[00:48:45]A systematic review aimed to assess the effects of GLP-1 receptor agonist and dual agonist, that's the trazepatide on weight loss and body composition in individuals with overweight or obesity with or without type two diabetes.

[00:48:56]Basically they did a meta analysis. They they searched for all the studies in this realm and they put it together the details of it in this paper. So the paper itself wasn't a clinical study. It was a metaanalysis. It was a systematic review. Um this is like more of a research review paper if you will. The results were GLP1 receptor agonist treatment consistently reduced body weight BMI and waist circumference across all time points. At 3 months mean body weight decreased by approximately 9%. accompanied by marked reductions in fat mass and visceral atapost tissue.

[00:49:30]That is a win. We love it when visceral atapost tissue goes down. At six months, weight reduction averaged 5%. That means it was declining. They they lost the most weight initially and it was starting to wne a bit showing comparable effects while lean mass remain largely preserved. And that's lean mass, not just muscle. At 12 months, weight loss persisted at around 4% with variability between the different agents they used.

[00:49:55]most notably lagglutide.

[00:49:58]Across studies, fat mass decline predominated whereas reductions in lean body mass were modest. The conclusion is that JLP1 receptor agonists provide clinically meaningful weight loss primarily through selective fat mass reduction with relative preservation of lean tissue, supporting their role by achieving quality weight loss.

[00:50:19]Differences between agents highlight the importance of individualized treatment strategies complemented by nutritional and exercise interventions to optimize long-term outcomes. It's not destroying our muscle, guys. It's just not. Check this paper out. It's a big one. I put it in the link is in there. You can find it. Basically, the lean mass was largely preserved across all those time points.

[00:50:41]So, they were looking going out 12 months and the body was preferentially losing atapost tissue, visceral fat, and ectopic fat. this distinction matters a lot and lean mass is still not the same as muscle. So they were looking at lean mass and it was still preserved. They weren't even specifically flushing out whether it was muscle. And lastly, what I want to drive home is that GLP1s may actually improve muscle biology. So the proteomics were looked at in the cell paper. When you look at it overall, basically what they do is they improve skeletal muscle glucose uptake. They improve vascular profusion of the muscle, meaning the muscle gets blood flow and amino acids better into the muscle. That's a win. They reduce glycotoxicity. They support mitochondrial function. They activate EMPK insert one pathways which are wonderful for mitoenesis, mitochondrial genesis. They suppress atrophy signaling and they support muscle protein synthesis pathways. That's what GLP1s do inside the muscle. We have the studies.

[00:51:46]They're not harming muscle. They're not toxic to muscle. They're not preferentially eating muscle. They're not catabolic poisons to muscle. They are very potentially protecting and helping muscle. They also have a protective mechanism on bones. So, which again remember they're BFFs. And at the end of the day, exercise remains the primary driver of muscle preservation.

[00:52:06]No matter what you're doing, whether you're doing nothing, whether you're doing GLP1, whether you're trying to lose weight or not trying to lose weight, you got to go to the gym. If you're over 40, you really got to go to the gym. If you're over 50, you really, really got to go to the gym. Yes, protein is important. Yes, getting enough macros of your protein and your essential amino acids in are important, but at the end of the day, the muscle strengthening is the signal. The exercise is the anabolic signal that drives the muscle protein synthesis. And so we have to do that. So if you guys want to check out my strength vault, I have it linked for you. It'll get you started. It's a wonderful place to start. It was specifically designed for beginners. And I want to make sure that everybody has access to the nuts and bolts of the skill set of strength training because we all got to do it.

[00:52:48]Okay. So to summarize, 40% lean mass loss does not mean 40% muscle loss.

[00:52:54]Okay? If that's all you take from this, that's it. That's your homework. Number two, muscle quality matters a lot more than quantity. So we want strong, healthy, lean, contractile skeletal muscle. We got to use it to get there.

[00:53:08]So squeezing your muscles actually helps you with getting glucose into the cell.

