Sarcopenia, better known as muscle loss, is an unfortunate common condition in older adults. It’s estimated that 10% of adults over the age of 50 suffer from the condition (1).
Your body needs muscles to stay mobile, digest, and protect your skeletal system. When your muscles weaken, your lifestyle and comfort also suffer. Although sarcopenia is a natural part of aging, there are many things you can do to slow down the process.
What Is Sarcopenia?
Normally, your body continuously repairs and builds up muscles in healthy and active individuals. Sarcopenia can occur in young people who don’t exercise. As Web MD warns: “Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30.”(2)
Sarcopenia isn’t just about feeling weak or having trouble getting from point A to point B: it can dramatically shorten life expectancy (3).
Your body regularly breaks down muscles throughout your lifetime to replace older cells and repair damage. Sarcopenia occurs when your body breaks down muscle (catabolism) faster than it can replace it (anabolism) (4).
This occurs due to an imbalance between signals for muscle cell growth and signals for teardown.
Four Factors That Accelerate Muscle Loss
1. Immobility, Including a Sedentary Lifestyle
You don’t use it, you lose it. You may not be as fast or agile as you once were, but inactivity will expedite muscle loss. As we age, we lose muscle mass faster as the result of inactivity than when we were younger, which makes continued physical activity all the more critical. (5)
A Dutch study at the Maastricht University Medical Center found a significant loss of muscle mass (ten percent) in healthy young men after only five days of inactivity. In the elderly, five days of inactivity can result in the inability to accomplish routine daily activities. Compared with younger people, the pace of muscle degradation in older people exceeds the body’s ability to replenish muscle mass, resulting in a permanent loss. (6) Regular physical activity is crucial at all ages and lack of it in younger years can increase the risk of developing sarcopenia as you age.
With the loss of muscle come changes to the rest of your body as well: bones; joints; connective tissues; respiratory, digestive, nervous, immune, and circulatory systems; and even organs (including skin). Moreover, one of the causes of osteoporosis, another common degenerative condition that comes with age, is declining muscle activity on bone mass, reducing bone density. Bone density from inactivity can decrease up to fifty percent in only three months. (7) The body was made to move; when it doesn’t, good health fails. It’s that simple.
2. Unbalanced Diet
We get all of our fuel and nutrition from the food we eat. As our bodies change, so do our nutritional needs. A poor diet leads to poor health. Older people tend to eat less so what you do eat is important. Malnutrition in elderly people is not uncommon because the little they eat is inadequate to support bodily functions. Not enough protein and too much acidic food (processed foods, grains, soft drinks) with not enough vegetables and fruits can lead to loss of muscle mass. (8)
In his book Clinical Nutrition and Aging: Sarcopenia and Muscle Metabolism, Chad Cox, Ph.D. has this to say about the importance of diet:
“Regrettably, poor diet is one of the most common problems practitioners encounter when treating older adults. Many individuals in this population have low nutrient intakes, for a variety of reasons that range from physical deficits to economic hardship. Dental problems in the elderly may make them more likely to choose softer foods that often lack protein; delayed gastric emptying can reduce appetite; hormonal changes may cause longer-lasting feelings of satiety. On top of that, meat is more expensive than foods rich in starch, and for this reason, individuals who are living on a fixed income may tend to fill up on cheap, processed carbohydrates. Lack of physical strength may also make packaged, processed foods more appealing.
“… sarcopenia prevention needs to begin before old age. Research confirms that the greater the peak strength attained during a person’s younger adult life, the more likely an individual will have greater strength in their older years. Early intervention can make a difference. We need to teach our students and patients that if they optimize their nutrition now, they will be investing in their future well-being.” (9)
It may seem counterintuitive but the metabolic factors associated with obesity and diabetes are contributing factors to sarcopenia. These are directly attributable to diet. Protein and physical activity are required for muscle development and retention. A balanced diet that includes adequate protein intake and minimal inflammatory foods like sugar and complex carbohydrates can stall the progression of sarcopenia. (10)
Chronic systemic inflammation is the precursor to virtually all illness and disease and sarcopenia is no exception. (11) Inflammation is an immune response to a variety of factors, from injury or infection to poor diet. Chronic inflammation occurs when our diet, lifestyle, and environmental toxins constantly invade our bodies, forcing the immune system into continual overdrive.
