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Best Of Sarcopenia

December 24, 2010 Written by JP       [Font too small?]

Physical strength isn’t just a characteristic of athleticism and youth. Rather, it’s something we rely on in order to live the type of lifestyle we choose. It’s not imperative that we look like bodybuilders on Muscle Beach or bikini models in a sports magazine. But, we all hope to have enough power in our muscles to take walks in the park, shop at a sprawling super market and to play catch with our grandchildren. Unfortunately, maintaining lean body mass as we age is not a given. For many, it requires actively railing against the course that nature has plotted.

Sarcopenia is a term used to describe age related muscle loss. This process by which the body loses strength is a major contributor to disability and mobility issues that affect seniors throughout the world. The fact is that if you don’t have the ability to move around, illness, in one form or another, is rarely far behind. That is, unless you take every possible step to counter the expected changes that often accompany this “golden age”. (1)

There are several practical steps that may help to protect against the development and progression of sarcopenia. All of these strategies address at least one aspect of this muscular dysfunction and loss of lean body mass.

Step # 1 – Adequate Protein and Amino Acids

In the September 2009 edition of the Journal of the American Dietetic Association, a group of researchers from the University of Kentucky attempted to establish the optimal amount of protein per meal. As a test, they enrolled 17 younger volunteers (with an average age of 34) and 17 elderly participants (68 years old on average). Each group was fed two separate meals on different occasions: Meal #1 consisted of 113 g of lean beef containing 30 g of protein. Meal #2 was comprised of 340 g of lean beef containing 90 g of protein. The scientists used blood tests and muscle biopsies to determine protein absorption and utilization.

  • There was a 50% increase in muscle protein production in both the younger and older volunteers.
  • The 30 gram protein meal was as effective as the 90 gram meal in promoting muscle growth in both groups.

These results are very hopeful because they indicate that older individuals are still capable of deriving significant benefits from good sources of dietary protein. It’s also helpful to note that excessive amounts of protein are not required to achieve the desired muscle supportive effects in those at risk for sarcopenia. Two other studies from 2009 also recommend similar amounts of protein intake. One medical journal advises “25-30 grams of high quality protein per meal” and the other suggests a minimum of 1.0-1.2 grams of protein per kilogram of body weight. Currently the RDA (Recommended Daily Allowance) for adult protein intake is set at .8 g/kg. (2,3,4)

When the body digests protein, it liberates amino acids from the food source. In short, amino acids are the isolated building blocks of protein. Several recent trials have determined that supplementing with purified amino acids can help increase lean body mass and improve insulin sensitivity in those with sarcopenia. One study even found that amino acids provided superior results when compared to a whey protein supplement. The researchers chose whey protein as a comparison because it’s previously been shown to support muscle growth and is generally easily digested and utilized. (5,6,7)

Step # 2 – Exercise Therapy

Use it or lose it. That’s how the saying goes and it’s so very true in the case of sarcopenia. An Italian study from 2008 examined the effects of a “specific resistance training program” consisting of chest press, leg press and vertical row in a group of 20 seniors. Over the course of 18 weeks, they all performed a supervised set of these exercises 3 times per week. Improvements in muscle strength were registered and a particular benefit was found in the lower limbs. This is very important because increased muscular ability in the legs can help reduce falls and fractures that often accompany advancing age. Resistance and strength training not only help to improve muscle mass and performance, but they also appear to restore energy production on a cellular level (in the mitochondria). Mitochondrial dysfunction is believed to be a hallmark of this form of muscle incapacity. (8,9,10)

Source: J Nutr Health Aging. 2008 Aug-Sep (link)
Step # 3 – Inflammation and Vitamin D

Elevated levels of inflammatory substances have consistently been detected in those with sarcopenia. Vitamin D is documented as having potent anti-inflammatory activity in a variety of conditions. In addition, this nutrient is frequently found to be deficient in those with poor musculature. Because of these established connections, some researchers have advised raising the “target value” for vitamin D in those at risk for or suffering from sarcopenia. At present, a vitamin D blood level of 40 ng/mL is considered adequate. Certain experts believe that shooting for a goal of 75 ng/mL may be advisable and advantageous as a means of ensuring optimal vitamin D levels. This is yet another inexpensive and safe strategy worth considering. (11,12,13,14,15,16,17,18,19,20)

Other contributing factors such as hormone deficiencies, insulin resistance and inadequate oxygen saturation also seem to exert some influence on sarcopenia. Currently, there are a number of medications under investigation as viable treatments for this growing problem. But the truth is that proper nutrition, specialized exercises and vitamin supplementation can go a long way in influencing just about every known factor relating to this condition. That’s not to say that these natural approaches will always be enough to provide full resolution of symptoms. But what I’m suggesting is that doctors and patients alike at least consider these natural approaches before resigning themselves to potentially dangerous prescriptive options or just allowing nature to take its course. (21,22,23)

