Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time

For this week’s edition of Dear Mark, I’m answering three questions from readers. First, is the reduced protein efficiency in older adults due to inactivity, or is it something inherent to the aging process, or both? Second, how does a person know if they’ve actually “earned” any carbs? Does everyone on a keto diet earn carbs by virtue of exercising, or is there more to it? And finally, how can a hardgainer with a packed schedule all week long and limited gym time maintain what little muscle mass he’s managed to gain?

Let’s find out:

Interesting observation on protein needs and training in Sunday with Sisson – general consensus is that older folks need more protein as they age but maybe that’s because they are less active and not simply a result of aging.

That’s probably part of it, but it’s not all of it.

In studies where they compare resistance training seniors who eat extra protein with resistance training seniors who don’t, only the seniors eating extra protein gain muscle mass.

Now, it may be that a lifetime of inactivity degrades your ability to utilize protein, and if these older adults had always lifted weights they would have retained their protein efficiency. But maybe not. As it stands, all else being equal, an older adult needs more protein to get the same effect, even if he or she is lifting weights.

Enjoyable read. As someone who lives a ketogenic lifestyle, and who is athletically active, I am not sure exactly how to go about consuming the carbs I’ve “earned.” I rarely run into problems with athletic energy, at least not below anaerobic threshold. Not sure that eating more carbs will improve my performance. And, if they would improve my performance, how does one go about calculating earned carb replacement without losing the fat burning benefits of ketosis?

It sounds like you’re in a good place.

When I say “eat the carbs you earn,” I’m talking to the people who do run into problems with athletic energy, poor performance, insomnia, and other symptoms of exercise-induced stress. Typically, the people who “earn their carbs” are doing stuff like CrossFit, high volume moderate-to-high intensity endurance work, martial arts training, and team sports.

I doubt extra carbs will improve your performance if most of your training takes place in the aerobic zone. But if you wanted to experiment, you could try a small sweet potato immediately after a workout where you passed the anaerobic threshold.

That’s the best way to determine if you’ve earned carbs. Eat 20-30 grams after a workout and see if you enjoy performance gains without gaining body fat. There’s no consumer-friendly way to directly calculate carb debt; self-experimentation is it.

I recently took a job that has me out of bed at 4am and not home until 6pm Monday Through Friday. Is there an efficient way I can maintain muscle mass only lifting weights Saturday and Sunday? I’m a hardgainer at 5’10” and only 140lbs. I’m afraid giving up my 5 day split will ruin what muscle I’ve been able to gain.

Any hardgainer has to eat, and eat, and eat. Increase your food intake. Just eat. Stick to healthy Primal fare, but pack in the food. Meat, milk, veggies, potatoes, rice, eggs, avocados, fruit. Throw some liver in, too (old bodybuilder staple). It doesn’t sound like fat gain is an issue for you, so I’d take advantage of that and just consume calories.

As for training, get some exercise snacks in during the week.

As soon as you wake up, do a quick superset of pushups. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. There you go. That shouldn’t take more than 5 minutes in the morning. Can you squeeze that in?

Repeat this every morning with a different exercise. Pullups, bodyweight rows, kettlebell swings, handstand pushups, dips, bodyweight squats, goblet squats, reverse lunges, reverse weighted lunges. Just choose one thing to do every morning, cram as many reps as you can using the same format (max reps, 30 s rest, max reps, 30 s rest, max reps). Buy any equipment you can if you choose to use weights.

When you get home at night, do the same thing with a different exercise. Morning pushups, evening KB swings, etc. That way, you get about 10 minutes per weekday of intense strength training without impacting your sleep or schedule in any real meaningful way.

Make sure your sleep hygiene is rock solid. Dim those lights at night, turn on f.lux or night mode, wear the blue blocking goggles, get to bed (ideally) by 8:30, 9 to give you 7 to 7.5 hours of sleep. Sleep is essential for gaining lean mass (and staying healthy in general).

On the weekend, hit the weights hard on both days, hitting the entire body. Go high volume/reps. If size is your goal, dropping the weight a bit and focusing on range of motion and a high rep count (10-15 per set) is very effective.

Food, sleep, reps. Good luck!

Thanks for stopping in today, everybody. Additional thoughts for these folks—or questions of your own? Share them below.


Tieland M, Dirks ML, Van der zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-9.

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About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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19 thoughts on “Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time”

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  1. When a person is elderly, the last thing they care about is whether they should eat 75g of protein or 110g of protein a day.

