by Melissa Blake, BSc, ND
By 2020, more than 20% of the US population will be 65 and over.1 Healthy aging is and will continue to be an important focus in many Functional Medicine offices.
Sarcopenia, the gradual loss of muscle mass that occurs in healthy adults as they age, begins after the age of 30 and accelerates after 60. The difference between the muscle mass of a 20-year-old vs. an 80-year-old is about 30%.2
Loss of muscle contributes to reduced mobility, increased hospitalizations (fragility and falls), prolonged recovery, and mortality.3 Factors that contribute to earlier onset and more rapid progression of sarcopenia include lack of physical activity, inflammatory conditions, blood sugar imbalances, history of smoking, hormone imbalances, and low vitamin D status.4 Addressing these risk factors is part of an individualized, preventative approach.
Therapeutic considerations that may slow this sarcopenic process down and improve overall quality of life (QOL) in an otherwise healthy, aging adult include:
Adequate, daily protein intake is essential for muscle health and possibly even more important in the aging population. Based on the evidence, the ideal protein intake for a healthy, older adult is 1.0-1.2g protein/kg body weight/day, while higher intake levels may be required in patients with acute or chronic disease.5
Achieving optimal protein intake may generally be more difficult for elderly patients at high risk for sarcopenia. Based on the results of a 2011 analysis of health and aging trends, nearly 1/2 of all US adults over age 65 have difficulty or receive help with daily activities.6 Protein powders with added BCAAs are a convenient way to support patients in meeting their protein requirements and obtain critical nutrients to help address sarcopenia.7-8
Adequate protein may also reduce risk of other age-associated events such as strokes9 and hip fractures.10 Furthermore, a practitioner does not have to wait until signs of sarcopenia are present before assessing protein requirements. In combination with physical activity, adequate protein throughout adult life may offer protection against early onset and progression of sarcopenia.11
Key clinical points:
- Addressing increased dietary guidelines for protein intake is important for preventing loss of muscle mass in older adults7
- Higher protein intake and lower fat mass might be positively associated with physical performance in elderly women12
- Practitioners may help delay onset and progression of sarcopenia by assessing protein intake prior to presence of clinical signs and symptoms11
Marine omega-3 fats
The diverse, significant health benefits of omega-3 polyunsaturated fatty acids (PUFAs), namely, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well documented. Specific to the aging population, research points to benefits in cognitive health and cardiovascular markers, as well as physical function.13
Despite the evidence, dietary intake of omega-3 fatty acids is consistently insufficient in North America, with over 90% of the population consuming <500 mg/day of EPA and DHA.14 This is a far cry from the therapeutic intake (for muscle mass and function) suggested in clinical trials of 2g-4g/day.15 Nutritional guidance around omega-3 intake provides a therapeutic opportunity for clinicians to support their aging patients.
Key clinical points
- Supplementation with fish oil helps address the EPA+DHA nutrient gap from one’s diet14 and may help slow the decline in muscle mass and function in older adults.16
- Increased omega-3 intake stimulates muscle protein synthesis and may be useful in prevention and treatment of sarcopenia15
- Improvement in grip strength and muscle tone are positive benefits that may be achieved with fish oil supplementation16
Vitamin D deficiency is a common occurrence in the elderly population, and its relationship to bone health is well-established. Furthermore, normal vitamin D status has also been positively correlated with functional outcomes in the elderly.18 Optimizing vitamin D status may prove to be an essential component of a protocol addressing age-related frailty and sarcopenia, especially when combined with physical activity and a protein-rich diet.17
Key clinical points
- Treating vitamin D insufficiency and deficiency may lead to improved muscle performance, reduced risk of falls, decreased bone loss, and reduced fracture incidence18
- Meta-analysis data indicates that serum 25-hydroxyvitamin D levels are significantly and directly associated with the risk of frailty19
Regular exercise is important in the prevention and treatment of sarcopenia. By positively influencing blood sugar levels and body composition, physical activity helps reduce many of the risk factors associated with early onset of sarcopenia. Exercise also directly supports healthy muscle mass and function.
Whether young or old, encouraging patients to live an active lifestyle is an important and healthy addition to a sarcopenia prevention and management plan. Therapeutic benefit is optimized when fitness programs include resistance and endurance exercises 3x/week.2
Key clinical points
- Physical activity consistently mitigates frailty and improves sarcopenia and physical function in older adults20
- Older patients who participate in resistance and endurance exercise programs may improve not only their function and independence but also their quality of life21
The implications of sarcopenia are potentially severe. Many complications may be reduced and QOL improved with a Functional nutrition approach.
- Ortman J et al. Population Estimates and Projections Current Population Reports. https://www.census.gov/library/publications/2014/demo/p25-1140.html. Accessed September 14, 2018.
- Frontera W et al. Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol. 2000;88(4):1321-1326.
- Prado CM et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018:1-19.
- Szulc P et al. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr. 2004; 80(2):496-503.
- N. Deutz et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929-936.
- Disability and Care Needs of Older Americans: An Analysis of the 2011 National Health and Aging Trends Study. https://aspe.hhs.gov/report/disability-and-care-needs-older-americans-analysis-2011-national-health-and-aging-trends-study
- Garilli B. https://www.metagenicsinstitute.com/articles/bcaa-leucine-supplementation-increases-muscle-protein-synthesis-healthy-women/. Accessed September 14, 2018.
- Devries MC et al. Leucine, not total protein, content of a supplement is primary determinant of muscle protein anabolic responses in healthy older women. J Nutr. 2018;148(7):1088–1095.
- Zhang Z et al. Quantitative analysis of dietary protein intake and stroke risk. Neurology. 2014;83(1):19-25.
- Kim BJ et al. The positive association of total protein intake with femoral neck strength (KHANES IV). Osteoporos Int. 2018;29(6):1397-1405.
- Paddon-Jones D et al. Protein and healthy aging. Am J Clin Nutr. 2015;101(6):1339S–1345S.
- Isanejad M et al. Dietary protein intake is associated with better physical function and muscle strength among elderly women. Br J Nutr. 2016;115(7):1281-1291.
- Casas-Agustench P et al. Lipids and physical function in older adults. Curr Opin Clin Nutr. 2017;20(1):16-25.
- Richter CK et al. Total long-chain n-3 fatty acid intake and food sources in the United States compared to recommended intakes: NHANES 2003-2008. Lipids. 2017;52(11):917-927.
- Smith GI et al. Fish oil–derived n−3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015;102(1):115–122.
- Smith GI et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr. 2011;93(2):402-412.
- Bauer JM et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015;16(9):740-747.
- Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008;88(2): 537S–540S.
- Ju SY et al. Kim. Low 25-hydroxyvitamin D levels and the risk of frailty syndrome: a systematic review and dose-response meta-analysis. BMC Geriatr. 2018;18(1):206.
- Phu S et al. Exercise and sarcopenia. J Clin Densitom. 2015;18(4):488-492.
- Landi F et al. Exercise as a remedy for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014;17(1):25-31.
Melissa Blake, BSc, ND
Dr. Melissa Blake is a clinical specialist on the Medical Information team at Metagenics. She completed her pre-medical studies at Dalhousie University in Halifax, Nova Scotia and obtained her naturopathic medical training from the Canadian College of Naturopathic Medicine. Dr. Blake has over 10 years of clinical experience, specializing in the integrative and functional management of chronic diseases.