Muscle Mass, Strength and Longevity

MUSCLE MASS is the most ignored part of our adult body for an average Indian. We hardly bother to find out how much muscle mass we are carrying. We have been tuned into this frame of mind that only an athlete, sports person, a model and these days actors should be bothered about this. Why should I? I am a normal office going or a businessperson, or I am a housewife, take care of my family and daily household core, why should I be bothered about building or checking muscles. That’s so weird… isn’t it?

You are so wrong. And let me help you to understand this and get this to your head. Your body’s main framework is your musculo-skeletal system, on top of which you have an adipose tissue layer & your skin to give it an external shape, while all your vital organs reside within this framework. Do you agree to this? Musculo – stands for your muscles & skeletal – stands for your bones, joints that build your skeletal system. This is like the iron rod & frame, being supported by the concrete in that high-rise building. Hope, you are getting this.

For a high rise building to stand tall for the longest time (say 100 + years) what do you think is required. Of course, high quality iron frame well supported by very high-quality concrete. Very similarly, if your musculo-skeletal system is built in combination with high density bone and well supported by higher density of healthy muscle mass, tendons & ligaments, your body can survive longer, which leads to your longevity. Of course, it also require your behavioral support in terms of a stress free, well-disciplined eating behavior to attain this longevity. Its not too far, we all have seen people living till their 90s & 100s. But where have they all gone now? Why we have taken it for granted, we will survive till our late 60s or early or max. late 70s. WHY ?

When it comes to optimizing our health and longevity, our muscle mass and muscle strength plays the most critical role. Remember, your heart is nothing but a set of muscle.  Our muscle mass, and strength decline with age. The changes that occur to our muscles as we age can be profound. These changes, as we will discuss, can have dramatic effects on our health. Muscle mass starts to diminish as early as our 40’s. if not taken care of well in time & 40 is not that old. What say?

Muscle loss which leads to loss in muscle strength is very common as we enter our 60’s. If we do not focus on our muscle mass & muscle strength at our younger age, the risks of muscle loss increase multi-fold and become too difficult to overcome as we age. 

Sarcopenia:

Sarcopenia is a condition of age-related muscle mass loss. Decline of skeletal muscle tissue with age, used to be a major health crisis in 3rd world countries during food scarcity in older adults. In many lower socio-economic strata Sarcopenia starts to appear in as early as 40s. Loss of muscle mass is predictive of a shorter lifespan, and worse recovery after injury or surgery. Loss of muscles also possibly leads to neurological decline, hormonal changes, chronic inflammation, chronic illness, contributing to the declining of overall health.

There are number of factors that can affect the sarcopenic muscular decline. This can be broadly categorized into :

1. Body’s inbuilt genuine disfunctions &
2. Lifestyle Induced condition (can be addressed, if identified in early stage.)

Possible Body’s inbuilt genuine disfunctions: (Normal Decline)

• Decrease Protein synthesis
• Anabolic resistance
• Decreased anabolic hormones
• Muscular dystrophy
• Mitochondria dysfunction
• Impaired regenerative capacity
• Impaired vascular response

Possible Lifestyle Induced condition: (punctuated decline)

• Insulin Resistance
• Illness
• Insufficient Energy
• Hospitalization
• Protein malnutrition
• Chronic inflammation
• Habitual Physical Activity decline

In a healthy body, our muscle tissue ideally should account for more than 50% of our body mass. Our muscles are metabolically very active tissue, lack of which can have dramatic consequences in adults. Muscles help us control our glucose levels, use glucose as fuel, and have a role in insulin resistance and type 2 diabetes.  Loss of muscle mass contributes to poor health outcomes, fatigue, loss of function, disability, fall risk, frailty, and death. 

I hope I have convinced you enough, that maintaining and building lean muscle mass is essential. Let’s dive deeper to understand what exactly adding lean muscle mass mean. Look at the picture below. When you can achieve the condition, to add on muscle tissue, it adds on to your existing muscle fiver & tissue, increasing in its density, on the contrary, you burn more fat. Your body’s lean ness remain intact, you may add on little bit to your body weight which is good for you ( not all the weights are bad, the same way as not all calories are bad).

Muscle Synthesis and Muscle Breakdown

Muscle mass and protein synthesis are two continuous process inside the body. Our body is continually breaking down muscle protein (MPB), and rebuilding synthesis of muscle protein (MPS). When breakdown exceeds synthesis, we start to lose muscle mass. MPB & MPS processes occur on a micro-level (daily basis) aas well as on a macro level (long term basis). Achieving a situation where muscle protein synthesis exceeds muscle protein breakdown is essential to counter the effect of aging and inactivity. 

