Sarcopenia and osteoporosis

A few days ago, people were shocked to hear about the news how some nursing homes announced a new policy in which they would start to diminish food portions for their inhabitants because they wanted to prevent excessive waste.
Of course, I was angry as well about this policy, but actually not as much about the plan to weigh portions but about the other announcement which barely received any attention: they would change to vegetable soup rather than the usual chicken soup or tomato soup with meat balls.
Both of us shaked our head and I said: "They are crazy! Look at your father! He's already so weak after having been ill, he can even barely sit up! The last thing he needs is being fed less protein!"

Everyone including old people need both exercise as well as protein to make sure their muscles keep functioning in good order. Once we grow older, we move less and get sick more often. Each time we are sick, we are not moving as much as we are used to, which will result in muscle loss even when we are still eating.
Since most of us will spontaneously fast, we are losing muscle mass even faster. Yours truly saw this happen when I suffered from a bout of food poisoning and subsequently was struck with pneumonia mid-December causing me to skip gym, not just for myself but also to not infect other people.

Once I wasn't sick anymore, I went back to the gym along with many others with good intentions. Sadly, while strength training is so important at our age, only a a small minority of gym-goers are over 50 years old. Apart from eating enough protein and calories so that lost muscles come back , I'm also relying on creatine and HMB as 'secret weapons'.

But let's talk about sarcopenia first. What is it and why is it dangerous for your health?

What is sarcopenia?

Sarcopenia literally means “lack of flesh.” It’s a condition of age-associated muscle degeneration that becomes more common in people over the age of 50.
After middle age, adults lose 3% of their muscle strength every year, on average. This limits their ability to perform many routine activities.
Unfortunately, sarcopenia also shortens life expectancy in those it affects, compared to individuals with normal muscle strength.
Sarcopenia is caused by an imbalance between signals for muscle cell growth and signals for teardown. Cell growth processes are called “anabolism,” and cell teardown processes are called “catabolism”.
For example, growth hormones act with protein-destroying enzymes to keep muscle steady through a cycle of growth, stress or injury, destruction and then healing.
This cycle is always occurring, and when things are in balance, muscle keeps its strength over time.
However, during aging, the body becomes resistant to the normal growth signals, tipping the balance toward catabolism and muscle loss.

Your body normally keeps signals for growth and teardown in balance. As you age, your body becomes resistant to growth signals, resulting in muscle loss.

What factors accelerate muscle loss?

Although aging is the most common cause of sarcopenia, other factors can also trigger an imbalance between muscle anabolism and catabolism.

1. Immobility, including a sedentary lifestyle

Disuse of muscle is one of the strongest triggers of sarcopenia, leading to faster muscle loss and increasing weakness.
Bed rest or immobilization after an injury or illness leads to rapid loss of muscle.
Although less dramatic, two to three weeks of decreased walking and other regular activity is also enough to decrease muscle mass and strength.
Periods of decreased activity can become a vicious cycle. Muscle strength decreases, resulting in greater fatigue and making it more difficult to return to normal activity.

2. Unbalanced diet

A diet providing insufficient calories and protein results in weight loss and diminished muscle mass.
Unfortunately, low-calorie and low-protein diets become more common with aging, due to changes in sense of taste, problems with the teeth, gums and swallowing, or increased difficulty shopping and cooking.
To help prevent sarcopenia, scientists recommend consuming 25–30 grams of protein at each meal.

3. Inflammation

After injury or illness, inflammation sends signals to the body to tear down and then rebuild the damaged groups of cells.
Chronic or long-term diseases can also result in inflammation that disrupts the normal balance of teardown and healing, resulting in muscle loss.
For example, a study of patients with long-term inflammation resulting from chronic obstructive pulmonary disease (COPD) also showed that patients had decreased muscle mass.
Examples of other diseases that cause long-term inflammation include rheumatoid arthritis, inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, lupus, vasculitis, severe burns and chronic infections like tuberculosis.
A study of over ten thousand older adults found that blood levels of C-reactive protein, an indicator of inflammation, strongly predicted sarcopenia.

4. Severe stress

Sarcopenia is also more common in a number of other health conditions that increase stress on the body.
For example, people with chronic liver disease, and up to 20% of people with chronic heart failure, experience sarcopenia.
In chronic kidney disease, stress on the body and decreased activity lead to muscle loss.
Cancer and cancer treatments also place great stress on the body, resulting in sarcopenia.

To summarize: In addition to aging, sarcopenia is accelerated by low physical activity, insufficient calorie and protein intake, inflammation and stress.

How can you recognize sarcopenia?

