The GLP-1 paradox

We now have solid evidence showing that GLP-1 agonist medications can be quite deleterious when prescribed without meaningful lifestyle change, with loss of lean mass as the most widely discussed issue, but it is not the only one.

It is very positive to see mainstream institutions finally emphasising that lifestyle interventions must accompany GLP-1 prescriptions, especially for weight loss. The message is suddenly clear: medication on its own is not enough.

But here is where the mental gymnastics begin. These same institutions are now promoting the very lifestyle principles many of us have been advocating for years while still avoiding acknowledgment that their previous positions may have been insufficient. In particular, they are struggling to reconcile the fact that the “adequate” protein intake they defended for decades might merely represent the bare minimum needed to prevent deficiency, not the amount required for a genuinely healthy lifestyle, preserving lean mass, or supporting weight loss.

They continue to pledge that 0.8g/kg/day is adequate and that most of the population manages to reach these levels without issue. I would argue that there is a gap in their logic:

A.- Adequate protein intake for what? The truth is, this could be the bare minimum sufficient intake to prevent muscle loss in a specific healthy individual, it doesn't make it adequate.

B.- If at population level we consider that this intake is being reached, why lean mass loss is a problem to mitigate with "adequate" protein intake.

They bridge the gap arguing that it's actually strength training what will make the difference and, of course, strength training will make a difference, but questions are not being resolved.

They now support strength training, sleep hygiene, stress management, and higher functional protein intake as critical adjuncts to GLP-1 therapy, yet without recognising that this is precisely what has been argued for all along.

And the final paradox?If we had been consistently delivering this message from the start: truly sufficient protein for health (not just for deficiency prevention), strength training, stress management, and proper sleep (among others), the widespread need for GLP-1 medications would likely never have emerged at the scale we see today.