Natural Living Newsletter

Sarcopenia and the Importance of Increasing your Muscle Mass.

Introduction

Everyone knows that regular physical exercise is obviously a major key to good health, but we seem to be focused more on aerobic exercises like walking briskly, jogging, bicycling, cross-country skiing, swimming, aerobic dance, and racquet sports. Aerobic exercise refers to movement that increases utilization of oxygen. Aerobic exercises are very important for cardiovascular health, but I believe for overall health and fitness that strength training such lifting weights and other resistance exercises as well as performing regular stretching exercises must absolutely be part of your program. I also believe that there is too much focus on aerobic exercises for weight loss and that strength training exercises are actually more critical to long-term weight control because they are able to build muscle mass.

Exercise and weight loss

Is exercise alone an effective weight loss strategy? The answer to this question may surprise you. What the research shows is that exercise alone is of limited value as a weight loss strategy. In one of the latest studies, in women, even substantial increases in exercise alone were not enough to produce weight loss. To lose weight the exercise had to be coupled with a reduced intake of calories. In contrast, men were able to lose weight through increased exercise alone. This difference might be because the men were able to burn more calories in exercise than women or it might reflect either some metabolic difference in how men and women respond to exercise. We think we know the real answer to this riddle. It has to do with muscle mass. The ability to lose weight with exercise is a direct reflection of a person’s muscle mass. Since men have a larger muscle mass than women, the effect of exercise alone as a weight loss strategy is more apparent in men. The more muscle mass that you have, the more fat you burn. Muscle mass is the primary fat burning furnace in the body. A muscle cell burns as much as 15 times more calories per day than a fat cell. The importance of building muscle mass for effective weight loss cannot be overstated.

A personal observation

I have belonged to the same health club for over 20 years, but have gone there infrequently over the last 10 years because I put in a nice fully equipped exercise room in my house. Nonetheless, when I do go to the club I see many of the same people. What I have noticed is that the people who literally seem to live on the treadmills, stair climbers, and elliptical trainers seem to be fatter now then they were in the past. In contrast, the regulars who spend most of their time in the weight rooms seem considerably more fit. My feeling is that aerobic exercise is great, but it absolutely must be combined with some muscle building exercise for maximum benefit.

A friend of mine, let’s call him Mr. Aerobic, is a living example of the point that I am trying to make. He literally does 45 minutes to an hour of aerobic exercise 3-5 times a week and has done so for more than 20 years. When he is doing his treadmill or elliptical time he is a sweating, huffing, and puffing fiend. He really works hard. But, I have seen his muscle mass decline and his fat mass increase dramatically over the years. Being a friend, I went up to him a couple of years ago and said “Mr. Aerobic I don’t want to be rude but I have known you for a long time. I know how much you want to lose that 30 extra pounds that you are carrying. Have you ever thought that the exercise program you are on might not be the best way to burn more calories? Have you ever thought about trying to build your muscle mass?”

Well, to make a long story short, Mr. Aerobic still has the misconception that aerobics are best for losing weight and that lifting weights builds bulk. He was totally defensive about his exercise routine even though it should have been painfully obvious that his dedication to aerobic exercise alone was counter productive to his fitness goals.

The importance of building muscle mass

Muscle mass increases in childhood and peaks during the late teens through the mid-to late 20s. After that there starts a decline in muscle mass that is rather slow. From he age of 25 to 50 the decline in muscle mass is roughly 10%. In our 50’s the rate of decline is slightly accelerated, but the real decline usually begins at 60 years. By the time a person reaches the age of 80 their muscle mass is a little more than half of what it was in their twenties.

This degenerative loss of skeletal muscle mass and strength as we age is termed sarcopenia which comes from the Greek meaning of “poverty of flesh.” Sarcopenia is to our muscle mass what osteoporosis is to our bones. The combination of osteoporosis and sarcopenia results in the significant frailty often seen in the elderly population. The degree of sarcopenia as we age is predictor of disability and is linked to decreased vitality, poor balance, gait speed, falls, and fractures.

Just like in the prevention of osteoporosis where we want to build the bone while we are young to help us preserve it longer through the aging process the same is true for sarcopenia. And, just as it is important to engage in dietary, lifestyle, and exercise strategies to fight osteoporosis in our later years we must do the same to fight sarcopenia. You must build muscle to maintain your health.

So, what causes sarcopenia? One of the key reasons is that as we age the muscle cells lose their ability to respond to growth promoting substances especially insulin and insulin-like growth factors. Insulin resistance is also an underlying feature of most cases of obesity and type 2 diabetes. Another key factor in the development of sarcopenia is inflammation, not the kind of inflammation that occurs when you sprain your ankle or scrape your knee. The type of inflammation that we are referring to is the silent inflammation that is emerging as the underlying feature in virtually every chronic degenerative disease including heart disease, cancer, strokes, diabetes, and Alzheimer’s disease.

