What Is Sarcopenia and How to Avoid Sarcopenia In Menopause

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I'm Debra Atkinson and you're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness and menopause and beyond before you know to ask them. The goal: to help accelerate your results with the science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman.

It's not just you, but it's the 3 generations that you influence.

My unique 40-year career, including being a university senior lecturer in kinesiology an industry subject matter expert and international speaker, to founder of the first and the only exclusively made-for-menopause-and-beyond fitness membership in the world. Every week, I interview experts behind the science of optimal hormone-balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy you want, need, and deserve.

What is sarcopenia? Why is it so important for you? Well, number one, sarcopenia is to muscle what osteoporosis is to bone— significant loss of skeletal muscle mass and/or muscle strength. It could be one, could be the other, but generally it's going to be both. The challenge is often knowing how much you've lost because we never actually measured our peak. So if you are, for instance, a woman who's 45, 55, 65, we didn't measure our peak muscle mass at 25. That is really about the time it peaks. Bone density, by the way, peaks at about 30. We then start losing those, each of those masses respectively, about 5 years later. It's kind of like we can coast a bit because our hormones are at our peak. Protective hormones, keeping our muscle, keeping our bone. But at about 30, we start losing lean muscle mass. At about 35, we start losing bone density. So the challenge is, yeah, we don't know because we never measured. Pass this along to every young woman that you know and get them to measure their lean muscle mass. Make sure they have a smart scale and make sure they have done a DEXA scan if you really care about Sarcopenia is tied to anabolic resistance in midlife women, and that is we're more anabolic resistant to lean muscle growth. It's just harder to get lean muscle. Doesn't mean impossible. It's just not as easy as it was. We really have to fight for every little bit of muscle we get harder. We have to do the things, stay within the navigational buoys a little bit more. Because it's not just easy. We're not just, oh, I can go work out, I can eat pretty much what I want, and I still stay pretty lean. I think most of us can say, yep, that ship sailed. And so, you know, it's not quite the same as it was. Older adults, both men and women, have to work a little bit harder to gain lean muscle mass after 40. It gets even harder after 50, because yes, age has a cumulative effect. The further we are from that peak muscle mass and that point at about 30 when we started losing lean muscle mass easier than we gained it— those of you who are way ahead of the game and you were lifting weights consciously, purposefully when you were in your 30s, you probably didn't lose maybe any and you may have lost just a very small amount because you're— it wasn't as easy for you to keep it at 35 as it was at 25. And if you also and/or were eating more protein than most other women. But if you think back to some of us who are right now in our 50s, 60s, or 70s, that was kind of diet culture. So you may have been in a moment when you were in your 20s or 30s when you did a lot of dieting, you did a lot of cutting out foods that had the least amount of calories because we weren't quite sure what we were doing back then. It was like high fat, low carb, and, you know, nobody really talked about protein. It was carbs and fat got all the attention, and little protein kind of sat over here all by itself, not getting too much attention, while it was probably the one thing we should have paid attention to. Women, due to less overall body mass and muscle to begin with, so relative to males, We're smaller and we have less lean muscle mass for our bodies, partially because we have more, we have more body fat because we make the babies. We need it. We need it on our bodies during reproductive periods or reproductive years. And we are more prone to sarcopenia or muscle and strength losses than our males. And we also have a disadvantage because we have a more dramatic loss of our estrogen levels, you know, at the point of menopause than men do. For loss of testosterone, they come in for a landing and they do experience andropause, the men's side of menopause, but they come in for an easy landing. They coast downhill. We like do, done. So realize that estrogen for women is actually the bigger muscle and bone as well stimulus. It protected us, it helped us hold on to it easier. And yes, when we lift weights, or in order to lift weights, both, a little more testosterone helps us do that and helps us gain lean muscle. But it's estrogen that was the bigger muscle protein synthesis stimulant for us. It was like a natural muscle insurance policy. And now we got canceled, right? Even if you're doing HRT, you're probably— if you're doing HRT and you're on the right dose of estrogen, you're probably experiencing a little better efficacy for the exercise that you're doing and the lifestyle habits, period. But you're not at a disadvantage Let me just say this to you. If you're not doing HRT because you choose not to, because of budget, economics, it's just not something you can do, you can still gain lean muscle. So I want you to— everybody, it's, it's fair playing field. There are no non-responders to those who lift weights and/or eat higher protein. There's a benefit to muscle protein synthesis for everybody, so there's no discrimination here. Yes, if