Sarcopenia

We have all heard about osteoporosis or weakening of bones as we age. Many of us have done bone density tests and are taking supplements to prevent or treat osteoporosis. But what is sarcopenia? Sarcopenia is a loss of muscle mass that occurs as we age. As we mature into adults, hormonal changes ensure optimal muscle mass by the age of 25. But this muscle doesn’t remain constant with us throughout life. For those who lead a sedentary lifestyle, muscle loss starts as early as at the age of 30. Typically an inactive person loses up to 5% of muscle mass per decade.

What happens when we lose muscle? First and foremost a weak muscle offers poor protection to its neighbouring joint. Joints need strong muscles to function properly and durably for many years. When muscles are weak, the joints become vulnerable to damage. This damage can happen in any joint, but typically it is seen in the knee joint, the neck and the lower back. Initially patients complain of only occasional pain. Painful joints are instinctively rested by the patient. The rest worsens sarcopenia. This in turn predisposes the joint to even more damage. Thus the pain sets up a vicious cycle. This cycle ends in osteoarthritis of the knee or spondylitis of the neck or back, which in its last stages requires surgical treatment. 

Loss of muscle also results in a lower basal metabolic rate (BMR). In simple words, the body is unable to burn calories efficiently. Lower BMR combined with a modern high calorie diet leads to increase in body fat. Excess fat increases insulin resistance. The end result is central obesity or a pot belly with diabetes, coronary heart disease (heart attack) and hypertension (high blood pressure).

End stage sarcopenia which occurs in elderly patients results in frailty, loss of balance & frequent falls. Sarcopenia is thus responsible for not only musculo-skeletal problems like osteoarthritis and fractures but also life style illness' like diabetes.

Is sarcopenia preventable or treatable? The good news is that it is! We can slow down the loss of muscle that happens with age by making positive changes in our diet and lifestyle. If we work a muscle, it will respond by a tear - repair mechanism to become stronger and a stronger muscle means a reversal of sarcopenia. The best way to strengthen a muscle is by doing resistance training. This can be done by either lifting weights like dumbbells or by using our own body weight. Typical body weight exercises are squats, push ups and lunges. As sarcopenia affects all muscle groups, it is important to work out all muscle groups. We must exercise not only thigh and calf muscles but also chest, back, upper limb and abdominal muscles. Walking is not a good exercise for sarcopenia as it works out only leg muscles and it is not a resistance training exercise.

Diet is as important in the prevention of sarcopenia. For muscles to repair and become stronger they need protein as a raw material. Protein is essential in a healthy diet. We must ensure adequate protein intake. A normal adult requires 0•8 gm of protein per kilo of body weight per day. Meat, eggs and dairy products are rich sources of protein. Roasted, boiled or baked chicken or fish are the healthiest source of meat protein. Milk, cheese and yogurt are good dairy sources. Vegetarian sources of protein include beans, lentils, green peas, chickpeas, soy, spinach, asparagus and brocolli. Nuts like almonds and peanuts also contain protein. Fruits can also provide protein with the richest sources being guavas, berries and apricots. To be effective, a high protein diet must go hand in hand with a low carbohydrate, low sugar and low fat diet.

A lot of research is going on but there still is no medicine that can stop or reverse sarcopenia. Exercise and diet remain the key to prevention as well as cure. We must eat clean and exercise hard to remain healthy and keep illness at bay. We really have no choice!

The Not So Sweet Reality

Lets introspect on how things were a half century ago. At that time people consumed lots of fat, butter and pure ghee. Sweets were eaten rarely and the sweetener used was honey. Ninety percent of the food that people ate was cooked at home. The fast food industry was nearly non existent and there were few available brands of biscuits, potato chips, cakes, mithai, chiwda, chocolates, colas or ice cream. Going out to eat ice cream would be nothing less than a family event which would be fondly remembered for days. A box of mithai would come home but once in months. All of these snacks were consumed rarely! Restaurants were few and going out to eat was infrequent. Also infrequent at the time were here heart attacks, blood pressure, obesity and diabetes.

Then cholesterol was identified as the substance which was found in blocked blood vessels. This lead to a diet revolution based on fear. We were told that dietary cholesterol is bad for our health. We started avoiding fatty foods like cheese and butter, oily food or deep fried food. We didn't eat the egg yolk and only preferred the egg white. At a restaurant we started to ask for normal roti and not 'butter-roti'. We would frown if we saw a dish with excessive oil. This movement against fats and oil tilted the diet towards carbohydrates. Slowly but surely diets around the world became carbohydrate rich.