Though building lean muscle mass is a very complex topic but let me simplify it here for your understanding. Based on my personal experience, as well as being a sports nutritionist, I suggest people to focus on these three areas that works wonder to build lean muscle mass.

1. Diet with appropriate protein intake.
2. Resistance exercise
3. Dietary essential supplements to enhance muscle mass and muscle protein synthesis. 

We need to be sure that we are getting enough protein in our diet to stay in proper nitrogen balance. Your nitrogen balance is a way of saying that you have taken in enough protein. Protein ingestion gives you the building blocks that are necessary to synthesize muscle protein from.

Resistance exercise is critical too. You need to challenge your muscles if you expect to keep them & counter losing them. Muscles respond to load or force regardless of your age. Yes, a 20-year-old can build bigger and stronger muscles than a 60-year-old. But a 60-year-old will grow larger muscles when he performs resistance exercise. And this cannot be achieved without proper nutrition alongside exercise. 

Muscle mass and longevity

Muscle mass are highly metabolic tissues. How our tissues interact with our metabolic system matters. Visceral (Abdominal belly fat) fat is very toxic for our body, and we should make all the effort to minimize that. Visceral fat is responsible for considerable chronic diseases such as type 2 diabetes, heart disease, and fatty liver (NAFLD). Muscles, on the other hand, improve our ability to manage glucose, dispose of glucose and plays a very important role maintaining insulin sensitivity. Exactly for the same reason Antigravity as well as Nitric Oxide dump Exercises are prescribed to people with severe insulin resistance or type 2 diabetes to improve glucose control. 

Muscle mass correlates to decrease in chance of mortality. Simply put, the more muscle mass you have, the lesser the risk of dying from a chronic disease. It is proven 2-3 hrs of resistance-based strength training per week, can reduce your chance of mortality to multi-fold. Below graph shows the age progression and getting into the age-related disability threshold of two individual groups, one is engaged into muscle & strength building & the other group lead a normal progression of life.

Muscle mass improve your lipid profile.

Muscle mass is not directly correlated to your cholesterol level, but you need to look at the big picture. In general, if you are someone, making a conscious effort to build muscle mass and to improve your health, then you are equally engaged in other lifestyle changes to improve your health. This is how muscle mass is associates with your overall metabolic health, thereby you reduce the risk for inflammation, chronic disease, and improved lipid profile. In this context, I will give you my own example. In 2016, when I took up a challenge against myself to reduce my abdominal fat, I got engaged into clean eating, accurately tracking my daily (protein, fat & carb) Macros & started a structured resistance-based strength training. Initially, I was wondering, when my trainer used to put me workouts like dead lift, weighted squats and varieties of bench press. I was completely clueless, how such strength training can help me to get rid of my big belly. He was neither asking me to do 100s of floor crunches not hours of trade mill sessions. And by the end of 4 month, to my surprise, I not only lost 4 inches from my abdominal area, I lost quite a good nos. in that weighing scale. However, few miraculous things that happened internally within my body were, My fatty liver had completely gone, My insulin resistance had come to an insulin sensitive zone, bringing myself from pre-diabetics to a normal Blood sugar zone, and my lipid profile was showing just great. And with time, it just kept on improving. You may notice that in the below table.

Your Triglyceride: HDL ratio can predict your risk of having insulin resistance and type 2 diabetes. If you exercise to increase your muscle mass and eat a diet with emphasis to eat enough protein & healthy fat, you will increase your HDL. If you are now more conscious of your health and minimize simple carbohydrate intake, you will lower your triglycerides. That will decrease your triglyceride: HDL ratio and improve your overall metabolic profile. And that is what exactly happened with me since 2016, when I started giving emphasis to resistance training along side my change in eating behavior. 

Fall risk, frailty, and demise: The role of muscle mass

A complete exercise program includes aerobic conditioning, resistance exercise, high-intensity exercise, and balance training. Yes, balance training. While chronic disease sets the stage for our decline as we age, what ultimately leads to frailty and our demise is the risk of falling, and the injuries sustained from falling. Weakness and loss of balance increase our risk of falling. Each fall becomes progressively harder to recover from. Eventually, you might fracture your wrist, shoulder, or hip. Sadly, nearly 50% of people die within a year of suffering a hip fracture.

