ALS, Weight Loss, and Weight Loss Medication

Kristin Gustashaw, MS, RDN, CSG, LDN,
Rush University Medical Center

Things to Consider and Talk to Your Healthcare Team About

Most individuals diagnosed with ALS are encouraged to maintain their weight due to the muscle atrophy associated with the disease, as well as the potential for additional muscle loss resulting from intentional weight loss. Studies have shown that intentional weight loss, even when driven by positive lifestyle changes, can result in up to 25% muscle loss. Therefore, any weight loss in the context of ALS should be viewed as a potential health risk. However, in some cases, the degree of obesity and its associated comorbidities may outweigh the risks of muscle loss.

One often overlooked comorbidity of ALS—along with obesity and aging—is oxidative stress. Oxidative stress refers to the imbalance between free radicals and antioxidants in the body, leading to cellular damage. It is a condition that can have widespread negative effects on various tissues and organs. While its impact can vary depending on the specific disease or condition, reducing oxidative stress has become a promising strategy for improving overall health and longevity.

Interestingly, recent research has linked the reduction of oxidative stress with muscle preservation. This leads to a delicate balancing act: losing weight may result in some muscle loss but could also reduce oxidative stress, potentially lowering cellular and tissue damage while preserving muscle mass. Sounds like a win-win, right? Perhaps—though it’s more complex than it appears.

Currently, no one-size-fits-all treatment plan exists. However, in theory, optimizing one’s diet, engaging in exercise, and losing some weight could help strike the right balance. For individuals with neuromuscular degeneration, though, achieving this balance may be more challenging.

This is where weight loss medications may play a role. In recent years, medications designed to treat obesity have gained significant attention. Interestingly, many of these medications originally targeted type 2 diabetes, another condition associated with increased oxidative stress. Since 2005, several incretin-based “diabetes” medications have become available, most notably Glucagon-like Peptide-1 (GLP-1) receptor agonists. These drugs have been lauded not only for managing blood sugar levels but also for their ability to promote weight loss.

However, as we know, not all weight loss is the same. Do these medications cause more muscle loss than fat loss? To date, the evidence does not suggest that GLP-1 medications result in more muscle loss than conventional weight loss strategies, at least in the context of other causes of oxidative stress. In fact, some studies even suggest that GLP-1 medications may help reduce oxidative stress and preserve muscle mass, particularly in age-related muscle loss. Although there is no guarantee that these medications will have the same effect on individuals with neuromuscular diseases, the fact that they don’t appear to exacerbate muscle loss in the presence of oxidative stress is promising.

This opens up the possibility of using GLP-1 medications for individuals with excess weight, especially when that weight has negatively impacted their quality of life. However, these medications are not without side effects. They can alter taste, appetite, satiety, and gut motility, all of which could affect how much nutrition and hydration the muscles receive. For this reason, it is crucial to work closely with a healthcare team to weigh the risks and benefits of weight loss and to determine the most effective approach to meet individual health goals.