Simultaneously there was a surge in the economy and people's spending power increased. The food industry expanded and packaged foods and fast food became affordable. Refined sugar and refined flour became the main ingredients of these snacks. What was a luxury enjoyed once in many months, could now be easily consumed every week or even every day. Today, the smallest event is celebrated by cutting a cake. Home refrigerators are loaded with ice creams and colas. They have become oft consumed midnight snacks. Historically sugar consumption has increased from barely 2kg per person per year in the eighteen century to a whopping 70kg per person per year in the twenty first century. Calorie intakes have increased but physical activity has reduced. People are enjoying a sedentary lifestyle. With elevators and cars there is no need to exert. What has also increased unfortunately are the rates of obesity. People are developing pot bellies more than ever before. Low fat and high carbohydrate diets are not having the desired effect that was hoped for. In fact the absolute opposite is happening. Along with obesity, rates of blood pressure, diabetes and heart disease are up.

Only recently, the veil has been lifted. It is not fat, butter or cholesterol that is the real devil. It is the carbohydrates, especially the simple ones like refined sugar and foods that contain large quantities of this sugar. To reduce the rates of obesity, diabetes and heart disease we must re-adopt the lifestyle our ancestors. We have to change the way we think about food. It is time for a paradigm shift. We should not consume sugary drinks like colas, tang, rasna or sugary tea. They are directly linked to obesity and therefore many diseases. Biscuits are a strict no, at least not daily. We can eat a biscuit, or a piece of cake, or a few chips once in a while. Jam is full of sugar and we must stay away. Same is true with tomato ketchup. Snacks and mithai must be consumed only occasionally. On the same note, we must not eat out often. It is desirable to stick to home cooked food made with hand picked, quality ingredients. In addition to simple sugar, we must eat less quantities of starchy foods like potato, maida, rice and bread.

Sugar from a cola or an ice cream or a chocolate is easily digested and quickly absorbed in the blood stream. This puts a strain on the pancreas to produce a large quantity of insulin. This insulin in turn reduces the sugar in the blood by converting it into fat. Moreover it makes you hungry and you end up eating more food. Regular high sugar consumption literally burns out the pancreas and the end result is diabetes.

Along with diet we must re-adopt the physical activity of our ancestors. We must exercise by going to the gym, walking, cycling, swimming or similar activity. The best results are seen with weight training either in the gym or by using body weight (push ups, dips, squats etc).

In conclusion, sugar is the real problem. Lots of sugar indirectly enters our system through packaged foods. We must make it a habit to read the ingredients before we consume any foodstuff. Our food should come from our own kitchens and not from restaurants, bakeries or factories. Carbohydrates are the new enemy!

Self Preservation

How often have we seen a personal crisis ruining life? A young man just managing to settle down in life suffers a heart attack! He now faces a prolonged recovery and loses his job. Medical expenses coupled with a loss of income push him into a financial crisis. A young woman juggling her job and family life suffers an accident. A slow recovery means she cannot look after her children. All of us dread a personal crisis but what do we do to prevent it? We must think about self preservation. We must take precautions to avert a potential crisis!


An accident is top on the list. Accidents can occur in a variety of places. They can occur on the road, at home, at work or when travelling. The most common and the most dreaded are road accidents. The road conditions in many developing countries are pathetic and accidents occur rampantly. Yet I see few people thinking about prevention. Wearing a helmet is a simple basic precaution which will save a person from a potentially lethal or paralysing head injury. It is the difference between getting up and walking away from an accident versus an injury which may  lead to permanent disability and handicap if not death. The same applies to wearing a seat belt in a car. Seemingly simple, easy and effective precautions and yet many of us don't do it! Why? Because we don't think about life preservation untill it's too late. Following road rules (like using an indicator or not cutting lanes), avoiding rash driving and speeding, stopping at signals, keeping the vehicle well maintained and regularly serviced go a long way in accident prevention. Talking on the phone while riding a bike or driving a car is another recipe for a catastrophe! What about accidents at home? In the kitchen, be careful with the cooking gas! Old malfunctioning pressure cookers can burst, hurriedly used sharp knives can cut fingers and hot utensils and boiling oil/water can burn. The other danger zone at home is the bathroom. Make sure the bathroom floor is non slippery. There should be support handles for old people to get up. Beware of sharp shelf edges which could injure if one falls.  Don't climb on a chair to reach for a high shelf or clean the fan, use a stable ladder. The same rules apply for the work place or when travelling. We must be extra careful when travelling. An accident in a foreign land can be particularly nasty as we are helpless and often end up with less than ideal medical care.


