Sarcopenia and the importance of maintaining skeletal muscle in older adults

Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well being. And now, here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Well, hello there and welcome to Docs in a Pod, the award winning podcast. Available wherever you get your podcast. We're also on the radio in a number of markets in Texas and Florida as well. I'm Ron Aaron. Our special co-host today is Desarea Murray, a nurse practitioner, and Desarea has been on before. We love talking with her. She's with WellMed at Live Oak in Dallas. She's a nurse practitioner there and says she always knew she wanted to help people and provide her patients with the care they needed. Desarea started with that when her parents bought her a Fisher Price doctor's kit. So, you're going way back when she wanted to do what she's doing now. We'll get a little more background on Desarea as we go on. Hey, it's great to have you on again, Desarea.

DESAREA MURRAY, NP
I'm so happy to be here. Thanks for having me again, Ron.

RON AARON
This is a topic, and we'll introduce our special guest today, Dr. Edwin Davila, that we have never talked about on Docs in a Pod. So, this is groundbreaking. It's sarcopenia, loss of muscle as one ages. Well, starting when you're 30 or so. Let me introduce Dr. Edwin Davila. He's a doctor of internal medicine and primary care physician for WellMed at Southwest Military in San Antonio. Earned his medical degree from the University of the Incarnate Word School of Medicine, and both his Master of Science in Exercise Physiology and a Bachelor of Science in Biology from Baylor University. He's a Certified Clinical Exercise Physiologist with the American College of Sports Medicine and a Certified Sports Nutritionist with the International Society of Sports Nutrition, former naval officer. Edwin, it's great to have you on again.

DR. EDWIN DAVILA
I'm happy to be back. Thank you so much, Ron. It's always been a blast to be here.

RON AARON
Talk to us about Sarcopenia, which I guess all of us face in life. What is it? Is it life threatening?

DR. EDWIN DAVILA
We're going to go with the quick nerdy definition and then we're going to say what it actually means and how it impacts us on a daily basis. Sarcopenia defined by the European working group for sarcopenia stage two is a large cohort that looked into this. It's a loss of three things. Skeletal muscle mass, skeletal muscle function, and skeletal quality. How? What does that mean to the person? It means that skeletal muscle is what we need to do, every task throughout the day. Stand up, grab something, interact with the world, complete the task of daily living and engage with the things we enjoy. We need skeletal muscle, but as we age, we begin to lose some of this, and we don't notice it that much because we're not all bodybuilders. We're not all trying to be huge, but it's not about that. It's about the function of the muscle and how this begins to creep up on individuals. Sometimes it's, well, now that I think about it, a year ago, I was able to get up off my chair without much issue. And if I really think about it now, it's a little bit of a struggle to stand up. And then a year from now, now I need some help standing up. Two years from now, I need help walking. Four years later, I have trouble getting out of bed. All of this can be stemmed on the ability and the quality of the muscle.

DESAREA MURRAY, NP
So, this is progressive?

DR. EDWIN DAVILA
Yes, it's progressive. What we know, and Ron, you already made a good point on it, is this is something that will begin to happen throughout the course of our lives. There's a term now called anabolic resistance, which is not to get into all the nerdiness of that, what it basically means is our body is in this constant seesaw of building muscle and losing muscle. Building muscles is anabolic. Losing muscle is catabolic, and we're doing this all the time. Hormones are always in play. Our engagement in physical activity, our nutrition, all of this goes into this balance. But as we get older, due to just how we used to say it, we do say the word insulin resistance. We have anabolic resistance. The body doesn't respond as well to the hormones produced. We make less of these hormones, but we don't have the same diet that we normally had when we were younger. We eat less protein. All of this compiles into the anabolic side now being overtaken by the catabolic side. So, we're breaking down faster than we're building.

RON AARON
Now, I know one of the most important muscles in our body is our heart is it affected too by sarcopenia?

DR. EDWIN DAVILA
It's funny you say that. Yes. Just last year, the American College of Cardiology put out a wonderful paper that looked into it, and the title was Sarcopenia, mortality and its impact on cardiovascular disease. It was a wonderful article that was highlighting how the systemic effect of muscle loss and what goes with it, chronic inflammation, decrease protein intake, decrease anabolic activity, actually can impact cardiovascular muscle and increase the risk of death associated to cardiovascular events. So, it was groundbreaking to see something like that.

RON AARON
I love how excited you get about a paper. Hang on just a second. For those of you who just joined us, you're listening to Docs in a Pod, the award winning podcast available wherever you get your podcasts. I'm Ron Aaron. Our co-host today is Desarea Murray, a nurse practitioner in Dallas, and our special guest, Dr. Edwin Davila, who is a doctor of osteopathy, who graduated from one of the newest medical schools around the Incarnate Word School of Medicine. He's got a tremendous background in physiology, in exercise, in wellness, in diet and nutrition. What attracted you to that aspect of your life, physiology, exercise, diet?