Update: December 2010 - A new line of scientific inquiry has recently entered the sarcopenia realm: the role of omega-3 fatty acids in muscle breakdown and production. The September 2010 issue of the Journal of Nutrition started the ball rolling with a report revealing an apparent connection between plasma DHA and EPA levels, n-3 fatty acids found in fish, and the degree of accelerated muscle loss in cancer patients. Now, a new study presented in the December 15th edition of the American Journal of Clinical Nutrition takes it one step further. Scientists from Washington University School of Medicine in St. Louis, Missouri conducted a trial involving 16 healthy older adults who were randomly given either corn oil or fish oil over an 8 week period. The patients receiving the omega-6 laden corn oil did not demonstrate any increase in muscle protein synthesis. However, the fish oil did stimulate the muscle building process. Therefore, it was concluded that omega-3 fatty acids “may be useful for the prevention and treatment of sarcopenia”. Very welcome news indeed. (24,25)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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12 Comments & Updates to “Best Of Sarcopenia”

  1. anne h Says:

    Omega 3 and muscle building.
    Another good reason to ditch the corn products!

  2. JP Says:

    Well taken points, Anne! Let’s encourage our family and friends to enact such positive changes in 2011! It would be a great and inexpensive Christmas gift to all who receive it! :)

    Be well and Merry Christmas!

    JP

  3. Pradip Gharpure Says:

    Highly informative and encouraging article.

  4. Mark Says:

    One only needs to look at a prime example like Jack LaLanne. This man is incredibly fit even at his age.

  5. JP Says:

    I agree, Mark. A wonderful example indeed. Mr. and Mrs. L. also seem to have a truly fulfilling marriage. Nice to see.

    Be well!

    JP

  6. Cynthia D'Auria Says:

    Hello JP,
    Excellent article! too bad Docs do not inform patients of these things.
    Hopefully a friend or relative will suggest this to them…
    I am sure it would be beneficial to many.
    Thanks!

  7. JP Says:

    Thank you, Cynthia!

    IMO, this is such an important topic. I think we’ll (hopefully) see a shift in how doctors approach healthful aging in the days, months and years to come. It sure would prevent a lot of suffering and unnecessary health care spending. And, that’s not even factoring in the impact it would surely have on quality of life. Here’s hoping that change will come soon!

    Be well!

    JP

  8. JP Says:

    Update 05/24/15:

    http://www.ncbi.nlm.nih.gov/pubmed/25994567

    Am J Clin Nutr. 2015 May 20. pii: ajcn105833.

    Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults.

    BACKGROUND: Age-associated declines in muscle mass and function are major risk factors for an impaired ability to carry out activities of daily living, falls, prolonged recovery time after hospitalization, and mortality in older adults. New strategies that can slow the age-related loss of muscle mass and function are needed to help older adults maintain adequate performance status to reduce these risks and maintain independence.

    OBJECTIVE: We evaluated the efficacy of fish oil-derived n-3 (ω-3) PUFA therapy to slow the age-associated loss of muscle mass and function.

    DESIGN: Sixty healthy 60-85-y-old men and women were randomly assigned to receive n-3 PUFA (n = 40) or corn oil (n = 20) therapy for 6 mo. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises were evaluated before and after treatment.

    RESULTS: Forty-four subjects completed the study [29 subjects (73%) in the n-3 PUFA group; 15 subjects (75%) in the control group]. Compared with the control group, 6 mo of n-3 PUFA therapy increased thigh muscle volume (3.6%; 95% CI: 0.2%, 7.0%), handgrip strength (2.3 kg; 95% CI: 0.8, 3.7 kg), 1-RM muscle strength (4.0%; 95% CI: 0.8%, 7.3%) (all P < 0.05), and tended to increase average isokinetic power (5.6%; 95% CI: -0.6%, 11.7%; P = 0.075).

    CONCLUSION: Fish oil-derived n-3 PUFA therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.

    Be well!

    JP

  9. JP Says:

    Update 06/16/15:

    http://www.tandfonline.com/doi/full/10.1080/07315724.2014.938790

    J Am Coll Nutr. 2015;34(2):91-9.

    The addition of beta-hydroxy-beta-methylbutyrate and isomaltulose to whey protein improves recovery from highly demanding resistance exercise.

    OBJECTIVE: This study evaluated whether a combination of whey protein (WP), calcium beta-hydroxy-beta-methylbutyrate (HMB), and carbohydrate exert additive effects on recovery from highly demanding resistance exercise.

    METHODS: Thirteen resistance-trained men (age: 22.6 ± 3.9 years; height: 175.3 ± 12.2 cm; weight: 86.2 ± 9.8 kg) completed a double-blinded, counterbalanced, within-group study. Subjects ingested EAS Recovery Protein (RP; EAS Sports Nutrition/Abbott Laboratories, Columbus, OH) or WP twice daily for 2 weeks prior to, during, and for 2 days following 3 consecutive days of intense resistance exercise. The workout sequence included heavy resistance exercise (day 1) and metabolic resistance exercise (days 2 and 3). The subjects performed no physical activity during day 4 (+24 hours) and day 5 (+48 hours), where recovery testing was performed. Before, during, and following the 3 workouts, treatment outcomes were evaluated using blood-based muscle damage markers and hormones, perceptual measures of muscle soreness, and countermovement jump performance.

