By Kristin Kirkpatrick
Kristin Kirkpatrick is a 20+ year registered dietitian, a best selling author, and a nationally recognized expert in integrative nutrition. Find her on Instagram @fuelwellwithkrissy or at Kristinkirkpatrick.com.
Why Aren’t More People Taking Creatine with Ozempic?
Ozempic and other GLP-agonist drugs have changed the weight loss game. There is so much interest that a quick survey of current studies reveals over 350 clinical trials currently in progress to assess components of GLP-1 agonist utilization. Some popular options include Ozempic, Mounjaro, Wegovy, and Trulicity. Despite the excess of information that comes out daily, plenty of factors surrounding GLP-1 utilization are not discussed – but should be. One such element relates to Creatine for the retention of muscle mass.
What are GLP-1 agnostic mechanisms and benefits?
GLP-agonists are pharmacological agents that help control blood sugar and reduce obesity. These medications were initially meant for individuals with type 2 diabetes but have now become popular as a weight loss method independent of metabolic dysfunction. The primary mechanism of GLP-1 drugs is to delay gastric emptying and reduce cravings and hunger (which subsequently increases satiety). Benefits seen in clinical trials include weight loss, reduction of blood pressure and cholesterol, reduction of HbA1c, and reduction of major cardiovascular events. Clinical trials underway are also assessing effectiveness towards addictive behavior (such as alcoholism) as well as improvements in mental health (such as reduction of depression).
The potential downside of GLP-1 agonist drugs include nausea, vomiting, diarrhea, and gastrointestinal distress. More serious adverse reactions have also been reported though appear to be less common.
Why is there a risk of muscle loss when taking GLP-1 drugs?
Perhaps the most significant side effect is one no one talks about – the very real risk of substantial muscle loss. Currently, weight loss appears to be one of the primary drivers responsible for the massive popularity of these drugs, but weight and body composition are two different factors. Weight is simply a number on the scale, whereas body composition delves into the components (such as fat, water, and muscle) behind the number. In essence, body composition tells a more accurate story related to overall health.
As weight loss occurs, a combination of both fat and muscle may be lost. Loss of muscle has been linked to a reduced metabolism and an increased risk of sarcopenia. Studies also show the potential impact on cardiovascular risk, insulin sensitivity, and even mortality. From a weight management perspective, losing muscle is a critical factor if/when you choose to reduce the dose or stop the medication completely, as low muscle mass increases the risk of rapid weight gain. This phenomenon is confirmed in clinical trials assessing the effectiveness of these drugs and the long-term sustainability of weight loss once the drug is discontinued. A loss of muscle mass often accompanies quick weight loss; however, weight loss that involves maintaining muscle is doable with a few lifestyle-related behaviors. One such behavior may involve adding Creatine to your lifestyle regimen.
What role can Creatine play in keeping the weight off?
Creatine can help preserve muscle mass in various populations (no gym membership required). Systematic reviews show that creatine can play a role in supporting general health and well-being across the lifespan. For example, creatine has been shown to help older individuals maintain muscle mass. It has even been associated with better cognitive function and mental health and may play a role in diabetes management via its beneficial impact on blood sugar.
From a weight management perspective, creatine may help offset the weight gain fears by helping maintain muscle mass. A 2022 study in the journal Nutrients found that Creatine was an efficient supplementation for muscle growth in a healthy young population. According to a 2019 study, Creatine may help maintain muscle mass and even play a role in fat loss. Muscle gains and fat loss are mainly seen when Creatine is combined with resistance training—finally, a 2022 study associated creatine supplementation with increased muscle mass and muscle strength.
Does the type of Creatine I use matter?
Yes. Some individuals can experience gastrointestinal discomfort with a form of creatine called creatine monohydrate. However, there is another form, called creatine HCL (hydrochloride) that is found in the data to be 7x more concentrated and 59% more soluble than traditional creatine monohydrate. This means you need a smaller dosage to achieve optimal results, so there is far less likelihood of digestive discomfort as a side effect.
What other lifestyle changes should you consider while on GLP-1 drugs?
Make every bite count – GLP-1 agonist drugs reduce appetite and, consequently, the volume of food intake. A deficient volume of food may increase the risk of malnutrition, so getting a nutritional bang in every bite is critical. Start by assessing what foods you are eating, then reduce or eliminate the options that lack nutrients, such as ultra-processed foods, refined grains, sugary sweetened beverages, pastries, and candy. In their place, focus on fruits and vegetables, whole grains, healthy fats, and lean protein sources.
Embrace protein – In addition to considering creatine supplementation, following a moderate to higher protein diet may also play a role in maintaining muscle mass. Multiple studies have associated high-quality protein with muscle mass across one's lifespan. Focus on lean meat (such as flank steak for high-quality protein and iron), seafood (such as wild fatty fish for omega 3’s), and dairy (such as cottage cheese and yogurt for microbiome benefits) as well as plant-based proteins like beans and legumes as well as quinoa and whole soy sources.
Pump it up – Resistance training is a must to help maintain muscle mass and reduce the risk of muscle loss. Start slow, and consider working with a fitness expert to help build and maintain muscle mass in both your upper and lower body.
Make sleep a priority. Studies show that a lack of sleep or low-quality sleep may increase the risk of cardiovascular disease, dementia, insulin resistance, and weight gain. If health is your "why" for weight loss, better sleep is necessary.
If you are considering a GLP-1 agonist to help reduce the risk of diabetes or obesity, the first step is to talk to your healthcare provider. Muscle loss may be a problematic side effect of the potential rapid weight loss that may occur, and taking steps to limit this loss may help in keeping the weight off long term. Working with your health practitioner can help to ensure that your dietary, supplemental, and physical activity considerations make sense for your overall safety and health