When most people worry about getting old, they focus on the obvious degenerative diseases like diabetes and cancer and Alzheimer’s or the catastrophic health emergencies that can occur, like strokes or heart attacks. They think about the melange of medicines they might have to take, the panicked rush to the ER in the dead of night, the slow but unmistakable descent into painful oblivion. But one of the deadliest health conditions afflicting older adults is also one of the most silent and unknown: sarcopenia, or the degeneration and loss of muscle mass and strength.
People just don’t think about losing muscle mass and strength as they get older. If they do, they assume it’s just part of the aging process. They figure it’s unavoidable, because, after all, everyone around them just gets weaker and more decrepit as they age. It’s one of those “inevitabilities” that you “just have to accept.”
Muscle loss is not your destiny. You don’t have to sit there and take it. In fact, sitting there and taking it is the single best way to get sarcopenia; standing up and fighting is the single best way to avoid it. Plus, taking the necessary steps to mitigate or even prevent sarcopenia will help prevent all those other age-related maladies I mentioned in the opening paragraph.
Health Problems Related to Muscle Atrophy, or Muscle Loss
Sarcopenia the specific condition is linked to a number of poor health outcomes:1
3.5x higher risk of mortality
3x higher risk of functional decline
Greater risk of falls
Higher chance of hospitalization
Muscle itself is a powerful endocrine organ, emitting hormonal messages that regulate metabolism, inflammation, and overall function.
Muscle also provides a metabolic reservoir for support and recovery from physical trauma—injuries, wounds, damage to our tissues. When muscle mass drops to extremely low levels, it means you’re not only more likely to be hospitalized, you’re more likely to never make it out of that hospital bed.
Worse still, sarcopenia isn’t just loss of muscle2:
It’s degradation of the muscle tissue.
It’s conversion from fast-twitch Type 2 muscle fibers that can handle heavy loads and high intensity to slow-twitch Type 1 muscle fibers that can only handle lighter loads and lower intensities.
It’s the loss of motor units at the muscle itself, forcing the few remaining motor units to pick up the slack and extending recovery times.
It’s the loss of cardiac strength, which impairs cardiovascular function and lowers VO2max.
It’s the impairment of tendon function, reducing strength and mobility and increasing the risk of injury.
The European Working Group diagnoses sarcopenia if you have two of three conditions:3
Low muscle mass
Low muscle strength
Poor physical performance (walking speed, for example)
Even if you don’t have full-blown sarcopenia, you may have “pre-sarcopenia.” Millions of people are walking around (or, rather, shuffling around) with lower-than-ideal muscle mass and strength. Today’s post applies to them, too.
So whether you’re looking at the clinical condition or simply the reduction in muscle mass and strength, you must stave off sarcopenia if you hope to live a healthy, happy, productive life.
Sarcopenia Treatments You Can Do At Home
Let’s be clear about something. Sarcopenia is usually “age-related,” but it doesn’t have to be. Sarcopenia is any muscle loss or degeneration resulting from disuse. Immobility—wearing a cast, being on bed rest, leading a totally sedentary life—can trigger sarcopenia too. “Age-related” sarcopenia also ultimately comes down to disuse; the age thing makes the effect stronger.
This is good news. If immobility causes sarcopenia, mobility should help prevent it. If disuse of the muscles causes muscle wasting, use of them will prevent it. These are all within your grasp.
Okay, so how do you fight it?
Lift Heavy Things
Strength training has to come first because it’s the direct refutation of sarcopenia’s pull. When you contradict gravity, your muscles do work and sarcopenia loses. When you acquiesce to gravity, your muscles do nothing and sarcopenia wins.
Many studies show that seniors can actually gain and not just maintain lean mass through resistance training:
Even immediately after hip surgery, the elderly can utilize resistance training to put on lean mass.4
In elderly women, resistance training induces hypertrophy and lowers inflammation.5
Stroke survivors (aged 50-76) were able to enjoy significant hypertrophy with strength training.6
Even in subjects older than 80, strength training seems to counter the effects of sarcopenia.7
If senior citizens can build muscle by lifting heavy things, sarcopenia doesn’t stand a chance.
Eat More Protein
Seniors have poorer “protein efficiency” than the general population. To get the same amount of muscle protein synthesis, they need to eat a lot more protein than younger people. Recent studies indicate that a protein intake of at least 1.0-1.3 g protein/kg bodyweight or 0.5-0.6 g protein/lb bodyweight is more suitable for the healthy and frail elderly to ensure nitrogen balance.8 Even more may be needed, since attaining nitrogen balance isn’t necessarily optimal. 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.9
Vitamin D is vital for fighting sarcopenia. Assuming you’re deficient in it, and many older people are, taking it boosts testosterone production and improves sarcopenia outcomes—particularly in women.1011
Sunlight is also vital for the increased nitric oxide production, which tends to plummet in and contribute to sarcopenia by impairing muscle protein synthesis.12
Normally I’d favor just sunlight, but the potential for impaired vitamin D production in older adults makes supplementation plus sun a wise choice.
Check Your Hormone Levels
For older men, low testosterone is a huge risk factor for sarcopenia. Inadequate testosterone makes building and retaining lean muscle mass harder than it should be, so even if you strength train and eat extra protein to fight sarcopenia, you get subpar results. Optimize your T levels, whether through natural means or, if required, supplemental.13
Women need testosterone too, in lower amounts, so it’s a good idea to check levels. In older women, using hormone replacement therapy is also linked to a lower risk of sarcopenia.14
Get a Handle on Inflammation
Patients with sarcopenia tend to have higher baseline levels of inflammation.15 In older women, for example, higher levels of the inflammatory cytokine IL-6, was linked to reduced strength and walking speed.16
Eat plenty of seafood and fish oil while avoiding seed oils to balance out your inflammatory precursors.
Recover from your workouts with adequate protein and calories and fat.
Don’t overeat too much. Not only is overeating on a regular basis inflammatory, it can increase intramuscular levels of fat in the muscles which degrade their function and exacerbate the sarcopenia.
Lose Body Fat
For years, researchers assumed the causality went sarcopenia—->obesity. Makes sense on some level. The weaker and more frail you are, the less you’re able to get enough physical activity to stay fit and trim. But the latest research suggests the causality runs the other way: excess adipose tissue secretes inflammatory adipokines which impair muscle function and structure.17 Obesity causing sarcopenia is looking a lot more likely.
The biggest drops typically start after age 50, with strength and muscle mass declining by 1-2% annually thereafter. What you don’t want to do is wait until you’re 50 years old to start trying to counteract the sarcopenia. You want to go into middle age with as much muscle as you can build so that you’re starting your “decline” (if it even happens) from a higher baseline.
Do everything I suggest before it becomes a problem.
That’s about it for today, folks. Follow these recommendations and you should reduce your chance of developing sarcopenia. And if you already have it, following them becomes even more crucial—as long as you check things over with your doctor first, of course.
Take care, everyone. Let me know down below if you have any experience dealing with sarcopenia. If so, what worked? What didn’t?
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.