Article by Dr Manasa S, B.A.M.S
Sarcopenia – Meaning & introduction
Sarcopenia, literally meaning “lack of flesh” is a condition characterized by age-related muscle degeneration, becoming increasingly prevalent in individuals over 50 years of age.
This is a medical condition where there is gradual loss of muscle mass, strength and function. This condition leads to an average annual muscle strength loss of 3% post-middle age, significantly impairing the ability to perform everyday activities, presenting challenges such as difficulty walking, climbing stairs, and carrying heavy objects, alongside an elevated risk of falls and fractures.
Moreover, sarcopenia is linked to a reduced life expectancy compared to those maintaining normal muscle strength. The underlying cause of sarcopenia is an imbalance between anabolic (muscle-building) and catabolic (muscle-tearing) signals. Typically, growth hormones and protein-destroying enzymes work in concert to maintain muscle integrity through cycles of growth, stress response, destruction, and healing.
In youth, this cycle remains balanced, preserving muscle strength. However, aging disrupts this equilibrium as the body becomes less responsive to growth signals, shifting the balance towards catabolism and resulting in muscle loss. The prevalence of sarcopenia varies, affecting 5-13% of individuals aged 60 and older, and escalating to 11-50% among those aged 80 and above.
Diagnosis involves a series of tests evaluating muscle strength, quality, and physical performance. Although no medications are currently approved for sarcopenia treatment, lifestyle modifications can effectively manage the condition and enhance muscle mass and strength.
Causes & risk factors of Sarcopenia
The primary cause of sarcopenia is the natural aging process, but several other risk factors have been identified –
– Physical inactivity
– Obesity
– Chronic diseases such as chronic obstructive pulmonary disease (COPD), kidney disease, diabetes, cancer, and HIV
– Rheumatoid arthritis
– Insulin resistance
– Reduction in hormone levels
– Malnutrition or inadequate protein intake
– Decreased ability to convert protein to energy
– Decline in the number of nerve cells transmitting movement signals from the brain to muscles
Brief pathophysiology of sarcopenia
Type II Muscle Fiber Decline – Sarcopenic patients predominantly experience a significant decline in type II muscle fibres, whereas type I muscle fibres remain relatively unaffected.
Age-Related Hormonal Declines – Sarcopenia is linked to age-related decreases in anabolic hormone levels, including testosterone, human growth hormone (HGH), and insulin-like growth factor-1 (IGF-1). These hormones are essential for muscle development, maintenance, and rejuvenation. Their reduced levels in older adults support the pathophysiology of sarcopenia.
Insulin Resistance and Sarcopenic Obesity – Aging individuals often develop “sarcopenic obesity” characterized by increased adipose tissue and decreased muscle mass, leading to metabolic dysfunction such as insulin resistance (IR). This IR results in the accumulation of visceral fat and an inverse relationship with skeletal muscle mass. Dysfunctional insulin effects on skeletal muscle, including impaired anti-proteolytic and muscle protein synthesis (MPS) enhancing properties, contribute to sarcopenia. Additionally, reduced lean body mass further exacerbates IR by limiting glucose uptake into skeletal muscle.
Neurodegeneration – Progressive neurodegeneration, including the decline of alpha motor neurons in the spinal cord, loss of peripheral nerve fibres, and fewer neuromuscular junctions, is prevalent in aging populations. This neurological decline negatively impacts muscle fibre recruitment, leading to reduced muscle strength and size, thereby contributing to sarcopenia.
Increased Inflammatory Markers – Elderly individuals often exhibit elevated levels of inflammatory markers such as C-reactive protein (CRP), tumour necrosis factor-alpha (TNF), interleukin (IL)-6, and IL-1. The catabolic effects of these cytokines on skeletal muscle are well-documented, providing a mechanism through which sarcopenia may develop with age.
Symptoms of sarcopenia
– Difficulty in doing daily activities
– Walking slowly
– Trouble while climbing stairs
– Poor balance
– Frequent falls and fractures
– Loss of stamina
– Decrease in muscle size
Risk factors for Sarcopenia
– Not consuming enough protein
– Physically inactive
– Obesity
– Younger people with inflammatory diseases, malnutrition, and cachexia
– Heart failure
– Chronic kidney disease
– Human immunodeficiency virus
– Cancer
– Diabetes mellitus
– Chronic obstructive pulmonary disease
Diagnosis and Tests
Diagnosing sarcopenia involves a combination of physical examinations, symptom questionnaires, and various tests to assess muscle strength and mass. The most common questionnaire used here is SARC-F, which evaluates:
S- Strength
A- Assistance with walking
R -Rising from a chair
C- Climbing stairs
F- Falls
Scores range from 0 to 10, with a score of 4 or higher indicating the need for further testing.
Muscle Strength Tests
– Handgrip test – Assesses overall muscle strength through handgrip strength.
– Chair stand test – Measures leg muscle strength by counting how many times you can stand and sit from a chair in 30 seconds without using your arms.
– Walking speed test – Evaluates gait speed by timing a 4 meter walk.
– Short physical performance battery (SPPB) – Combines chair stand, standing balance, and walking speed tests.
– Timed-up and go test (TUG) – Times the process of rising from a chair, walking 3 meters, returning, and sitting down.
