Stop the Clock

Stop The Clock: The Shocking Truth About Age-Related Muscle Loss and Steps to Fight Back

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By: Sarita Khemani, MD

As a physician specializing in peri-operative medicine, I have witnessed firsthand the detrimental impact of muscle loss on patients. Whether it is individuals presenting with hip or spine fractures, or those who have suffered from bleeding in their brain following a fall, many of these acute conditions have a hidden underlying cause: the loss of muscle mass.

Although losing muscle may not seem like a significant concern, it can be a silent yet deadly issue that progressively drains our vitality and strength, leading us to become frail and dependent.

In this blog, we will explore the latest scientific research on the trajectory of muscle loss as we age and discuss practical steps that we can take to prevent or alleviate its effects.

Understanding Skeletal Muscle: Composition and Function

Skeletal muscle is the type of muscle tissue that we can control voluntarily, such as when we intentionally flex our biceps or perform other movements. It is composed of many smaller bundles of muscle fibers, each containing hundreds to thousands of individual fibers. These fibers are primarily made up of two proteins: myosin and actin, which work together to facilitate muscle contraction.

The muscle fibers themselves are arranged in a specific pattern, extending the muscle’s length between the tendinous ends, and are bundled together and wrapped in connective tissue. This arrangement allows the muscle to generate force and produce movement when it contracts.

In terms of composition, muscle tissue is approximately 70% water and 30% protein. The body synthesizes muscle protein from the amino acids that are present in the protein we consume through our diet.

Image credit: University of Miami: https://www.bio.miami.edu/dana/360/360F18_15.html

 

As we age, the gradual decline in muscle mass and strength worsens with each passing decade. This decline can be attributed to several factors, including reduced dietary protein intake, decreased physical activity, a decline in hormone levels, chronic inflammation, muscle denervation, mitochondrial dysfunction, infiltration of fat into muscle, and insulin resistance.

Research suggests that the rate of loss of muscle strength is greater than the loss of muscle mass and plays a crucial role in healthy aging. When low muscle mass and function, including strength and physical performance, occur with aging, it is known as sarcopenia. The term “sarcopenia” originates from the Greek words “sarx,” meaning flesh, and “penia,” meaning loss.

Sarcopenia can be classified into two categories: primary sarcopenia, which is the cumulative result of various factors leading to muscle loss with aging, and secondary sarcopenia, which is caused by a specific insult, such as surgery, hospitalization, or injury. By understanding these categories, we can better diagnose and manage sarcopenia in older adults.

The trajectory of age-related muscle loss

The loss of muscle strength with age can be surprising to many people, as it can start as early as age 30. As numerous research studies have shown, the rate of decline for muscle mass with age worsens with each decade.

Age Percent loss of muscle mass/decade
50s 0.5-2%
60s 4-5%
70s 7-8%

The decline in muscle strength is more dramatic and can be 2-5 times greater than decline in muscle mass.

Age Percent loss of muscle strength/decade
50s 3-4%
60s 9-10%
70s 11-12%

A study found that there was muscle loss of between 35% and 40% occurring between the ages of 20 and 80. Additionally, studies of nursing home residents have found that sarcopenia, affects 30-40% of individuals. Mobility aids, such as canes, walkers, or wheelchairs, are commonly used by older adults, with 24% of those aged 65 years and older relying on such aids. Alarmingly, the death rate from falls is projected to rise sharply in the coming years, as shown in the graph below.

Image Credit: CDC:

Skeletal muscle mass is shown to be an independent predictor of death, highlighting its crucial effect on longevity.

These statistics don’t consider the sudden health events that can accelerate muscle loss. A rapid decline in muscle mass and health occurs with hospitalizations and illnesses. In addition to the lack of activity during hospital stays, other factors like increased levels of pro-inflammatory agents and cortisol can have a compounding effect. For older adults, this loss of muscle mass and function can lead to permanent disability or even death.

Connection between muscle health and dementia

Dementia affects more than 55 million people worldwide, and physical inactivity is one of the modifiable risk factors for the condition. There is a well-established link between low muscle mass, low physical activity, and cognitive impairment in old age.

Exercise releases myokines from the muscle, which crosses the blood-brain barrier and helps regulate BDNF, a protein that supports the survival and growth of neurons in the brain. Furthermore, the lower an individual’s muscle mass, the more significant their cognitive decline, suggesting a dose-dependent effect.

Steps to preserving muscle health and function.

Protecting your muscle mass is like increasing your savings: the greater the savings, the more comfortable you will be as you age.. While we might develop pharmacological treatments for muscle loss in the future, currently, the best way to preserve muscle function is to put in work upfront.

1. Strength training, “the medicine”

Resistance training activates our DNA to respond to stress, leading cells to produce increased muscle protein.

Initially, we may see an improvement in strength but not much muscle hypertrophy because of an increase in muscle protein breakdown. However, this slows down after about six weeks, and we start seeing an increase in muscle size.

Strength training can counteract the accumulation of fat in the muscle, improve the health of neuromuscular junctions, improve muscle quality, and reduce inflammatory markers.

People who do regular resistance training have a 20-year advantage. For example, 85-year-old weightlifters showed similar power and muscle features as 65-year-olds who did not engage in regular training in studies.

To achieve optimum improvement in muscle mass and strength, we should engage in resistance training 2-3 times per week per muscle group in addition to any aerobic exercises.

Resistance exercises that involve increasing load and speed should be done under supervision to ensure proper form and avoid injury.

2. Protein intake

Studies have shown that higher protein intake is associated with greater muscle mass and lower risk of developing frailty in older adults.

Protein intake should be individualized based on age, sex, activity level, and health status, but generally range from 1.6-2.2 grams per kilogram of body weight per day.

A systematic review and meta-analysis published in the British Journal of Nutrition in 2020 found that plant-based protein sources can be just as effective as animal-based sources for improving muscle health. It’s best to mix and match various plant-based sources of protein for optimum effect.

Consuming more than 35-50 grams of protein at one time does not provide any additional benefit for muscle growth, as excess protein is used for energy production. Therefore, it is best to spread protein intake out throughout the day rather than consuming the whole day’s amount in one sitting.

3. Supplements: Please see an excellent blog by Dr. Kaufman on this website to gain more knowledge about the safe use of supplements.

4. We all know to get good sleep and stay hydrated—more on these topics in future blog posts.

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Study Suggests the Benefits of Prebiotic Supplements Were Dependent on Dietary Fiber Intake

This small proof-of-concept study found something for further exploration: the high dietary fiber vs low dietary fiber interaction with different prebiotic supplements. The  study found that the supplements only affected those who weren’t taking in dietary fiber, thus taking prebiotic supplements may be ineffective if you already consume the recommended amounts of dietary fiber. The study included a very wide age range so the findings shouldn’t be printed on t-short quite yet, however it brings to light an interesting interaction. Ironically it’s often the people who already have a healthy diet that lean towards supplement intake even though they don’t need it!

By: Marily Oppezzo, PhD, MS, Head of Lifestyle Medicine Nutrition Pillar

 

Journal Reference:

  1. Holmes ZC, Villa MM, Durand HK, Jiang S, Dallow EP, Petrone BL, Silverman JD, Lin PH, David LA. Microbiota responses to different prebiotics are conserved within individuals and associated with habitual fiber intake. Microbiome. 2022 Jul 29;10(1):114. doi: 10.1186/s40168-022-01307-x. PMID: 35902900; PMCID: PMC9336045.

 

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Creatine Supplementation Improves Healthspan and Muscle Preservation in Older Adults

Creatine Supplementation Improves Healthspan and Muscle Preservation in Older Adults

This article is a fantastic summary of the work on creatine and dispelling myths. Creatine is one of the approved, safe, and effective aids for older adults. In this population, creatine supplementation can be beneficial for improving healthspan and muscle preservation. Some key findings of this article show:

  1. Creatine loading is not necessary, but it is safe and effective at smaller doses (3-5 g or 0.1 g/kg of body mass).
  2. Creatine supplementation and resistance training produce musculoskeletal and performance benefits in older adults.
  3. Creatine supplementation can be beneficial for a variety of athletes.
  4. Creatine supplementation benefits females across their lifespan.

By: Marily Oppezzo, PhD, MS, Head, Lifestyle Medicine Nutrition and Behavioral Change

 

Journal Reference:

  1. Antonio, J., Candow, D.G., Forbes, S.C. et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. J Int Soc Sports Nutr 18, 13 (2021). https://doi.org/10.1186/s12970-021-00412-w

 

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Non-Nutritive Sweetener May Affect Human Microbiomes and Alter Glycemic Response

Non-Nutritive Sweetener May Affect Human Microbiomes and Alter Glycemic Response

This elegant study looked comprehensively at whether four non-nutritive sweeteners (aspartame, sucralose, stevia, and saccharin) are metabolically inert. Non-nutritive sweeteners (NNS) are used to reduce or replace sugar in various products with the goal of minimizing calories and avoiding glucose spikes in the body. Because many of these NNS are poorly absorbed, they do not provide direct calories for us like sugar, and generally skate through the small intestine unchanged, making their way into the colon. However, instead of just passing out of the body and into the bowl unchanged, this study showed that each of these four NNS have distinct, physiological effects on the microbiome! Some NNSs may be fuel for certain bacteria, while others may stunt the proliferation of other bacteria. The authors suggest a number of possible microbiome alterations-each a starting point for many more future studies to uncover all the details.

Another finding from this study was that two of the sweeteners tested, Saccharin and Sucralose, impaired individual’s oral glucose tolerance test response*. Aspartame and Stevia did not. You might think – oh, this means Diet Cokes make you insulin resistant. Not quite- the participants didn’t eat the sweetener alone, each NNS was paired with glucose, or “carb fillers,” found in the sachets. Also, there was significant individual variability in responses across individuals, so it’s tough to generalize this result.

The authors suggest future studies should look at sugar alcohols and other NNSs used in sugar-free products, as well as extend the period of time that people use the sweeteners, to look for long term effects.

One thing the authors made clear: This study shows exciting new findings, and is a great starting point. Don’t all of sudden toss out your Diet Coke and buy Regular Coke as a result.

*An oral glucose tolerance test is not like a meal or even a food people would typically eat, it is a bottle of pure glucose (75 grams of sugar) and then timed measures of how efficiently the body clears this abnormally high glucose load from the bloodstream.

 

By: Marily Oppezzo, PhD, MS & Maya Shetty, BS

Journal Reference:

  1. Jotham Suez, Yotam Cohen, Rafael Valdés-Mas, Uria Mor, Mally Dori-Bachash, Sara Federici, Niv Zmora, Avner Leshem, Melina Heinemann, Raquel Linevsky, Maya Zur, Rotem Ben-Zeev Brik, Aurelie Bukimer, Shimrit Eliyahu-Miller, Alona Metz, Ruthy Fischbein, Olga Sharov, Sergey Malitsky, Maxim Itkin, Noa Stettner, Alon Harmelin, Hagit Shapiro, Christoph K. Stein-Thoeringer, Eran Segal, Eran Elinav. Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell, 2022; DOI: 10.1016/j.cell.2022.07.016
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Consuming a Whole Food Plant-Based Diet is Associated With Lower Odds of Moderate-to-Severe COVID-19

The power of lifestyle medicine! According to a study recently published in BMJ Nutrition, Prevention & Health, consuming a predominantly whole food plant-based diet is associated with lower odds of moderate-to-severe COVID-19. This large sample size diverse multi-countries population-based case-control study showed that those consumed predominantly plant-based diets had 73% lower odds of moderate to severe COVID-19 severity compared to those who did not. Similarly those who followed either pant-based diets or pescatarian diets had 59% lower odds of moderate to severe COVID-19 severity compared with those who did not. Compared to those who did not follow low carbohydrate, high protein diets, following low carbohydrate, high protein diets was associated with 48% greater odds of moderate to severe COVID-19.

By: Rusly Harsono, MD, Head, Lifestyle Medicine Social Engagement

 

Journal Reference:

1. Kim H, Rebholz CM, Hegde S, et al. Plant-based diets, pescatarian diets and COVID-19 severity: a population-based case–control study in six countries. BMJ Nutrition, Prevention & Health 2021;bmjnph-2021-000272. doi: 10.1136/bmjnph-2021-000272
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Whole Food Plant-Based Diet

Whole Food Plant-Based Diet

By Julia Pangalangan

The Standard American diet contributes significantly to risk of disease, mortality, and morbidity in the United States. In contrast, dietary patterns emphasizing a whole food, plant-based approach to eating promotes health and longevity. A whole food, plant-based (WFPB) dietary pattern involves consuming a variety of vegetables, legumes, nuts, seeds, fruits, mushrooms, herbs, and grains. A plant-based approach can be difficult to implement, but even small, incremental changes can be extremely impactful. Increasing intake of minimally processed foods can help to prevent and manage chronic diseases. A plant-forward approach to eating is not a diet, but a lifestyle to move towards. 

Dr. Marily Oppezzo, RD, PhD is an educational psychologist at Stanford University and her research focuses on behavioral approaches to improve health and well-being. I was able to sit down with Dr. Oppezzo to discuss why this type of eating is so challenging for most of us. She used her expertise as a behavioral and learning scientist and her experience as a registered dietician to share helpful insights. 

Firstly, Dr. Oppezzo emphasizes that following a plant-forward approach does not require you to become a vegan or a vegetarian. After all, some vegan foods require a lot of processing and highly processed foods are typically higher in sodium, saturated fat, and sugar. Instead, think about food with minimal processing like homemade maple-glazed carrots or a veggie stir-fry. Dr. Oppezzo would suggest a plate rich in diverse vegetables and whole grains even if that plate also includes chicken. As Americans, we are used to the western diet which is high in meat and prepackaged food, but substituting these for plants and whole grains can have tremendous benefits for our health.

Many people want to change their eating patterns, but change can be hard when the typical western diet has been made so easy. However, making a sustained effort to increase whole foods in one’s diet may help individuals with a variety of health concerns. For instance, an individual may feel their energy is plateauing throughout the day. Another may notice their blood pressure creeping higher at every doctor’s appointment. For some, they already have a chronic disease diagnosis, and they want to manage it well. Despite the large amount of scientific evidence highlighting the potential health benefits of a WFPB diet, making these changes can come with a variety of roadblocks. Dr. Oppezzo believes one major reason for this is because of the continuous flood of marketing campaigns and fad diets. “Dump butter in your coffee, bacon is back, and lose 2 pant sizes by summer,” Dr. Oppezzo listed as she considered all of the dietary claims she has heard. In comparison to these marketing claims, choosing less processed and more green things and making moderate changes rather than drastic ones is quite boring. These phrases and advertisements are made to be alluring but they lack the research backing of a plant-predominant dietary pattern and may lead to unsustainable eating habits. Aesthetic-based fad-diets, supplements, and detoxes are prevalent in marketing, and media often emphasizes visual changes as markers for health instead of how your body and mind feel. A plant-forward diet instead helps you meet your energy needs, tastes delicious, and has been scientifically proven to increase your overall health, longevity, and to help you feel your best.

Moreover, many fad diets tend to leave individuals feeling depleted. These diets often rely on an all or nothing approach — where one must cut out entire food groups and restrict calories. In contrast, a plant-predominant eating pattern is not a diet change but a lifestyle change. To get started, instead of banning all carbs and eliminating all of your favorite foods, Dr. Oppezzo recommends setting up a gradual plan and making one change to your diet per week. Challenge yourself to swap a sugary beverage for herbal tea, remodel your fridge to have the fruits and vegetables front and center, or add one new nutritious food to your grocery list. 

Furthermore, Dr. Oppezzo recommends eating regular meals and snacks to ensure we are meeting our energy needs. If you’re feeling hungry make sure to listen to your body and satisfy that hunger. But, Dr. Oppezzo also recommends being mindful when you are wandering into the snack cabinet if you are bored or upset. This may be a sign that something else is going on such as stress or sleep deprivation. If we can recognize these moments, we can make the choice to call a friend, go for a walk, or engage in something restful instead. 

For more thoughts and tips from a dietician, check out Stanford’s BeWell’s Ask the Dietician.  

 

How to transition to a plant-predominant diet:

  • Set SMART goals: specific, measurable, attainable, relevant, and time-bound.

A plant-based diet can have substantial short-term and long-term benefits. However, it also has its challenges. It is important to identify why it is important to you to eat a plant-based diet. Try to write a few health goals that are personally meaningful to you. How important is it that you accomplish these goals? How will consuming a plant-based diet help you achieve these goals?

Setting SMART Goals — 

Instead of:

“I am going to eat only whole foods from now on. No exceptions!”

 Try:

“I am going to include one vegetable at lunch and one at dinner on the weekdays.”

 

This goal is specific, easy to measure, achievable given a busy lifestyle, and has a time associated.

 

  • Address the built environment

Our environment influences our decisions and behaviors. It is essential to set up your environment for success. This is particularly important when we are tired and stressed. When you come home from a long day and open the fridge, do you see ready-to-eat veggies and dip? Do you find an empty fridge and immediately open DoorDash? Do you rummage through the pantry to grab a bag of chips or crackers?

If we have set up our environment for success, we can make the healthy choice the easy choice. Here are some ideas for how to set up your environment for success:

  1. Stock up on the good stuff: Make sure to have lots of your favorite fruits and veggies available for the week. Frozen or canned produce are great to have on hand because they are inexpensive, and they last a long time. Lentils, beans, and chickpeas are a wonderful source of plant-based protein that can be added to make any meal more satisfying. 
  2. Enjoy your favorite meals: You don’t need to buy the latest vegan cookbook. You may be surprised how easy it is to make your favorite meals plant-based! Try using Dr. Oppezzo’s one change strategy. Consider a meal you regularly make and then add a vegetable or swap a refined grain for a whole grain.
  3. Make a plan: A plant-based diet can feel overwhelming when we are hungry or short on time. Write a list of easy, quick meals that you feel confident you can make at any time. You can save time by planning to make extra of your meals so you can use them for lunches throughout the week. It can also be helpful to have a list of healthy take-out options

 

  • It’s a group effort (rely on support, talk to loved ones, seek a community of like-minded individuals)

It can feel hard to eat well if those around you do not. Who in your life is supportive of your desire to eat healthy? If you haven’t already, have a conversation with your loved ones to let them know about your health goals. If you feel that you need more support, try joining groups on Facebook . You can also look for groups at gyms and community centers. 

If you are involved at Stanford, check out the BeWell  program resources. If you are not affiliated with Stanford, check to see if your employer offers any wellness programs.  

 

  • Focus on what you get to eat

Many people are hesitant to begin a whole food, plant-based approach because of all of the foods they will have to give up. Instead of dwelling on what you are trying to eat less of, consider all that you get to eat in a day. Try using Dr. Gregor’s “Daily Dozen” as a self checklist. He includes foods like beans, berries, cruciferous vegetables, nuts, and spices. Challenge yourself to add in one new food each week. When you’re trying to eat more items from the Daily Dozen, you won’t be so consumed with the foods you are eating less of. It is less about restricting “bad” foods — It is more about trying to increase your intake of healthful and nourishing foods. 

 

  • Keep it simple (easy and quick staple recipes that you can have on rotation)

Eating a plant-based diet does not mean making fancy new recipes every night or buying expensive green juice and Impossible burgers. It is critical to find what works well for you. Again, what meals do you and your family enjoy? Can you add a new vegetable to that meal? What would it look like to swap a refined grain for a whole grain source?

If you are looking to try some new recipes, there are plenty of wonderful resources. Stanford’s BeWell program has several great suggestions. I also love Forks Over Knives and Ornish Lifestyle Medicine.  

 

It is not important that we have the perfect diet, but that we have a diet that fuels us and makes us feel our best. Through introducing more whole and plant -based foods into your diet you can make sustainable changes towards a healthier you. Each meal we eat is a new chance to make a healthy decision for our long-term health. A whole food, plant-based eating pattern is not a diet. It is a lifestyle change to promote quality of life and longevity.

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