First and foremost, I am convinced that maintaining the largest healthy lean muscle mass is central to overall human. Nature pre-programmed us to use our muscles and to permit our muscles to maintain its optimal mass and health. With all of the breakthroughs in cellular medicine, maintaining our muscles and preventing muscle loss as we age is one of the easiest tool sets we have out there. Muscle loss, or Sarcopenia, is a decline in skeletal muscle, usually in older people, that contributes to a host of problems.
New York Times Health editor, Jane Brody, published an article about Preventing Muscle Loss as We Age. This is an underappreciated topic affecting millions of people worldwide, especially those over 65 years of age. If you ever wonder why there are so many hip fracture surgeries or people using the disability scooters, you can place much of the blame on sarcopenia. Sarcopenia is a fancy medical term for loss of muscle; it is also known as frailty syndrome. As we age, we lose the ability to maintain and regenerate muscle leading to several health issues. In usual fashion, Ms. Brody barely scrapes the surface and gives some paltry formula for how much protein people need in their later years. I can tell you from years of clinical practice, seeing 1000’s of hip fracture surgeries, 1000’s of debilitated elderly patients, that keeping your muscle mass in your elder years is a challenge. That being said, strategies exist which can slow this loss of muscle mass to a crawl.
Slowing or Preventing Sarcopenia?
Prevention of sarcopenia is probably not the right way to think about it. As we age, it’s an uphill battle and we will inevitably lose muscle and therefore bone strength which leads to another disease called osteoporosis, which needs no introduction. Bone strength is not about how much calcium you have, rather about how much protein you can keep inside our bones. Keep is the key word here. The whole idea of optimizing your health as we age should be thought of in a way as to slow down the inevitable loss of muscle mass, not stop it.
Can the rate of sarcopenia be slowed with the intake of enough dietary protein? The hormonal changes that people experience with age is very important in maintaining bone integrity. Physical activity and dietary protein are also equally as important. There are examples of individuals who remain extremely active in later life that maintain the body composition of someone in their 30’s or 40’s. Unfortunately, when you look around, this is rare to see. For people who don’t perform any physical activity, the muscle mass is lost at a faster rate.
As humans, we are taking in minimal, rather than optimal amounts of protein. In the NYT article, Ms. Brody tries to put a number on the amount of protein we should include in our diets each day. Dietitians have been telling us for years to limit our protein for one reason or another, usually something about heart health and cancer. Fact is that we probably cannot consume enough protein and we don’t start young enough to slow down the muscle loss affecting us later in life. If you want current research on this subject, don’t look at diet studies, most are horribly designed and have companies like General Mills and Nestle as sponsors. Rather look at researchers like Keith Baar from University of California at Davis and Stuart Phillips in Canada.
Banking muscle when you are younger
The concept of banking muscle when we are younger is very underappreciated. If you ever want to learn more about this concept, read Dr. Stuart Phillips research. Exercising when we are young is the norm (although this is changing with video games and obesity). The idea of what it means to be old is changing as life-expectancy has increased (up to now). We need to keep the “bank” open and keep exercising well into our elder years. In fact, the human body is designed to never stop exercising. Living in France, I regularly see people in their 70s and 80s hiking 40 kilometers without any issues. In the U.S., we all see people in their 30’s and 40’s who could not perform such a task. It is good to keep in mind that physical activity comes in many shapes and forms, whatever will get people off the couch is . If you are serious about maintaining healthy muscle mass as you age, exercise with a mix of highly aerobic physical activity combined with 2-3 weekly sessions where HIIT, resistance and/or strength are incorporated. The aerobic efforts are to increase and retain mitochondrial respiratory health and biogenesis while the HIIT, resistance and strength provide the adaptive stress necessary to foster muscle hypertrophy.
