Preservation of Muscle Mass Over Life
My name is William Conway, MD. I am a Nashville concierge physician who has spent my career caring for patients who want a concierge physician. “ Concierge” means a physician who is available, discrete, and attentive-someone you always call and truly trust. I am here for you over the years, without layers of bureaucracy separating us. I practice both internal medicine and addiction medicine through Suboxone+Primary Care™ and Nashville Concierge Medicines. My approach to you is simple. I listen to you. I am your steady partner. You have easy, direct access to me. I constantly study Medicines to serve you better.
Remain Strong Over a Lifetime
Americans often think about obesity in Nashville. But Americans often ignore that muscle mass silently declines over the decades. In later life this decline can lead to weakness, frailty, falls, and loss of independence
The new generation of weight loss medications, GLP-1 agonists such as semaglutide and tirzepatide, help people lose weight, but they may also accelerate loss of lean muscle mass if used without medical guidance.
Your size, weight, and health are not defined by a single number on a scale. What truly matters is body composition- the balance between muscle and fat Simply taking semaglutide and tirzepatide outside of a thoughtful medical treatment carries risk.
Executive Summary
Your body composition is critical:
- Too much fat is harmful
- Too little muscle is equally dangerous
- Weight is not straightforward
- Muscle Peaks at age 40, and then begins to decline
- Exercise and protein protect muscle
- Medications can shift body composition
Case Study
Susan became my patient at age fifty. Susan is a mother of two children, both in college now. Happily married, living in their home with her husband, Susan is concerned about her weight. Well dressed, charming, and articulate, Susan hides her sadness well.
In high school, Susan was goalie on the high school soccer team. Demonstrating aptitude, Susan attended Vassar College on an athletic scholarship. In graduate school at Boston University getting a master’s in accounting, Susan was a diligent student. After graduate school, Susan began her accounting career to support her husband, who was completing a MBA at Harvard. The world was at their feet.
After his graduation, Susan became pregnant and elected to be a full-time mother. Her first pregnancy was complicated by postpartum depression. Susan’s depression was never completely resolved. She was able to function as a wife and mother, but her sadness was persistent.
After college, Susan was too busy to exercise. With her depression, Susan went for two decades with minimal exercise. Susan had excellent psychiatric care in Boston. However, she did not respond well to psychopharmacology.
After several therapeutic trials of multiple different medication, she finally responded to quetiapine. On quetiapine, Susan rapidly gained 75 lbs., which she never lost despite multiple attempts at dieting. With her inactivity, Susan lost her athleticism which she had in college.
During her menopause, Susan experienced severe hot flashes disrupting sleep, as well as brain fog which made work harder. She noticed her arms and thighs softening where muscle had once been. Even climbing stairs felt harder. Susan gained another 25 lbs.
On our first visit to my Nashville Concierge Medicines office to see me, Dr. Conway, Susan is requesting GLP-1 agonist for weight loss. But, as Susan spoke, she quietly worried about how weak she felt.
“ I used to be strong. I struggle now where I didn’t before.”
I replied, “ GlP-1 medications usually suppress appetite, but they can reduce muscle if you do not add resistance training and increased protein. Our goal is body composition, not chasing a number. We are not going to reduce your quetiapine which is so important to you. You are finally not sad all the time. It took a long time for you to get there.”
“ Susan, we need a plan that we design. We will treat your hot flashes, and gently add tirzepatide to see how you do. I would like you to eat more protein and get a personal trainer for strength.
How Muscle and Weight Change across Time
Average weight over a lifetime
Every patient’s story is special, or unique. However, basic patterns do exist which help us understand the body’s arc through life. Designing your treatment depends upon understanding common patterns while recognizing your uniqueness in biology, preferences, and situation in life.
The most common pattern for weight is gradual increase to age 60 followed by a decline in weight.
Average Muscle Mass Across Life
The common pattern for the lifetime arc of muscle mass is quite different from lifetime pattern for weight. Muscle mass builds until age twenty, remains stable until age 49, and begins a gradual decline.
Susan was an athlete. As an accountant, Susan easily understood the graph demonstrating the gradual decline in muscle mass. Susan is a pleasure to have an patient. Together, we made a difference in her life. Susan got herself a personal trainer.
Protecting Muscle with Lifestyle
Exercise is truly the best Medicines to retard aging. Resistance training is important for the preservation of muscle mass. Just a few sessions each week can preserve muscle, bone, and balance. Strength training tells your body to keep the muscle. It is needed. Without strength training, your muscle declines or disappears, which is called atrophy.
Effect of Exercise on Muscle Mass
This graph shows that a lifetime of strength training slows the loss of muscle mass, preserving the necessary strength required for later life. The average American looses 50% of his muscle mass between age 40 to 70.
Effect of Protein Calorie Deprivation Over a Year
Adequate protein and calorie intake is essential to preserve muscle mass over a lifetime. Diets which cut calories too aggressively often result in muscle breakdown as well as fat loss.
Susan found that the tirzepatide reduced her appetite more than she expected. There are days that Susan barely ate. With my coaching, Dr. Conway, on every visit, I inquired about her protein intake. Susan finally agreed to eat more salmon.
Special Risks
Potential Adverse Effect of Psychiatric Medication on Weight
Susan was on quetiapine, a very powerful treatment, which was effective in Susan. Her sadness significantly improved, almost disappearing on certain days. We talked
‘” Susan, how is your quetiapine working?” I asked
Susan replied “ Dr. Conway. It is the first medication that I have ever taken that makes my sadness almost disappear. Nothing else has worked. “
I replied” We must keep your quetiapine. We will work on weight with other treatments.”
We simply acknowledged that Susan had gained 100 lbs on quetiapine. We elected to keep Susan from gaining more weight while on quetiapine while preserving her muscle mass.
Aging and Inactivity
Decades of inactivity in Nashville accelerate muscle loss. Even short periods of inactivity such as hospitalization can cause muscle loss. Restoration of strength is possible, but becomes more difficult with age. Susan fortunately never had an ICU admission.
Conclusion
At Nashville Concierge Medicines, your size is important. Preservation of your muscle mass is discussed with you, with development of an individualized action plan. Preservation of muscle mass is equally important to weight loss
Call to Action
CTA: Call Nashville Concierge Medicines at 615-708-0390 to begin your personalized plan for your weight with Dr. William Conway
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