you're on HRT, we do see women in our programs and membership have a greater efficacy for it. Don't let that get in your way. Okay. So you are, as a female, overall body mass and muscle, there's less of it. So you're at a disadvantage. We have a dramatic reduction in estrogen than do males with testosterone. And we are going to suffer more, especially if we're not offsetting it with resistance training and eating adequate high protein. And that's where the other downfall is for a lot of women. We don't— I mean, we spend a lot of time on salads and vegetables, probably do a better job there than males do, but we don't always hit our protein goals, and we do need to do that. For women, estrogen plays that bigger role again of muscle and bone, both in terms of protecting So what contributes to sarcopenia? Really, we just laid that out, but sadly, one of the key reasons cited for muscle loss and sarcopenia— listen to this— for all of you, especially who are here in the United States, it's malnutrition. And I'm not talking about somebody with poor economic status. I'm talking about all of us. I'm pointing to all of us. We have probably in our pantries and our refrigerators and our freezers right now a lot of food, even though as I'm recording this, it's Friday afternoon, which for me is like, somebody better go to the store. You know, I look around and I'm like, oh yeah, I'm somebody. But even though we have a lot of food, we may have more processed food than would be really good for us. We may not have How many fruits and vegetables do you have in your counter and in your refrigerator right now? It's, I can tell you I've got green beans and other than that, I'm really pretty depleted. A couple of little kiwis, sad little kiwis and green beans. That's it. And that's not probably enough or enough variety, but combined effect here of muscle loss and sarcopenia, the reason cited for both. And although sarcopenia is muscle loss and strength loss, if we separate them and say muscle loss, because that is impacting negatively your metabolism, the combined effect may be a better predictor for all-cause mortality, meaning any reason you could die, than sarcopenia alone, right? So the combined muscle loss and sarcopenia, malnutrition is the problem. Go figure. We're not eating enough high-quality protein and whole foods. Recently in another podcast, I shared that for older adults, it was proven that not only did we need high protein in order to gain lean muscle mass, but we needed micronutrient density. That is, we can't just only eat protein. We can't only take in protein powder or a shake or pop essential amino acids for that matter. We have to be getting a wide variety of vegetables in our diet. And yes, vegetables and fruits, but I always say vegetables first because we need to get the density, the micronutrient density that is in that, without ideally the, the sugars. And I know there's a lot of good things in it, it's different than just, you know, table sugar, but depending on when you have things, your blood sugars can still spike So you have to watch out for just downing all the fruit if you're not also getting vegetables. So here's the thing to remember: we're not eating well enough to sustain our own health, even where we are and we can afford it. And it is 100% avoidable that we get sarcopenia. How do you measure sarcopenia? And this is where it gets sticky again, coming back to that— your fat-free mass. So if you've got a smart scale, it will generally tell you that. Some of our smart scales are really smart, like they've gone to college, and they will tell us skeletal muscle mass, which is what you want. Skeletal muscle mass being your biceps, your triceps, your chest, it's your back, it's your legs, quads, thighs, hamstrings, all of that. And there's total muscle mass, and that's every muscle in your body. So striated muscle mass— your tongue is a muscle, the, the muscles that move food through your intestines, all of it. What we really care about is skeletal muscle mass because when we lift weights, when we're trying to get up and down out of a chair, that is what's impacting our life, or that we impact positively or negatively if you're not lifting weights. So your fat-free mass and your height together can be an indicator, but it can also independently be based on strength, just your strength lot. But here's the deal, there are online calculators. I'm going to put a link to one in the show notes for today. Show notes, by the way, if you're watching on YouTube, the YouTube video is coming out first before the podcast episode does. So just know you'll have a little delay before you can get to the show notes. But online calculators, and you can look one up exist so that you don't have to do math. In most cases, you have to have the answers to some physical tests. Have you done a, you know, 10-rep max test for chest press so that you can get to the equal single 1-rep max in, in an equation? That might include also your grip strength, or easier to acquire things like your calf circumference in certain tests. And unfortunately, in most cases women didn't measure or track our skeletal muscle mass decades ago to know where it was at peak. So we can't actually say how much did we lose. It's so much harder to say how much mass or strength you've lost. And truly, to those of you— shout out to you— if you are now at whatever age you are and you're lifting weights consistently, you probably have more strength than you did at 30, when that point in your life when you and I were really busy, maybe, and we weren't all tuning into it equally. So a few sarcopenia-related statistics that I want you to know so that you understand how important this is.

