Muscle Loss on the Shot: Worth the Risk?

If you've been considering doing the shot, you cannot be a woman alive today who has not heard about GLP-1s and what they can do, what the risks might be. And you are probably on one side of the fence or another. Maybe you're confused, maybe you're so very tempted but a little fearful or hesitant based on negative side effects. Well, I'm here to share a couple of studies in science, and really this comes from a deep dive. I'll tell you a little bit more about in the episode. So whether you are a health fitness coach or you're a woman here interested in her own benefit in doing her own research, this is for you. It's for all of us. You're in perimenopause, menopause, or postmenopause. And you're not slowing down, you're just getting started. But the old rules don't apply anymore. The workouts that worked before, they're working against you now. The advice you've been given, incomplete at best. I'm Debra Atkinson, and I'm the founder of Flipping 50, the pioneer in fitness for women in midlife. For more than 40 years, I've been in the trenches with women just like you, and for the last 12, right here on this podcast, and, and the founder of Flipping 50: The Stronger Way app and membership. Welcome to Flipping 50 the Stronger Way, where science meets strength, where you'll find the tools, research, and real talk to build the body and the life you want in your second half. Each week you'll get evidence-based exercise and nutrition strategies, conversations with leading experts, and honest answers to the questions your doctor didn't get answers to in medical school and doesn't have time to answer in an appointment. This is your show. Let's get stronger. Hey, welcome back to another episode of Flipping 50 the Stronger Way. We're gonna unpack some science today, and a lot of this research comes from things that both made it and didn't make it into the course called GLP Fitness Specialist that we're working on right now. And if you happen to be a health coach or a trainer who's interested in positioning yourself, or you're already working with people who are on GLPs, and you wanna do it with a little more intel and knowledge, this is it. This will come with continuing education credits from NASM and from ACE and AFA, and we are working on NSCA. So a number of them, and by the way, I've been doing this for 42 years, and a lot of times if you are certified by somebody else, and you need credits for that, you can generally petition if it's been approved by one of these larger agencies because there are so many cert agencies out there now. But I share this with you because as I'm unpacking this, um, it's so very interesting that I was on a panel 2 years ago now about GLP use and what it was going to mean to the fitness industry at a major, major conference that was held in LA at that time. And I was sitting on that board with the moderator, mediator of the agency, of the organization hosting, along with two other doctors in longevity and internal medicine. And, you know, we were, I was really optimistic. And I think everybody who came into the room, the majority of those professionals were nervous. Like, this is going to put us out of business. People won't want to come because we know that the number one reason people begin personal training is often weight loss. We want to change our body. We want to lose weight. And now we've gotten wiser and you've all gotten wiser. You want to lose fat and you know that. But, you know, we really, I think, hoped that we turned those people around to see this is a huge opportunity because without proper resistance training and exercise supervision, we will lose muscle. And there is that, and that's why everybody was saying, "This is terrible, everybody's gonna lose so much muscle." And yet, you know, all of that came out because GLP has been around for a very long time. And when they first came out, Nobody was talking about weight training as the basis of— this needs to be part of the lifestyle change that is recommended. And we're all talking about it now. I mean, thank goodness. Look at what's happened in the last 5 years, even the change of people doing resistance training. And in part, this positive change came about because of the negative change in COVID. The huge rapid weight gain that we all know, y'all, was not muscle. You know, when we were at home next to the wine and the snacks and the munchies and we were highly stressed, gyms were closed, you know, and you couldn't get dumbbells off the shelf in Target because all the gym goers got them first. So it was a very interesting time, but what we found Is that the average weight gain? And don't quote me because I'm going from memory and some days it's better than others, but if I remember correctly, the average, average everyone, 15 to 28 pounds. That's a wide range, but that is terrible. I mean, can you imagine on your own personal frame right now gaining 28 pounds? That's That's just incredible. And that is life-changing, not in a good way. So let's talk about what research is really out there that says, number one, we have to look at what happens and what happens to specific populations. So I'm going to share some research