Powerlifting on GLP-1 — strength gains while cutting weight

Dr.DermMIA said:

Dr.GutHealth said: ...the muscle loss concern with lean mass...

Sharing my comprehensive lab data relevant to lean mass:

Protocol: Semaglutide 2.4mg/wk, resistance training 3x/week, protein 1.4g/kg/day.

The improvements in lean mass are clearly reflected in these numbers. The inflammatory marker reduction (hsCRP) is particularly striking.

MariaRD said:

Right, and protein targets should be set on a reference weight rather than current weight.

That reframing is the part I needed.

Dr.DermMIA said:

Dr.GutHealth said: ...the muscle loss concern with lean mass...

Physical therapist weighing in on lean mass. I work with bariatric and metabolic patients daily.

The resistance training evidence is critical here:

The Lundgren 2024 JAMA paper[1] showed that structured resistance training preserved 73% more lean mass in GLP-1 patients vs medication alone. When discussing lean mass, we MUST include the exercise component.

My minimum prescription: 3x/week compound movements (squat, deadlift, press, row), progressive overload, 7-10K steps/day, and 1.2-1.6g protein/kg/day.

JakeBK_lifts said:

I lifted three times a week throughout and still lost lean mass.

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Lumbar spine T-score: -0.11 → -0.8 (stable to slightly improved)
Femoral neck T-score: -0.11 → -0.9 (stable)

No significant bone loss despite 58 lbs of weight loss. Key factors: adequate calcium (1200mg/day), vitamin D (5000 IU/day), resistance training 3x/week, and adequate protein. Weight-bearing exercise is critical for maintaining bone density during rapid weight loss.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful. Thread quality here is what the rules are for. Keep it up.