The RDA for protein is not reality
The RDA for many things is not in line with reality and protein is included. The Recommended Daily Allowance (RDA) of protein is currently too low. The RDA is designed to measure the minimal amount to avoid disease tool. Many quote the RDA and suggest that amount of protein that humans should be allowed to consume is 0.8 grams of protein per day. Other studies suggest different lower and higher amounts, (again most poorly designed). They use traditional nitrogen balance technology, but if you really get into the research, this method is very old and flawed. There are disagreements on what method should be used to replace the currently used methodology, but strides have been made. It is mostly observational findings that indicate that older people who eat more protein tend to do better, particularly in preservation of muscle. Interestingly, people over 65 also have less incidence of heart attacks with a higher protein intake, at least this is what the studies suggest.
Clarifying what the RDA numbers mean; current amount is set to 0.8 g of protein per kg of body weight. For example, a woman of 50 kg (130 pounds) should be consuming about 40 g of protein, this could be about 500 ml (two cups) serving of milk – which contains 18 g of protein – plus a moderate serving of meat.
We can see from this example that we don’t have to consume a lot of protein to hit the target. One hundred grams of meat is not 100 grams of protein. Depending on the type of meat, there is water and fat content to consider. On average, a 100-gram steak would equate to about 30-40 g of protein . This brings me to an important point. Protein is best assimilated by humans in a fat rich matrix. What we consider natural animal based protein sources; whole eggs, poultry, red meat, fish, dairy has plenty of fat in it to facilitate protein assimilation. Removing the fat actually makes the proper assimilation less efficient creating protein being wasted. This can mean it is converted to glucose or shunted to the kidneys for excretion etc.
Vegetable protein vs. Animal protein
There are 9 essential amino acids, meaning we can only get these amino acids from the diet. The question is, can we get these from vegetables alone? Proteins are graded on a quality scale which includes a measure of digestibility and the content of essential amino acids. Plant proteins have lower essential amino acids concentrations and contain dietary fiber which adversely affects digestibility. It is fair to say that, in general, animal source proteins have higher protein quality and are nutrient rich sources of dietary protein. Balancing amino acid intake to obtain optimal protein assimilation is also important. This is the reason for “Whole Animal Eating” which includes organ meats, skin & connective tissues (broth) as well as muscle meat. When protein/amino acid intake is balanced it is very surprising how little a person needs to obtain optimal health including muscle retention.
But it doesn’t stop there, many of these nutrients such as iron, zinc, B 12, calcium and potassium are abundant in animal protein. That being said, there are areas where there is a scarce supply of meat and dairy, and people consume more beans, rice, and legumes which are sufficient in supplying the essential amino acids. A well formulated plant based diet can provide enough protein and amino acids, the key word is well formulated!
Vitamin C and Sarcopenia
There was a time that Vitamin C was once treated in the same way as protein. It is now known that there are other benefits to a higher intake of Vitamin C, other than just having the minimal amount necessary for preventing scurvy. Things like endothelial cell health in the blood vessels, ligament and tendon healing, virus protection are all integral parts of adequate vitamin C levels in the human body. Similarly, protein has other benefits with increased intake. Did you know that 1 serving of liver contains more vitamin C than 2 pounds of carrots? If you want to explore this idea further, listen to Dr. Keith Baar from UC Davis and his take on muscle physiology and vitamin C.
Myth – Too much protein creates kidney damage!
That is just not correct. You’ve heard it said lots of times and it’s a categorically incorrect statement This belief comes from the renal hospital wards where people suffering from kidney disease are all told to consume lower protein diets because this results in generation of less urea. It is true that if you decrease the urea load in patients with renal disease, they do better, but this has nothing to do with normal, healthy humans. People who say these kinds of things, like Ms. Brody are just spreading mis-information.
Myth – Body Builders live shorter lives because of extremely high protein intake
Data on bodybuilders does not provide a fair representation of the effects of high protein diets. Bodybuilders tend to experiment with other substances that may be shortening their lives. We should not be looking to them and assuming eating a lot of protein is what’s causing the damage to detoxing organs such as kidneys or the liver. Body Builders also tend toward high protein, low fat diets including lots of whey protein shakes and other highly processed low fat protein sources. Again, protein is best assimilated with adequate fat, think natural protein source and like whole eggs or a juicy steak instead of a protein shake and you’ll be on the mark.
