Sarcopenia, The Undiagnosed Epidemic

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Article Title:

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Sarcopenia, The Undiagnosed Epidemic

Article Description:

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Is a loss of strength, mobility, and functionality an inevitable

part of aging? No, it's not. It's a consequence of disuse,

suboptimal hormone levels, dietary and nutrient considerations

and other variables, all of which are compounded by aging. One of

the greatest threats to an aging adult's ability to stay healthy

and functional is the steady loss of lean body mass - muscle and

bone in particular.

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2475 Words; formatted to 65 Characters per Line

Distribution Date and Time: 2007-01-29 10:48:00

Written By: Will Brink

Copyright: 2007

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Sarcopenia, The Undiagnosed Epidemic

Copyright © 2007 Will Brink

Brink Zone

http://www.brinkzone.com

Is a loss of strength, mobility, and functionality an inevitable

part of aging? No, it's not. It's a consequence of disuse,

suboptimal hormone levels, dietary and nutrient considerations

and other variables, all of which are compounded by aging. One of

the greatest threats to an aging adult's ability to stay healthy

and functional is the steady loss of lean body mass - muscle and

bone in particular.

The medical term for the loss of muscle is sarcopenia, and it's

starting to get the recognition it deserves by the medical and

scientific community. For decades, that community has focused on

the loss of bone mass (osteoporosis), but paid little attention

to the loss of muscle mass commonly seen in aging populations.

Sarcopenia is a serious healthcare and social problem that

affects millions of aging adults. This is no exaggeration. As one

researcher recently stated:

" Even before significant muscle wasting becomes apparent, ageing

is associated with a slowing of movement and a gradual decline in

muscle strength, factors that increase the risk of injury from

sudden falls and the reliance of the frail elderly on assistance

in accomplishing even basic tasks of independent living.

Sarcopenia is recognized as one of the major public health

problems now facing industrialized nations, and its effects are

expected to place increasing demands on public healthcare systems

worldwide " (Lynch, 2004)

Sarcopenia and osteoporosis are directly related conditions, one

often following the other. Muscles generate the mechanical stress

required to keep our bones healthy; when muscle activity is

reduced it exacerbates the osteoporosis problem and a vicious

circle is established, which accelerates the decline in health

and functionality.

What defines sarcopenia from a clinical perspective? Sarcopenia

is defined as the age-related loss of muscle mass, strength and

functionality. Sarcopenia generally appears after age 40 and

accelerates after the age of approximately 75. Although

sarcopenia is mostly seen in physically inactive individuals, it

is also commonly found in individuals who remain physically

active throughout their lives. Thus, it's clear that although

physical activity is essential, physical inactivity is not the

only contributing factor. Just as with osteoporosis, sarcopenia

is a multifactorial process that may involve decreased hormone

levels (in particular, GH, IGF-1, MGF, and testosterone), a lack

of adequate protein and calories in the diet, oxidative stress,

inflammatory processes, chronic, low level, diet-induced

metabolic acidosis, as well as a loss of motor nerve cells

A loss of muscle mass also has far ranging effects beyond the

obvious loss of strength and functionality. Muscle is a metabolic

reservoir. In times of emergency it produces the proteins and

metabolites required for survival after a traumatic event. In

practical terms, frail elderly people with decreased muscle mass

often do not survive major surgeries or traumatic accidents, as

they lack the metabolic reserves to supply their immune systems

and other systems critical for recovery. There is no single cause

of sarcopenia, as there is no single cause for many human

afflictions. To prevent and/or treat it, a multi-faceted approach

must be taken, which involve hormonal factors, dietary factors,

supplemental nutrients, and exercise.

Dietary considerations

The major dietary considerations that increase the risk of

sarcopenia are: a lack of adequate protein, inadequate calorie

intake, and low level, chronic, metabolic acidosis.

Although it's generally believed the " average " American gets

more protein then they require, the diets of older adults are

often deficient. Compounding that are possible reductions in

digestion and absorption of protein, with several studies

concluding protein requirements for older adults are higher than

for their younger counterparts (Young, 1990; et al.,

1994; et al., 1996). These studies indicate that most

older adults don't get enough high quality protein to support

and preserve their lean body mass.

There is an important caveat on increasing protein, which brings

us to the topic of low level, diet-induced, metabolic acidosis.

Typical Western diets are high in animal proteins and cereal

grains, and low in fruits and vegetables. It's been shown that

such diets cause a low grade metabolic acidosis, which

contributes to the decline in muscle and bone mass found in aging

adults (Frassetto et al., 2001). One study found that by adding a

buffering agent (potassium bicarbonate) to the diet of

post-menopausal women the muscle wasting effects of a " normal "

diet were prevented (Frassetto et al., 1997). The researchers

concluded the use of the buffering agent was " ... potentially

sufficient to both prevent continuing age-related loss of muscle

mass and restore previously accrued deficits. "

The take home lesson from this study is that - although older

adults require adequate intakes of high quality proteins to

maintain their muscle mass (as well as bone mass), it should come

from a variety of sources and be accompanied by an increase in

fruits and vegetables as well as a reduction of cereal

grain-based foods. The use of supplemental buffering agents such

as potassium bicarbonate, although effective, does not replace

fruits and vegetables for obvious reasons, but may be

incorporated into a supplement regimen.