    Trying to fit an elderly person into someone else’s idea of health is really cruel. I’ve seen what happens when a parent is cared for in a “facility” and the mistaken mainstream ideas of health are used. Like my FIL who has memory problems, and was placed on a statin, and then ordered to eat a low fat diet. I consider that to be assault.

    The game changes once a person starts being incapable of much activity. And eventually that comes to us all. I just hope I meet it with half the calmness I’ve seen in family members. The best thing the health community could do is institutionalize hands-off care of elders in “facilities.” If one thing has been proven by the diet wars, it’s that nobody’s fully right, and the reason is probably because individual differences matter.

    I happen to think that a keto diet would really help my FIL, but he loves cookies, it’s something he is given multiple times a day by his wife, and it’s an act of love. I would never tell him to quit cookies in the last couple years of his life. It would be unimaginably cruel. The reverse, will hopefully be true when I’m old and a nurse says, “I may not agree, but I’ll make you deviled eggs regularly.”

    1. I disagree. While my 76yo Mom would “rather be sick” [her exact words] than get off the couch or stop eating ice cream, her 76yo companion has changed a lot of habits after being exposed to the primal message, the podcasts I listen to, and a book or two. He would rather know to eat more protein and try to do that.

      Let’s face it, the vast majority of people are in these homes because they eat crap and have insufficient physical activity. Why is that? Well, most never even got the message that strength exercises, activity, protein, and nutrients were important. Instead, they think they are healthy because they are drinking fruit juice and eating oatmeal and a low fat cookie for breakfast. Now, we can let people know you need more protein as you age to help retain lean muscle mass which will help keep you out of the old age home. Of course not all will listen, but many will.

      My family (husband, daughter, me) has been primal for over 7 years after a couple of deaths in the family; I’m 51. With each passing decade, there will be more and more elderly who got the message soon enough so they can live a life without going to the home. They will be mowing the lawn at 94 and drop dead a few days later. That’s the goal.

      1. Your experience is different from mine, that’s ok, but this sentence you wrote is not ok with me: “Let’s face it, the vast majority of people are in these homes because they eat crap and have insufficient physical activity.”

        Um, no, my inlaws were not inactive at all and kept a garden up by themselves until their mid 80s. Whether they ate crap is a widely debated topic and I won’t bother to debate it, but their health didn’t decline until their 80s and I consider that good. But the reason people in “these homes” is because their relatives live lives that don’t allow them to live with family, as they would in any other country, even most European countries. Also, “these homes” force them to live a non keto life and force them to take drugs they don’t want. Neither of which is under their control once they are there.

        1. I hear you, Angelica! My mother is 96 with such advanced dementia she cannot use her legs. If I can get her to smile by making her cupcakes, I will do it! She raised vegetables in our home garden all through my home life, and cooked and ate a balanced, healthy diet. But in this end game, any pleasure is a wonderful thing.

        2. Well, it’s a choice to put people in the home and give them drugs. It’s a sacrifice to do otherwise. Getting back to the Main issue, the majority are in homes based on their own behavior, let’s educate younger people now to avoid future problems. I don’t give my kid a cookie so she has a smile, why poison an elder? Sure, the Titanic is sinking in the 90yo, but the disaster can be averted in much of the population, you’re just feeding into the mentality of these homes instead of working to make them obsolete.

    2. The act of love could change. It could be making steak or another meat or a vegetable instead. Carbs and statins are not good for you if you have mental decline.

      While I think individual differences matter, in general, moving away from sugar and seed oils will benefit everyone. There is no one who needs to eat sugar or seed oils. Can you have them as (infrequent) treats? Sure. But they should not be daily.

      As a person getting older, I started on low carb (what would be called primal) over 5 years ago. I’ve tried higher fat and higher protein versions, and I prefer the higher protein version. Protein is filling to me, whereas fat is not. I’ve also used a continuous glucose monitor (FreeStyle Libre) and tried to eat massive amounts of protein per meal (80+, 120+, 150+ grams per MEAL) to see what would happen to my blood sugar. I could find no effects. NOTE: this is not true for everyone, as Jimmy Moore gets hypoglycemia if he has too much protein. For me, however, I find higher protein is better.

      1. We did our part, my husband and I for a while when they decided to leave their care facility. During that time, we helped my MIL to recover from horrible neglect at the facility. Her skin was breaking down because they didn’t bathe her, she was having a bad reaction to a drug… etc. I didn’t know I was celiac yet so my “gluten free” home wasn’t cleaned of all gluten, but it was a low gluten experience for her. We restored the good fats in her diet. But ultimately, we knew she might die in the next few months, so we made her grilled cheese if that’s what she wanted. Can you imagine being denied your favorite food?