Myth – Too much protein results in acidosis, resulting in osteoporosis
The Harvard study, led by Dr. Walter Willett, observed that people with higher protein diets had a higher calcium content in their urine. Thus a theory was born explaining that a high acid state is responsible for calcium being sucked out of the bones and being washed out in the urine. This theory has never played out. In reality, the human body absorbs more calcium so you get rid of more calcium. Again, It is interesting to note that 50% of the bone is made up of collagen protein which is primarily responsible for bone strength. Of course, it should be pointed out that Dr. Willet is supported by the National Osteoporosis Foundation, who in turn is supported by the pharmaceutical companies that make osteoporosis drugs.
Collagen in your diet
Dr. Keith Baar, has done extensive research in this area and believes that if you take gelatin (collagen protein) and a high dose of Vitamin C before exercise that it helps to regenerate active tissues, like tendons. More studies probably need to done in this area, but follow his research. Collagen is low in essential amino acids, but has amino acids such as proline that are present in collagen. Someone on a high protein diet would be getting all the amino acids they need to make adequate amounts of collagen.
What to eat
Ms. Brody says that you should be eating things like non-fat milk, peanut butter and fish to get adequate protein amount. This is typical advice and again uses circular logic and is mis-informed. Take non-fat milk for example, Ms. Brody purports a low fat diet as can be read on her other NYT articles. The best advice is to find whatever source of protein works for you and embrace getting your protein. Eat protein like its your job. Find non-processed sources of protein and try not to depend on drinking protein shakes on a regular basis. I encourage you to read Ms. Brody’s article below and compare it to the current research and writings on this subject. You’ll appreciate that the subject of protein intake and sarcopenia is much more complex than you ever thought.
Special thanks to Peter Defty, OFM pioneer, for reviewing and providing insight to this article
Also check out Peter Defty’s video on Ketosis vs. Fat Burning
Dr. Baar’s UC Davis physiology department bio:
Keith Baar PhD
UC Davis biology department bio:
Functional Molecular Biology Lab website:
Molecular brakes regulating mTORC1 activation in skeletal muscle paper:
Age-related Differences in Dystrophin article:
Stuart Phillps PhD
NYT Article by Ms. Brody
By Jane E. Brody
Sept. 3, 2018
“Use it or lose it.” I’m sure you’re familiar with this advice. And I hope you’ve been following it. I certainly thought I was. I usually do two physical activities a day, alternating among walking, cycling and swimming. I do floor exercises for my back daily, walk up and down many stairs and tackle myriad physical tasks in and around my home.
My young friends at the Y say I’m in great shape, and I suppose I am compared to most 77-year-old women in America today. But I’ve noticed in recent years that I’m not as strong as I used to be. Loads I once carried rather easily are now difficult, and some are impossible.
Thanks to an admonition from a savvy physical therapist, Marilyn Moffat, a professor at New York University, I now know why. I, like many people past 50, have a condition called sarcopenia — a decline in skeletal muscle with age. It begins as early as age 40 and, without intervention, gets increasingly worse, with as much as half of muscle mass lost by age 70. (If you’re wondering, it’s replaced by fat and fibrous tissue, making muscles resemble a well-marbled steak.)
“Sarcopenia can be considered for muscle what osteoporosis is to bone,” Dr. John E. Morley, geriatrician at Saint Louis University School of Medicine, wrote in the journal Family Practice. He pointed out that up to 13 percent of people in their 60s and as many as half of those in their 80s have sarcopenia.
As Dr. Jeremy D. Walston, geriatrician at Johns Hopkins University School of Medicine, put it, “Sarcopenia is one of the most important causes of functional decline and loss of independence in older adults.”
Yet few practicing physicians alert their older patients to this condition and tell them how to slow or reverse what is otherwise an inevitable decline that can seriously impair their physical and emotional well-being and ability to carry out the tasks of daily life. Sarcopenia is also associated with a number of chronic diseases, increasingly worse insulin resistance, fatigue, falls and, alas, death.
A decline in physical activity, common among older people, is only one reason sarcopenia happens. Other contributing factors include hormonal changes, chronic illness, body-wide inflammation and poor nutrition.
