Jack LaLanne died last month (January 2011) at the age of 96. He was physically and mentally fit until his death from pneumonia. For over 70 years before that, he was an American Icon as an advocate for better fitness and nutrition with his long-running morning exercise television show and other physical fitness demonstrations. He was my model of Successful Aging because he practiced what he preached and was able to conquer frailty in old age. What set LaLanne apart from other fitness experts of his generation down to 20 years his junior was his promotion of a combination of cardio-exercise and body building routines with good nutrition that created a model for physical fitness and longevity. It was his belief and charisma that won over the public, because there wasn’t much, if any, scientific evidence to support or discredit what he pioneered. In the 1970s, Dr. Kenneth Cooper presented his research results about positive outcomes of cardiovascular parameters with his patented aerobic exercise program which included lots of jogging and instantly started the jogging and aerobic exercise craze in the USA and around the world. Regrettably, the body building message of Jack LaLanne was ignored until the last 10 years, when it became apparent that being cardio fit may extend one’s life span by lowering the prevalence of cardio-vascular diseases but it does not protect anyone from frailty in old age. Concomitantly, the US has been experiencing an epidemic of obesity, metabolic syndrome and type 2 diabetes; research efforts to combat these conditions shed light onto the importance of skeletal muscles in normal human metabolism and expose how the loss of this muscle mass in extreme long distance running (i.e. marathon runners) or old age can lead to frailty. Jack LaLanne was a man before his time; he was right all along and this article is, in a small way, a tribute to a great pioneer.

What is Sarcopenia and how it happens in aging?

Normal aging includes a gradual loss of skeletal muscle mass after age 25, with a rate between 0.5 to 1% per year; muscle fibers are infiltrated and replaced with fat.

 There are also neurological diseases and malignancies that can accelerate the muscle atrophy. When there is no other cause than age itself, it’s called Primary Sarcopenia, which is a major component of frailty in old age. Many factors associated with aging are implicated in the process:

The results are serious with weakness, disability, frailty and poor quality of life:

Can something be done to combat Sarcopenia in old age?

The answer is YES. Just as Jack LaLanne believed over 70 years ago, good nutrition and exercise can slowdown the loss of muscle mass with aging.

1-      Adequate protein intake: Current RDA (Recommended Daily Allowance) of 0.8 to 1.2 gram of protein per Kg of body weight is too low. We should consider raising the RDA to 1.25 to 1.75 g/Kg for older people without any complication and with benefit to muscle protein synthesis.

2-      Weight resistance exercise: This should be included in all exercise regimens with various intensity, depending on one’s state of health, to strengthen or build up muscles of the upper and lower body. The best results belong to those who are involved in body building exercise in middle age (late 40-early 50).

Recent data indicates beneficial effects of Angiotensin Converting Enzyme Inhibitors (ACE-I), normally used as anti-hypertensives, on  skeletal muscle mass comparable to those of exercise in some studies:

Indeed, we should consider ACE-I in our strategy to fight sarcopenia, particularly in patients who can’t participate in meaningful weight resistance exercise regimen due to physical disability.

Better still, the work of Dr. Robert Wolf and colleagues clearly shows that the essential amino acid (EAA) Leucine is very important to muscle protein synthesis, and a patented formula of EAAs called ViaLeuPro  (commercially available as BeneVia For Strength and Energy) is the most effective way  in inducing protein synthesis of skeletal muscles:

Because of side effects and complication, we only recommend Testosterone replacement in hypogonad males. We strongly discourage using anabolic steroids or growth hormone to treat primary sarcopenia.

Pham H. Liem, MD

Disclosure: Dr. Liem and Dr. Wolf are Professors in the Donald W. Reynolds  Department of Geriatrics at UAMS. Dr. Wolf is the Chief Scientific Officer of Health Span Institute, which produces and markets BeneVia products.