C-Reactive Protein

Silent inflammation is an important factor in the development of sarcopenia. To measure the degree of inflammation, physicians determine the level of C-reactive protein (CRP) in the blood. CRP is one of the acute phase proteins that increase during systemic inflammation. Most of the research on CRP has focused on its role in predicting a heart attack. The higher the CRP levels, the higher the risk of developing heart attack. The same is true for sarcopenia, the higher the CRP level, the greater the acceleration in the loss of muscle mass. Elevated CRP levels are also associated with a significantly higher risk for the development of insulin resistance and type 2 diabetes.

I recommend that part of your annual physical exam include determining CRP levels. The goal is keeping your CRP level below 1.0 mg/L. At this level, there is little silent inflammation occurring. If the CRP is between 1.0 and 3.0 mg/L, that is a major caution – a yellow flag. If the CRP is higher than 3.0 mg/L, it is a serious red flag.

Dietary interventions alone have been shown to lower the CRP levels. In particular, the Mediterranean diet can be quite effective in lowering CRP levels to normal. If you follow these basic dietary recommendations, your CRP should easily fall into the normal range. One food group that you definitely want to focus on to fight sarcopenia are foods rich in carotenes as recent population-based studies have shown these foods are protective against a decline in muscle strength and walking disability as we get older. Good sources of carotenes include dark-colored vegetables, such as carrots, squash, spinach, kale, tomatoes, and yams and sweet potatoes; fruits, such as tomatoes, cantaloupe, watermelon, apricots, and citrus.

The Mediterranean Diet

One diet that appears to be representative of a way of eating that provides significant protection against silent inflammation is the traditional “Mediterranean diet.” This term has a specific meaning, it does not mean to simply eat more Italian food. The Mediterranean diet reflects food patterns in the early 1960s typical of Crete, parts of the rest of Greece, and southern Italy. The traditional Mediterranean diet has shown tremendous benefit in fighting heart disease and cancer, as well as diabetes. It has the following characteristics:

It centers on an abundance of plant food, including fruit, vegetables, breads, pasta, potatoes, beans, nuts, and seeds. Foods are minimally processed and there is a focus on seasonally fresh and locally grown foods. Fresh fruit is the typical daily dessert, with sweets containing concentrated sugars or honey consumed a few times per week at the most. Dairy products, principally cheese and yogurt, are consumed daily in low to moderate amounts and in low fat varieties. Fish is a consumed on a regular basis. Poultry and eggs are consumed in moderate amounts, about 1-to-4 times weekly, or not at all. Red meat is consumed in small, infrequent amounts. Olive oil is the principal source of fat. Wine is consumed in low to moderate amounts, normally with meals.

The importance of protein

Dietary protein is essential in supporting muscle growth and fighting sarcopenia. The best choice for protein supplementation is whey protein. Whey protein is a natural by-product of the cheese making process. Cow’s milk has about 6.25% protein. Of that protein, 80% is casein (another type of protein) and the remaining 20% is whey. When cheese is made, it uses the casein molecules leaving whey. Whey protein is made via filtering off the other components of whey such as lactose, fats, and minerals. Whey protein is easier to digest and is better tolerated than casein.

Whey protein has the highest biological value of all proteins. Biological value is used to rate protein based on how much of the protein consumed is actually absorbed, retained and used in the body. One of the key reasons why the biological value of whey protein is so high is that it has the highest concentrations of glutamine and branched chain amino acids (BCAAs) found in nature. These amino acids are critical to cellular health, muscle growth, and protein synthesis.

Although the most popular use of whey protein is by body builders and athletes looking to increase their protein intake, whey protein is also used to support recovery from surgery, preventing the “wasting syndrome” of AIDS, and to offset some of the negative effects of radiation therapy and chemotherapy. This increased efficiency of protein use is particularly important in battling sarcopenia as it has already been shown to be of tremendous value in muscle wasting diseases such as HIV infection and cancer. Whey protein supplementation has also been demonstrated in clinical trials compared to a placebo to produce greater strength and muscle mass gains in elderly subjects involved in a weight training program.

You can find whey protein powder in a variety of flavors including vanilla, chocolate, and strawberry available in pre-measured individual serving packets and bulk canisters. Usually these sorts of protein powders are found in the “body building” section of a health food store. I really like Whey Factors from Natural Factors because it is a very “clean” undenatured whey protein source free from artificial sweeteners, sugar, and food additives. The typical recommendation for to boost protein levels is 25 to 50 grams daily; though for severe sarcopenia I would recommend a dosage of one gram for every two pounds of body weight.

Creatine

Creatine is one of the most popular nutritional supplements for athletes and bodybuilders. It is used primarily to increase strength and lean body mass and has shown consistent results in promoting these effects in clinical studies. Creatine is used in muscle tissue for the production of phosphocreatine, an important factor in the formation of ATP, the source of energy for muscle contraction and many other functions in the body. Creatine supplementation works by increasing phosphocreatine levels in muscle.

