Sarcopenia: Causes, Prevention, And Treatement. Part 1

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; Campbell et al., 1994; Campbell 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.

End Part 1

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