here that talks about premenopause to postmenopause. What changes do we see with exercise? And with lifestyle, no exercise in general, and why that might say for certain populations, as you are listening, you're one of them potentially, that doing a GLP can be more risky if you don't, and I always want you to finish that sentence, if you don't mitigate the changes. There will be negative repercussions. Those will come back to bite you, you know where. And there is no getting around that. So if you're considering it, and I am not here to be pro or con, and if you wanna stay till the end, I will share what I personally am doing and my personal feelings about it. So I've been asked behind the scenes, nobody's asked me, in public. So it's, it's very interesting. I think we think, oh, this is hush-hush. I don't, don't know that it is, but I will, I will share my own if you stay till the end. All right. So I want to look first at, I think we have to know what happens. And if we're tracking body composition, we have to start at the beginning. So we are here to talk about GLP-1, the shot, the, the peptides that everyone is talking about, the glucagon, which is what it stands for, glucagon-like peptides. So when you're hearing GLP-1 and then maybe you're confused because you're thinking, everybody's talking about peptides, but what peptides are they talking about? Well, the GLPs are peptides. So just to kind of help you understand that or make that connection if you have not yet, we have to talk about body composition. Because if we're talking about, "Is there a risk that I will lose muscle?" Well, the only way you're going to know that is when you are looking at your current status, you should know, "How's my muscle mass now?" Right? You need to know where you are when you start. So if we look at the optimal ways of measuring body composition in the assessment of health, this is from topics on clinical nutrition. And this is 2015. You also just aware this is 11 years ago, but some studies get anchored in— we already know this, so there's not necessarily going to be more studies until something better comes out. So we know these things. So looking at comparing body composition methods, and I will tell you that so frequently When I went through college, so let's call this back in my undergrad days, you know, what we were taught is how to do skinfold calipers. And I was taught by Dr. Wally Hutchinson, who I believe he's either a very old man who's no longer with us, but he was a gem. He had completely white hair and he was just a wonderful guy. And, you know, I remember him drilling it into us over and over and over that you had to do and you had to do it again. And when you do skinfold calipers, so there are many protocols that you can use to get to the right answer, but generally we did a 3-site for females. That would be the back of your upper arm. Exactly, I hear somebody groaning right now. And so we're pinching your tricep, and we do the top of the thigh right in the middle, Another smaller groan. And then we do your iliac crest. And that is basically if you put your hand on your hip bone and you kind of put your hand in, you feel that front corner bump. That's your iliac crest on your pelvis. And between that and your pubic bone on a diagonal, we take a pinch there as well. Right. So yes, you want to be standing up, not sitting down. It helps a little bit. And basically you're relaxed, you're not tight, you're in the same status, just like you would be if you were getting on a smart scale. But I remember over and over, and here's the thing, you pinch and shake. Like, it is literally a technique, you know? And I remember many, many times going out the door from my roommates and maybe then my fiancé or my husband and say, I'm gonna go pinch fat. It's like I've pinched fat in a lot of people today. But those 3 places for females, men slightly different, but we do it for them. We do it in the chest. Gosh, I haven't pinched fat on a man for a very long time, so I'm actually thinking. So the chest, the abdominal, and it's a different kind of a measure for them, and the thigh again. But we do it over and over. And when we're actually testing, so you would pinch it and then let go of it and then pinch it again, and you would do do it again. So 3 times at each site to look at how consistent am I, and then we would do the average, and that's the number we'll take for the tricep. It's hard to get a good reading in skinfold calipers when someone is severely overweight, and it's hard for the wrong reasons. And then when they lose weight, you're much more easily able to get fat, and it's, it's totally backwards. So skinfold calipers don't work accurately for all people. And in fact, it may show that you're worse because if somebody's skin is really tight because they are really overweight, it's hard to get a reading. So you can't get it. And then when they lose weight, things become a little bit more lax. And so although their number may be better, we can get more of that. And so skinfold is not perfect. And underwater weighing is the other one. We've talked about it on this show. It used to be called the gold standard. However, underwater weighing goes something