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!

Which exercise is best for weight loss?

We now know that obesity is a problem. The pot belly is a house of disease. Obesity and high blood pressure go hand in hand. So do obesity and diabetes and obesity and coronary heart disease (chest pain and heart attack). Losing weight is the need of the hour. Weight loss is no more a goal for mere good looks. It is essential if one wants to lead a healthy life.

Diet is the key to weight loss. I have written on diet and weight loss, the pot belly and the evils of sugar. For some people, diet alone may not be enough. Their basal metabolic rate (B.M.R) is so low that changes in food habits are not enough to bring about the weight loss. In simple words they are just not burning enough calories. The fat burning engines of their body have gone to sleep. Exercise is the only way to increase their metabolic rate.

All of us think of walking when we are considering exercise. We feel it is the best exercise to do the job. In fact it is the first exercise that comes to our mind. Many of us have taken up walking only to give it up after a few months or weeks. Many of us have stuck to walking for years. But how many have really succeeded in losing weight by walking alone? Probably very few. All our life we have been brain washed by health experts, doctors and dieticians into thinking that walking is the best exercise. Gyms spend crores on treadmills and have entire sections dedicated to cardio. Those who can walk are encouraged to jog and even run. Marathons have evolved from a sporting competition to the new health fashion! But alas, all this is far from the truth!

Walking is not the best exercise to lose weight. Walking falls in the category of what experts call 'steady state cardio'. Walking is a basic life function and the body has evolved over the years to make it very energy efficient. So not enough muscle groups get involved when we walk. If we walk for longer distances then the muscles quickly adapt and become more energy efficient. A similar process happens when one jogs or runs at a constant pace. That's why we feel tired or get palpitations (can feel our heart beating) only for a few of the initial walks. After a week or so of walking, we can walk the same distance with ease. An energy efficient muscle will conserve calories and not burn them! However for patients with existing heart problems, walking remains a good exercise. They require an exercise that will put less strain on the heart. Heart patients should not try any other exercise without consulting their physician.

Which are then the best exercises to lose weight? To lose weight we must increase our metabolic rate. That will happen when large groups of muscles work hard. To achieve this we must do the opposite of steady state cardio. It is called High Intensity Interval Training (HIIT). As the name suggests periods of high intensity workouts should alternate with short intervals of rest. If you choose to exercise on a treadmill, then short bursts of brisk walking should alternate with short periods of walking slowly. People who are more fit, can do bursts of sprinting alternating with intervals of slow jogging. A similar interval training can be done in cycling and swimming. These short bursts require the muscles to work hard. By pushing the muscles out of their comfort zone we can force them to become calorie hungry. Metabolic rate and calorie burn is thereby increased.

Another way to lose weight efficiently is by weight training. By lifting weights we can exercise large muscles of the body and the exercise is not restricted to only a few muscle groups. The entire body musculature gets involved. Furthermore by pushing the muscles to their limits, there is a tremendous increase in calorie burn which lasts throughout the day as the muscles recover. We can thus achieve a sustained rise in metabolic rate. Weight training is perhaps the most efficient way to increase metabolism. 

Boot Camp exercises or Body Weight training is an alternative for those who cannot join a gym. These are sets of exercises which make use of the body weight instead of dumbbells and machines. Examples of such exercises include squats, dips, lunges and burpees. Quick sets of such exercises performed with short breaks are effective in achieving a higher metabolic rate.

Losing weight is all about diet for most of us. Both quality and quantity is important. For some people changes in diet are not enough. They need to fire up their metabolic engines to burn up those calories. Age old beliefs of types of food which increase weight, have recently been proven to be wrong. Similarly its time for a paradigm shift in our ideas about exercise. The words cholesterol and walking have now been replaced by sugar and HIIT!