Chapter 12
Sarcopenia versus Your Independence
“Older Adults Are Not Sick – They Are Just Weak!”
Wall Street Journal article, July 2014
What is Sarcopenia? “The term was coined back in the late 1980s by Irwin Rosenberg, MD, dean of the Gerald J. and Dorothy R Friedman School of Nutrition Science and Policy at Tufts”. When you break down the word into Latin, ‘sarco’ for flesh (or muscle) and ‘penia’ for loss, you end up with what Tuft’s University describes as a loss of muscle mass. A more colorful phrase would be ‘poverty of the flesh’.
The debilitating uncertainties surrounding our aging population are mostly the result of consistent neglect of one’s physical health. Just as a home becomes a hovel when it is allowed to regress to a high level of disrepair, so too does the body deteriorate with disuse. This chapter’s opening quote points to the proposition that the weakness of the body creates the sickness environment, not the other way around.
Bruce G. (62) – “As a stroke survivor and diabetic, I found my quality of life diminishing as I aged (now age 62). I needed to focus on healthy routines that I had ignored most of my adult life”
If you have remained relatively inactive for years, sarcopenia begins its emergence. By your mid 40s the rate of lose can be around 1% a year and accelerate beyond that as you enter your 60s. The generations that follows the baby boomers are progressively less and less health. This presents a discouraging picture of the world’s health profile going forward.
The number of people worldwide older than 65 will grow from the 461 million calculated for 2004 to a projected 2 billion by 2050. The stakes are high for this demographic, not only for you the individual, but for your family, for America and, ultimately, for the world. Let’s delve into specifics, going down an incomplete list of health issues that are impacted.
Women have a special interest in addressing the muscle equation because Mother Nature has put them behind the starting line in one specific area versus men. Statistically, women have about 30% less muscle mass than men. Miriam Nelson, PhD, director of the Center for Physical Activity and Nutrition at Tufts stated “Their muscle loss has an impact sooner. More women end up in nursing homes. Also, women live longer – so they’re older but much weaker”. [2]
Using the excuse weight training will make your bulky and less feminine is an urban myth. My female clients, who in the beginning were more than a little reluctant to touch a dumbbell, now relish going to the gym to lift weights because of the multiple physical positives they have been experiencing.
Let’s first look at the job description of muscles (Remember the word ‘muscle’ also includes tendons and ligaments):
• Muscle supports our skeletal structure, reinforcing good posture. Poor posture negatively affects your health because you are now out of alignment, placing unnecessary stress on your body.
• Muscle stabilizes your joints, both from a spacing standpoint as well as keeping the joints centered. Strength training may be recommended for people with arthritis so the elbows, knees, shoulders, etc. have more stability.
• All movement is contraction based. Any push, pull, walk, kick, lift, carry, run or throw is initiated when muscles contract to move your body. You could look at the muscle/tendon complex as a cable system, moving your skeletal structure this way and that so you can handle whatever task is at hand.
Now let’s consider what positives (or negatives) come from addressing (or not addressing) sarcopenia.
Burn Those Calories
Muscle cells and fat cells have two distinctly different compositions. Fat doesn’t turn into muscle and muscle doesn’t turn into fat. Fat is our stored energy, waiting to be utilized, while muscle is an active participate in your day-to-day life.
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The end result: a pound of fat burns one or two calories because it’s not doing anything. It is literally just ‘hanging out’ on too many of us. Conversely, a pound of muscle will burn ten times or more calories per day because muscle is directly responsible for all the actions you take during the day. When you build more muscle, that added muscle allows you to generate more movement, resulting in more energy (calories) being utilized. You just feel like doing more.
Type 2 Diabetes
While type 1 diabetes is genetic, type 2 diabetes is an affliction our society has cultivated directly due to lifestyle choices. If you had been exercising and eating right from an early age, the odds of developing Type II will be dramatically less. If you have developed Type II, one of the key steps in combating this illness is to build more muscle. Why?
When you stimulate muscle growth, you will naturally become more physically active. You will increase the burning of glycogen (simple sugars stored in your muscle) and glucose (simply sugars in your blood). If you start losing muscle mass, your metabolic rate (your body’s ability to burn calories hour by hour) begins an inevitable downward slide.
Muscle is also the primary location in your body for storing glycogen (simple sugars). Loss of muscle reduces our ability to store sugar safely. The excess (not stored) sugar is now floating around, looking for somewhere else to land and cause mischief.