like this. You in your bathing suit get into a deep tub. You sit in a chair, and this is, trust me, this is in the early '90s and the late '80s. So this is potentially a little dated and things are better now. Lord, I hope so. But then you've got somebody, me, who has you put on nose plugs, and then you have to basically, you know, if you were on a plane and you needed to put your head between your knees, that's what you're going to do. So you're going to duck down, blow all the air out of your lungs, like you're going to get rid of it. And so you're underwater without any air, And imagine how successful that is for people who, number one, are not comfortable in water. Number one, you're basically in a very deep bathtub and people are staring at you and above you yelling at you, "Blow it out, blow it out, blow it out." Those were the words I had to say over and over and over. And then we have them do 3 attempts on that and we're measuring and then using a calculation to figure out what their percent body fat was. And I remember distinctly somebody showing up on the show and saying, you know, well, under underwater weighing is the gold standard. And I'm like, have you ever tested people with that? Because it's not. I, I know it's supposed to be, but I'm telling you, people can't get all the air out of their lungs and stay underwater long enough to get an accurate reading. It's, it's difficult, and you have to be highly motivated and comfortable in the water with no breath in your lungs. And who can say yes, oh, that's me? I don't think so. So I come back to that to say, um, maybe, maybe not. Um, but both of those I would shoot holes in. So what else do we have left? You know, at home we have bioelectrical impedance, and the accuracy, which is a question that I get a lot, within 3 to 5% error. And that's, you know, really population-dependent. If you are really overweight or obese, it is going to be a little bit harder for a bioimpedance scale to work. The precision is not going to be totally great. The error in lean body mass tracking is probably 2 to 3 kilograms, by the way. So remember, 2 to 3 kilograms, 2.2 to do your dividing. You got to do a little math here. And if your status is that you are hydrated, it's going to— you're going to be much better off because you're going to get your body fat overestimated by 3 to 8% if you're dehydrated. That always used to really motivate people to, okay, I'll come in, I'll be, I'll be hydrated. Um, so I want to share that with you so that you know if your scale fluctuates on a day-to-day basis That can be largely— women do fluctuate. We retain water and lose water based on the outdoor barometric pressure, or is it barometric? Um, you tell I'm not a weatherman. And the foods we eat, the sodium in it or not, the amount of stress, the amount of exercise and humidity. So many things will impact our hydration level. Edema, fluid retention. Does that sound like a female to you, that will underestimate fat mass. So we've got two things that probably for females really might dictate that you're going to fluctuate. But having a bioimpedance or a smart scale, which is what we mean, not a dumb scale but a smart one, is really important. And if you are looking in the market for a smart scale, I have a list that I put in my Amazon store of ones that I either personally own, the one I use, I have extras, as you might guess, in a closet. People have shared with me to test, and one for every budget. And I'll put a link— my Amazon store is flipping50.com. It's under my favorites or /resources. You, you can get there too. But having one is so much better than not, and even if it is slightly off, whether it's not calibrated perfectly accurately or your day-to-day fluctuates a little bit, you are going to see trends. You are going to see change. I don't think it's the accuracy that we should be concerned about. I think it's, you know, if you didn't know yesterday, at least today you know a number and you're going to get on the same scale. It's going to be calibrated the same direction, positive or negative, correct or not correct, but it is correctly going to show you change. And that's really what we should all be concerned about. Before we get started, there is one thing that I recommend you do, whether we're talking your fitness level, your micronutrients, or your hormones, and that is test, don't guess. There are a lot of people out there telling you a lot of different health options, but randomly trying any of them without knowing where you are to begin with is like throwing darts with a blindfold on. So I personally test regularly and I advise my clients and members to do the same. But look, I just moved to a smaller city in a Midwestern location and I no longer had a lab testing site 6 minutes away from my house to do testing until this— Cyfox. Comprehensive at-home blood testing delivered to my door. No lab visits, no waiting rooms, and in my case, no 70-mile commute. Painless upper arm collection that takes about 5 minutes, and if you're squeamish, stay with me, you really don't even have to look. Results include a personalized action plan, insights, and supplement recommendations. Included in membership are 4 unique