Creatine supplementation appears to be useful in battling sarcopenia, but it must be combined with weight training. When combined with weight training, creatine supplementation has been shown to increases muscle mass and improves leg strength, endurance, and power in elderly subjects just as it has in younger subjects as well. Basically, creatine supplementation augments the muscle growth stimulation of weight training, but without the weight training it has little, if any, benefit. My dosage recommendation is based upon body weight, take 1 gram of creatine for every 50 pound of body weight. So, if you weigh 150 pounds your dosage would be 3 grams daily. If you suffer from any kidney or liver disease, please consult a physician before supplementing with creatine.

A comprehensive nutritional approach to prevent sarcopenia

Reduce the amount of saturated fat, trans fatty acids, cholesterol, and total fat in the diet by eating fewer animal products and more plant foods. Increase your intake of omega-3 oils by eating flaxseed oil, walnuts, and cold-water fish like salmon. Eat at least two, but no more than 3, servings of fish per week. Increase the intake of monounsaturated fats and the amino acid arginine by eating more nuts and seeds, such as almonds, Brazil nuts, coconut, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, sesame and sunflower seeds, and using a monounsaturated oil, such as olive, macadamia, or canola oil for cooking purposes. Eat five or more servings daily of a combination of vegetables and fruits, especially green, orange, and yellow vegetables; dark colored berries; and citrus fruits. Limit the intake of refined carbohydrates (sugar and refined grains). Sugar and other refined carbohydrates lead to the development of insulin resistance which, in turn, is associated with increased silent inflammation. Utilize the benefits of whey protein by taking 25 to 50 grams of whey protein daily. If you are on a strength training program, take 1 gram of creatine for every 50 pounds of body weight.

Weight training reduces sarcopenia

Perhaps the most important step to preventing sarcopenia is to follow a regular strength training program – that is lift weights or engage in resistance exercises. The benefits of strength training are vast, particularly for women and for people over 50. In addition to helping burn more fat, a larger muscle mass is associated with a healthier heart, improved joint function, relief from arthritis pain, better antioxidant protection, and a higher self esteem. While many women do not strength train because they fear gaining weight, just the opposite occurs. Building muscle mass actually helps to more effectively burn calories.

You don’t have to lift barbells or dumbbells or utilize clumsy machines to strength train. Resistance exercises include those which utilize your body weight. There are even forms of yoga that build strength and muscle mass. Here is a simple at home resistance exercise program to get you started:

1. Squats

Place your feet about shoulder width apart. Keeping your upper body straight and tall, bend your knees as far down as you feel comfortable when first starting out, but try to go down to a point where your thighs are parallel to the ground. Go down to a count of four. Using leg power, slowly push yourself back up to the start position to a count of two.

2. Chest

Stand facing a wall with your feet about 1 to 2 feet back from it. Place your hands on the wall just outside shoulder-width apart. Bending only at the elbows, lower yourself forward towards the wall to a count of four and then push yourself away from it at a count of two. Keep your body stiff and straight during the movement.

3. Shoulders

If you don’t have dumbbells, you can use soup cans or water bottles – you don’t need a lot of weight for this exercise. Stand erect with your arms at your side. Keeping your arms straight, bring them in front of you to shoulder height to a count of two. Next, extend your arms out to form a cross to a count of two then slowly, to a count of four, bring your arms back to your side. Immediately begin bringing them back up in front of you. Do 15 reps.

4. Biceps

Stand with your knees slightly bent, arms at your sides. With your right hand at your side, place your left palm into your right palm. Apply resistance with your left hand as you slowly bring your right hand up bending only at the elbow to a count of 2. Once at the top, slowly return your right hand to your side applying resistance the whole time with your left hand to a count of four. Repeat 15 times then switch arms.

5. Triceps

Sit on the side edge of a flat bench or the front edge of a chair. Place your hands on the edge of the chair right beside your buttocks and grip the edge. To start with, your feet should be flat on the floor about two feet in front of youwith your knees bent. Move yourself off the chair so you are now supporting yourself on your hands. Bend your arms, dipping your body down. Go down only as far as you feel comfortable to a count of four, being careful not to bounce out of the bottom. Push back up by extending your arms to a count of 2. It is important to keep your back close to the edge of the bench as you do these to minimize shoulder stress. Do 15 repetitions.

6. Abdominals

Lie down flat on your back with your knees bent and your feet on the floor. Cross your arms by placing the palm of your hand on the opposite shoulder. Perform a crunch by lifting your chest and head up towards the ceiling pushing your lower back flat onto the floor. Hold at the top of the movement for a second and concentrate on squeezing your abdominal muscles hard. Perform these crunches slowly. Do 15-20 repetitions.