What is Sarcopenia?

Have you noticed your body is starting to look different, maybe your composition has changed? Have you started to notice more fat in your muscle tissue, maybe you have noticed you are not as strong as you used to be? This could be the start of a natural process called Sarcopenia? The good news is this can be slowed down and significantly improved.

I might as well get the scary stuff over with first, but please stay to the end to see what you can do to change this. One study of women aged 40-50yrs of age found a 21% reduction in muscle strength. Unfortunately, I know many women that fall into this category, some can even pinpoint the exact age they were when their strength reduced. This really worries me as I believe that function is everything. 

Sarcopenia is the reduction in both muscle mass and muscle function. Muscle decline with age is inevitable but the menopausal transition accelerates this decline.  The exact mechanism of why the loss is fast-tracked at this stage is unclear but it's suggested to be linked with the reduction of estrogen, DHEA, and/or Growth Hormone. But other factors like the reduced sensitivity of insulin, reduced circulation, dehydration, increased inflammation, and oxidative stress may also be causative factors.

Starting in your twenties, your muscle mass can start to decline but it's at a really low rate. This speeds up around the age of 40 and by the time you have completed your transition into menopause the amount of non-contractile tissue (otherwise known as intramuscular fat) per unit of muscle increases, it may even have doubled by the time you reach 65. 

There are a few different ways to diagnose sarcopenia across the globe but in Australia, we use the European method which involves having a handgrip strength of under 20kg and a gait speed or a walking speed of under 0.8m per second.  

What I really want to focus on today are the changeable factors. These either tip the scales towards the loss of muscle function or away from it. And the good news is you have the power to change all of these on your own.

The first one is Physical inactivity. There really are no excuses to not get moving these days. I’m in lockdown and can’t get to the gym but I have a kettlebell and a set of resistance bands at home to complement my daily walk. The research is really pointing to resistance-style exercise, aiming for a minimum of 2 to 3 sessions a week. This frequency helps maintains muscle mass and helps to minimize the accumulation of intramuscular fat. 

The next factor involves consuming adequate protein. Animal proteins are the far superior form of protein due to their higher levels of essential amino acids,  such as leucine. Leucine is an essential branch chain amino acid and it has performed well in various studies. It has been found to be well-tolerated and helpful in increasing lean muscle mass.  Looking at general protein requirements these actually increase. The current recommendation of 0.8g of protein per kg of body weight is inadequate at this stage of life Depending on sources 1.2 or even 1.5gram of protein per kilogram is recommended to curve the muscle wastage. Let me walk you through what this means in food terms. 

Imagine I’m 65kg. In my premenopausal phase, I would be recommended to have 52 grams of protein daily and to get this I might eat 2 x eggs for breakfast, nibble on a serving of almonds during the day, and have a chicken breast for dinner. If I starting going peri-menopause this recommendation would be increased to 78gms of protein a day and this might be a 2 egg omelet with 1/4 cup of cheese for breakfast, a 95gm tin of tuna for lunch, and a 240gm rib-eye steak for dinner. It's a big increase in the amount of protein and if you used the 1.5grams per kg of weight equation it would be just under 100 grams daily. To get this I would add a protein smoothie to the above plan. I’m not a fan of counting macronutrients I just wanted to give you an example of what to aim for. In reality, if you add an animal protein source into each meal you will probably be close and if you want to add a protein shake as an insurance policy you can add this in. I am aware this recommendation will seem impossible for some of you as it is commonplace for protein digestion to become more difficult as we age. This is due to the age-related reduction of digestive acids and enzymes. Reach out if you need a hand.

On to Vitamin D status: Having optimal Vitamin D status help increase muscle fibre numbers and muscle fibre size, increases protein synthesis, decreases inflammation, decreases intramuscular fat, and increases lean muscle mass and strength. If you haven’t had a vitamin D test in a while it might be worth asking your doctor for one because it's a simple fix with supplementation. On a side note, I don’t tend to use straight Vitamin D these days. I most often combine it with other fat-soluble nutrients such as Vitamin K.

Some of my other favourite nutrients to consider for general muscle health include magnesium, calcium, potassium, sodium, CoEnzyme Q10, Omega 3, and Collagen. It’s also worth considering your iron status.

My final thought is on the role of phytoestrogens to help slow sarcopenia at menopause and I’m so excited to tell you about a study I found that gave women 70mg of isoflavones (a type of phytoestrogen) daily for 24 weeks and this significantly increased their lean muscle mass. 

The best strategy is a preventative strategy, but if you have started noticing muscle changes you need to take action NOW and continue to work on it moving forward in order to save your muscles and ultimately your independence. Even if you just focus on resistance exercise, 2-3 times a week, increasing your daily protein intake, and taking a Vitamin D supplement you will be much better off.