Bruce G (62) - “The most amazing additional benefit is that I was able to stop using my insulin pump 24/7 and go to just oral medication and a few insulin shots each day that significantly reduces my insulin and supplies cost for the insulin pump”
Osteoporosis
Wolff’s Law states “changes in the form and function of bone are followed by changes in its internal structure”. In other words, bones will adapt to the stress placed upon them. If your skeletal structure receives minimal challenge from pushing, pulling or lifting movements, your bones will be thinking ‘we’ve got very little to do here, so we don’t need to be that strong’.
That load from an external force, be it dumbbells, a 40# bag of top soil, a barbell or two bags of groceries being carried up a flight of stairs creates a stress that your bones will acclimate to naturally, as long as you are doing these activities on a regular basis.
To bring the point home, it was discovered in the 1960s that weightlessness (zero external stress/load) caused the astronauts’ bones (and muscles) to deteriorate at an accelerated rate the longer they stayed in space. The absence of gravity actually caused their bodies to age faster, possibly by a factor as high as 10 versus being sedentary on Mother Earth under gravity’s influence.
Check YouTube 90 minute interview of Dr. Vernikos by Dr. Mercola . Very informative and a great insight into the history of the space program. Type in: ‘Dr. Mercola Interviews Dr. Joan Vernikos’
[What happens to bones in space? “One of the major obstacles to long-term space missions in the threat of severe bone loss in astronauts. In the micro gravity environment of space, astronauts lose on average 1% to 2% of their bone mineral density every month. For a short-duration flight, bone loss is a fairly minor consequence.
On a long-duration space flight, such as those planned for missions to Mars and beyond, bone loss can be a serious impediment. This loss may not hinder astronauts while they are in orbit, but upon return to Earth, their weakened bones will be fragile and at an increased risk of fractures. At this time, it is unknown whether this bone loss will eventually reach a plateau, or whether it will continue indefinitely.” [5]
When astronauts returned from extended flights, because they were in a weightless environment “Their skeletons become useless; bones don’t need to support muscles in microgravity, so they start losing minerals and regenrate cells at a slower pace. Astronauts can lose 1 percent of their bone density a month. Back on Earth, it takes a year for aging men and women to lose the same amount of bone mass. In an environment that requires little strength to move around and work, muscles atrophy, their fibers shrinking”] [1] Dr. Vernikos reported Russian cosmonaut Valeri Vladimirovich Polyakov lost 80% of his bone mass while in space for 437 days ]
Osteoporosis was never a subject for discussion when I was growing up. Today, it is a common talking point with all generations. The reason osteoporosis has become more common place is today we are living longer and, arguably, not as well. The activity level and nutritional intake of today’s adult is compromised versus my generation’s early years. Again, lifestyle is the main driver as to whether you will experience this debilitating bone loss.
[Alan V. (76) – “We are now in the 6th month of a carefully developed program which has taken me back in fitness and muscularity to where I probably lasted visited while in my 40s. I feel better, look better and am slowly continuing improvement to wheree I soon expect to be competing on the golf course where I was when I suffered the fractured leg (about 18 months earlier).”]
Obesity
Muscle is an active tissue while fat is a stored energy source. As you strength train, you begin to change your body’s composition. You replace inactive fat with high energy muscle. As mentioned earlier, muscle consumes 10 times or more calories versus fat’s requirements, which means the higher your percentage of muscle, the more calories your burn all during the day. You will have increased your overall metabolic rate.
In addition, strength training initiates EPOC (excessive post oxygen consumption), meaning your body continues to burn calories up to 24-48 hours (or longer) afterward, depending on the intensity of your workout. Cardio training, unless it is extremely high intensity (sprinting, hill sprints, kick boxing), generates minimal EPOC
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If you try losing weight with cardio and food planning alone, the journey to reach your ‘ideal weight’ becomes much more daunting, far harder to maintain plus many of the benefits that only come from strength training will never be realized.
Sick Sicker Sickest
The following quote from Tuft’s University explains another important aspect of muscle. “When you’re sick, the body burns protein faster than usual, pulling protein components from the muscles and delivering them to the immune system, liver and other organs for use in healing wounds and building the antibodies and white blood cells needed to fight illness.” [2] This is one key reason why, when sarcopenia begins to progress, most elderly become far more susceptible to the flu, pneumonia, injuries and require more recovery time from surgeries.
Another health benefit of muscle is its composition. Muscle is comprised of protein and water, with 75% of that mass being water. Since dehydration is a common malady with seniors, losing muscle mass reduces your body’s ability to retain water. The more dehydrated a body becomes, the more compromised one’s health becomes. [See Chapter 7]
Inflammation
ADD anti-inflammation from muscle ??