panels for longevity, thyroid, hormones, and heart and metabolic. It's not just about the results that I got. I personally can't stop talking about the customer experience. Every step of the way, from video calling a coach who was on standby at 6:00 AM when I wanted to do the blood draw and talked me through it step by step. The FedEx return label and then the communication after I dropped it off at FedEx telling me it's en route, it was received, it's being analyzed. And within less than a week, I had my results including my biological age, personal action plan, and those supplement recommendations, which I'm currently following through with two of those. And I'll retest in 3 to 6 months to see how they're impacting my health. You too can get your convenient test kit from Siphox Health at siphoxhealth.com/Flipping50 and get 20% off at this link. That's Siphox, S-I-P-H-O-X, health.com. And I know some of you are overachievers and know, I want the data, I want to really know. But here's the kicker, even if you, for instance, do a bone density scan, so I've lived in— lived in Colorado, then I lived in Scottsdale, Phoenix area. I did 2 DEXA scans there. If I go to a different lab, a different DEXA machine may measure me differently. So I'm going to have a number again, but I have to take it with a grain of salt and say, you know, if it tells me I went up or went down, I have to be willing to say that could be off because the machine is different than the other one that I did, right? So I want you to realize that that stands true across the board. The DEXA scan, the accuracy, however, is between 1 to 2% error for body fat percent. And know this, please know this, if it's the same machine time to time, but still going to be a change. So the cost is between $100 and $300. The that's a limiter. It will be covered by insurance, and of course if you've got a copay, there's that, or deductible. But if your physician will set you up with one— I had a pretty progressive physician who ordered one for me at 58. She's like, you haven't done one yet, you should do one, you know. And there wasn't anything in my health history that said, you know, there's something wrong with me or I should do it, but You know, it really depends on will your physician write it and will your insurance cover it. So I got one, I got one the following year that also was covered. So it's— there's a lot of variation out there. So in terms of weight loss intervention, now the DEXA is actually known as the gold standard for weight loss. For those of you, however, who are going in for your bone scan and think, oh great, I'll get my body comp too. You won't unless it's written up for you. So they have to know that we're doing both. So just be sure that you're, you're still covered and you know what you're going to get. If you're thinking this is a two-for-one, it may not be. A lot of women I've spoken to, that's not what happened. Okay, so what are we going to do? Again, DEXA is probably gold standard. And I want to tell you that if you go to a franchise, DEXA Fit is an easy way to get a DEXA, but it doesn't tell you what you want. It will give you your body composition and that it could be well worth it. And that's about $100 at a franchise. But the bone scan information it's going to give you is one lump number. They're going to say Hey, you're -1 or you're, you know, -2, but they're not gonna tell you where. So you will need to get a clinical DEXA scan for your bone density because it is important. It's important to me as a trainer, a medical exercise specialist, or me personally, I wanna know how is my forearm, how is my total hip measure, and how is my spine? Because then I'm choosing my exercises far more wisely and I'm suggesting, okay, I'm— I know what I was doing, that wasn't quite enough. I'm going to be doing more X, Y, and Z because it's very specific to that area. Case in point, I had improved— I reversed in 3 areas. I reversed the bone loss, um, everything improved. 2 of them went from osteopenia to healthy bone again, but one of One of them still was osteopenia. It had improved, but it wasn't completely. And it was my forearm, non-dominant forearm, which makes sense. You know, I'm, I'm lifting heavy with a chest press and pulls, um, as well, but you're not walking around on your hands. At least I'm not. If you are, go you. But, you know, we need to do a little bit more. And so I started to do plyometric pushups, right? And you can do that by the way. And I'm starting to use, or did start to use my Power Plate to do planks on my palms, on my forearms. So directly getting the stimulus there where I need it. So, and I am due again, and I put it off just because moving was a big deal. Then moving in was a big deal. And now I'm I'm committing to you. So now you're hearing it. But just so that you know, you want to know that information. Had I not, I might have just— okay, swoop. When you have a goal, you know where you're running, the chance you'll get there is far better. So we need to monitor body composition, no contest. So now I want to look specifically at what happens to those of us pre versus post-menopause. So I'm going to break down a couple studies for you, and the first one is from 2019 in Cellular Metabolism. So it looked at 107 obese older adults. 