Hormonal considerations

As most are aware, with aging comes a general decline in many

hormones, in particular, anabolic hormones such as Growth Hormone

(GH), DHEA, and testosterone. In addition, researchers are

looking at Insulin-like Growth factor one (IGF-1) and Mechano

Growth factor (MGF) which are essential players in the hormonal

milieu responsible for maintaining muscle mass as well as bone

mass. Without adequate levels of these hormones, it's

essentially impossible to maintain lean body mass, regardless of

diet or exercise.

It's been shown, for example, that circulating GH declines

dramatically with age. In old age, GH levels are only one-third

of that in our teenage years. In addition, aging adults have a

blunted GH response to exercise as well as reduced output of MGF

(Hameed et al., 2003), which explains why older adults have a

much more difficult time building muscle compared to their

younger counterparts. However, when older adults are given GH,

and then exposed to resistance exercise, their MGF response is

markedly improved, as is their muscle mass (Hameed et al.,

2004).

Another hormone essential for maintaining lean body mass is

testosterone. Testosterone, especially when given to men low in

this essential hormone, has a wide range of positive effects. One

review looking at the use of testosterone in older men

(Gruenewald et al., 2003) concluded:

" In healthy older men with low-normal to mildly decreased

testosterone levels, testosterone supplementation increased lean

body mass and decreased fat mass. Upper and lower body strength,

functional performance, sexual functioning, and mood were

improved or unchanged with testosterone replacement "

Contrary to popular belief, women also need testosterone!

Although women produce less testosterone, it's as essential to

the health and well being of women as it is for men.

The above is a highly generalized summary and only the tip of the

proverbial iceberg regarding various hormonal influences on

sarcopenia. A full discussion on the role of hormones in

sarcopenia is well beyond the scope of this article. Needless to

state, yearly blood work after the age of 40 is essential to

track your hormone levels, and if needed, to treat deficiencies

via Hormone Replacement Therapy (HRT). Private organizations like

the Life Extension Foundation offer comprehensive hormone testing

packages, or your doctor can order the tests. However, HRT is not

for everyone and may be contraindicated in some cases. Regular

monitoring is required, so it's essential to consult with a

medical professional versed in the use of HRT, such as an

endocrinologist.

Nutrient considerations

There are several supplemental nutrients that should be

especially helpful for combating sarcopenia, both directly and

indirectly. Supplements that have shown promise for combating

sarcopenia are creatine, vitamin D, whey protein,

acetyl-L-carnitine, glutamine, and buffering agents such as

potassium bicarbonate.

Creatine

The muscle atrophy found in older adults comes predominantly from

a loss of fast twitch (FT) type II fibers which are recruited

during high-intensity, anaerobic movements (e.g., weight lifting,

sprinting, etc.). Interestingly, these are exactly the fibers

creatine has the most profound effects on. Various studies find

creatine given to older adults increases strength and lean body

mass (Chrusch et al., 2001; Gotshalk et al., 2002; Brose et al.,

2003). One group concluded:

" Creatine supplementation may be a useful therapeutic strategy

for older adults to attenuate loss in muscle strength and

performance of functional living tasks. "

Vitamin D

It's well established that vitamin D plays an essential role in

bone health. However, recent studies suggest it's also essential

for maintaining muscle mass in aging populations. In muscle,

vitamin D is essential for preserving type II muscle fibers,

which, as mentioned above, are the very muscle fibers that

atrophy most in aging people. Adequate vitamin D intakes could

help reduce the rates of both osteoporosis and sarcopenia found

in aging people (Montero-Odasso et al., 2005) leading the author

of one recent review on the topic of vitamin D's effects on bone

and muscle to conclude:

" In both cases (muscle and bone tissue) vitamin D plays an

important role since the low levels of this vitamin seen in

senior people may be associated to a deficit in bone formation

and muscle function "

and

" We expect that these new considerations about the importance of

vitamin D in the elderly will stimulate an innovative approach to

the problem of falls and fractures which constitutes a

significant burden to public health budgets worldwide. "

Whey protein

As previously mentioned, many older adults fail to get enough

high quality protein in their diets. Whey has an exceptionally

high biological value (BV), with anti-cancer and immune enhancing

properties among its many uses. As a rule, higher biological

value proteins are superior for maintaining muscle mass compared

to lower quality proteins, which may be of particular importance

to older individuals. Finally, data suggests " fast " digesting

proteins such as whey may be superior to other proteins for

preserving lean body mass in older individuals (Dangin et al.,

2002).

