Expert calls for tailored nutrition as GLP-1 muscle loss hits menopausal women harder

Menopause brings various health changes driven by shifts in hormones, metabolism, and body composition. It is a life stage where many women gain weight, and as a result, turn to GLP-1 drugs. However, these drugs make users lose more than body fat. They have been shown to decrease muscle mass, which is essential for blood sugar regulation, bone density, and strength, and especially important for perimenopausal and menopausal women. 

Nutrition Insight sits down with Cindy Stickle, a functional nutrition practitioner and certified menopause specialist, to discuss the emerging concerns about GLP-1 use for perimenopausal and menopausal women.

Stickle has developed a program tailored for this GLP-1 user group, using a “metabolism-first” approach with tailored nutrition focusing on preserving muscle, energy, and long-term metabolic health. 

“Most GLP-1 programs focus exclusively on what to eat. Mine starts with why the body isn’t responding in the first place. In perimenopause and menopause, the nervous system loses its hormonal buffer. Estrogen and progesterone have been regulating stress responses for decades, and when they drop, the body becomes far more reactive to stress.”

She further explains that hidden stressors, such as under-eating, blood sugar crashes, poor sleep, and chronic overwhelm, keep the body in protection mode. 

“A body in protection mode holds on, regardless of what medication you’re taking. My program addresses the nutritional needs specific to GLP-1 use first, then layers in nervous system regulation to remove the roadblocks that prevent the medication from working as well as it should. When both are in place, the body finally has what it needs to respond.”

A different approach

Stickle says most GLP-1 guidance focuses on eating less and training more. She takes a different approach, centering on supporting metabolism and hormonal balance with functional nutrition combined with nervous system regulation.

Focus on metabolism goes before weight loss, with nervous system regulation being a part of metabolic support, she explains. 

Focus on metabolism goes before weight loss, with nervous system regulation being a part of metabolic support.Additionally, she underscores the need for tailored nutrition to support the body in the perimenopause and menopausal life stage.

“The single most important strategy is intentional protein intake at every meal, 25 to 30 g, three times a day, regardless of hunger level. This is where most women on GLP-1s fall short. The medication suppresses appetite effectively, but it does not protect muscle. If protein drops too low, the body breaks down lean tissue for fuel, which slows metabolism and worsens body composition over time,” explains Stickle.

Similarly, experts recently told Nutrition Insight that GLP-1 users need significantly more protein daily than people not using the drug. Meanwhile, they stressed it is also important that the protein is evenly distributed throughout the day, such as including 30 g per meal.

“Beyond protein, I focus on consistent meal timing, balanced plate structure, and avoiding the under-eating pattern that GLP-1s make so easy to fall into without realizing it. Strength training two to three times per week is also non-negotiable. Muscle in midlife is metabolically critical and has to be actively preserved.”

Recent data from Innova Market Insights shows supplements with GLP-1 claims have surged by 124% CAGR, with the majority being in the US market. Over one third (34%) of supplements launched are in the subcategory of weight loss, followed by probiotics (24%) and dietary fiber (12%).

Stressors for the body

Stress management is not a side element of the program but a core pillar, explains Stickle.

“Hidden stress is what keeps the body stuck in survival mode, and survival mode directly suppresses metabolic function. I teach women to identify their specific hidden stressors, which include over-exercising, blood sugar instability, poor sleep, and chronic emotional load, and to use simple, physiologically-based regulation tools to interrupt the stress response.”

When cortisol comes down consistently, the body finally feels safe enough to respond. Stickle explains that this is the piece most GLP-1 programs are missing entirely, and it’s why so many women do everything right on paper and still don’t see results.

Another stressor for the body is under-eating. When the body doesn’t receive consistent fuel, cortisol rises, metabolism slows, and the body shifts into fat preservation mode, holding on to fat while breaking down muscle instead.

“For women over 40, this is significantly more pronounced,” notes Stickle. “Insulin sensitivity has changed, estrogen loss has accelerated muscle loss, and the stress response is more reactive than it was in earlier decades.” 

“A younger woman might under-eat for a period and bounce back relatively quickly. A woman in perimenopause or menopause may under-eat for weeks on a GLP-1 and experience fatigue, muscle loss, stalled results, and worsening hormonal symptoms, all of which she’s likely to blame on the medication rather than on insufficient nourishment.”

Zooming in on nutrients

Stickle says she approaches menopausal GLP-1 muscle loss from a “food-first” perspective rather than a “supplement-first” angle. 

She underscores that the most critical nutritional priorities are high-quality complete proteins, adequate fiber from whole food sources to support gut health and blood sugar stability, and consistent hydration, which is often severely neglected on GLP-1s. 

Weight loss drugs are a powerful tool but not a complete solution, especially for perimenopausal and menopausal women, says Stickle.“Magnesium is one supplement I consistently recommend, given its role in sleep, cortisol regulation, and muscle function, areas where midlife women are almost universally depleted. Beyond that, I’m cautious about recommending specific formulations without knowing a client’s full picture, because what the menopausal body needs most is foundational nourishment, not more products.”

Furthermore, the conversation around GLP-1 medications needs to evolve, she asserts. “These medications are a tool, a powerful one, but they are not a complete solution, especially for women navigating perimenopause and menopause simultaneously. The hormonal shifts of midlife change everything about how the body handles food, stress, and recovery.”

“A GLP-1 protocol that doesn’t account for those shifts is incomplete,” she argues. “My goal is to be the resource that fills that gap, helping women get the results the medication is capable of delivering, without sacrificing their muscle, their metabolism, or their long-term health in the process.”

Losing muscle rather than fat

Stickle details that clinical data suggest that a significant portion of weight lost on GLP-1 medications can come from lean mass rather than fat. “For women in menopause who are already losing muscle faster than at any other life stage, that’s a serious problem.”

Her program addresses this through three strategies: intentional protein targets at every meal, resistance training as a non-negotiable component of movement, and consistent nourishment that prevents the body from entering the under-fueled state where muscle breakdown accelerates. 

“I also teach women to recognize the early signs of muscle loss, fatigue, weakness, and slowing metabolism, so they can respond quickly rather than wait until results stall completely.”

She observes that the most consistent “early wins” from the program are steadier energy, reduced brain fog, and fewer afternoon crashes, usually within the first two to three weeks. Additionally, sleep quality tends to improve as cortisol regulation stabilizes and cravings become more manageable as blood sugar steadies. “Women report feeling less reactive, more patient, and more in control of their bodies,” Stickle notes. 

“I measure progress without the scale as the primary metric, because weight is one of the least informative measures of what’s actually changing. Instead, I track energy patterns, sleep quality, mood stability, strength, and how the body is responding to food and movement. These markers tell a far more accurate story of metabolic health than a number on a scale.”