74 of them were women. 69%, almost 70%, were post-menopausal women, and then there were 33 men. So It's a good study, right? Representative of females. So they were randomized into 4 groups: diet only, and that was a 1,000-calorie-a-day deficit. And by the way, I would not recommend that. Put your body into stress mode. Number 2, diet plus aerobic exercise. Isn't that what we all thought we needed to do? Number 3, diet plus resistance exercise. And number 4, diet plus combined exercise, meaning they did aerobic exercise during their week and they did resistance training. It was a 6-month-long intervention, and what they were doing was muscle biopsies. And that means out of your, your quadricep muscle, they take a big dose of your muscle. It's— yeah, it's not fun, a little painful, but but you do heal. And the outcomes were muscle protein synthesis via looking at a stable isotope. They inject your muscle so that they can see it when they extract it and strength. And they wanted to also look at the muscle cell quality. So not just quantity, but quality. And what happened to muscle protein synthesis? To refresh your memory, Muscle protein synthesis is that thing that stimulates our ability to build muscle versus the opposite side of the fence is muscle protein breakdown. And the fence, by the way, is paper thin. You, you're not on the fence. You're either in one side or the other. And so you— we want to work really hard to be in muscle protein synthesis. And I want to say building muscle is a great goal. But maintaining your muscle is also a great goal, right? Two great goals. You might not gain, but I think you've got to look at, am I holding my own? Is my body composition okay? And am I gaining strength and improving the quality of my muscle and/or at least maintaining it? Then you're doing really well. Do not forget that we all are telling you the statistic from historical data say 3 to 8% of muscle loss every decade after 30 is kind of the norm. That has an uptick at age 60 because that's kind of a critical mass we've hit in terms of aging. And we see that number go from 1— go up to 1 to 2% a year. If you're doing math, that's 10 to 20% a decade. But if we're not doing something about it. So if you are doing something about it, you're way ahead of the game and you're not losing. That's huge. It's also, don't berate the fact that, "Oh, my skeletal muscle mass hasn't changed." But has your strength? And if it has, then the quality of that muscle has changed. This one, replay that little last segment because it's really important. I think so many UpView listeners I know in our membership community sometimes it seems that it's disheartening for you not to make the progress when you feel like, "But I've made the progress," right? Don't negate. You're stronger, you're picking up stronger weights, you go up stairs faster, you pick up the grandkids and you have one on each hip, no problem. All those things are wins. You are making progress. So let's unpack what happened to these 4 groups. Let's talk about lean muscle mass because that's really what we're talking about. Now we're not talking on GLPs yet, but we were laying this foundation for doing it. The diet-only group lost 3.6 kilograms of lean muscle mass. That was 33% of their weight loss was muscle. That's not good. Okay. Diet and aerobic group, they lost 3.2 kilograms, or 29% of total weight loss was muscle. Diet and resistance training lost 1.8 kilograms, or only 16— almost half of that was really great, right? And then the diet plus the combined— they were doing aerobic and they were doing resistance— lost 1.4 kilograms of lean muscle mass. Only 13% of their weight loss was lean mass. The best, right? So doing a little bit of cardiovascular work probably helped with some fat loss. The resistance training helped them sustain and maintain their muscle mass. And then the diet helped them be in a deficit so that they again could lose that weight. So muscle protein synthesis, so your ability to boost muscle versus to lose it. Diet only, the muscle protein synthesis went down by 16%. Diet and resistance training, there was an increase by 8%. The diet and the combined aerobic and resistance training increase muscle protein synthesis by 12%. Now, in terms of cardiovascular exercise, I just want to say this. This was literally aerobic exercise. This wasn't HIIT. We actually refer to that as anaerobic exercise if we were talking about it as physiologists. So just know it's, you know, without oxygen basically because we're keeping those intervals very short. Anaerobic versus aerobic. So this was more of a steady-state kind of aerobic. So what about strength, muscle strength? Diet only lost 8% of their leg strength. Diet and combined exercise increased by 21% leg strength. So even on a diet, a caloric deficit, and resistance training, and doing cardio as well, improved on leg strength. And by the way, the type of cardio that you do will potentially change the impact. Back during early pandemic, in probably 2019 or '20, I shared a study that came out about high-intensity interval training and positive impacts on visceral belly fat