Dr Paul Clayton 2013
Sarcopenia – loss of muscle mass – is a very common but surprisingly little-known
condition related to bad nutrition and an inactive lifestyle.
From early middle age on, most of us lose muscle mass. It’s not inevitable – a very
physically active lifestyle can delay or prevent it – but people who are physically inactive lose
up to 5% of their muscle mass per decade from age 30! Some estimates are as high as 1% a
year. As the urban lifestyle tends to be very inactive, this age-related loss of muscle mass
(sarcopenia) affects very large numbers of people: over 20% of 60 to 70 year-olds, rising
to 50% of the over 75s.
And as numbers of elderly folk increase, the socio-economic costs of ill health caused by
sarcopenia have become very significant. The most recent (2004) survey of US costs put
them as high as $26 billion a year(1) and in 2008 the Centres for Disease Control named
sarcopenia as one of the top five health risks facing the US population. The EU has adopted
a similar position.
Patients whose lifestyles have left them with sarcopenia generally also have symptoms of a
number of related medical conditions. When the loss of muscle mass has led to a loss of
mobility and appetite, osteoporosis and general wasting often co-present as the so-called
‘frailty syndrome’. If calorie intake has been preserved, sarcopenia generally presents with
obesity (‘sarcobesity’) and with diabetes (‘metobesity’).
Not just an issue of fracture risk
This explains why sarcopenia is not only associated with the falls that cause fractures,
but also with all the complications of diabetes including a raised risk of vascular disease,
heart attacks, strokes, blindness, liver and kidney disease and a range of gastrointestinal
cancers. In short, sarcopenia contributes to the entire ageing process and in the process inflicts
a substantial burden of morbidity and mortality.(2)
Muscle is an important metabolic organ
Sarcopenia is at the centre of all these diseases because muscle is not just a way of moving our
bodies; it is also a highly important metabolic organ, and is critically involved in blood
glucose control and plasma lipid (blood fat) profiles. When we consume carbohydrates, for
example, and insulin kicks in, some glucose istaken up by the liver and stored as glycogen –
but in a fit and physically active person, the bulk of blood glucose is taken up and used as
fuel in the skeletal muscles.
If muscle mass has fallen, the capacity of muscle to take up and ‘burn’ glucose is
dramatically compromised. This contributes to insulin resistance, glycative stress (where sugar
molecules bind to protein in the body), chronic inflammation, widespread tissue damage and
accelerated ageing. Similarly, loss of muscle bulk and functionality impairs the muscles’
ability to remove LDL cholesterol from the circulation – creating an situation where the
danger of atheroma (hardening and furring of the arteries) is heightened.
Causes of sarcopenia
By examining the causes of sarcopenia we can begin to design programmes that will delay or
even prevent this core element of the ageing process. This will improve quality of life as we
age, increase the independence of the elderly, reduce their needs for health care and cut
healthcare costs. The causes include:
.. Endocrine shift: the menopause and viropause or andropause trigger hormone shifts
that degrade muscle in women and men
.. Sedentary lifestyle: a risk factor for sarcopenia and many other disorders.(3) Being
bed-bound is even worse; if a relatively healthy person in their 70s is bed-bound for 10 days, they can lose 10 percent of their total lean leg mass.
.. Chronic inflammation: a vicious cycle, whereby chronic inflammation drives muscle breakdown and the build-up of fat drives further inflammation.
.. Dysnutrition(4): insufficient protein and the co-factors required to build muscle protein.
Fast foods—foods cooked at high temperatures contain high levels of pro-inflammatory compounds.
.. Smoking: worsens chronic inflammation
Countering the risk factors
Removing or countering the above risk factors is the key to reducing the incidence and
severity of sarcopenia, and all the related pathologies. The optimal protective strategy
includes exercise, enhanced nutrition and of course smoking cessation.
When fully implemented, this strategy triggers an energy switch called AMP-Kinase (AMP-K)
and creates a favourable environment in which the body can start to burn more energy as fuel
for movement and to stop storing it as fat and cholesterol. [See refs 5-9 for AMP-K mode of action.]
If the combination of exercise and optimum nutrition were integrated into a pill, it would be
regarded as a wonder drug – perhaps the wonder drug of our age. It replaces two of the
most lucrative pharmaceutical drug sectors (anti-glycemic agents and statins), providing
greater benefits than both of them without any of the adverse effects.
The supplement industry is selling high protein shakes and other foods for sarcopenia, with
limited success. There is little point in pouring amino acids into the body if it is suffering from
chronic inflammation, and if the muscles are not being ‘instructed’ to grow. It is essential to
put out the fires first, which easily can be achieved with a comprehensive anti-
inflammatory regime as outlined in my recent e-book Inflamm-ageing. It is slightly more
difficult to generate the muscle growth signals.
Exercise doesn’t have to mean pumping iron
The most familiar way of growing and strengthening muscle is via exercise, but many
elderly people are not willing to exercise to the level needed, and for those with disability or
disease this may be impossible. Luckily, it is not necessary to run marathons or to pump
iron. These classical forms of exercise are aerobic and isotonic (ie you gasp for breath and
move your limbs), but we now know that equal gains can be made via anaerobic and isometric
exercise, where you do not become breathless and indeed hardly have to move.
