#398 ‒ AMA #86: GLP-1 RAs and muscle loss: new data, better questions, and how to preserve muscle during weight loss

Hey, everyone. Welcome to a sneak peek, ask me anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything AMA episode 86. In today's AMA, we're gonna look at the effects of GLP one receptor agonists. So these are drugs like Ozempic, Wegovy, and Zepbound. But, specifically, we're gonna look at the impact they have on muscle. We're gonna talk about how much lean mass people actually lose on these drugs and how that compares to weight loss by any other means. We're gonna define exactly what lean mass is and how loss of lean mass on DEXA can actually mislead us, how these drugs impact bone mass and fracture risk, the all important effects of these drugs on strength and physical function, which probably should be the most important metric, the effect of these drugs on different fat depots across the body, who's at most risk for lean mass loss, how to maintain muscle and bone strength on these drugs, and the initial insights of the effects of retrotide, which is a drug I'm sure many of you have heard of as it's making its way through the peptide cesspool at the moment, but nevertheless will be an FDA approved drug in the not too distant future. And so people have lots of questions about how will retrotide affect weight loss, but specifically its impact on muscle mass as well. So without further delay, I hope you enjoy AMA number 86. Dear, welcome to another AMA. How are you doing? Very well. Thank you. Awesome. So for today, we are gonna talk GLP one agonists. And we did our first episode on this about five years ago. It was you and Bob. And back then, no one was really paying attention, and no one really cared about that episode. And then about a year and a half later, we did a second episode on them, and all of a sudden, people really started to care. And so thinking back at this, what do you think it was about that second episode that got so many people's attention on this? I mean, if I were to think about it through the the arc of the story of these drugs, I think it was obviously the impact on weight loss. I mean, my first foray into GLP one agonists clinically was in 2014. So, you know, twelve years ago, I started experimenting with lira liraglutide in patients, found it relatively uninspiring, and for that reason, given the cost and the logistics, kind of abandoned it. And I think when we did our first episode, we were already seeing …