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Sarcopenia 2021

Sarcopenia Issues
Sarcopenia, the loss of muscle mass with aging, doesn’t receive as much publicity as the bone loss of osteopenia and osteoporosis, but it’s been on my radar for years. It doesn’t afflict everyone and is difficult to diagnose, but by the time you know you have it, it requires a lot of intention to reverse it.

Five years ago, I decided to tackle sarcopenia head on and now I’ve found more research to support my decision. Aging feels like keeping a leaky boat afloat: one has to keep all of the little leaks patched before they sink you. Muscle loss has the potential to substantially diminish one’s quality of life.

Muscle mass loss accelerates with aging but can be markedly diminished with exercise and by eating sufficient protein. We are flooded by the press with the need to exercise but protein intake suffers from lack of agreement as to what is the right amount. More often, you’ll hear “Americans eat too much protein.” Below is a link to wonderful research article from the NIH that hones in on the issue of protein intake in seniors to blunt sarcopenia. Reading it was a game changer for me because it is concise, clear, and specific. Here are my key take-aways from it:

Analytical Method Improvements. In my opinion, we are all short-changed by the many flaws in the RDAs (recommended dietary allowances) and these NIH researchers highlight one specific issue: crummy analytical technology for determining protein requirements. Unbeknownst to me, that dramatically changed sometime before 2015 when the linked article was published. Unlike the older methodology, the new technic is easy and accurate and, as a result, many more studies are being done to drill-down on protein requirements instead of repeatedly reciting a few, old, flawed studies.

Conclusions From the New Methodology. With the benefit of better analysis, an increasing number of studies demonstrate that seniors actually need more protein that younger people. They recommend 30 grams of protein 3 times a day to reverse and prevent sarcopenia. Interestingly, I first read about this aged-based divergence in needs in 2015.
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Using a rock while hiking to time-slice resistance training to compliment my high protein intake.

Anabolic Resistance. I’ve read the words but still can’t explain what “anabolic resistance” is beyond being that our metabolism of proteins doesn’t work as well when we are older. Fortunately, there is a very simple fix for this system degradation, which is to use the hammer approach. Recent research has demonstrated there is a tipping point to overcoming anabolic resistance and it’s as simple as eating a lot of protein at one meal. Thirty grams, or perhaps 25-30 grams, of protein is the magic number, the hammer, that breaks through the resistance. Give an 85+ year old even one daily meal with 30 grams of protein and their muscle synthesis increases without increasing their exercise. Give them 2 or 3 such meals a day, and they pack-on even more muscle.

Our Observations
I eat what some consider a high protein diet of about 100 grams of protein per day. The RDA for protein for my weight is 44 grams. But in 2014, when I went on the ketogenic diet, I nervously popped my protein intake to this new, keto-friendly level. Looking at my current meals, I was almost but not quite, hitting the magic 30 grams per meal recommended to fend off sarcopenia. My breakfast overshot the target at 37 grams of protein and my dinner undershot by about 2 grams, which was probably close enough. But, nonetheless, it was a simple matter for me to move my few breakfast walnuts to garnish my dinner’s green beans to clear the 30 gram mark for protein at all 3 meals.

Bill, who switched from a ketogenic diet to the less stringent low carb one, wasn’t quite achieving 30 grams of protein at any of his meals. It only took a minute to realize that he could redistribute his current protein sources between breakfast and lunch to increase his protein intake to 30+ grams at those meals and add 100 grams of lean chicken at dinner to break the potential anabolic resistance at all 3 meals.

In contrast, a senior friend that is new to being a vegan, knows that she is short on protein, and doesn’t have any plans at this time to increase it, would be ahead from a muscle synthesis stand point to shovel in all of her protein for the day at 1 meal to hit that tipping point. She is currently spreading her protein intake throughout the day, never breaking through the anabolic resistance, and likely falls short on muscle growth syntheses every day. Hitting the 30 gram tipping point once a day is better than never achieving it. Interesting, she recently has lost more weight that she desired and seems weaker than in the past on the trails. I wondered if she could be suffering from muscle loss because of her sudden diet change and associated protein shortfall.

We have athletic, overly-thin, vegetarian, friends about our age that both have been diagnosed with sarcopenia and they started gaining weight, and presumably muscle, since increasing their protein intake to this 30 gram/meal level. It’s hard for any of us to know for sure what is going on with our bodies at a given time, but it’s best to be observant and thoughtful about our choices.

Other Issues
Too Much Protein?
Limiting protein intake has been the conventional wisdom for people like me with reduced kidney function and I’ve been admonished by well-meaning friends for eating too much protein. That position is considered “old school” by some and the “new school” instead recommends a hefty protein intake regardless of kidney function. You’ll need to make your own decision about the protein intake that is appropriate for your optimal health.

Exercise is well documented to increase muscle mass and that is true for seniors as well. This NIH sarcopenia article doesn’t address the exercise component for maintaining or increasing muscle protein synthesis though there is a plethora of online articles about the subject. The best exercise program for muscle growth or retention is the one that you will actually do. For most of us, brisk walking and resistance training are good choices because they don’t require specialized equipment and both have been shown to strengthen bones as well as muscles.

Protein Snacks
We rarely snack, but had to remind ourselves after reading this NIH article that any protein we consumed in a snack did not count towards our 90 g/day of protein. At our age, our best bet towards fending-off sarcopenia is to cluster all of our protein intake at our 3 meal times. A snack of nuts is fine but the protein contained in them doesn’t diminish our protein requirement for the day.

Here’s the link to the sarcopenia article: