Hi. It’s Dr. Connie.
Last week I spoke about the importance of movement. Not just any movement, but safe movement to ensure you keep your joints and muscles safe.
I blogged about the importance of muscle mass for our health and longevity a while back. Click here to read it.
As I emphasized in this blog, muscles are the largest organ in our body and they’re important for our metabolism. Because after all, if we don’t move, we can’t function.
The problem is that we take our muscles for granted and many of us move only when absolutely necessary. We’ve gotten lazy in this convenient world of technology.
Today I want to talk about sarcopenia.
What is Sarcopenia?
Sarcopenia is the muscle loss related to aging. It may start developing slowly in your thirties and continue to progress rapidly as you get older.
Because sarcopenia is not something we routinely measure, in the medical world, it’s just accepted that we get weaker as we grow older.
But the problem is that muscle mass is fundamental to health and longevity and if we don’t use it, we lose it.
Loss of muscle mass is a critical factor in health decline in older populations because it’s progressive.
Sarcopenia affects our functional ability in the following ways:
- With a loss of muscle comes a loss of strength and endurance
- It becomes difficult to perform normal functional activities, like climbing stairs and getting in and out of the bed and the car
- It leads to falls and serious injuries, including broken bones
- When injuries occur, it takes longer to heal
- Surgeries may cause more complications due to increased potential for infection
Unless measures are taken to stop it, sarcopenia may lead to prolonged hospitalizations, nursing homes, and possibly even death.
I know it’s hard to fathom but for many of you with aging parents, this hits you hard as you witness the decline in your parents.
Anabolism and Catabolism
When talking about muscles, it’s important to discuss the building of muscles (anabolism) vs breaking down of muscles (catabolism).
Our bodies are constantly remodeling. We build and rebuild molecules, break down old cells and tissues to make way for the new, and detoxify the broken down cells.
When we are younger, our body’s ability to build (anabolism) exceeds the rate of break down (catabolism).
It’s important to note that there are multiple factors that contribute to higher rates of catabolism than anabolism as we age:
- Changes in neurochemistry
- Hormone imbalances
- Production of inflammatory cytokines (cells produced by the immune system that act on other cells)
- Gut permeability
- Chronic stress
- Environmental toxins
- Sedentary lifestyle
Muscle is made up of many different cell types.
One particular cell, the satellite cell, is not active unless there is some stimulus, either from injury to the muscle or from the environment, carried in the blood stream. When activated, these satellite cells become new muscle cells.
Satellite cells are important because they have receptors that respond to estrogens and testosterone. This is another reason why we tend to have shrinking of muscle mass as we get older.
Estradiol and Testosterone
We know that sarcopenia develops with the decline of sex hormones. There’s also studies to support that estrogen has beneficial effects on muscle strength.
Most muscle cell types have receptors for testosterone, but testosterone receptors predominate in satellite cells.
Replacing testosterone increases the number of satellite cells. Also, this directly prevents inflammation in our bodies.
Higher testosterone levels contribute to increased strength and mass. Since women generally have less testosterone than men, this might explain why women tend to develop sarcopenia at twice the rate as men.
DHEA and Human Growth Hormone
Adrenal DHEA, another androgen, also declines with age. This decline may affect muscle strength through a number of mechanisms.
First of all, DHEA is converted to estrogens and testosterone in the body, which may have a direct effect on receptors.
Also, DHEA increases sensitivity to insulin, another anabolic hormone, which may also increase levels of growth hormone. Studies show that growth hormone increases muscle mass.
Aging Frailty Triad
In their article “Frailty and the Older Man”, Drs. Jeremy Walston and Linda Fried proposed looking at the concept of frailty in the elderly as a triad:
1. With aging, the hypothalamic responses to stress change, cortisol levels increase, and the signals to produce sex hormones and growth hormone decline
2. The immune system is affected, producing fewer antibodies and more inflammatory cytokines
3. Both of these effects contribute to sarcopenia
Key point is that all three systems are interdependent: the endocrine system, the immune system, and the muscular system participate together in a spiral of decline.
Health is wealth. Maintaining the health of the body requires collaboration between various factors.
Furthermore, our awareness of these factors provides us with the tools to slow aging by optimizing and leveraging our resources to promote strong bodies. Such factors include:
- Eating a healthy, whole foods diet and promoting healing for our digestive tract
- Enhancing our metabolic processes and detoxification with essential vitamins and minerals
- Minimizing environmental toxic exposure
In addition to these factors, our health is significantly affected by our hormones. Sarcopenia is an example of how hormone deficiencies hinder us from achieving optimal health.
Fortunately, our commitment to our own health allows us to slow the inevitable decline as we age and stave off the effects of sarcopenia and other age-related conditions.
A simple validated questionnaire, FRAIL, can be used to screen for sarcopenia. If you answer “yes” to three or more of the following, you are considered “frail”, which is potentially indicative of sarcopenia.
1. Fatigue: Did you feel tired all or most of the time in the last 4 weeks?
2. Resistance: Can you walk up 10 steps without resting?
3. Ambulation: Can you walk several hundred yards?
4. Illnesses: Do you have more than four illnesses?
5. Loss of weight: Have you lost 5% of your normal weight in the last year?
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La Colla A, et al. 17 Beta Estradiol and testosterone in sarcopenia: Role of satellite cells. Aging ResRev. 2015 Nov:24(Pt B): 166-177. doi: 10.1016/j.arr.2015.07.011. Epub 2015 Aug 3.
Health Sciences Institute. This hidden disease will land you in a nursing home. February 2016 (20) 6.
Walston J, Fried L. Frailty and the Older Man. Med Clin North Am. 1999 Sept;83(5):1173-1193.
Balagopal P, Proctor D, Nair KS. Sarcopenia and Hormonal Changes. Endocr. (1997) 7:57-60. https://doi.org/10.1007/BF0277
Morley JE, Malmstrom TK. Frailty, Sarcopenia, and Hormones. Endocrinol Metabl Clin N Am. (2013)42:391-405. https://doi.org/10.1016/j.ecl.
Morley JE, Malstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012 Jul;16(7):601-8.