Cytokines are cellular transmitters that are responsible for stimulating an immune system response. It has been established that people with sarcopenia have higher cytokine levels in their blood than healthy people. (12) The loss of muscle mass and strength in older people is directly associated with these inflammatory markers. (13)
Inflammation goes hand-in-hand with oxidative stress, a condition that occurs when there are too many unstable oxygen-containing “free radical” molecules in the body that interact with other cells causing a general molecular imbalance. If not counteracted with dietary antioxidants that give their electrons to free radicals to stabilize them, oxidative stress can occur. Oxidative stress is a primary cause of inflammation.
The link between these and the loss of muscle mass was the focus of a 2010 study:
“Evidence suggests that oxidative stress and molecular inflammation play important roles in age-related muscle atrophy. The two factors may interfere with the balance between protein synthesis and breakdown, cause mitochondrial dysfunction [cell structures that convert nutrients to energy], and induce apoptosis [cell death].” (14)
4. Severe Stress
Chronic stress is bad for every function of your body, including the metabolism of proteins into muscle. Psychological stress causes the release of hormones designed to help your body cope (fight, flight, freeze). Unmanaged stress causes hormone overload that stimulates an immune response, causing inflammation and impeding a host of processes. The result is a variety of symptoms, including muscle cell apoptosis. In addition, stress activates cytokines, which we’ve mentioned above as pro-inflammatory. (15)
Bodily stress caused by other illness and disease works the same way. People who suffer from chronic diseases are known to experience sarcopenia as well. Liver disease, diabetes, cardiovascular disease, and cancer are among those associated with significant loss of muscle and muscle strength. (16, 17) A severely taxed immune system focuses the body on fixing what’s wrong and pulls whatever it needs from wherever it can toward that end—to the exclusion of lesser functions.
Exercise That Can Reverse Sarcopenia
So now that we know the primary factors that cause sarcopenia, we can take steps to prevent it. Physical activity is crucial; following are three types of exercise known to help retain muscle mass and strength.
1. Resistance Training
Also known as strength training and weight-bearing exercise, resistance training (RT) begun as late as middle age goes a very long way in preventing muscle and bone density loss later in life. In fact, RT is so effective that it can reverse sarcopenia in the elderly by redeveloping muscle mass. (18)
Meta-analyses of the effects of RT on muscle take into account sex and genetic factors that can influence the effectiveness of this type of exercise. They all conclude, however, that muscle mass, strength, and quality are significantly improved with RT for both sexes at every age. (19)
It’s important to keep in mind that sarcopenia results in not only the loss of muscle mass but the motor functions that they perform:
“The less active a person’s lifestyle, the earlier age-related changes will manifest. A reduction in motor capacity and visual and vestibular skills [balance and eye movement] are foremost among these changes. In addition to a reduction in muscle fibers (type 1 and especially type 2 fibers, especially in the lower extremity), the responsibility for this lies with neuronal factors (a reduction in spinal motoneurons or spinal inhibitions) and impairments to mechanical muscle function (such as for example reduced maximum frequency or reduced elasticity)…an increase in muscle activity and frequency during isometric and dynamic muscle work have been observed. The extent of adaptation in elderly people is comparable to that in younger people. Sarcopenic muscle fibers thus do not per se have reduced mechanical muscle function but have a confirmed potential for adapting to strength (resistance) training.” (20)
Progressive RT can prevent, restore, and increase muscle mass and strength “even in the oldest old”. It promotes the loss of fat that so often occurs with aging, reduces blood pressure, and improves glucose tolerance—a whole health package. (21)
Regardless of your age, it’s a good idea to consult a healthcare professional if starting new exercise but even more important if you’re over forty.
2. Fitness Training
General physical fitness is the ideal for any age. To prevent sarcopenia from taking place or restore muscle strength after the effects have begun, overall fitness is strongly recommended.
The first muscular atrophy experienced with sarcopenia is often found in fast-twitch fibers: those responsible for immediate bursts of action but tire quickly. These are balanced in the body by slow-twitch muscle fibers that are used for endurance and consume oxygen to produce energy for muscle contraction. (22) This explains why reflexes and mobility slow as we age. Fitness training that includes aerobic exercise keeps the fast-twitch fibers in use, preventing atrophy. (21)
Aerobic/endurance exercise that raises heart rate is known to increase muscle mass, although not to the extent of RT. A combination of aerobic, RT, and flexibility training has been consistently shown to prevent and ameliorate sarcopenia. (24) Aerobic exercise also aids weight (fat) loss. (25) Strenuous workouts for elderly people (relatively speaking) are most effective. (26)
Simple walking is one of the best exercises for older people. A large Korean study of 3598 men found that those who regularly walked were significantly less likely to show signs of sarcopenia. (27) Walking is a skill mastered before the age of two and becomes the most natural physical activity in which we engage. We may not think about it but it’s a weight-bearing exercise!
