Managing age-related muscle loss
In a nutshell
We lose muscle mass and strength as we age in a process called sarcopenia which can contribute to poor health, increase the risk of disability, and contribute to a very poor quality of life and premature death
Muscle mass and strength can be conserved or increased, even later in life, primarily through a combination of resistance training, proper nutrition, and adequate sleep
Resistance training can easily be achieved with good technique and a little effort
Proper nutrition can be achieved with a regular diet of balanced and bioavailable proteins, and timely use of carbohydrates from real whole food
Proper sleep should be a priority because it is necessary for muscle growth
As always…I’ve described some general principles and provided a few details that work for me…
Age-related loss of muscle and strength
As we age, we lose muscle mass and strength. This process is called sarcopenia [1, 2], it can start as early as age 30, and accelerates as we age. Ultimately sarcopenia can contribute to poor health, increase the risk of disability, and contribute to a very poor quality of life and premature death [2].
The most effective way to prevent muscle loss and grow muscle mass and strength is through a combination of resistance training, proper nutrition, and good sleep [3].
Resistance training
Resistance training is a fancy term for using our muscles to move against something that requires effort and a bit of strength. It can take the form of lifting and pushing weights, moving our own body weight (e.g., calisthenics and yoga), and stretching resistance bands or cables. We build muscle when we work more than we’re used to either by, for example, lifting heavier weights or when we do more repetitions of a given weight [3].
When I have access to them, I favor lifting weights and I’ll follow as regular an exercise routine as I can that includes the following:
Legs – squats, I favor the barbell back squat
Back – deadlift, barbell row, pullups, lat pulldown
Chest – bench press, pushups
Shoulder – overhead press
When I’m away from home I try to keep things going with a very simple 15-min body-weight routine that emphasizes my chest and legs. I do a series of pushup and squat repetitions one after the other followed by a one-minute rest and then repeat. I do this for 15 minutes and try to set the repetitions such that I exhaust my muscles by the end of the period.
I augment resistance leg training with a series of high intensity sprints once a fortnight. For me this involves a 10-minute warm-up run followed by a series of five to eight hill sprints interspersed by three-minute rests. By the end of this I’m pretty exhausted.
I try to remember a few simple principles when strength training, as follows:
Warm up properly. The idea here is to get blood flowing around the muscles and joints before starting to train properly. I aim for 10 minutes and favor rowing to warm up upper- and lower-body. If I didn’t have a rowing machine, I’d go for an easy 10 minute run
Develop proper technique. I favor barbell and dumbbell weight training and whilst I’m just trying to prevent muscle wasting, not to bulk up, it is still necessary to avoid getting hurt, and that requires proper (not difficult) technique. There are probably thousands of videos that can be found but I prefer reading and looking at pictures. I’ve listed a couple of my favorite books below as references 4 and 5
Train the muscles in a way that makes the most of my effort. This involves things like which exercises are conducted and when, the use of warm-up weights (not the rowing and running warmups described above) and strength-inducing weights, the number of repetitions, and the length of rest periods between each. This sounds a bit daunting to the beginner but it’s not really. References 3 and 4 give lots of guidance
“In order to maintain muscle mass we need to consume adequate amounts of protein”
Proper nutrition
For me, proper nutrition consists of whole real food sources of bioavailable protein and carbohydrate plus specific supplements. I follow a mixture of ongoing baseline principles plus specific post-exercise nutrition.
Bioavailable protein
In order to maintain muscle mass we need to consume adequate amounts of protein. My review of the available literature has led me to believe that animal-based foods are the best sources of bioavailable protein. Irrespective of the source, it appears that we should consume around 30g to 50g of bioavailable protein with each meal [3] (I eat twice/day, spaced 3-5 hours apart).
Leucine
In addition to total bioavailable protein, it is necessary to consume enough of an amino acid (protein building block) called leucine. Leucine appears to be an important signal for muscle protein synthesis and we should consume around 2-3g/meal [3]. The best sources are again animal-based.
Good sources of protein and how they affect age-related muscle
I’m going to cover a couple of papers that describe types of protein, their availability, effects on muscle formation, and their effects on various muscle-related outcomes.