Balance
Chapter 9 addresses this subject in detail. Without strength, keeping your balance will always be more of a challenge.
Your Own Health Savings Account
The Cooper Clinic did a study covering nearly 7000 men ranging in age from 20 to 80 over a 19 year period. The results of their findings verify that a planned fitness regimen directly effects your bottom line. “The collected data suggest that fit men reduced their medical visits—and, thus, their medical bills—by a by hefty 46%”
Dr. Larry W. Gibbons, a co-author of the study and medical director of the Cooper Clinic, found that the men who were not necessarily in the best of shape going in to the study but who applied themselves to a workout protocol going forward were able “to lower their chances of being hospitalized 42%”. [ ]
It is not uncommon to have a shoulder issue, knee problem or wrist concern mitigated or actually go away after a month or so of strength training. Taking the stairs is no longer an issue. I have had clients who, having strength trained several months prior to their hip or knee replacement surgery, found their recovery times were much shorter than projected.
Compare this to renovating an older home, something we did to our family home 20 years ago. The overall functionality of our living space was definitely extended. The same can happen with your body.
John B. (63) – “The acid test for my personal fitness happened when I went in to surgically correct a spinal stenosis issue I had been dealing with since my early twenties. My recovery time was much faster than original expectations, which meant my time off from work (aka lost income) was much less than planned. My accelerated recovery paid for the cost of Rick’s services”
On Being a Muscle Head
Strength training has been shown to stimulate the growth of brain cells, a process known as neurogenesis or neuroplasticity. Being sharper mentally helps you in many areas. We may even make a case for strength training being a positive factor in preventing, or at least delaying, Alzheimer’s.
[Neurogenesis: the process by which new neurons are formed in the brain. Neurogenesis is crucial when an embryo is developing, but also continues in certain brain regions after birth and throughout our lifespan. The mature brain has many specialized areas of function, and neurons that differ in structure and connections] [4]
There was a study of 324 female twins (43-73 years old) over the course of a decade in which their memory and ability to learn were evaluated regularly. One of the conclusions from this study was “leg strength was a better predictor of brain health than any other lifestyle factor looked at in the study.” I could see why leg strength would have the most impact because 50% or more of a person’s muscle mass is below the waist. [ ? ]
My own observations confirm the confidence level of the individual goes up with improved physical capabilities, which comes from having a stronger body. Feeling better about one’s self goes a long way toward having a more positive attitude. My common sense says ‘How can this not improve one’s optimism about their life’.
Crisis Central
Envision being in the middle of an earthquake, tornado or a Katrina like event. What if you had to walk five miles, climb over a fence or three, move a heavy object (a couch, a jammed door) or provide assistance to another family member? How do you think you would fair?
Try this experiment. Make sure you have an able bodied person with you in case you need assistance. Sit down on the floor. Try and get back to a standing position without any help. Did you need your teammate’s assistance? Try repeating this process four more times. Now imagine in a crisis, will you be an asset or a liability? Strength training will make you an asset.
Nancy M. (65) – “I want to tell you I am stronger than I have ever been in my life! I am more fit now than I was in my 30s or 40s. It has helped me with my flexibility, stability , and stamina. But most of all, my golf game has improved so much due to the workouts.”
Your Independence
When I first meet a potential client, I paint a simple picture. If you are finding the stairs to be a concern recently, that is a cautionary alarm going off. What was once a non-issue is now a looming problem. If getting out of a chair is proving to be more and more of a challenge, a red warning light is flashing. You are on the brink of losing your independence. You are looking at becoming a distraction for your family. You may be having strangers in your home to help with your care. Your sense of control over your life will be in jeopardy.
I am not being overly dramatic. This is a reality I witnessed up close and personal for years. Review the inventory of negatives you just read. All are part and parcel to your independence. Each one by itself is a clear and present concern, each a worry you and your family may be facing today or in the near future. Without strength training in your life, you will lose your independence sooner than later.
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Cindy G. (61) – “I assisted my son moving. He lived on the third floor with a very slow elevator. That morning I did two flights of stairs for an hour and forty-five minutes carrying boxes. Yes, I was tired after both, but I know that I wouldn’t have been able to do either of these activities without all of the previous strength training.”
There is Still Time
What I have experienced with my clients gives me confidence the path which lays ahead for all of us can be paved more smoothly by engaging in strength training. Weightlifting baby boomers rediscover their physical confidence, realizing they are not necessarily on a downhill slide. They regain that positive attitude which has been slowly eroding over the past decade. They become more active, more alert, more involved. The future is viewed with more clarity and decisiveness, just like they did back in the day.