in post-menopause. And the way that study went was like 8 seconds really hard, 12 seconds recovery for 20 minutes. And I think it was an 8-minute warm-up and an 8-minute cool-down on either end of that. So looking, um, at that, those people also, they were burning belly fat and they gained muscle strength local to the quadriceps, top of your thigh, because that's what they were using. So So if you choose wisely, if you chose something else, like you chose swimming, you're probably not going to gain that leg strength to as great a degree. But I also want to call your attention to, we know that lower body strength, the strength of your thighs is directly related to longevity. That, that is mobility. It's getting up and down out of a chair safely, getting up off the floor if you should need that to do that in an emergency. Right. Um, so just realize that you can probably impact that a great deal by what you're choosing for your cardio or not choosing for your cardio might lose you a little bit of that edge. So estrogen interaction, I want you to pay attention. So postmenopausal women in the study had 40% lower baseline muscle protein synthesis versus premenopausal women. That basically is a red flag for all of you saying, You absolutely have to do resistance training and you want to make sure you're taking in that high protein at every meal. Hit at least 30. If you're older, I would say postmenopausal women aim for 40 if you can. And if you're not there, you're nowhere close to that, start where you are and gradually work on bumping it up because we do have to work harder to reach or attain that muscle protein synthesis. Resistance training though overcame estrogen deficiency effect. It normalized the muscle protein synthesis back to premenopausal levels. So we don't have to fear, okay, we're postmenopausal, we're gonna go down the tubes. That's it. Not if we're resistance training, at least to stimulus that gives us muscle protein synthesis. So the application here is postmenopausal women who might be using a GLP-1, you're going to face compounded muscle loss risk if you're not resistance training. So resistance training is non-negotiable, I would say, for anybody postmenopausal, but definitely for postmenopausal women on a GLP It's got to be like your job, like it's in your MO. All right, I want to share with you, um, a couple other things in terms of what really we've got to look at in what happens in menopause and muscle strength and mass both. And this is an older study, so just a heads up. Generally, if I were, you know, writing a book and including studies I'd probably make a plea for, please accept this. If I were talking on stage at a medical conference, they may not accept something greater than 10 years old. So realize that I'm sharing this with you open-ended, being totally forthright in this, but this is a study published in the Journal of Musculoskeletal Neurological Interactions, and this was in 2009. So heads up on that. It looked at 304 women followed through their menopause transition. So that's like you or me from beginning to end. Ages were 45 to 60 years at baseline, and they were followed for 10 years from pre- to postmenopausal. So they looked at DEXA scans for lean mass and bone density. They looked at their strength testing, and it was what we call isokinetic strength, knee extension and knee flexion. Basically, you are trying to extend against a resistance. And so the machine is measuring what are you— what force are you producing? And it also looked at hormone panels, their estradiol and FSH, to know where they are and what stage. So the perimenopause, 2 to 3 years around their final menstrual period, so is predicted, and that's that's that time when maybe you were clueless, you didn't know, you didn't have hot flashes and night sweats to give you that dead giveaway. This is where I'm at. You now start skipping periods, and it's at that time when you figure, okay, this must be starting to happen to me. So what happens is the lean muscle mass loss starts to occur, and that was, uh, 0.6 kilogram per year, and it accelerated a little bit beyond found premenopause, which was 0.2. So in our 30s, you know, about 0.2 kilogram per year, maybe muscle loss. Again, not doing anything about it. Or we lose perimenopause, 0.6. And strength losses was 3.2% a year. That was pretty big. Early postmenopause, So we hit that point where last period, boom, hello, welcome to the club. You're in post-menopause. Your initiation is lean muscle mass is 0.4 kilogram per year, strength minus 2.1% per year. Not as big as perimenopause, right? And part of that may be very well tied to the fact that perimenopausal women go through a bigger roller coaster. And if you think about where were you between, and this is just an estimate, we're all different, between 40 and 50, it's a busy time. You know, if you have a career and you have a family, you're going to practices and games and events, you know, for kids, and you're taxiing still and/or staying, you know, attached to the phone. I mean, and then you're going through your work and your career and it's there's a lot going on. So, um, you know, some of that evens out as you become more of an empty nester, and that is part of the reason why things stabilize. But hormones also stabilize. Late post-menopause, so 6 or more years post, that club, lean mass loss is 0.3, so the least amount. It actually has stabilized. And strength loss is 1. 