DR. EDWIN DAVILA
So glad you asked that. When I was young, I was the quintessential, skinny kid, who, no matter what he was able to do, could never put any weight on. I always wanted to have more functional capacity. That's why I call it now in reality, when your kids just want to be stronger, and I never could do it. When I went to college, I started to see the application from a scientific level to how this actually applies and what I was doing wrong. So, that's a personal thing, but what really drove me to wanting to apply this to people was my time in the military. A simple quick story is I had an airman who was close to losing her job. In the military you have to meet certain physical standards, and what they did was they provided this airman with a very rudimentary, generic course of action to improve her functional capacity, her weight, her everything, and it was not catered to her. It was not something that was backed by science. It was very cookie-cutter, and she had failed two what PFTs. I think they call it a physical function test if I'm not mistaken. I'll be corrected on that one. I'm a Navy guy. But if she would have failed the third one, she would have been kicked out of the military.

DESAREA MURRAY, NP
Oh no!

DR. EDWIN DAVILA
So, me and a few individuals, I was an officer at the time, and I created something more detailed for her based on her dietetics, her situation, her injury. Very catered, and not only did she achieve, but she also passed. She broke any record she had ever had before, well before she even started, and it highlighted the simple fact that we elevate so many things in medicine when it comes to pharmacologic intervention, surgical intervention, which we should, they are powerful things, but if we miss the power and the importance of the foundation of diet, lifestyle, exercise, and everything, we are just basically building a house on a very poor foundation. The foundation needs to be there before we start adding all these little accouterments. So, now I just take that into the day-to-day activity of individuals, and I see how much of our patients are unfortunately not having that foundation. If you're my patient, you almost probably get really sick of hearing it because every time we see you, we're talking about it. I don't care what you're in here for, you're here for the sniffles or you're here for what is a spot on my arm? I'm like, well, that's this, but tell them about your physical activity.

DESAREA MURRAY, NP
I love it. I think that's great, Edwin.

RON AARON
It's interesting, and I know you're friendly with my cardiologist, Dr. Chris Thompson. He's the same way. You walk in, do a check-up. Hey, things are looking good. Let me talk to you about the importance of exercise. And he really drives it home. Which is, I gather, what you do as well.

DR. EDWIN DAVILA
Absolutely. Dr. Thompson and I have spoken at length about these kind of things, because at the end of the day, we do not want the misconception that people aren't going to do it anyway, so let's not talk about it, or even worse, is we treat it as an afterthought. We are restricted on time; we all know that. We wish we all wish we had more time with our patients, there's no doubt. So, we try to emphasize the important things and then we get to the, FYI's if you get to it. It seems to always be the exercise, the lifestyle, the dietetics as is the FYI. But we need to change that. It needs to be the foremost part, and then we build everything on top of that. It's just the way me and Dr. Thompson are.

RON AARON
Well, what Dr. Thompson tells me every time I see him is if we can get you doing a regular program so many times a week, you may be able to get rid of a lot of the medications you take. It's the antidote for whatever ails you.

DR. EDWIN DAVILA
100%. You said something right there. A scheduled plan. We treat medicine the same way. If I give you a prescription, I'm telling you the dose, I'm telling you the frequency, I'm telling you when to take it. I'm telling you all these things. It's scheduled, it's planned, it's executed with thought. Whereas sometimes when we tell patients, you should probably go move more. Okay, awesome. But what does that mean? What the data has shown us, and there's a lot of wonderful data to support this, is that when you apply even the most basic scheduled resistance training, especially for the lower extremities, and what does resistance training mean? It means putting the muscle under a mechanical load. It doesn't mean I've got to go to a squat rack and I'm going to start doing that. It could be something as simple as having a scheduled regimen of a patient who has difficulty standing. Monday, Wednesday, and Friday, I'm going to have you stand up 15 times every hour and just stand up. So, body squats, basically using their own body multiple times. For a patient who has gone hours and hours and hours without ever standing, something as simple as that on a scheduled time can show great results.

RON AARON
Well, my Apple watch does a guilt trip on me. It says time to stand up.

DESAREA MURRAY, NP
Mine does the same thing, Ron. I was going to ask Edwin, what type of response do you give your patients? Because I see this often. Oh, Desarea, I have a job that requires me to walk. I have a job that requires me to lift. I have to tell them that is not scheduled physical activity with the purpose of building muscle or trying to be cardio or something like that. How do you typically respond to that?

