Jacqueline Jacques, ND, FTOS
What is Lean Body Mass
Muscle
 Bone

When we lose lean mass we lose
health
Medical term is sarcopenia
 A syndrome characterized by progressive
and generalized loss of skeletal muscle
mass and strength with a risk of adverse
outcomes such as physical disability, poor
quality of life and death
 Sarcopenia is a powerful predictor of late-life
disability

Report of the European Working
Group on Sarcopenia in Older People
What is Sarcopenia
Between 20 - 80 years of age, there is
approximately a 30% reduction in
muscle mass
 Sarcopenia very likely begins in early
adulthood with atrophy and loss of type
II muscle fibers
 There is a decline in both muscle fiber
size and number
 There can also be increasing fat mass

What is Sarcopenia

Recent estimates indicate that approximately 4
5% of the older U.S. population is affected by s
arcopenia. That equated to 18 million people in
2010
 The Healthcare Costs of Sarcopenia in the United States. Journ
al of the American Geriatric Society 52:80–85, 2004.)
The risk of disability is 1.5 to 4.6 x higher with
sarcopenia than in persons with normal muscle
 Costs around $26 Billion per year to the US
health care system (and rising)

Causes
Causes

Major factors considered to be involved
include
 genetic heritability
 nutritional status (protein intake, energy
intake, and vitamin D status)
 physical activity
 hormonal changes (declines in serum
testosterone and growth hormone)
 insulin resistance, atheroscelorosis and
changes in circulating pro-inflammatory
cytokines
Causes: Weight Loss…
Percentage of FFM loss with various methods of weight loss
Method
Number of
Study groups
Mean of
study groups
25% or
greater loss
of FFM
< 25% FFM
loss
LCD
15
17%
2
13
LCD & EX
6
19%
1
5
LCD & Drugs
3
28%
1
2
VLCD
4
29%
3
1
VLCD & Ex
5
16%
1
4
BPD
15
30%
9
6
RYGB
4
30%
3
1
LAGB
15
17%
2
13
Chaston TB, & Dixon JB. Int J Obes (Lond). 2007;31:743-50.
Casues: Vicious Cycle
Consequences
Metabolic Risks of Sarcopenia
A loss in muscle mass is related to metabolic
problems such as insulin resistance, type 2 d
iabetes and obesity (including lean obesity)
 The combination of more body fat and lower
muscle leads to increased insulin resistance

 This is a set up for poor cardiometabolic health
Exercise

Resistance training is
the most effective
exercise for slowing
the rate of loss of
muscle mass and
maintaining or
improving muscle
strength.
Exercise

Resistance Training:
 Reduces falls
 Improves muscle strength
 Improves ability too complete ADLs
 Has been studied to improve QOL
It is also preventive
 Overall total activity is also very
important but harder to measure

Exercise

AHA Guidelines are often used in
sarcopenia:
 All sedentary adults should participate in
resistance training activities 2 to 3 days per
week.
 Individuals who are younger than 50 years
should perform 1 set of 8 to 12 repetitions of 8 to
10 different exercises.
 Individuals who are 50 to 60 years old or who
have CVD should perform 1 set of 10 to 15
repetitions of 8 to 10 different exercises at a
lighter weight.
Protein

Recommended Dietary Allowance (RDA) for
healthy adults (0.8 g/kg/day).
 Though many over age 50 do not achieve this

There needs to be a post-prandial rise in
blood AAs to stimulate protein synthesis
 Low intake hampers this
 As we age, more AAs are taken up by the liver
and never get into circulation
Protein
Current recs may be too low to stimulate
muscle synthesis in older adults
 Studies have indicated that levels of 30g/meal
can produced protein synthesis similar to
younger people

- Paddon-Jones D, Sheffield-Moore M, Zhang XJ, et al.
Amino acid ingestion improves muscle protein synthesis in
the young and elderly. Am J Physiol Endocrinol Metab.
2004;286:E321-E328.

An expert panel recommended a total
protein intake of 1 to 1.5 g/kg/day with equal
amounts of protein consumed at breakfast,
lunch, and dinner
- J.E. Morley et al., JAMDA, 2010. 11: p. 391-396
Protein after bariatric surgery
Protein intake should be individualized,
assessed, and guided by an RD, in
reference to gender, age, and weight
 A minimal protein intake of 60 g/d and
up to 1.5 g/kg (0.7g/pound) per day
should be adequate;
 Higher amounts of protein—up to 2.1
g/kg (1 gram/pound) per day—need to
be assessed on an individualized basis

From the 2013 TOS Guidelines
Protein after bariatric surgery
“Recommendations for protein intake
are variable but studies suggest higher
protein levels (80–90 g/d) are
associated with reduced loss of lean
body mass.
 Protein intake is generally reduced
following surgery and adequate intake
can be facilitated through the use of
protein supplements”

From the 2013 TOS Guidelines
Branched Chain Amino Acids
(BCAAs)
The amino acids valine, leucine and
isoleucine
 Nearly 25% of all whey protein is made
up of BCAAs - one reason why a lot of
people recommend whey
 They help both to decrease muscle loss
and promote muscle synthesis
 Good to supplement both with increased
weight loss and with exercise

Leucine
One of the 3 branched
chain amino acids
 As we already discussed,
branched-chain amino acids
regulate muscle protein
synthesis and help prevent
loss
 Leucine is the principal
branched-chain amino acid
responsible for the anabolic
effect on muscle protein
synthesis.

Leucine
Studied range is 3 to 12 grams/day
 May be more effective for protein
synthesis if co-administered with whey

 Combination seems to give higher/faster
rises in serum amino acids
HMB
Beta-hydroxy-beta-methylbutyrate (HMB) is
the active metabolite of leucine.
 May be more effective (than leucine) in
untrained individuals
 Levels of 3g/day together with mild
resistance training significantly increased
LMB in elderly men in 8 weeks. Also
resulted in fat loss.

- Vukovich MD, et al. Body composition in 70-year-old
adults responds to dietary beta-hydroxy-betamethylbutyrate similarly to that of young adults. J
Nutr. 2001;131:2049–2052
Vitamin D

Vitamin D deficiency appears to be an
independent risk for sarcopenia;
 Muscle loss/weakenss
 Bone loss
 Increased risk for falls and hip fracture

Fall prevention has been observed at
levels starting at 700iu/day
Vitamin D
In studies, anti-fall efficacy started with
achieved 25-OH D levels of at least 60
nmol/L (24 ng/ml)
 Anti-fracture efficacy started with
achieved 25-OH D levels of at least 75
nmol/L (30 ng/ml)
 Higher levels may give a better result

- H.A. Bischoff-Ferrari, Best Pract Res Clin
Rheumatol, 2009. 23(6): p. 789-795
Other Tx

Nutrition:
 Creatine – related to amino acids. 95% of
creatine is stored in muscle
○ May improve muscle strength and energy –
allowing people to do more exercise and thus
promote more lean mass
○ Typical doses are around 5 grams. Be cautions if
you have kidney disease ot take medication for
diabetes
 EPA – from fish oil. Can help prevent muscle
break down
Other Tx

Drug:
 Testosterone
 Estrogens
 DHEA
 Growth hormones
 Angiotensin-converting enzyme inhibitors
Conclusions
Whenever you lose weight, you will lose
lean mass
 It is important to work hard to preserve
lean mass as it will continue to decline
with age
 Maintaining health lean mass is
important not just for strength, both for
overall lifelong health
