Ask the Pharmacist

Q) My mother has been continuing to lose weight. Should I be concerned?

A) Sudden, unexplained weight loss should always be brought to the attention of your physician but what if your parent/ loved one starts losing weight slowly over time? Shouldn’t that be celebrated given that we seem to be living in the age of obesity?  Well, that depends.

While there is no doubt more than a few members of the golden generation who could benefit from losing a few pounds, there are many who shouldn’t and are in fact not trying to reduce their weight. These people may be suffering from sarcopenia, which is the term we use for the age-related loss of muscle mass (and hence weight) along with function.

This process actually starts for most of us in our 30’s (prior to that our muscles tend to grow bigger and stronger on their own, however by middle age we lose on average 3% of our muscle strength annually) rate accelerating often around the age of 75. While that sounds like a happy problem to have, it can be quite serious as this decreased muscle mass negatively impacts our strength and mobility. Symptoms can include weakness, a loss of stamina and an increased risk of falling.

Sarcopenia has also been linked to a decrease in life expectancy and quality of life scores. And it is far from rare. It is estimated that 10% of the people over the age of 50 are affected by this condition. The causes of sarcopenia are complex in nature but include the fact that muscle cells in older adults stop responding as strongly to the muscle-building stimuli that exercise and protein intake provide, a process known as anabolic resistance.

As well, as we age, there is seen a reduction in the numbers of the nerve cells that are responsible for sending signals from the brain to the muscles to initiate movement. Combined with age related declines in hormones such as growth hormone, testosterone, and insulin-like growth factor and the natural decrease in our appetites leading to reductions in our calorie and protein intake, there is in some ways a perfect storm of factors that leads to this muscle loss.

Those most at risk include people living more sedentary lifestyles, who eat diets low in proteins and calories, people living with medical conditions that result in chronic levels of inflammation within the body (such as COPD, rheumatoid arthritis, the inflammatory bowel diseases, lupus, TB and many others) or that put severe stress on the body such as those living with chronic kidney & liver disease or those with chronic heart failure (up to 20% of these people will eventually be diagnosed with sarcopenia).

Treatment, not surprisingly, involves changes in diet and exercise habits as there are no magic pills at this point in time. Most experts believe that just following the current guidelines from Health Canada are insufficient to reverse the course of sarcopenia.

They are suggesting eating between 1.0 to 1.5 grams of protein a day for every kilogram that you weigh. It also seems to be important that this protein intake is spread throughout all three meals of the day rather than just in a massive supper.

The type of protein ingested can also make a difference. Animal protein (such as from meat, fish, eggs and dairy, as a side note on average there is about 7 grams of protein in 4 ounces of cooked meat) contains the amino acid leucine which seems to play a larger role in muscle growth than plant-based proteins meals do.

When it comes to exercise, rather than the 150 minutes weekly of moderate to vigorous exercise current guidelines suggest, experts say that people dealing with sarcopenia should spend more time doing full-body resistance training with progressively higher weights two to three times a week to get the most bang for their time spent. Two harder workouts, along with a lighter one seems to give the best results when it comes to maintaining strength.

Resistance training comes in many forms and includes lifting weights, pulling against resistance bands or moving parts of your body against gravity. This type of training seems to increase levels of some of the hormones we mentioned earlier as well as to cause muscle cells to grow and repair themselves.

On the supplement side of things, besides taking a protein powder (to supplement their diet if necessary), there is some evidence that taking vitamin D and 2 grams of fish oil (with its omega 3 fatty acids) seem to be beneficial as well. Creatine, a supplement used for many years by weightlifters, might also be beneficial but only when used in combination with resistance training.

Sarcopenia is reversible, but it takes effort and, like anything, is easier tackled early on rather than waiting for years to pass. Failure to do so can greatly diminish your ability to fully enjoy your life