        At this time, if she wanted to cook a steak, she’d need to negotiate an oxygen tank and a walker around the kitchen. She hasn’t cooked anything in over 5 years. Also, my FIL is to far gone to understand it if you start talking to him about anything, much less try to tell him to eat different. For the last few years of his life he’d be asking you “can I have a cookie?” and not understanding the answer. If that’s not cruel, I don’t know what is.

        Do you really expect people to become healthy and active by switching to the Primal lifestyle in their 90s? It’s a pretty extreme health expectation.

        1. Would you give the in-laws heroin? I don’t see much difference. You’re way off the main point, let 50, 60, 70 somethings know of increased protein needs and the importance of muscle mass to avoid the parade of horribles. If you look forward to that, by all means put your head in the sand and avoid the main point.

    3. This doesn’t make sense. I don’t give my 97 year old grandmother very much sugar *because* I love her . I want her to reach 100. She has all her teeth too but that would change if she ate sugar nonstop like she wants too. It’s a stress reaction to eat sugar. Not a necessity.

  2. With the older people in our lives it would be great if we could feed them a better diet than the SAD (or high carb/low fat) but……. there comes a time when we have to let them eat what they want. My mom did well on a high fat/moderate protein diet, however, her mind was deteriorating and some days she didn’t like even her favorite foods. She loved candy so we’d hide it but get the “bite size” so if she really wanted some it wouldn’t give her a crash later. My dad, on the other hand, thinks that oatmeal is a gift from God and would love to eat it every day, all day long – we don’t let him get away with that, he has to eat some protein every day. At 94 he’s pretty set on what he’s going to do and NOT do for sure.
    My FIL is living in an assisted living facility, very nice one. However, when we eat meals there with him it’s all prepared foods, no real fresh food choices – SAD for sure but most of the residents like that kind of food. It’s not an easy thing to change, maybe if we started before they all turned 85? Perhaps.

  3. 2Rae, “my Dad thinks oatmeal is a gift from God”, and he is 94? Hmm…….some kind of lesson there, I think. Maybe oatmeal isn’t the worst thing a person can eat?

    1. That’s funny. It’s ok for him, however, he suffers from OCD (squared) (eye roll). His mental state suffers from not enough fat but he’s pretty set on what he’s NOT going to do and that’s eat any fat, it makes you fat don’t cha know. (another eye roll)

  4. For a fellow hardgainer, also with limited time (…and who is not a fan of gyms), in addition to Mark’s routine I recommend the X3 Bar. You get a lot of bang for your buck with a short (usually less than 10 minute) workout. It’s very effective and can be done at home.

  5. I wonder if maybe the elderly’s “inefficiency” of Protein Metabolism is actually nature’s built in protection mechanism to lower MTOR. Hmmmmmmm…. 🙂

  6. I’m a hard gainer too. 138 pounds at 5′ 11″. I’m very active. This time of year I’m doing a fair amount of nordic backcountry skiing where I live in the Colorado mountains.

    My wife and I started eating primitive for the overall health benefits, not weight loss (obviously). Still, I quickly lost a little weight, dropping from 155 lbs to my current weight of 138 lbs.

    I eat a lot of food. Three big meals a day plus snacks at work and after workouts. Meat, oils, eggs, fruit, potatoes (regular and sweet potatoes), veggies, greens, avocado, honey, nuts.

    I’ve just brought dairy back into my diet, which I tolerate very well, and am hoping that some milk and yogurt daily will help me get to 150 lbs. I have been doing primal strength workouts (squats, pushups, planks, chinups) , and I’m going to start doing the supersets Mark mentioned in addition to some squats and deadlifts with weights.

    I’m going to see how the dairy works for a couple weeks and then bring rice back into the diet if needed.

    I guess it’s a good problem to have.

  7. I’m definitely in the hardgainers category. How do you go about “packing in the food” when you can’t seem to fit it all in your stomach comfortably?

  8. The study referenced in the seniors and protein efficiency discussion pertains to the frail elderly – wonder if increased protein needs also pertain to healthy elderly.

  9. When you say, as soon as you wake up, do a quick superset of pushups – doesn’t it require a warm-up session beforehand? Can you really do them right away, as soon as you get out of bed? Is a warm-up not always essential?

    1. I don’t think exercise as soon as you wake up is good for the heart. In fact, I don’t think anyone should jump out of bed as soon as the alarm goes off. Wake up gently to soothing alarms, like birds chirping, think about your day in positive terms, practice a short gratitude meditation, then get up and expose yourself to sunshine and a drink of warm water. Stretch lightly. Only then is your body ready for whatever the day brings.