Additional Nutrients of interest

There are several additional nutrients worth considering when

developing a comprehensive supplement regimen designed to prevent

and or treat sarcopenia. In no particular order, they are: fish

oils (EPA/DHA), acetyl-l-carnitine, glutamine, and buffering

agents such as potassium bicarbonate. There is good scientific

reason to believe they would be beneficial for combating

sarcopenia, but data specific to sarcopenia is lacking. For

example, EPA/DHA has been found to preserve muscle mass (e.g. is

anti-catabolic) under a wide range of physiological conditions.

The anti-inflammatory effects of fish oils would also lead one to

believe they should be of value in the prevention or treatment of

sarcopenia. In general, fish oils have so many health benefits,

it makes sense to recommend them here.

Acetyl-l-carnitine also offers many health benefits to aging

people, and data suggests it should be useful in combating this

condition. More research specific to sarcopenia is needed

however.

Glutamine is another nutrient that should be useful in an overall

plan to combat sarcopenia. Finally, data does suggest strongly

that bicarbonate and citrate buffering agents containing minerals

such as potassium, magnesium, and calcium can reverse the

metabolic acidosis caused by unbalanced western diets. However, I

hesitate to recommend this particular strategy as it does not

address the root cause, which is the diet itself. Much greater

health benefits will result from improving the diet over simply

adding in this supplement. In addition, there are potential

problems that could result from excessive intake of buffer salts,

such as hyperkalemia and formation of kidney stones.

Exercise Considerations

Exercise is the lynchpin to the previous sections. Without it,

none of the above will be an effective method of

preventing/treating sarcopenia. Exercise is the essential

stimulus for systemwide release of various hormones such as GH,

as well as local growth factors in tissue, such as MGF. Exercise

is the stimulus that increases protein and bone synthesis, and

exerts other effects that combat the loss of essential muscle and

bone as we age. Exercise optimizes the effects of HRT, diet and

supplements, so if you think you can sit on the couch and follow

the above recommendations...think again.

Although any exercise is generally better then no exercise, all

forms of exercise are not created equal. You will note, for

example, many of the studies listed at the end of this article

have titles like: " GH and resistance exercise " or " creatine

effects combined with resistance exercise " and so on. Aerobic

exercise is great for the cardiovascular system and helps keep

body fat low, but when scientists or athletes want to increase

lean mass, resistance training is always the method. Aerobics

does not build muscle and is only mildly effective at preserving

the lean body mass you already have. Thus, some form of

resistance training (via weights, machines, bands, etc.) is

essential for preserving or increasing muscle mass. The CDC

report on resistance exercise for older adults summarizes it as:

" In addition to building muscles, strength training can promote

mobility, improve health-related fitness, and strengthen bones. "

Combined with HRT (if indicated), dietary modifications, and the

supplements listed above, dramatic improvements in lean body mass

can be achieved at virtually any age, with improvements in

strength, functionality into advanced age, and improvements in

overall health and general well being.

Conclusion

Hopefully, the reader will appreciate that I have attempted to

cover a huge amount of territory with this topic. Each

sub-section (nutrition, hormones, etc.) could easily be its own

article if not its own book. This means each section is a general

overview vs. anything close to an exhaustive discussion. Below is

guide to web sites that offer additional information regarding

the topics covered in this article and should (hopefully!) help

fill in any gaps. To summarize, to prevent or treat sarcopenia:

* Get adequate high quality proteins from a variety of sources

as well as adequate calories. Avoid excessive animal protein and

cereal grain intakes while increasing the intake of fruits and

vegetables.

* Get regular blood work on all major hormones after the age of

40 and discuss with a medical professional if HRT is indicated.

* Add supplements such as: creatine, vitamin D, whey protein,

acetyl-l-carnitine, glutamine, and buffering agents such as

potassium bicarbonate.

* Exercise regularly, with an emphasis on resistance training, a

minimum of 3 times per week.

I'm going to conclude this article the way most people would

start it, with the good news and the bad news. The bad news is,

millions of people will suffer from a mostly avoidable loss of

functionality and will become weak and frail as they age from a

severe loss of muscle mass. The good news is that you don't have

to be one of those people. One thing is very clear: it's far

easier, cheaper, and more effective to prevent sarcopenia - or at

least greatly slow its progression - than it is to treat it later

in life. Studies have found, however, that it's never too late

to start - so don't be discouraged if you are starting your

sarcopenia fighting program later in life.

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Will Brink is a best selling author and columnist for

various health, fitness, medical, and bodybuilding

publications. His articles relating to nutrition,

supplements, weight loss, exercise and medicine

can be found in such publications as Lets Live,

Muscle Media 2000, MuscleMag International, The

Life Extension Magazine, Muscle n Fitness,

Inside Karate, Exercise For Men Only, Body

International, Power, Oxygen, Penthouse,

Women's World and The Townsend Letter For

Doctors. You can read many more free articles

and more about Will Brink at his website here:

http://www.brinkzone.com