5% a year. So also not as great, but here's probably where the problem is gonna come there. If you had a big loss of strength per year in perimenopause and it continued in early postmenopause, even though it's stabilized, you've had a significant loss of strength overall if you do all the addition there. So hormone correlations. When estradiol declined, you know, it was correlated with muscle loss indirectly, mostly due to sleep loss, fatigue, injury, hot flashes, the— all of the things, and the life disruption, right? Muscle and strength loss can be significant post-menopause at 60 and over, although we can control that. We mitigate it with eating a little bit higher protein and getting in your resistance training on a regular basis. And not to forget recovery, complete recovery. So we often think 4 times a week of resistance training must be better. Is it? Are you exhausted? Are you tired all the time? I would say we change that and we fix that exhaustion first, and we make sure we get you rested, get you recovered. We're stimulating muscles at least twice weekly But maybe we do it in two slightly longer sessions so that we can allow a lot more recovery time during the week. I think there's always room for, let's look at what results you're getting now based on what you have been doing and how we can improve by tweaking. So realize that this group, they were doing 3 times a week progressive resistance training for 2 years. During perimenopause, and this was a subgroup of this study, it prevented the muscle loss. Yay! Compared to control group, and they maintained strength. In fact, they gained it— 2% strength gains versus that negative 6% loss in the controls. That's pretty big, right? So big changes. We have a lot more control than we know. So it's really important to look at in GLP use during perimenopause or early postmenopause, we are at higher risk, period. And we need to track our weight loss composition. So the body weight composition, that is what is important. If we lose weight, what did we lose? You have to be asking that question. It is so very important. In the course, I break down some of these studies to a greater degree, give you all of the science. If you happen to be a health coach or a trainer who's listening, I highly encourage you to, um, consider the course. We're still doing a preorder. The course will be released on May 15th. When it's first released, we don't yet have CEUs available, but most of us who are recording those CEUs or CECs, as you might think of it, do that by the end of the year. I know some of you might belong to organizations that do that on an anniversary date, but we will give you the credits once we have you take the quiz. We build that out, we have to go through a reviewer process, people have to volunteer, and yes, want to do that, and we give you a little perk of some kind as well. But if you're interested, get started. There will be CEUs granted for that. And if your renewal period has already come up for this year, we will give you that, and you can say, okay, I've tested after, you know, my most recent renewal, then it's going to apply for you to your upcoming. So if you're interested, either for yourself, but primarily this is for health coaches, and really important that you look at the science related to you, who you are, or if you're working with clients, are they premenopause, perimenopause, or postmenopause? Because it puts them at a different kind of a risk factor, and there are certain things that we really want to monitor. If you're working with somebody or are yourself in perimenopause thinking GLP, you want to really look at how's my sleep before you get into it. You want to look at how is my appetite and my choice of food as I get into it and look at knowing how I keep myself motivated to eat enough, because that often becomes part of the issue, is a lack of protein and/or lack of total micronutrients lends itself to fatigue that gets in the way of somebody doing the resistance training and/or being able to recover from it. So there's a comprehensive inclusive list of things that you want to make sure that you've considered before you go on it. If you're on it, things to consider now depending on how you're feeling and what you're measuring. And for those of you who are coaches and trainers, this is not going away. People will consider it. All right, so as promised, I've been asked before, what are you doing? Have you tried How are you using it in your practice with clients? And I have had several private clients on it. I have a small group right now, and I can point to 3 who are on it using it in different forms, or were and are no longer. So every client is different. I've got some case studies that will be in the course, but personally, I resisted for a really long time and And I will tell you why. It was from lack of knowledge. And once I educated myself, you know, I tried it and I've really explored this myself. I think you and I, if we were talking about