As a doctor with a focus on preventative medicine, I have watched in dismay as the general health of people in the United States has declined over the last few decades. In fact, it seems as though the detrimental changes are accelerating. It seems like only yesterday that it was said that 2/3 of Americans were overweight or obese. Now it’s 80%. That’s stunning.
I would think that there would be legislation to restrict salt per serving of food (not because salt is so bad for us, but it’s part of the triad of salt-sugar-fat that makes food so addicting). That they would take vending machines out of the schools. That certain foods would have restrictions on sugar content and all its varieties. That the Surgeon General would be sounding the alarm and start an educational program on TV.
But it’s deafeningly silent in this regard, on Capitol Hill.
I apologize for the diatribe. This is supposed to be about how to maximize results and minimize potentially devastating effects from taking GLP-1 agonists like Ozempic. Okay, deep breath. Here we go. By the way, I’ll be repeating some of what I say in other blog entries about weight loss, because the principles are the same, whether you’re on Ozempic or not. They’re just more important when you’re experiencing rapid weight loss. And they’re not all that hard to do, if you take them one step at a time.
First, most diets cause both muscle loss and fat loss at the same time. The muscle loss contributes to a lowered metabolism and other hormonal factors that contribute to weight regain, and then some. So, by far, one of the highest priorities while on any semaglutide is to preserve, and preferably gain, muscle.
This involves two things–getting enough protein, plus sending signals to the muscles that they’re needed. For protein, the rule of thumb (unless you have kidney disease and your doctor recommends against it) is 1 gram of protein per pound of target goal weight, per day. It can be challenging at first to get used to more protein. And while on a medication that decreases appetite, it can be even more difficult. A good protein shake isn’t a bad idea to assist with this. If you can’t tolerate that much protein and have normal kidney function, I would suspect that your dosage is too high for you.
Sometimes a lot of protein without enough fat makes people feel a little nauseated and develop an aversion to protein. You have to live on something, and our bodies prefer to use carbohydrates and fat for energy. Cutting carbohydrates is fine, but take it easy on cutting down on fat.
Another advantage of increasing your intake of protein is that it doesn’t leave much room for hyperpalatable, highly processed foods. Being on a diet is a great time to gradually reset your taste buds and hunger for healthier foods. Don’t stress out about trying to eat the perfect diet. Gradual changes tend to be more successful. Exercise, by the way, has been found to the most powerful habit to drive us to naturally improve our lifestyles.
As for sending that vital signal to the muscle, nothing does it like strength training/resistance training/weight lifting.
The point of lifting weights isn’t to burn calories, though it does help with that. The point is to challenge the muscles enough that they think they’re important, and that they should get stronger.
I want to emphasize that the right dose, and the right mindset, are important. This is not about punishing your body for getting fat. This is about caring for your body so that you get fit and healthy.
Too much weight training breaks down too much muscle without allowing proper recovery, and that makes it harder psychologically to keep going. You want the optimum “dose.” After the first few times, you should feel better when you’re done than when you started.
A good resource is Sal di Stefano, a trainer and educator for 2½ decades, who has many YouTube videos on practical ways to get started. He also has a great book, The Resistance Training Revolution: The No-Cardio way to Burn Fat and Age-Proof Your Body—In Only 60 Minutes a Week, a podcast, Mind Pump, and website with reasonable prices for courses if you’re interested.
You can get started with a few dumbbells, bands, or a suspension trainer (about $50 on Amazon), or a kettlebell. Doing it with someone else makes it much more likely that you’ll keep it up, until you get into the habit.
Yes, it takes some effort, but you don’t have to beat yourself up to get great results. I lift weights, hard, two times a week, and I feel great after a workout.
Second, dosage. Your doctor should start you on the minimal dose, and gradually increase it just enough to get the desired effect. Starting people out on the highest dose because they want rapid weight loss is a great way to increase the number and severity of side effects. You don’t want to be vomiting and have to go to the ER for dehydration. It will only take 1-3 months, most likely, to get to a useful dose.
Third, make a plan with your doctor for weaning off of Ozempic. Don’t stop it abruptly. If our bodies receive high doses of compounds like these, the receptors become used to being full and less responsive. You don’t want it to stop working for you. I can’t advise you myself on what schedule is best. We’re still learning the best protocols for tapering down or cycling these medications.
Fourth, if you’re having any concerning symptoms, get checked out right away. It’s better to prevent a major problem than have one and risk your health. You may have to stop or lower your dose of Ozempic temporarily, but that’s better than getting kidney damage or some other serious problem that is going to interrupt your goals even more.
I know that the main causes of obesity are hyperpalatable foods and a sedentary lifestyle. With the multitude of programs and supplements marketed to us, it can be easy for us to lose sight of the basics. If you focus on the basics, that is time well spent.
As for the myriad of other contributors, such as poor sleep, food triggers, chronic stress, anxiety, and depression, please seek out help for your individual needs. You’ll be more successful, and save a lot of time.
The fifth consideration is maintenance. Happy, happy maintenance.
I would strongly recommend keeping the protein high. I would also advise mild intermittent fasting or alternate day fasting (ADF), perhaps gradually adopting the modified version. I hope you noticed the words mild and modified. These approaches to eating help us to appreciate our food, while changing our tastes. They also help us get used to eating more for hunger than for psychological satisfaction. And the health benefits are outstanding.
They’re something that you approach gradually, so it turns out not too difficult to do.
I’m such a fan of ADF, that I would suggest it for anyone having doubts about being on a semaglutide.
For some great information on how to do this, I highly recommend the YouTube videos by Dr. Frank O’Neil on this lifestyle. He also has a very reasonably priced, more detailed course available on Udemy. Besides being a great teacher, he’s a great example. After about as many diets as me (40 is when I quit counting), he lost 165 pounds, he has more muscle than when he started. The ADF can be gradually phased down in the maintenance phase. And maintaining muscle takes about a fifth of the effort to build it, so it’s not a tough lifestyle.
I do think that with these strategies, maintenance is possible for the vast majority of us. You don’t have to be on Ozempic for life. I’m rooting for you.
Take care,
Teresa de Roulet, M.D., a.k.a. Dr. Terry
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