Is Sarcopenia Inevitable as We Age?


September 14, 2018

Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape.

I recently published a Medscape At Large column extolling the value of the bathroom scale. Indeed, I called it "The Most Perfect Medical Device of 2018."

Most of the reader comments were favorable, but one negative remark really caught my eye. Frequent commenter George McDonald, RN, wrote: "...take a typical sedentary, pizza eating senior: As they lose muscle mass they are gaining fat mass, yet the scale and BMI show that they are holding steady..."

OK. Fair criticism. A bathroom scale only provides one number, and the components that comprise that number are multiple and not distinguishable, one from the other, by the reading. But it can still be very useful as a monitor and motivator to not let that number go up. Don't worry so much about losing weight; try hard not to gain more weight in the first place.

On a recent visit with my primary care physician to gain clearance for cataract surgery (got approved; cataract out; seeing clearly, thank you all; but I hated the after-effects of short-term ketamine anesthesia), I listed my chief complaint as "sarcopenia." My physician looked surprised, suggesting to me that he may not often hear that complaint from a patient.

But I was quite serious. I know I have sarcopenia; all it takes is an honest look in the mirror with my shirt off, despite my normal BMI and weight stability for many years. I don't like that.

There is a substantial literature about sarcopenia. Some estimate a 0.5%-1% loss of muscle mass per year beginning at age 30, accelerating after either age 65, 75, or 80.[1] I am 85, so that's 27.5%-55% of muscle mass that I have already lost. Really? Eww.

Why is sarcopenia bad? Its consequences can include loss of essential movement function, disability, increased insulin resistance, fatigue, falls, frailty, and resulting greater risk for mortality.[2]

What to do about it? Prevention suggestions I have found include:

  1. Eat 30 g of protein in each meal.[3]

  2. Protein intake of 1.0-1.2 g/kg of body weight per day is probably optimal for older adults.[4]

  3. Creatine supplements.[4]

  4. Maintain appropriate blood levels of vitamin D.[4]

  5. Testosterone supplements.[5]

  6. Whey protein, apple peels, and green tomatoes.[6]

  7. Growth hormone supplements.[5]

  8. An abundant caloric intake.[4]

  9. Exercise! Every reference recommends that we stay active, exercise aerobically, and use resistance training.[3,4,5,6]

I currently average 6500 steps per day and endeavor to perform fitness training (with equal mixes of cardio, balance, walking backward, hand-eye coordination, stretching yoga with cobra pose, planks, lunges, crunches, and resistance training) during three 1-hour sessions a week. But my sarcopenia seems to progress anyway, although, oddly and gratefully, my actual strength and stamina seem unchanged and are comfortably effective.

Most references portray the sarcopenia of aging as inevitable, relentless, and inexorable. Some believe that the prevention measures above may ameliorate its progression somewhat.

How do you address sarcopenia for yourself? What do you recommend to your aging patients? Share what you think with the readers on the comments board.

That's my opinion. I am Dr George Lundberg, at large at Medscape.


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