intermittent fasting or we were talking about GLPs, many of us would say, you know, or we'd like to say, "Oh no, I'm doing it for the autophagy, for the longevity benefit." I think we— I call BS, okay, for lack of a better term. If it were going to improve your longevity but there was a risk that you might gain 5 or 10 pounds, and that was almost across the board what we were seeing, many of you would say, "No, I'm out. Not going to do that if there's weight gain involved." So if you're honest with yourself, there is subconscious draw that this is gonna help me lose weight or lose fat and make that better, improve my body composition, or we wouldn't be motivated by it. And I looked at that very closely myself, but I am on a microdose. However, I have to say, at this point I've been on it long enough that it's really not doing anything. Now, nothing that I can tell— I mean, it's not doing anything in terms of body composition. And then when I say that, you also have to look at, or is it like, maybe I would be far worse off? And, and yet I highly doubt that because we know that there are things that we can do and we can control. You know, if you go down the line and we're looking at how's your gut health, elimination, digestion, gas, bloating, anything like that present, you got a problem. Your metabolism is not going to function really well. If you're tired all the time and you're taking a thyroid, you probably have some adrenal and cortisol things we need to look at. And cortisol is not a bad guy, but it's supposed to be high at certain times and low at others. And if that's not true, we have to look at that and the interaction with the exercise that we're doing. So personally, yes, I've been on it, but I've been on the same small dose for long enough to know it's not really doing anything. And if I'm looking at labs, I also don't see any huge improvements. There was nothing really out of bounds in terms of inflammatory numbers there, but I'm not seeing any loss in fat or belly fat, control of blood sugars. I've worn a continuous glucose monitor before, I've worn it during, again, no real change. So just to share and be totally transparent, you know, this was not a big, quote-unquote, game changer for me. I am not really interested in increasing my dose, and that's an option, but I don't really think that I need to do it. I don't think I'm of a population who needs to or should. And I am, you know, wondering about the negative side effects. So I'm not interested in, you know, screwing up digestion and, and/or gut. And I do have an option for coming off. So I'm actually thinking about that. Um, and probably next doctor appointment I'll speak with my physician about, you know, I'm not seeing anything that really helps me say this is really worthwhile, it's a great investment, you know, of time and energy. It's not much time, but you know, it's, it's also money. So there's that, that's where I'm at. But I, many of you have heard me talk about CaluCurb, so that is actually what I would use. I'm using it now to decrease cravings for caffeine in the afternoon. And as of May, I'm zero caffeine in the afternoons. That's my plan. So I think I'm binging a little bit right now because I'm doing that. Isn't that psychologically interesting? My mother would say, but that is a great taper system to help you turn on and dial back up your personal GLPs. So the amount that I'm willing to go to I've already gotten to it. I'm not interested in doing more than a microdose and didn't see, um, any— and I started with a much smaller one and then titrated up, which is what you would do if you're working with a physician. But there you have it. So sharing that little personal behind the scenes in case you're wondering. And, and it will be interesting. So there'll be a certain amount of, of you who might be judgmental about that, who might just be interested, or might be saying, okay, but there was just really no great improvement in any direction for me. So for me, it wasn't worth it. For me, I'm not interested in doing anymore. So there's that. I can say I've tried it, um, and if you have any further questions, happy to do a really quick follow-up and we could do a little Q&A, but respond. You can respond behind the scenes in Instagram DMs. I get those all myself. Let us know. And if you would please rate the show, it really helps us spread the word. Hope that the science has been helpful for you and look forward to hearing from you about how this one sat, whether you are or you're not on the shot, the information about muscle loss, strength loss, and what and where we are pre to peri to post-menopause and what you can do about it. Really, really important. All right. I will see you on the flip side. The information shared on Flipping 50 the Stronger Way is for educational and informational purposes only. Intended as a substitute for medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider before beginning any exercise program, making changes to your diet, or adjusting any medications or supplements. Individual results may vary. Debra Atkinson and Flipping 50 are not responsible for any injury or adverse outcomes resulting from information presented on this podcast.