Hey, this is Debra Atkinson.

I love creating the Flipping 50 podcast for you, and I have for over a decade. I also love helping midlife women shift not only their physical energy, but their beliefs about what effective exercise looks like and how much it can positively and powerfully impact your life. How you menopause and exercise in menopause determines how you will live, not just now, but decades from now. If you're not exercising right now, you're getting tired, not stronger, or you think you don't have time or the energy to exercise, do a 5-day flip with me. I'll send you one short video a day for 5 days. It's just 15 to 20 minutes long, so you can see exactly how I plan out a fitness plan for myself and for thousands of clients I've worked with. You can get this at flipping50.com right now. What are you waiting for?

Let's start flipping 50 together. On average, average muscle loss. And you're not average, I'm not average, we're not hoping to be average, but this is if we're not doing anything about it. Muscle loss occurs at 3 to 8% a decade starting at age 30. So by the time we're 40, we've lost 3 to 8. What's the difference? Who's losing 3 and who's losing 8%? 8% is probably those people who are not exercising. They're definitely not doing resistance training and they're not eating very much protein. 3%. You may be lifting weights or exercising, maybe not working quite hard enough. You're eating protein, maybe not eating enough. Those people who don't do the average, they're way above average, they may not be losing any because they've been diligent doing the right thing. And that can accelerate during menopause transition, so you're not losing 3 to 8%. Each decade during your menopause transition, it may actually accelerate even greater. So 1 to 2% a year for the 3 to 5 years of the menopause transition. It isn't all associated with loss of estrogen driving skeletal muscle protein down, though. So it's not just there's no estrogen signaling we need muscle, hold on to muscle. It's the side effects of the decline of estrogen for a lot of women. You're not sleeping, and so you're gonna struggle exercising as hard or as long as you actually need to. You have brain fog. You are higher at risk for injury. Many women experience that suddenly at midlife, in their 40s and 50s— plantar fasciitis, hip bursitis, frozen shoulder. And by the way, those things are not mandatory either. I know a lot of people are telling you this is happening and that you're more likely to— please don't take that as a suggestion. Question that you have to hold on to. Let that go right on past. Not every woman experiences these injuries. If you're eating well, if you're sleeping well, you're warming up— please don't skip that anymore— you're going to be okay. So you will find it though, if you're not struggling, harder to exercise as long. You'll have less support for your muscle from testosterone and growth hormone because they're released while you're sleeping. You're going to have cortisol, ghrelin, and leptin hormone dysregulation the day after you don't sleep. Those things interfere with muscle and, to a greater extent, increase your storage of fat. Not the desired effect we were after. We do have the ability to regain muscle if you've lost it. You feel like I'm— I've lost my strength, I'm not as strong as I used to be. It's proven, and I've shared this in prior episodes, that 85 -year-old-plus and older groups can both gain muscle mass and strength. But more a little bit later on the possibilities of gaining lean muscle mass and the positive side effects of it. But we do, as we age, have to not only eat the protein and all the veggies, the micronutrient-dense diet, but we also need to be doing that resistance training. We should be the generation that says, I'm never going to stop. Like, the week we die, we should still have been in the gym. We need to start thinking, that's who I am, that is what I do, because we will live a lot longer and we will live a lot better if we're doing that. There is a simple questionnaire called the SARK-F, and it may feel like much too easy an assessment for you if you're watching this. Depending on who you are, it may seem like one maybe for your parents or older adults in your family, but it's a good point of reference. And by the way, for those of you listening who feel like this is way too easy as I describe it, you can get the fitness scorecard at flipping50.com/fitness-scorecard. I put that in the description to help not only better measure muscle strength and mass, but power, but how you rank according to others in your age group. So You don't want to be average. It's more important that you compare you to you, but start where you are benchmarking it, knowing, okay, today I was, I was in the below average category. All I have to do is get to X. And so a little practice, a little repetition, a little focus on strength training, and you could be improving your mortality rate, or probably improving your longevity by decreasing your mortality rate. The SARGF includes 5 components like strength, assistance walking, rise from a chair, climb stairs, and falls. And then it rates everything and the scores are from 0 to 10. You get 0 to 2 points for each component. And then it's kind of all dichotomized to represent symptomatic of sarcopenia versus healthy status. So strength, for instance, was measured by asking respondents how how much difficulty they had lifting or carrying 10 pounds. So you can see how this might be too easy for you if you're very fit and active. Assistance walking was assessed by asking participants how much difficulty they had walking across a room, whether they used aids like a cane or a wall or chairs, or they needed help to do it. The rise from a chair was measured by asking respondents how much difficulty they had transferring from a chair or a bed and whether they used aids or they needed something to do that. Like, again, a cane, hands, putting their arms down on a table or chair or wall first. So how, how is sarcopenia diagnosed? You know, it can be diagnosed in women if the following conditions are met. And basically, I'm going to give you an online calculator here in the notes. But it has to do with your fat-free mass index. And I'm going to put you to a link that will help you calculate that. And if you're under that range, it's definitely