Once we hit age 30, unless we take appropriate measures, we begin to lose 3-8 percent of our muscle mass each decade. Muscle sarcopenia, which is commonly seen in elderly persons, is the condition that occurs in age-related loss of skeletal muscle mass and function. When it becomes severe, sarcopenia affects one’s gait, balance and overall ability to perform the common tasks of daily living. Besides its association with aging, sarcopenia may occur in conditions not exclusively seen in the elderly population such as cachexia and malnutrition
Factors that Contribute to Muscle Loss
Beside aging, other factors contribute to muscle loss. These include hormone decline; unbalance of muscle anabolism and catabolism, which is seen in inflammatory diseases and conditions associated with systemic inflammation such as malignancy, insulin resistance, diabetes and rheumatoid arthritis; medical conditions and treatments that stress the body; increased body fat; periods of decreased activity or bedrest; a sedentary lifestyle; and nutrient deficiencies. Males are affected with sarcopenia more often than females. In addition, males with sarcopenia are more likely to have lipid abnormalities and osteoporosis.
Sarcopenia can be prevented or reversed with exercise and nutrition. Regular exercise is reported to reduce the incidence of falls by 23 percent. Still, some exercises, described in the next section, are not recommended for people over age 65.
Exercise in Aging
The best exercises for preserving muscle mass include:
Resistance band workouts
Body weight workouts
Dumbbell strength training
Exercises to Avoid after Age 65 include:
Squats with dumbbells or weights
Long Distance Running
High Intensity Interval Training
Older individuals who have had a lifelong exercise habit have a better capacity for exercise than individuals starting out in later years and may be able to perform exercises that are more intensive. In addition, men with low testosterone levels should use progressive resistance training.
While there are no formal diagnostic criteria, low muscle mass and strength are assessed by the European Working Group on Sarcopenia in Older People on the basis of several skills. These include muscle mass; handgrip to assess muscle strength; and walking speed to assess muscle power and function. Other assessment tools include chair rises and standing balance.
The Role of Diet
A healthy diet along with a reasonable exercise program can reverse sarcopenia, which may increase lifespan and improve the quality of life. The three most important nutrients include protein, vitamin D, and omega-3 fatty acids.
Age related weight loss and diminished muscle mass are seen in individuals who eat inadequate amounts of protein. Sixty percent of the body’s protein stores is found in muscle. Eating adequate amounts of protein signals muscle tissue to grow and strengthen. The amino acid leucine is one of the most important building blocks of protein and is essential for muscle growth. Dietary sources of leucine include whey protein, meat, fish, eggs, and soy protein isolate. Geriatric specialists recommend 1.0 to 1.3 grams/kg/day of protein along with resistance exercise.
Vitamin D deficiency and vitamin D insufficiency are commonly seen, especially in older individuals and those of us with an autoimmune disease. A blood test for the hormone 25OH vitamin D is essential to tell if a deficiency exists. In my case, despite taking 4,000 IU of vitamin D3 daily and spending lots of time in the sun, I had vitamin D insufficiency. For optimal levels, I need to take 10,000 IU daily. Vitamin D deficiency is related to sarcopenia, although the exact biochemical reasons are poorly understood.
Omega-3 fatty acids are typically deficient in the Western diet. Processed foods which are more likely to provide omega-6 fatty acids are one of the reasons for the imbalance on omega-3 and omega-6 oils seen today. High amounts of omega-3 fatty acids are found in oily fish from the Atlantic and Pacific Oceans, including mackerel, salmon, sea bass, and halibut but not in farm-raised fish. Eggs can have optimal levels of omega-3 depending on the diet of the poultry.
Creatine supplements have also been well studied for their role in reversing sarcopenia and improving muscle function in Aging. While positive results have been seen in younger patients, the role of creatine in the elderly is still being investigated. To date, studies show that creatine supplements alone do little, but they do show some efficacy when used as an adjunct to resistance training. A two-year follow-up of postmenopausal women taking 3 grams of creatine showed no adverse effects although this may not be the case with higher doses.
Researchers at Australia’s Edith Cowan University, while studying ways to reduce the incidence of falls in people aged 65 and older, found that eating a cup of nitrate-rich vegetables daily increases leg strength and promotes a faster walking speed. Nitrate-rich vegetables include kale, spinach, arugula, lettuce and beetroot.
Sarcopenia as a Risk Factor
Sarcopenia can lead to a condition of sarcopenic obesity where muscle mass is lost while body fat is preserved or increased , causing a normal weight with increased amounts of fat causing marked weakness. Fat embedded into muscle can also lower muscle quality and function.
Sarcopenia also increases the risk of physical limitation and disability as well as an increased risk for fractures, cognitive diseases, cardiovascular diseases, hospitalization and institutionalization. In addition, sarcopenia is associated with higher all-cause mortality and higher health-care costs.
Eimear Dolan, et al. 2019. “Muscular Atrophy and Sarcopenia in the Elderly: Is There a Role for Creatine Supplementation?” Biomolecules Nov 9(11). doi: 10.3390/biom9110642
Valter Santilli, et. al., 2014. “Clinical Definition of Sarcopenia.” Clinical Cases in Mineral and Bone Metabolism. Sept-Decl 11(3): 177-180.