In short order, Nordic walking (which increases the number of muscles used, increasing exertion) promotes muscle strength and functional performance, with implications for the reduction of both muscle and bone loss. (28)
Watch the short video below for a description of Nordic walking with instructions on how to do it.
Nutrients That Fight Sarcopenia
We recognize the importance of the foods we eat in all stages of life. Below are key nutrients that will help to prevent and reverse sarcopenia as we get older.
Muscles are made of protein and most mature adults don’t get enough. (29) Some studies suggest that the daily protein requirement for people over sixty years is greater than that of younger people. (30) All of the studies of sarcopenia relate inadequate protein intake with rapid loss of muscle mass.
There’s no set amount of protein that fits every person; however, noticeable loss in muscle mass is an indication that you’re not getting enough. Increase in protein intake in tandem with RT has been proven effective in restoring muscle mass and strength. Please note that a protein-rich diet is contraindicated for people with impaired kidney function. (31)
Part of the challenge with getting enough protein as we age is the body’s increasing inability to process it. Proteins should come from a variety of sources, not just animal meat (which is acidic). Other foods with significant protein include:
2. Vitamin D
Vitamin D is necessary for bone density and the absorption of calcium. It is also important in its role in metabolic pathways for muscle function. (32) Proteins that regulate cells are partially modulated by vitamin D. (33) Vitamin D deficiency worldwide is becoming a crisis and people with sarcopenia have been found lacking this important nutrient. (34, 35) Increasing the amount of daily vitamin D has been associated with improved muscle mass and strength. (36) Additionally, vitamin D is an anti-inflammatory.
The best source of vitamin D is the sun. The skin absorbs it from the sun’s ultraviolet light and synthesizes it into usable form. You can get synthetic vitamin D in a dietary supplement but it isn’t as potent or effective as natural sources. Food sources of vitamin D can be found by clicking here.
3. Omega-3 Fatty Acids
We hear a lot about omega-3 fats but why are they important for muscle health? This type of fat isn’t made in the body and must be gained from foods (this is why it is termed an “essential” fatty acid). This type of fat is a component of cell membranes and is responsible for cells’ ability to communicate with one another. In addition, omega-3 fats are necessary for hormone production and regulate genetic function. (37)
Omega-3s stimulate the synthesis of proteins, including those from which muscle is made. (38) Not only do these fats (especially from marine sources like fish) make muscle proteins more sensitive to nutrition but they also improve muscle function after exercise.
The important piece in the context of sarcopenia is the addition of ample omega-3 fatty acids in conjunction with exercise; taking a supplement or eating more fish alone won’t drive out all of their restorative effects. (39)
You can find the top ten foods rich in omega-3s by clicking here.
Creatine is an amino acid, a building block of protein. The body produces it in the liver, kidneys, and pancreas—it’s also found in animals that we eat. Creatine is involved in protein and cell metabolism; it’s stored in muscles and used for energy.
Depending on how much creatine you already have in your muscles, adding creatine to your diet may improve muscle mass, strength, endurance, and improve mood. Creatine supplements have become popular with athletes as performance enhancers for these reasons. (40)
Clinical research into creatine’s effects on sarcopenia is mixed: some studies have found supplementation to support the development of lean muscle mass while others have not. (41) In a 2014 study, creatine was found to compound the beneficial results of RT on muscle mass than with RT alone. (42) You can get creatine from meat and fish.
Oxidative stress is a known precursor to sarcopenia. Antioxidants prevent oxidative stress and reduce inflammation by balancing free radicals. All plants contain multiple and varied antioxidant compounds that promote general health and can help to prevent muscle loss.
Carotenoids, flavonoids, selenium, and tocopherols have been especially identified as improving physical function. (43) Supplementation with antioxidants alone won’t prevent or treat sarcopenia. They are, however, part of the bigger picture.
Now that you know how to fight sarcopenia, you can also apply these tips in an earlier age. If you work long hours at a desk or if you have a hard time going to the gym, it’s high time you start taking care of your muscles.
Remember that your heart, the most important muscle in your body, can also be affected by poor lifestyle habits and inactivity, so there’s no better tiem to start taking care of yourself than now!