But — and this is a critically important “but” — no matter how old or out of shape you are, you can restore much of the strength you already lost. Dr. Moffat noted that research documenting the ability to reverse the losses of sarcopenia — even among nursing home residents in their 90s — has been in the medical literature for 30 years, and the time is long overdue to act on it.
In 1988, Walter R. Frontera and colleagues at the Department of Agriculture Human Nutrition Research Center on Aging at Tufts University demonstrated that 12 previously sedentary men aged 60 to 72 significantly increased their leg strength and muscle mass with a 12-week strength-training program three times a week.
Two years later in JAMA, Dr. Maria A. Fiatarone and colleagues at the Tufts research center reported that eight weeks of “high-intensity resistance training” significantly enhanced the physical abilities of nine frail nursing home residents aged 90 and older. Strength gains averaged 174 percent, mid-thigh muscle mass increased 9 percent and walking speed improved 48 percent.
So, what are you waiting for? If you’re currently sedentary or have a serious chronic illness, check first with your doctor. But as soon as you get the go-ahead, start a strength-training program using free weights, resistance bands or machines, preferably after taking a few lessons from a physical therapist or certified trainer.
Proper technique is critical to getting the desired results without incurring an injury. It’s very important to start at the appropriate level of resistance. Whether using free weights, machines, bands or tubes, Dr. Moffat offers these guidelines:
“Start with two repetitions and, using correct form through the full range of motion, lift slowly and lower slowly. Stop and ask yourself how hard you think you are working: ‘fairly light,’ ‘somewhat hard’ or ‘hard.’ If you respond ‘fairly light,’ increase the weight slightly, repeat the two reps and ask yourself the same question. If you respond ‘hard,’ lower the weight slightly and do two reps again, asking the question again.
“If you respond truthfully ‘somewhat hard,’ you are at the correct weight or machine setting to be exercising at a level that most people can do safely and effectively to strengthen muscles. Continue exercising with that weight or machine setting and you should fatigue after eight to 12 reps.”
Of course, as the weight levels you’re working at become easier, you should increase them gradually or increase the number of repetitions until you fatigue. Strength-training will not only make you stronger, it may also enhance bone density.
The fact that you may regularly run, walk, play tennis or ride a bike is not adequate to prevent an incremental loss of muscle mass and strength even in the muscles you’re using as well as those not adequately stressed by your usual activity. Strengthening all your skeletal muscles, not just the neglected ones, just may keep you from landing in the emergency room or nursing home after a fall.
Dr. Morley, among others, points out that adding and maintaining muscle mass also requires adequate nutrients, especially protein, the main constituent of healthy muscle tissue.
Protein needs are based on a person’s ideal body weight, so if you’re overweight or underweight, subtract or add pounds to determine how much protein you should eat each day. To enhance muscle mass, Dr. Morley said that older people, who absorb protein less effectively, require at least 0.54 grams of protein per pound of ideal body weight, an amount well above what older people typically consume.
Thus, if you are a sedentary aging adult who should weigh 150 pounds, you may need to eat as much as 81 grams (0.54 x 150) of protein daily. To give you an idea of how this translates into food, 2 tablespoons of peanut butter has 8 grams of protein; 1 cup of nonfat milk, 8.8 grams; 2 medium eggs, 11.4 grams; one chicken drumstick, 12.2 grams; a half-cup of cottage cheese, 15 grams; and 3 ounces of flounder, 25.5 grams. Or if you prefer turkey to fish, 3 ounces has 26.8 grams of protein.
“Protein acts synergistically with exercise to increase muscle mass,” Dr. Morley wrote, adding that protein foods naturally rich in the amino acid leucine — milk, cheese, beef, tuna, chicken, peanuts, soybeans and eggs — are most effective.
Do You Have Sarcopenia?
To help doctors screen patients for serious muscle loss, Dr. John E. Morley and Theodore K. Malmstrom devised a simple questionnaire that anyone can use. It asks how difficult it is for you to lift and carry 10 pounds, walk across a room, transfer from a chair or bed or climb a flight of 10 stairs. It also asks how often you have fallen in the past year. The more challenging these tasks and more often you’ve fallen, the more likely you have sarcopenia.