The next is a medical crisis. We cannot control all the factors that lead to illness! But we can definitely control some of them. Young people get so busy with work and family that they don't have time for health preservation. The modern motto is to work hard now and enjoy the fruits after retirement. But reality is quite the opposite. By the time they retire,  people are bogged down with so many medical problems that their old age is nothing more than suffering, pain, doctors visits and a long list of medicines. Little does one realise that the efforts to achieve a healthy old age need to start when one is young. The idea of an investment which will pay returns in the future appeals to all but they are unable to apply the same logic to health. And yet, the truth is that investing in health remains the most profitable proposition. What factors can one control? Most critical is to stay away from addicting substances like cigarettes, alcohol, tobacco and drugs. These substances guarantee a life of suffering and a miserable old age. Beyond that, a healthy lifestyle boils down to two main factors - diet and exercise. I have written a number of articles on diet and exercise. Interested readers can access them on my blog - www.orthindia.blogspot.com. A good diet is about good quality foodstuffs and portion control. We must educate ourselves about which food is good for us. We ought to consume more protein and fibre (vegetables and fruits) and less carbohydrates and fats. We need to differentiate between good carbohydrates (chapati) versus not so good carbohydrates (rice) versus bad carbohydrates (potato, bread, maida, cake, jam, biscuits, cold drinks, sugar, mithai, ice cream, bakery products, chocolates and sweets). Stay away from bad carbohydrates. They are poor quality foodstuff. Portion control remains the key to weight reduction. Amount of food to be consumed in each meal should be decided before we start to eat. Eat only small amounts of food for lunch and dinner and compensate by having healthy snacks in between. A heavy meal neutralises the benefit achieved from a long period of starvation or a session of exercise. We must eat slowly to feel satiety with seemingly small quantities of food. Make it a habit to read the ingredients label on food packets to look for hidden sugar. As a thumb rule, food cooked at home will always be healthier than eating out. Be careful when eating outdoors or when travelling as chances of ending up with an upset tummy and loose motions are high. For exercise, do activities that you enjoy! There are no set rules. Choices are plenty from walking, running, cycling, swimming, aerobics, going to the gym or doing yoga. Remember that the only bad workout is the one that didn't happen. Aim to do some exercise for at least half hour, 5 times a week. Ideally one needs to exercise for an hour every day. Today people lead stressful lives, eat poorly, avoid exercise and buy medical insurance. The smart choice would be to work towards health and not ever need insurance.
The last aspect of illness prevention is timely screening for silent diseases and treatment of medical problems. Problems like blood pressure, diabetes and heart disease may not result in any symptoms for many years. An early diagnosis is crucial for preventing permanent damage. So everyone must get themselves screened for these illness' on a regular basis. It does not end with screening. One needs to to take proper treatment of his/her illness. For hypertensive patients, blood pressure should be controlled. For diabetes, blood sugars should be controlled. A diabetic patient must own a home blood sugar testing machine and must check blood sugars every week. Timely and regular intake of medicine coupled with regular testing and doctor's follow up is essential. 


A mention must be made here about the weekend warrior. These are the people who indulge in contact sports like football only on the weekends. Such sports require a high level of physical fitness which can come only with vigorous daily exercise. Those who don't exercise have weak muscles which offer poor protection to the joints. Hence the weekend warrior is much more prone to injury to the shoulder, wrist, knee or ankle than the physically fit person. Those who don't exercise daily are better off avoiding weekend sports.


Self preservation is an awareness that must be cultivated in the mind. A constant vigil will reduce the chances of a potential tragedy. Simply put it is the difference between happiness and suffering. The choice is really ours to make. Is it worth riding a bike for thrills or spending all your time at work or gorging on meals till your shirt buttons pop? We ought to rely on ourselves to look after our health rather than medical insurance ...... prevention will always remain better than cure!!