Eating out on GLP-1 — January 2024

Short answer first, then the reasoning. On a suppressed appetite the winning strategy is protein density per unit of volume, not per calorie. Isolate powders, Greek yoghurt and cottage cheese, egg whites, lean fish, and tinned tuna all deliver a lot of protein in a small physical volume. Front-load it: appetite is usually least suppressed in the first hours after waking and worst on the day or two after dosing, so get the majority in early in the day and early in the week.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

Dr.RenalNash said:

On a suppressed appetite the winning strategy is protein density per unit of volume, not per calorie.

Agreed on the target, with the caveat that reference weight and current weight are different numbers. Using current weight at the start of a large loss produces a target that is both unachievable and unnecessary.

Dr.NephBHM_UK said:

My appetite is suppressed enough that hitting a protein target is now the hardest part of the day, and everything I read assumes I can simply eat…

This matches mine closely enough to be worth saying so. The RDA is the wrong reference and it is worth understanding why. 0.8 g/kg is the intake at which nitrogen balance is not negative in healthy weight-stable adults — a floor for deficiency prevention, not an optimum, and derived in a population that is not in a deficit. In a substantial energy deficit, protein requirement rises because amino acids are being oxidised for energy and because muscle protein synthesis is blunted. The literature on preserving lean mass during weight loss lands around 1.4 to 2.0 g/kg of reference body weight, which is roughly two to two and a half times the RDA.

Clinical perspective, offered as context rather than as advice.

DEXA scan update relevant to protein intake:

Scanned at months 0, 6, and 12. Here are the body comp numbers:

Lean mass preserved — actually GAINED 1-2 lbs thanks to progressive overload + 1.4g/kg protein. The protein intake discussion needs to include body comp data, not just scale weight.