The first paper from scientists at the University of Illinois is about sources of protein and muscle building associated with age-related muscle loss [6]. It ranks several sources of amino acids (protein building blocks) according to a UN Food and Agriculture Organisation (FAO) approved method (see here for more of an explanation). I added to that list using Wikipedia and ended up with 53 records comprised of 19 animal-sources and 34 plant-sourced whole and processed foods.
The protein availability scores for the top animal-based and plant-based foods are listed in Tables 1 and 2, respectively. Note that the higher the protein availability number, the more likely we are to absorb the amino acids.
Table 1: Top 10 animal-based bioavailable sources of protein. The higher scores are the more bioavailable
Table 2: Top 10 plant-based bioavailable sources of protein. The higher scores are the more bioavailable
The obvious thing to note is that the top nine most bioavailable foods are animal-based. Only soy flour and potato come close to matching the animal-based foods for protein bioavailability
The same paper [6] also presented data showing a measure of amino acid synthesis in muscle after a meal. They express the data as a fold-increase over pre-meal. I reproduce this data in Table 3. Note that I combined duplicate entries for whey and beef, show their data as ranges, and list according to the higher value.
What we see here is that ingesting whey (for example) produces two- to three-times more muscle synthesis than was measured before a meal. This contrasts with wheat and soy products which resulted in only 1.4 times increase post meal. Overall, of the 10 types of food tested, the animal-based comprise the top eight followed by wheat and soy products.
Thus, however you look at the data [6], protein from animal-based food is more likely to be absorbed by our body and then more likely to be involved in creating muscle than protein from plant-based foods.
Table 3: Top 10 plant-based bioavailable sources of protein. Higher scores represent greater bioavailability
The second paper I drew from specifically for this topic comes from the University of Newcastle and NHS research groups in the UK. It describes which whole foods (meat, fish, eggs, fruit, vegetables, and non-liquid dairy) may be beneficial for muscle and sarcopenia in adults at or over 50 years of age [1]. I’ve summarized the results from this study in Table 4.
Table 4: Summary of evidence for the effects of whole foods on muscle-related outcomes
From this we can see that red meat, fruit and vegetables and dairy exhibited the greatest impact on muscle mass and muscle function and were found to be beneficial for strength and in combating sarcopenia. Things like cereal, fish and soy showed limited benefit or the results published were, at best, inconclusive.
The combined benefits to muscle outcomes of animal-based proteins and carbohydrates from fruit and vegetables agrees well with other studies on post-exercise effects.
Carbohydrates after exercise
Consuming bioavailable carbohydrates with protein after resistance training improves muscle production [7]. Therefore, in addition to my regular diet of mostly complex carbohydrates, I include bioavailable carbohydrates in my post-exercise nutrition (see below).
Supplements
I’ve found information on a couple of supplements that may provide benefit in relation to managing sarcopenia. Those are creatine and magnesium.
Creatine
Creatine (monohydrate) is a well-known muscle building supplement that has been used extensively with minimal side-effects [8]. It is stored mostly in our muscles and works by helping to increase energy production. When creatine is present in sufficient amounts, we are most likely to be able to lift the heavier weights that cause us to retain and build new muscle.
Creatine can be obtained from food such as red meat and fish or it can be made by our livers. Neither may be sufficient to reach the muscle-building amounts desired and so supplementation of between 3g to 5g is recommended [3]. I take 5g every day in my morning coffee plus an extra 5g after exercise.
Magnesium
Magnesium, selenium and calcium may be important in preventing or treating sarcopenia [9]. I haven’t done extensive on the subject but I have described the importance of magnesium previously. I was not, therefore, surprised to read that magnesium is involved in protein and energy production in our bodies and aids in muscle relaxation.
I regularly take 250mg of magnesium threonate (with vitamins D3 and K2) after a meal plus 2g of magnesium glycinate before bed. I supplement additionally at the faintest hint of muscle cramping.
Post exercise nutrition
I make a smoothie to consume after exercise as follows:
Home-made cow milk kefir
Bioavailable protein from whey powder
Bioavailable protein and micronutrients from one raw whole egg
Bioavailable carbohydrate from starch
Bioavailable carbohydrate from berries
Creatine monohydrate supplement (5g)
Sleep
Building muscle is a two-stage process. During resistance training, muscle tissue is torn or broken down. We rebuild muscle when we are at rest, primarily when we sleep [10].