Imaging Tests for Muscle Mass
Dual-energy X-ray absorptiometry (DEXA or DXA): Uses low-energy X-rays to measure muscle mass, fat mass, and bone density.
Bioelectrical impedance analysis (BIA): A more accessible and cost-effective test that measures body fat relative to lean body mass.
Management and treatment of sarcopenia
Sarcopenia, if due to the natural aging process, then it is difficult to reverse. However, it is definitely possible to slow down the process of muscle loss and strength associated with sarcopenia under the able guidance of medical professionals.
At present there are no proven medications for sarcopenia, so treatment modalities aim at periodic assessment and lifestyle strategies.
Main aim of treating sarcopenia is focused on promoting fitness and physical activity. Regular exercises like walking, jogging help in a long way.
Resistance training, using bands or weights to build muscle strength is considered as prime treatment strategy
Healthcare professionals’ advice two weekly sessions of strengthening exercises focussing on upper and lower body parts.
In addition to this, if a health care professional suspects malnutrition as the cause behind sarcopenia, then supplements like vitamin D, Vitamin B12, vitamin C, and minerals like selenium and magnesium are advised.
Role of nutrients in fighting sarcopenia
Someone who is deficient in calories, proteins or certain other vitamins and minerals may be at a higher risk of developing sarcopenia. If an individual is not deficient in nutrients, can get a higher dose of nutrients to maintain muscle mass, stamina and promote muscle growth and enhancing the benefits of exercise will help to restore the muscle stamina and mass.
Few important nutrients which help to fight sarcopenia are as under –
Protein – Consuming a good quantity of proteins helps to build and strengthen muscle tissue. As people age, their muscles become resistant to muscle growth as there will be gradual decline in the muscle mass due to the natural aging process. So, they need more protein to maintain muscle mass and strength. Protein rich sources include whey protein, meat, fish eggs and soya protein.
Omega-3 Fatty Acids-Omega – 3 Fatty acids are proven to have anti-inflammatory properties but they also help in muscle growth.
Vitamin D – Deficiency of Vitamin D is related to sarcopenia, although the reasons aren’t clearly understood. Regular consumption of Vitamin D supplements has shown to increase muscle strength and reduce the risk of fall.
Creatine – Creatine is a kind of protein made in the liver. Normally the body makes enough creatine which is good enough to prevent its deficiency. Creatine taken in the diet from meat or supplement might benefit muscle growth.
Some practical tips to cope up with sarcopenia
– Ensure that handrails are installed on all stairways.
– Make sure your home is well-lit to improve visibility.
– Maintain an orderly and tidy home environment, free from trip hazards.
– Avoid using area rugs, and ensure that carpets are securely affixed to the floor.
– Install grab bars near the toilet and shower for added support.
– Keep kitchen implements, pots, pans, and utensils in easily accessible areas
A study establishes the relationship between chronic obstructive pulmonary disease with physical performance, sarcopenia and respiratory function in older patients. It says that the aging process is characterized by a progressive decline of skeletal muscle i.e. sarcopenia, which, by closely interacting with chronic diseases, may predispose to the onset of physical disability.
Another study showed that Sarcopenia is a reliable marker of frailty and poor prognosis among the oldest individuals. The findings show that sarcopenia is associated with mortality in older adults living in the community, independently of age and other clinical and functional variables.
Sarcopenia: Ayurveda Understanding
Muscle loss is the main feature and sign of sarcopenia. Hence it can be correlated with ‘mamsa kshaya’ explained in Ayurveda which also means ‘muscle loss’.
This condition can also be correlated with aggravation of vata in the muscle tissue. Muscle has kapha in its matrix and vata is antagonistic to kapha, and so is pitta. Pitta damages the muscles in case of inflammatory afflictions and vata is predominant wherein there is degeneration and destructive changes in the muscles and tissues around it. Vata aggravation in the muscles is called ‘mamsagata vata’.
General vata disorders can also cause sarcopenia.
Sarcopenia is said to be a disease of old age. In old age, according to Ayurveda, vata is naturally predominant. Vata aggravation causes tissue destruction. The other pathway is also possible i.e. tissue destruction leads to vata aggravation. When these events happen in the muscle tissue, it causes sarcopenia.
The other causes for sarcopenia according to Ayurveda are –
– Excessive consumption of foods and activities causing aggravation of vata and pitta
– Ati vyayama – excessive indulgence in exercises or physical activities,
– Mandagni – reduced strength of digestive fire, ajirna – indigestion leading to inadequate nutrition of muscles and excessive formation of ama
– Contamination or damage to mamsavaha srotas
– Pathological decrease of rasa, rakta, mamsa and medo dhatu
– Avyayama – sedentary life
– Anashana – obsessive starvation or fasting leading to inadequate nutrition
Disease or disease syndromes which can cause sarcopenia are –
– Rajayakshma
– Shosha
– Mamsagata Vata
– Shwasa
– Hrdroga
– Medo Roga
– Karshya
Management of sarcopenia with Ayurveda interventions basically comprises management of mamsa kshaya and treatment of cause and avoidance of causative factors.
Important principles of management of mamsa kshaya include – combating vata, brimhana, balya and rasayana therapies.
Related Reading – ‘Sarcopenia – Ayurveda Understanding’