saying, okay, yes, you've got a challenge. And that's just based on mass. There are other ways of predicting strength, but again, you have to know, is it appropriate for you to do a strength test right now? And it's not always, so It'd be like you go in in this semester and you're going to have a final exam the first day. Sometimes that's okay. You can't get hurt with a pencil and pen. However, if you're lifting a really heavy weight and you haven't lifted for a while, that's not a very good idea. So we wouldn't necessarily want you to do a strength test, but knowing, can you carry a bag of groceries, getting you to think about how heavy of an object can you carry? Without having issues. I want to go through a glossary that I think is really important for you to understand before we wrap up. These 4 terms almost give me chills because they should never be happening, but sarcopenia is really what we're talking about today. There's something called osteosarcopenia. So as it sounds, that's the combination of low bone mass and low muscle mass. What does that tell you? That would tell you that you're an individual who is at really high risk for falling and fracture if you do, because you have very low muscle mass. You're probably weak, you're unstable, unstable. You can't right yourself if you fall, you can't react quickly. And when you go down, because you have low bone mass, your much more likely to fracture. Next up is sarcobesity, also problematic. So sarcopenia, putting that together with obesity, it means low muscle mass and high fat mass. Again, a bad combination because the injury risk to somebody where your Again, you're very unstable, so you're weak, you're not likely to right yourself, and you weigh more. So if you go down, the risk of injury is greater. Now, there's no mention there of osteo issues, so that's not in this one, but it's next, right? Osteosarcopenia, putting all them together. Low bone mass, low muscle mass, and high fat mass at the greatest risk for long-term injuries and complications from a fall. Osteo-obesity, putting the last combination together, low bone mass and high fat mass. So again, at risk, yes, but there's no indication of low muscle mass. So potentially you could be a very healthy but overfat individual who still needs to work on bone density. So there's, there's new vocabulary you didn't know you needed, but these things, as they are both related to sarcopenia, low muscle mass, is really at the base of safety for each and every one of them. The more muscle mass you have, whether you are also obese and overfat or you are at low bone density, the better off you will be. So I promised that we'd visit a couple of things so we know what's possible, the good end of things. So pay attention, I'm going to throw some numbers at you. A 1.9 to 3.3% increase in global— that's just overall lean muscle mass in humans— is associated about a 4.1 to 5.8 lower fat mass and reduced A1C. You all know that's an inflammatory marker. And fasting glucose levels— reduced A1C and reduced fasting glucose means you are much more metabolically healthy. In studies, this was proven in studies that were lasting 2 weeks to 3 years. So the, the range of the increase in muscle mass— and I want you to realize something, that very often I will have someone say, well, I don't increase my metabolism very much by gaining muscle, it's like 14 more calories a day. That's a very limited look at the benefit of getting more lean muscle, because what does happen is as we gain more lean muscle, we have decline of fat mass that occurs simultaneously and long-term because spontaneously we're moving more and we have a higher metabolic rate around the clock. When we're sleeping, we're burning a few more calories than before with less muscle mass when we're sitting, but definitely when we're exercising. And when we control more muscle mass, we are helping ourselves decrease inflammation. It's proven it's an anti-inflammatory hormone. Essentially, muscle acts like an endocrine organ. So to avoid sarcopenia, how do we do it? Resistance training 2 times per week minimum. And by the way, some of us are overachievers and need to hear this: doing more is not always better. So For some, 2 times a week should be maximum. You have to know your recovery needs. For me, often twice a week of a really high-quality total body strength training session for about an hour from start to end, maybe a little bit more, but that's because I can't get on what I want to. Maybe if I'm at a gym, that is better than doing more because I'm completely recovered. I've got energy more energy to do a little more walking, to do a little more spontaneous movement, than couch compensating. So if you go work out more but you're also then sitting on the couch more, you may not be getting the increase in metabolism that you think you are. So evaluate that. The second thing to avoid sarcopenia: consume high protein foods and micronutrient-dense foods every single meal. We really can't get away from this. Diet mentality needs to go. We need to be focused on how do I eat to sustain my strength and my energy. Wouldn't it be wonderful if right now the question, what is sarcopenia, is like a question similar to what is scurvy or what is rickets? Is now, right? So in 1920, scurvy and rickets were things that we had to worry about— we collectively as a population— but now it's never heard of. I mean, we don't worry about those things. We know how we can solve those very, very easily. But to change so that sarcopenia is something that we don't even have to talk about anymore, it's like historically that happened once, you know, and they think that's crazy. That starts with us, you and me. I hope this was informative. You understand a little bit better what sarcopenia is, how it is to muscle, what osteoporosis is to bone, and what you can do about it. If you have questions, I'd love to hear from you. I'd love to know what questions you have. And don't forget to start looking at your muscle your strength, your power, all related to muscle, and your overall longevity, you can get the fitness scorecard. We created it so you can do tests really at home, many of them in your comfort of your own home without any extra or complicated equipment. What are you waiting for? Let's start flipping 50 today.

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