Minimizing our risk of injury from a fall is directly related to our muscle mass, strength, and balance. Our muscle mass and strength also speed-up our recovery after a fall related injury. Our muscle mass starts to diminish in our 40s. Sarcopenia is a naked truth and require active effort, if you wish to break the cycle that starts to appear in our 50s. Exercising when we are younger induces epigenetic changes in terms of muscle memory. Developing muscle memory is nothing but an epigenetic change induced due to exercise on your muscle mass which has a direct impact on your DNA expression. Exercise leads to some of those genes being turned on (an epigenetic change), that decrease your risk of cardiovascular disease, insulin resistance, premature aging, neurocognitive decline, and so on. It is, therefore, never too late (or too early) to initiate and stick with a resistance exercise program. 

How to improve our muscle mass?

There is no shortcut here. Preventing the age-related muscle loss will require effort. We need to lift heavy as well as push and pull heavy. Recent research has shown that just few sessions of resistance exercise leads to muscle growth in 60+year-olds. So, it’s never too late to initiate a resistance exercise program. This very common that, people after age of 50 are afraid of hurting their back, or something else from exercise. Well, it is proven now, that exercise improves osteoarthritis conditions in 50 & 60+ people. Everyone will experience back pain or shoulder pain, etc. at some stage of their life even after not doing any workout. But the risk of not performing exercise can cost you more than the risks of performing exercise under proper guidance. 

I will once again give here my example. Year 2016, at the age of 44, I joined a gym and joined a structured weight training program under a fitness trainer. Before that, gym for me was 20 minutes of trade mill & another 20 minutes of ellipticals. Few stretches, then a sauna or steam bath and back. After 6 month of weight training, I faced lower back injury & right shoulder joint injury twice. I had to undergo physiotherapy session. But then , opted for a highly qualified sports injury specialist trainer, and there after never had any injury, and in the process, could improve on my muscle mass that is reflected on the above table.

To initiate a resistance exercise program, you need some guidance. Which muscles should you exercise? That depends on what you are prioritizing. For longevity and fall risk, you want to be exercising your legs, thighs, calf, and glutes. Those are our largest muscles and will have the most significant impact on our metabolism. Those are also the muscle groups that will minimize our risk of falling. I have seen 70-year-olds squat. I have seen them try lifting real heavy on that bench press & doing dead-lifts.

Try to embrace Squats, hip hinge exercises, and calf raises, should be part of your routine. Runners must concentrate on calf exercises, Both seated and straight leg calf raises. Our calf muscles are one of the first to succumb to the changes brought by sarcopenia.  It is essential to focus on them during our resistance exercise training. Checkout the below picture to understand the quadriceps muscle anatomy of a working out & a non-working out 70+ person.

Supplements for maintaining muscle mass

There are no magic bullets. For those of you who are exercising there is a fair amount of scientific literature to support the use of creatine to build muscle mass. Creatine works by getting into the muscle cell and bringing water with it. So you are enlarging the size of each muscle cell. A larger muscle cell can generate more force. A more massive muscle is physically capable of helping you avoid injuries following a fall. Creatine will raise your blood creatinine levels, so you need to discuss it out with your doctor if you are taking it. 

Adequate protein intake is critical. By eating enough protein, you are giving your body the building blocks, it needs to improve muscle protein synthesis. A useful basic guide is that you need 1-1.5 grams of protein per kilogram of body weight per day. Protein is made up of amino acids. They are the building blocks. It turns out that of all the available amino acids, Leucine is the most important. Leucine is necessary and enough to result in adequate muscle protein synthesis considering a basic minimum of the other amino acids are available.

Protein requirements increase as we age. We need more protein to combat sarcopenia, and we need more protein because our muscle-building machinery is not as efficient. A reasonable guide for an average-sized person is to get at least 25-30 grams of protein per meal, assuming you are eating three meals. 

I have met so many people at their late 40s and early 50s, and they are afraid to exercise. They are so scared of hurting themselves. That is a reasonable fear. Injuries might happen if you perform resistance exercise. But you should fear the effects of sarcopenia more. You should fear the onset of frailty more. Workout under the supervision of an able coach. Workout based on your daily strength, challenging your own muscles. Its your competition against your own muscles.

Just check with your doctor/ cardiologist, if you have a history of heart disease or shortness of breath. But you must take your own call.