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Sarcopenia is the gradual loss of skeletal muscle mass, strength, and functioning. It typically begins at some point in our 30s. Physically inactive people can lose 3-5% of their muscle mass each decade; active people also are likely to have some muscle loss.
Any loss of muscle is a concern because it lessens strength and mobility. The pace of muscle loss typically quickens around age 75. Sarcopenia in elderly people is a major cause of frailty and increased likelihood of falls and bone fractures.
Primary causes of muscle loss are declines in hormones, reduced numbers of neuromuscular junctions, systemic inflammation, declines in physical activity, alterations in cellular health, and malnutrition (e.g., inadequate protein intake). The good news is that sarcopenia can be prevented or reversed with dietary changes and strength training.
Skeletal muscle, the largest organ in the human body, is essential for physical functioning, optimal hormonal balance, cardiac health, bone density, pulmonary health, and metabolic functioning. According to a 2020 scientific literature review, strength training in combination with a healthy diet (e.g., sufficient protein intake) is the most effective way to prevent or slow the progression of sarcopenia.
Strength training involves lifting, pushing, or pulling movements to load and overload the muscle so that it will adapt by getting stronger. All major muscle groups should be targeted with heavy resistance – heavy loads – two or three times a week, with at least one rest day between working out the same muscle group.
Dietary and Supplementation Recommendations
Strength training by itself is a wasted effort. A healthy diet is the other essential component to staving off sarcopenia. An evidence-based nutritional support approach is synergistic with strength training.
Protein:
The first thing you need to know is that the U.S. recommended daily allowance (RDA) for protein intake has been unchanged for decades – and is woefully inadequate if you engage in regular strength training. The second thing you need to know is that total daily protein intake is the most important dietary contribution to muscle mass. Older adults typically consume insufficient amounts of protein. So how much protein do adults need to provide maximum stimulation of muscle protein synthesis (MPS)? And what are the best forms of protein to consume?
1. Adults daily require 1.2 grams of protein for every kilogram of body weight (1 kg = 2.205 pounds) to provide maximum MPS.
For example, a 200-pound person would need 90.7 grams of protein every day. Some scientists think even this recommendation is too low, recommending 1 gram of protein for every pound of body weight. I subscribe to this perspective. There is also evidence that we need more protein as we get older.
2. The National Health and Nutrition Examination Survey (2007-2016; n = 8,070) found a strong association between daily protein intake and disability.
People who consumed >1.0 g/kg/day of protein had 22% decreased odds for functional disability. The European Society for Clinical Nutrition and Metabolism has recently recommended that older adults should consume between 1.0–1.5 g/kg/day of protein.
3. Not all proteins are created equally.
They can be objectively scored for their quality using the protein digestibility-corrected amino acid score (PDCAAS) or the digestible indispensable amino acid score (DIAAS). Results of these analyses show that animal-derived proteins are superior to soy, pea, and most other plant-based proteins.
4. Protein distribution throughout the day is also important and contributes significant benefits to MPS.
This means it’s important to consume 25-50 grams of protein at every meal throughout the day, possibly with smaller protein snacks in between meals.
5. Contrary to popular belief, a higher protein intake is not detrimental to kidney or bone health.
A higher protein intake is probably beneficial to bone density health and may help reduce the risk of hip and other bone fractures common among older adults.
Creatine
Found in meat and fish, the primary function of creatine is to facilitate the transmission of high-energy phosphates in the production of adenosine triphosphate (ATP). Start by taking 5 grams of creatine monohydrate four times a day for one week, followed by an ongoing maintenance dose of 5 grams a day. Creatine supplementation is safe and well-tolerated, and an important component of building and maintaining skeletal muscle. If you engage in strength training you should almost certainly be supplementing with creatine.
Other Dietary Supplements
Many of us will also benefit from dietary supplements to ensure that we have the necessary micronutrients to support MPS.
1. Vitamin D3 + K:
A deficiency in vitamin D, common in most Americans, is associated with musculoskeletal disease.
2. Leucine:
Supplementation with leucine, an essential amino acid, may be beneficial if overall protein intake is insufficient. This may be especially important for people who consume plant-based proteins as their primary or only source of protein (e.g., vegetarians).
3. Omega 3 polyunsaturated fatty acids (n3-PUFA):
Commonly found in fish oil may be especially important during periods of relative inactivity (e.g., during illness or recovery periods).
My Strength Training Protocol
In case you’re wondering, my strength training protocol is to alternate push and pull days, aiming for 4 to 5 workouts a week (though 6 would be better). I use a variable-resistance band system[1] that involves large, flat, circular bands; a shoulder-width Olympic bar, and a plate to thread the band under (which prevents ankle rolls). This system fits easily in my carry-on luggage when I travel. At home, I use a vibration plate, which I replace with a stationary plate when I’m on the road.
Variable-resistance bands work with your strength curve, instead of against it as free weights do. What this means is that at the start of the motion, before the band has been stretched, the resistance is at its lightest. As you proceed through the motion, the band stretches and the resistance increases gradually – as does your strength through the motion. This means that acute and repetitive stress injuries are far less likely. It also means you can more effectively go to failure and beyond (i.e., partial reps).
For this reason, I only do ONE SET per muscle group. To get the most out of that one set you have to make full effort. This means doing as many reps (i.e., 15 to 40) as you possibly can, and then continuing to do partial reps until you are no longer able to move the bar more than an inch. On “push days” I do four exercises, one set each: chest press, triceps extension, shoulder press, and squats; on “pull days” I do four exercises, one set each: dead-lift, calf raise, bent-over-row, and bicep curl. My total workout time is less than 15 minutes. I’ve been using this approach for two years now with good results – and, a major bonus, all the chronic joint pain I lived with for decades has disappeared.
[1] I use the X3 variable-resistance band system by Jaquish Biomedical.
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