    RESULTS: Creatine kinase was lower for the RP treatment on day 2 (RP: 166.9 ± 56.4 vs WP: 307.1 ± 125.2 IU · L(-1), p ≤ 0.05), day 4 (RP: 232.5 ± 67.4 vs WP: 432.6 ± 223.3 IU · L(-1), p ≤ 0.05), and day 5 (RP: 176.1 ± 38.7 vs 264.5 ± 120.9 IU · L(-1), p ≤ 0.05). Interleukin-6 was lower for the RP treatment on day 4 (RP: 1.2 ± 0.2 vs WP: 1.6 ± 0.6 pg · ml(-1), p ≤ 0.05) and day 5 (RP: 1.1 ± 0.2 vs WP: 1.6 ± 0.4 pg · ml(-1), p ≤ 0.05). Muscle soreness was lower for RP treatment on day 4 (RP: 2.0 ± 0.7 vs WP: 2.8 ± 1.1 cm, p ≤ 0.05). Vertical jump power was higher for the RP treatment on day 4 (RP: 5983.2 ± 624 vs WP 5303.9 ± 641.7 W, p ≤ 0.05) and day 5 (RP: 5792.5 ± 595.4 vs WP: 5200.4 ± 501 W, p ≤ 0.05).

    CONCLUSIONS: Our findings suggest that during times of intense conditioning, the recovery benefits of WP are enhanced with the addition of HMB and a slow-release carbohydrate. We observed reductions in markers of muscle damage and improved athletic performance.

    Be well!

    JP

  10. JP Says:

    Update 07/09/15:

    An example of how not to supplement with vitamins C & E …

    http://onlinelibrary.wiley.com/doi/10.1111/sms.12506/abstract

    Scand J Med Sci Sports. 2015 Jul 1. doi: 10.1111/sms.12506.

    Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training.

    The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty-four elderly males (60-81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual-energy X-ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one-repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15-21% (P < 0.001). In conclusion, high-dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men.

    Be well!

    JP

  11. JP Says:

    Updated 07/15/15:

    http://www.jamda.com/article/S1525-8610%2815%2900388-6/fulltext

    J Am Med Dir Assoc. 2015 Jul 10. pii: S1525-8610(15)00388-6.

    Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial.

    BACKGROUND: Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability.

    OBJECTIVE: To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia.

    DESIGN: A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention.

    RESULTS: Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045.

    CONCLUSIONS: This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.

    Be well!

    JP

  12. JP Says:

    Updated 08/21/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26288012?dopt=Abstract

    J Bone Miner Res. 2015 Aug 19.

    Dietary Magnesium Is Positively Associated with Skeletal Muscle Power and Indices of Muscle Mass and May Attenuate the Association Between Circulating C-Reactive Protein and Muscle Mass in Women.

    Age-related loss of skeletal muscle mass and strength are risk factors for sarcopenia, osteoporosis, falls, fractures, frailty and mortality. Dietary magnesium (Mg) could play a role in prevention of age-related loss of skeletal muscle mass, power and strength directly through physiological mechanisms or indirectly through an impact on chronic low-grade inflammation, itself a risk factor for loss of skeletal muscle mass and strength. In a cross-sectional study of 2570 women aged 18-79 years we examined associations between intakes of Mg, estimated using an FFQ, DXA-derived measures of muscle mass (fat free mass as a percentage of body weight (FFM%), fat free mass index (FFMI, kg/m2 )), leg explosive power (LEP) and grip-strength (n = 949 only). We also examined associations between circulating hs-CRP (C-reactive protein) and muscle mass and LEP, and explored the potential attenuation of these relationships by Mg. We compared our findings with those of age and protein intake. Endpoints were calculated by quintile of Mg and adjusted for relevant confounders. Significant positive associations were found between a higher Mg and indices of skeletal muscle mass and LEP, and also with hs-CRP, after adjustment for covariates. Contrasting extreme quintiles of Mg intake showed differences of 2.6% for FFM% (P trend <0.001), 0.4 kg/m2 for FFMI (P trend = 0.005), and 19.6 watts/kg for LEP (P trend < 0.001). Compared to protein these positive associations were 7 times greater for FFM% and 2.5 times greater for LEP. We also found that higher hs-CRP was negatively associated with skeletal muscle mass and, in statistical modelling, that a higher dietary Mg attenuated this negative relationship by 6.5%, with greater attenuation in women aged over 50 years. No association was found between Mg and grip strength. Our results suggest that dietary magnesium may aid conservation of age-related loss of skeletal muscle mass and power in women of all ages.

    Be well!

    JP

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