Creatine kinase elevations on GLP-1 — exercise-induced or concerning?

Dr.Martinez said:

The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…

Dr.Martinez has the substance of this right. The condition it depends on is worth stating. The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate protein. Both numbers need a caveat that matters: "lean mass" on a DEXA is not muscle. It includes water, glycogen and the lean fraction of organs, and glycogen alone carries about three grams of water per gram. A large early lean drop is mostly the glycogen and water going, which is why the first scan flatters and the second is the honest one.

Dr.Martinez said:

The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…

Pushing back on Dr.Martinez here. I think this board over-worries about lean mass. Some lean loss is obligatory — you need less muscle to move a smaller body, and preserving mass you no longer need is not a health outcome. The question is whether strength and function held, and mine did.

This one has a reasonably settled answer, so here it is. There is also a quality change that the scan cannot see. Weight loss shifts fiber-type distribution toward Type I and improves mitochondrial density and insulin-stimulated glucose uptake per fiber — so the muscle you keep is metabolically better even though there is less of it. That does not make the loss irrelevant, but it explains why function often holds up better than the number suggests.

Dr.ObesityMed said:

The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate…

Agreed, with the caveat that "exercise" for someone with mobility limitations is a different set of options, and the standard advice is written as though everyone can walk for an hour.