The signs of sarcopenia are the result of diminished muscle strength.
Early signs of sarcopenia include feeling physically weaker over time, and having more difficulty than usual lifting familiar objects.
A hand-grip-strength test has been used to help diagnose sarcopenia in studies, and may be used in some clinics.
Decreased strength might show itself in other ways too, including walking more slowly, becoming exhausted more easily and having less interest in being active.
Losing weight without trying can also be a sign of sarcopenia.
However, these signs can also occur in other medical conditions. Yet if you experience one or more of these and can’t explain why, talk to a health professional.

Exercise can reverse sarcopenia

The strongest way to fight sarcopenia is to keep your muscles active.
Combinations of aerobic exercise, resistance training and balance training can prevent and even reverse muscle loss. At least two to four exercise sessions weekly may be required to achieve these benefits.
All types of exercise are beneficial, but some more than others.

1. Resistance training

Resistance training includes weightlifting, pulling against resistance bands or moving part of the body against gravity.
When you perform resistance exercise, the tension on your muscle fibers results in growth signals that lead to increased strength. Resistance exercise also increases the actions of growth-promoting hormones.
These signals combine to cause muscle cells to grow and repair themselves, both by making new proteins and by turning on special muscle stem cells called “satellite cells,” which reinforce existing muscle.
Thanks to this process, resistance exercise is the most direct way to increase muscle mass and prevent its loss.

2. Fitness training

Sustained exercise that raises your heart rate, including aerobic exercise and endurance training, can also control sarcopenia.
Most studies of aerobic exercise for the treatment or prevention of sarcopenia have also included resistance and flexibility training as part of a combination exercise program.
These combinations have been consistently shown to prevent and reverse sarcopenia, although it is often unclear whether aerobic exercise without resistance training would be as beneficial.

3. Walking

Walking can also prevent and even reverse sarcopenia, and it’s an activity most people can do for free, anywhere they live.
Exercise is the most effective way to reverse sarcopenia. Resistance training is best to increase muscle mass and strength. However, combination exercise programs and walking also fight sarcopenia.

Nutrients that fight sarcopenia

If you’re deficient in calories, protein or certain vitamins and minerals, you may be at higher risk of muscle loss.
However, even if you aren’t deficient, getting higher doses of some key nutrients can promote muscle growth or enhance the benefits of exercise.

1. Protein

Getting protein in your diet directly signals your muscle tissue to build and strengthen.
As people age, their muscles become more resistant to this signal, so they need to consume more protein to increase muscle growth.
For comparison : men over age 70 needed to consume at least 35 grams of protein in each meal to increase muscle mass, whereas young men only needed 15 gram of all essential amino acids, to increase muscle mass.
The amino acid leucine is particularly important for regulating muscle growth. Rich sources of leucine include whey protein, meat, fish and eggs, as well as soy protein isolate.

2. Vitamin D

Vitamin D deficiency is related to sarcopenia.
Taking vitamin D supplements can increase muscle strength and reduce the risk of falling. These benefits have not been seen in all studies, possibly because some research volunteers may have already been getting enough vitamin D.

3. Omega-3 fatty acids

No matter how old you are, consuming omega-3 fatty acids via seafood or supplements will increase your muscle growth.
Part of this benefit may be due to the anti-inflammatory benefits of omega-3 fatty acids. However, research has suggested that omega-3s might also signal muscle growth directly.

4. Creatine

Creatine is a small protein normally made in the liver. Although your body makes enough to prevent you from becoming deficient, creatine in the diet from meat or as a supplement may benefit your muscle growth.
Creatine is probably not beneficial for sarcopenia if used alone, without exercise.

5. Hormone replacement therapy (HRT)

HRT can help to raise lean body mass, decrease abdominal fat, and prevent bone deterioration in women whose hormone levels decrease with menopause. However, the use of HRT is debated because of an increased risk of some cancers and other severe health conditions.

6. Other treatments 

Some other treatments under investigation include

• growth hormone supplements
• testosterone supplements
• hydroxy methylbutyrate (HMB)
• angiotensin converting enzyme (ACE) inhibitors
• medications for the treatment of metabolic syndromes

Now we know what factors influence sarcopenia and how you can combat it with exercise, it's interesting to find out how HMB  can help fight sarcopenia. But before we touch that subject, it is useful to delve a bit more into nutritional deficiencies and its relationship with sarcopenia because it will help you to understand why HMB can be beneficial.

Sarcopenia & osteoporosis: two enemies of aging

Muscle mass and bone density go together. Muscles and bones are anatomically close and are synergistic in function. Done right, and when supported by diet and supplements, exercising muscles also improves bone strength.