Early in my life I misunderstood the importance of sleep as much as I did the harms caused by processed food. I now aim for 7-9 hours each night but still suffer from poor sleep. I do attempt to improve it as follows:
Regular schedule associated with circadian rhythm
Get up between 6am and 8am
Go to bed between 9pm and 11pm
Early morning sunlight – this sets up a healthy circadian rhythm and I try to do so by watching the sun rise when I can and exposing myself to its brightness as I write this blog at the window in the mornings
Caffeine only in the morning – I rarely drink caffeinated drinks after noon
Regular exercise
Cool temperature bedroom
Darkened bedroom – use heavy curtains/drapes
Night time supplements – magnesium, inositol, glycine, and L-theanine
I could probably do better, but that’s what I’m up to at the moment
Summary
If he were alive today, my dad might have said something like “…old age is not for kids playing with…”. I was relatively lucky because I grew up in an athletic family, at a time when healthy whole food was more common than processed, and where my early circadian rhythms were determined largely by nature. It was only later in life as I started to make more decisions for myself, that things started to go awry…! I never gave up regular exercise, but I did embrace processed food and I never prioritised sleep in my quest for career success and raising a family.
My exercise regime now includes much more strength training, in part because I’ve learned about the metabolic benefits of muscle mass but mostly because I’ve experienced sarcopenia first-hand. I can attest to the fact that regular resistance training, proper nutrition and sleep will reverse sarcopenia, and build muscle mass in this post-60-year-old male.
You may have to tweak the details, but I hope the principles I’ve laid out here will help you too.
References
Granic A, Dismore L, Hurst C, Robinson SM, Sayer AA. Myoprotective Whole Foods, Muscle Health and Sarcopenia: A Systematic Review of Observational and Intervention Studies in Older Adults. Nutrients. 2020 Jul 28;12(8):2257. doi: 10.3390/nu12082257. PMID: 32731580; PMCID: PMC7469021
Xu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis. Gerontology. 2022;68(4):361-376. doi: 10.1159/000517099. Epub 2021 Jul 27. PMID: 34315158
Dinicolantonio, D., Land, S. and Kennedy, T. (2021) Win: Achieve peak athletic performance, optimize recovery, and win. John Wiley & Sons
Rippetoe, M. (2017) Starting Strength: Basic barbell training. Wichita Falls, TX. The Aasgaard Company
Delavier, F. (2010) Strength Training Anatomy. Champaign, IL. Human Kinetics
Burd NA, Beals JW, Martinez IG, Salvador AF, Skinner SK. Food-First Approach to Enhance the Regulation of Post-exercise Skeletal Muscle Protein Synthesis and Remodeling. Sports Med. 2019 Feb;49(Suppl 1):59-68. doi: 10.1007/s40279-018-1009-y. PMID: 30671904; PMCID: PMC6445816
Børsheim E, Cree MG, Tipton KD, Elliott TA, Aarsland A, Wolfe RR. Effect of carbohydrate intake on net muscle protein synthesis during recovery from resistance exercise. J Appl Physiol (1985). 2004 Feb;96(2):674-8. doi: 10.1152/japplphysiol.00333.2003. Epub 2003 Oct 31. PMID: 14594866
Dinicolantonio, D. and Land, S. (2021) The Mineral Fix; How to optimize your mineral intake for energy, longevity, immunity, sleep and more. John Wiley & Sons
van Dronkelaar C, van Velzen A, Abdelrazek M, van der Steen A, Weijs PJM, Tieland M. Minerals and Sarcopenia; The Role of Calcium, Iron, Magnesium, Phosphorus, Potassium, Selenium, Sodium, and Zinc on Muscle Mass, Muscle Strength, and Physical Performance in Older Adults: A Systematic Review. J Am Med Dir Assoc. 2018 Jan;19(1):6-11.e3. doi: 10.1016/j.jamda.2017.05.026. Epub 2017 Jul 12. PMID: 28711425.
Land, S. (2019) Metabolic autophagy. Self published