[00:53:13]Insulin binds the cell on the receptor, the insulin receptor. Glute 4 transporter transllocates to the membrane, opens up, lets the glucose in.

[00:53:23]That's how we get blood glucose out of the blood and into the cell to be used for fuel. Okay, we talk a lot about insulin resistance, but that is not the only way to get glucose into the cell.

[00:53:35]Squeezing the muscle, actually just squeezing it will allow that glute 4 to transllocate, open up, and get glucose into the cell. So, it's equally as important in my opinion that you squeeze your muscle as much as you are working on your insulin resistance. And guess what? The more muscle you build, the more insulin receptors you actually get, the more insulin that you get to pull to bind and pull into. So, it's win-win.

[00:54:01]But we have to squeeze the muscle.

[00:54:03]That's critically important. And we need quality muscle. And quality muscle is muscle that is not fatty infiltrated, that is not metabolically compromised, and that is being used regularly. So, we got to go to the gym or we at least got to train at home. Check out the strength vault. And just know overall that GLP1s may be improving muscle biology. We have enough studies that add up to that at this point. And the proteomics in this cell paper prove it. So, it's it's a win-win. GLP ones are not eating your muscle, you guys. That's it. That's what that's the message I want to get across.

[00:54:35]I want you to spread it far and wide. I really want to end this misinformation.

[00:54:38]I think the people spreading this information don't either don't know or have an agenda to sell you something else. That's that's that's where I'm at with it all. And weight loss always includes some lean mass loss. That's just part for the course. That's how it goes. That's just obesity medicine 101.

[00:54:56]And it's something we all know if we've worked with anybody who's losing weight, right? If you do any kind of body composition analysis in your clinics, if you do any BIA, uh, impedance, any of that, you know that when people lose weight, they lose lean mass, and part of that lean mass is going to be their muscle. But if they're preserving their strength or even improving their strength, oh, that's the other part.

[00:55:18]really quick. The mice had improved mobility, improved treadmill stamina, they improved overall. So, it didn't matter that they were losing some lean mass, they were significantly improving overall. So, that's a win. If we can get people moving, if we can get them feeling better, wanting to move, having less pain because the inflammation, getting that macroofage to shift back to a less inflammatory version, we get better immune function overall. That way, it's all a win-win. There's a lot of upsides to GLP-1s used appropriately.

[00:55:47]And I don't mean cranking up the dose.

[00:55:49]You guys know I'm not a big fan of the high doses. I never have been. I've never been a defender great defender of high doses for weight loss. I am a great defender of common sense medicine and doing all the things. And the way that I've treated for decades in clinic is the same way I still treat. I still put people through the same hierarchy. I just now have a tool that moves the needle a whole lot better. And it ain't chewing up your muscles. at least so far as we know yet. So, I'll leave you guys with that. If you like this show, if you like this episode, please rate, review, and subscribe. If you're on YouTube, subscribe, ring the bell, let people know. The more that you do that, the algorithm catches it and it sends it out to more people so that we can This message is important. This is probably the most important one overall that I I really want to emphasize right now.

[00:56:34]Frailty kills. Listen to that podcast.

[00:56:37]And this whole GLP1 eating your muscle nonsense. It's got to go. So, I'll talk to you guys later. Thanks so much and we'll see you on the next episode.

[00:56:45]Thanks for listening to the Dr. Tina Show. This is a Wellness Loud production produced by Drake Peterson. Theme song is by John the Guilt. You can watch the full video version of this podcast inside the Spotify app or on YouTube. As always, you can email the podcast at podcasttina.com.

[00:57:02]That's drt na. And if you like this episode, please rate, review, and subscribe on your favorite podcast app.

[00:57:10]You can also find all of my offerings on my website at drtina.com.

[00:57:14]For more shows by my team, go to wellnessloud.com. See you next time and thanks for listening. This podcast is for generalformational purposes only. It does not constitute the practices of medicine, nursing, or other professional healthcare services, including the giving of medical advice. I am a doctor, but I am not your doctor. No doctor patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is intended not to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their health care professionals for any such conditions.