Aerobic exercise lowers levels of oxygen (and cAMP) in muscle, and this is one way of
activating the AMP-K enzyme. However, the latest research shows that AMP-K can also be
activated by putting tension on muscle fibres, and this can be achieved in practical terms by
any form of resistance exercise, which can even be semi-passive eg. standing on a
vibrating plate(10). But if even this is too much, work is well advanced on a supplement …
Exercise Chinese-style?
Ethno-botanical screening in South Korea, identified the herb Gymnestemma pentaphyllum
as a candidate for research. Traditionally made into a tonic to revitalise the frail and elderly, its
popularity and its Chinese name Jiaogulan (‘little herb of immortality’) sparked the
researchers’ interest.
Anaerobic and isometric exercise can be as effective as the traditional aerobic and
isotonic forms.
Initial studies showed that Jiaogulan extracts activated AMP-K. Later work proved that the
saponins Damulin A and B were the actives—very active in fact, far more so than
the synthetic compound AICAR that activates AMP-K so effectively that it is thought to
have won the Tour de France in 2009 and 2010 (before it was banned!).
More research showed that the standardised extract produced all the metabolic benefits of
exercise; including improved insulin sensitivity and improved blood fat (plasma
lipid) profiles and fat loss, in both pre-clinical models(11) and an initial clinical trial(12) recently published in the prestigious journal Obesity, reflecting the robust nature of the study. The
fat loss was preferentially from the hard-toshift visceral fat depots – exactly the same
ones that are targeted by exercise.
So is this supplement a weight loss product? Yes and no. It has traditionally been used to
improve blood glucose control and plasma lipid profiles. It has a role in sport and is useful
in improving muscle fitness and restoring insulin sensitivity not only in sedentary types
but also in those with disabilities which make physical activity difficult or impossible.
The spectrum of effects of Jiaogulan will undoubtedly give it an invaluable role in the
management of sarcopenia through its ability to activate AMP-K, combined with its anti-
inflammatory effect and its down-regulation of MTOR (which slows muscle wasting).
The standardised extract will be available in 2014 (Jiaogulan teas are already around) and
great things are expected. I believe this type of supplementation could save £4 billion in
the UK alone if widely implemented.(13)
REFERENCES
1. Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004 Jan;52(1):80-5.
2. Parr EB, Coffey VG, Hawley JA. ‘Sarcobesity’: a metabolic conundrum. Maturitas. 2013 Feb;74(2):109-13.
3. Owen N, Sparling PB, Healy GN, Dunstan DW, Matthews CE. Sedentary behavior: emerging evidence for a new health risk. Mayo Clin Proc. 2010 Dec;85(12):1138-41.
4. Vandewoude MF, Alish CJ, Sauer AC, Hegazi RAJ. Malnutritionsarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? Aging Res. 2012; 2012:651570.
5. Chen MB, Zhang Y, Wei MX, Shen W, Wu XY, Yao C, Lu PH. Activation of AMP-activated protein kinase (AMPK) mediates plumbagin-induced apoptosis and growth inhibition in cultured human colon cancer cells. Cell Signal. 2013 May 25.
6. Yang X, Huang N. Berberine induces selective apoptosis through the AMPK- mediated mitochondrial/caspase pathway in hepatocellular carcinoma. Mol Med Rep. 2013 May 31.
7. Holloszy JO. Regulation of Mitochondrial Biogenesis and GLUT4 Expression by Exercise. Compr Physiol. 2011 Apr;1(2):921-40.
8. O’Neill HM. AMPK and Exercise: Glucose Uptake and Insulin Sensitivity. Diabetes Metab J. 2013 Feb;37(1):1-21.
9. Sanchis-Gomar F. Sestrins: novel antioxidant and AMPK-modulating functions regulated by exercise? J Cell Physiol. 2013 Aug;228(8):1647-50.
10.Klarner A, von Stengel S, Kemmler W, Kladny B, Kalender W. Effects of two different types of whole body vibration on neuromuscularperformance and body composition in postmenopausal women.
Dtsch Med Wochenschr. 2011 Oct;136(42):2133-9
11.Park SH, Huh TL, Kim SY, Oh MR, Tirupathi Pichiah PB, Chae SW, Cha YS. Antiobesity effect of Gynostemma pentaphyllum extract (actiponin): A randomized, double-blind, placebo-controlled trial. Obesity (Silver Spring). 2013 Jun 26. doi: 10.1002/oby.20539.
12.Gauhar R, Hwang SL, Jeong SS, Kim JE, Song H, Park DC, Song KS, Kim TY, Oh WK, Huh TL. Heat-processed Gynostemma pentaphyllum extract improves obesity in ob/ob mice by activating AMP-activated protein kinase. Biotechnol Lett. 2012 Sep;34(9):1607-16. doi: 10.1007/s10529-012-0944-1
13.My own calculation, based on US incidence in 2004, medeconomic inflation and the relative size of the UK population.