Muscle cells become larger with physical stimulation and use, whether it’s hard physical work or strenuous exercise. Bigger, more viable muscle cells integrate better with muscle tissue to form more functional muscle circuits.. That’s why even a skinny kid can become buff with weight training and strenuous physical workouts, and a high protein diet.

Living bone is a type of connective tissue, like muscles and ligaments. Minerals make up 50% of bone; mostly calcium, the other 50% is protein. When you take HMB with BCAAs to increase muscle mass and vitamin D3, you also benefit your bones.

Sarcopenia is the medical term for age-related loss of skeletal muscle resulting in thin extremities and significantly reduced physical performance.

Causes of sarcopenia:

• unhealthy diet
• sedentary lifestyle
• use of glucocorticoid drugs such as prednisone and dexamethasone
• chronic inflammation
• steroid hormone deficiency: testosterone and estrogens
• lack of strenuous activity
• aging

Osteoporosis is a systemic skeletal disease with progressive bone tissue deterioration, leading to fragile bones with an increased risk for spontaneous fractures. Researchers believe there is a shared cause—interconnected biology of bone and muscle—with common metabolic pathways between sarcopenia and osteoporosis. That’s why when you improve muscle mass, you also benefit your bones.

Osteoporosis and sarcopenia share many of the same nutrient deficiencies: vitamin C, vitamin D3, calcium, potassium, zinc, boron, carnosine and protein!

An active lifestyle and healthy diet prevent muscle loss

Exercise matters. An active lifestyle with strenuous physical activity, including resistance training, prevents muscle loss. Gardening, carpentry, and hiking with a backpack are good ways to keep fit and stay strong. Exercises that improve coordination like yoga and tai chi improve the body’s ability to respond to growth signals. But, lifting weights at least twice a week improves muscle mass and tone better than low-impact aerobic exercises.

Diet matters. You have to eat enough food to keep your muscles and bones healthy. Low calorie and vegan diets do not support healthy muscle mass or strong bones without taking a vegetarian protein supplement. Unhealthy choices like consuming too much fat and sugar, not providing enough calcium, inadequate protein, insufficient antioxidants, and low micronutrient levels contribute to sarcopenia and osteoporosis.

To prevent and reverse sarcopenia, eat at least 20 grams of high-quality protein at each meal. Women’s protein requirement is less than men’s, but not by much. To rebuild muscle, you need more protein. Eat at least 30 grams of high-quality protein per meal. That may not seem like a lot but consider that one large egg has 6 grams of protein. Yogurt has about 20 grams per serving, making the right choice if you’re not dairy sensitive.

A serving of fish or shellfish beat eggs and yogurt, but not by much. Organically raised poultry or grass-fed beef provide the most protein per serving. Grass-fed beef is 95% lean and provides 24 grams per 115 gram serving.

Proteins for vegetarians

For vegetarians, protein choices include legumes like black beans, plus grains, seeds, and nuts. The healthiest vegetarians eat a lot of food, especially grains and legumes. Quinoa is a good choice with 14 grams of protein per 100 gram and contains all nine essential amino acids.

Quinoa (Chenopodium quinoa) is not a cereal grain like oats, wheat, or corn. It’s a flowering plant related to spinach, beets, and amaranth. But you can call it a “grain” without being wrong.

Researchers found it’s not only about the total protein you eat, but in particular, it’s the amino acid leucine that helps restore muscle loss. Leucine is a branch chain amino acid (BCAAs) and the primary regulator of muscle growth. It’s easy to gain muscle when you’re young—however, the body’s ability to synthesize leucine declines with age.

Supplementing with leucine may be oversimplifying muscle biology and the treatment of sarcopenia, but improving leucine levels will help muscle mass if you also do resistance training. However, there’s more to the leucine theory.

The leucine paradox

A 2006 study proposed taking an amino acid supplement with higher leucine. But other studies have shown that too much leucine shortens lifespan. Some researchers believe that low-calorie and protein-restricted diets promote longevity. Others are not so sure—the controversy centers around leucine.

It seems that a low leucine vegetarian diet regulates mTOR signalling and suppresses IGF-1. mTOR (mechanistic target of rapamycin) is a master regulator of cellular growth and metabolism that plays a central role in survival, lifespan, and aging. It promotes anabolic processes, including the biosynthesis of proteins, and limits catabolism.

IGF-1 (insulin growth factor 1) is a hormone similar to insulin necessary for anabolic effects like muscle growth. It’s produced in the liver and requires the stimulation of GH (growth hormone).

Both IGF-1 and GH decline dramatically, starting in middle age. That’s why one of the central therapies of anti-aging medicine is GH replacement and IgF-1 enhancement.

Longevity aging mTOR

However, these studies were on yeast and worms, not humans. But if they are right, we may trade a few extra years to be stronger and look better.

Quality, not just quantity, matters too. To get enough leucine, buy organic tuna, tofu, beans, cheese, pumpkin seeds, and eggs. If your diet is limited to vegetarian foods, add leucine as a supplement. But don’t take too much. Stay with the recommended daily allowance of 3-4 grams daily.
However, to build muscle, you may need 8-10 grams. The best way to consume leucine is in a formula with other BCAAs (branch chain amino acids).

HMB plays its role to rebuild muscle

HMB is more potent on a gram per gram basis at reducing muscle protein breakdown than leucine alone though less effective at inducing muscle protein synthesis. Due to this property, HMB is considered an anti-catabolic agent (reduces muscle breakdown) rather than an anabolic agent (increases muscle mass). For best results, take leucine with HMB.

What is HMB?

HMB (short for β-Hydroxy β-Methylbutyrate) is a metabolite of leucine. HMB might seem new, but it’s been around awhile. Research goes back to 1996. HMB has been available as a supplement since 1997 and a sought-after training agent for elite athletes. So why is it just now making headlines?

Much of HMB’s current marketing has to do with aging baby boomers, those born between 1946 and 1964 which form a substantial percentage of our aging population. By 2030 all baby boomers will be over age 65 and will want to stay active, fit, and healthy. That’s a significant market for antiaging products and services.

Does HMB work for younger people?

If HMB is useful for those over 65 years, what can it do for an active 35-year-old who wants more muscle mass or a 55-year-old who doesn’t want to lose muscle mass as she ages? Studies in young adults demonstrate the HMB can increase strength, reduce fat, and improve muscle mass.

Role of muscle mitochondria

Though getting enough dietary protein provides the building blocks for muscles and bone, there may be more to sarcopenia than lack of amino acids. Optimal muscle mitochondria function is essential to prevent sarcopenia. Getting enough leucine also supports mitochondrial function. And extra arginine may help.

Just as with sarcopenia and osteoporosis, exercise also counts when it comes to your mitochondria. Aerobic exercises like bicycling, walking, and hiking improve muscle mitochondria function. Researchers found that mitochondrial density in muscle tissue increases in response to workouts.

More functional mitochondria result in better utilization of oxygen in muscle tissue. And positive mitochondrial adaptation improves fitness, builds healthier muscle and bones, and supports longevity.

How to take HMB and optimize supplement synergy

Men require more HMB than women who should take half the recommended amount. First, get enough leucine in a BCAA or EAA supplement to support HMB balance. Add additional nutrients for the best effect.

Synergistic nutrients include vitamin D3 for bone and muscle metabolism and Pyrroloquinoline quinone (PQQ) to promote mitochondrial function. PQQ also has antioxidant activity as it supports cellular energy. It enhances endurance by helping muscles adapt to intense exercise.

Improve muscle carnosine with beta-alanine. Beta-alanine can increase muscle carnosine levels, helping muscle remodelling during intense exercise. Carnosine deficiency is associated with both osteoporosis and sarcopenia. Glutamine deficiency is linked to sarcopenia and is associated with low-grade chronic inflammation. Supplementing with L-glutamine helps muscles, and it’s good for the gut.

When it comes to your health, balance is the key—getting enough dietary protein, supplementing with a BCAA formula with adequate leucine but not too much. Adding vitamin D3 may optimize HMB and improve muscle strength.

Supplements to help rebuild muscle

substance	dose	frequency
HMB	1500-3000 mg	2x/day
L-leucine with BCAA/ EAA	600-1200mg	2x/day
vitamin D3	2000-5000 iu (50-125mcg)	1x/day
ß-alanine	800-1600mg	2x/day
L-glutamine	5- 10 gram	2x/day

Your body’s biology is a fantastic molecular machine. It works exceptionally well when given the right stimulus like exercise combined with optimal nutrition. To keep your muscles supple and bones strong, consider adding HMB to your supplement plan. HMB is a safe supplement without known side effects when taken in recommended dosages.

Prevent muscle loss and help reverse sarcopenia and osteoporosis

If you want to live longer, healthier, and stronger, get enough dietary protein and supplement with HMB. Include synergistic supplements to improve mitochondrial function. Establish a regular exercise schedule and stick to it. But the exercises you learned in high school are not your starting point and can even hurt you. Build muscle but spare your joints and ligaments.

It’s okay to increase muscle metabolism with branch chain amino acids, especially leucine, but don’t shorten your lifespan in exchange for a muscular body.

Sarcopenia comes on slowly. So, watch for the early signs. Don’t underestimate sarcopenia. A diagnosis of sarcopenia means an increased risk for falls and hip fracture, and a shortened lifespan.