DR. EDWIN DAVILA
Great question. A lot of times, patients think that just the act of moving is enough, and I tell them the body is very good at becoming efficient. If you told me that your day-to-day activity result was, I always do 5,000 steps, just as a simple number, and I am typically doing a job which requires me to bend down and lift boxes that are about 10 pounds, I'm like, great. How long have you been doing that? Oh, I've been doing that for years. Okay. So, your body has become efficient doing that. It no longer gets stimulation above what we need for you to actually have the results. Your body is not responding to this anymore. Now, I'm happy you're doing it. Keep this up. Our goal isn't for you to just be at your baseline. I need to stimulate you past your baseline. I will use the same example. Take for instance, me. I'm a weightlifter. I've been a weightlifter probably for going on 25 years, but my baseline is if someone were to do what I do it, it would tax them like nobody's business. But, you asked me to go run on a track for like two laps with somebody who's used to it, they're just going to look at me like you poor boy. What is wrong with you? But I do that on purpose, knowing that I'm taxing myself to improve that system. I highlight that I am happy this is your baseline, but we're seeing signs that you're starting to decline. I need to stimulate you past your base. I need to start getting your body to want to respond fast, what it's used to. When they conceptualize that, they're like, so, we need to do more because I'm already good at what I've been doing. My body doesn't think it's a problem. It's a task anymore. Absolutely. That's what we're trying to get at.

RON AARON
We're going to pick up on this conversation in just a moment. For folks who just joined us, you're listening to award winning Docs in a Pod. I'm Ron Aaron, along with our co-host today, Desarea Murray, nurse practitioner and Dr. Edwin Davila, Doctor of Osteopathy. We're talking about ways in which exercise, diet and strength training can combat something called sarcopenia, and we're going to pick up on that in just a moment. You're listening to the award-Winning Docs in a Pod.

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RON AARON
We're so pleased you're with us here on Docs in a Pod, the award winning podcast available wherever you get your podcasts. I'm Ron Aaron along with our co-host Desarea Murray, a nurse practitioner. You can find her up in Dallas. We're talking with our very special guest, Dr. Edwin Davila, Doctor of Osteopathy, who is talking about something called sarcopenia, muscle loss, which happens to all of us. Let's begin where we began for those who may have just joined us. Again, sarcopenia is what?

DR. EDWIN DAVILA
Sarcopenia is the collection of loss of skeletal muscle mass, quality and function. Now, it’s very important to note that people can lose muscle in terms of size, but the function may still be there. What do I mean by that? As we get older, we lose muscle. We know that. But there's a difference between a person losing muscle but still being able to do all the tasks they need to do without much limitation versus I lost muscle and now I'm having the burden of being able to do the day-to-day things. That's where the big difference happens.

RON AARON
It happens to everybody?

DR. EDWIN DAVILA
We all have the potential for it to happen. So, there are three main things that we need to address once we start seeing the signs of sarcopenia, because there's something called pre-sarcopenia, which is kind of like pre-diabetes. I'm starting to notice things. I'm starting to see things. Now, there's not necessarily a lab for this. It's more clinical. There's also imaging we can do, which is very expensive, but really it can be a clinical diagnosis. Something a person can do in the office by doing an algorithm called a SARCF, which is something for the clinical practitioner, but we can see these things, and then once we see them, there's ways that we can mitigate it or begin to address it.

RON AARON
Does it affect more men than women or more women than men?

DR. EDWIN DAVILA
It's funny, it seems to address more men now. There's debate whether or not that's because as men, our dominant sex hormone is testosterone and as it being a predominant anabolic hormone, as we develop resistance to that, we may have an attenuation or loss of muscle a little bit faster. But the function itself of sarcopenia, it's going to be equivocal.

RON AARON
You have to tell me, what is a predominant anabolic hormone?

DR. EDWIN DAVILA
Good question. In men, the predominant anabolic hormone is testosterone. That's ours. In women, it's estrogen or estradiol, depending on who you talk to.

RON AARON
I see all the ads on TV. Just take this pill and you'll be feeling great in the bedroom and everywhere else.

DR. EDWIN DAVILA
Well, I know we do live in the world of appeal for every ill, and with the rise of certain medications, actually, this could be a whole other discussion. There are pills right now looking at the potential for to stimulate the same kind of signal transduction cascades as exercise in an injection. We're not talking about that. It's just a really cool thing.

RON AARON
Wait a minute. I can stop exercising and just get a shot? I love it, Doctor.

DR. EDWIN DAVILA
It's a brave new world. I'm more low-key. I'm more like let’s do it from the ground roots of what we all can have at our disposal. There are three things I want to highlight. We talked about what it was, we talked about what it can do, and I want to highlight the impact it could have. It can impact increased risk of mortality, increased risk of worsening other co-morbidities, it could increase the health burden on the individual, meaning they have to take more medicine for other things because they're worsening. They need more help in order to do the day-to-day things like shopping, moving daily. Things like what we call ADLs, activities of daily living, washing your hair, cooking, and basically interacting with the world. Things that take away our ability to be independent. These are just as important as anything else.

RON AARON
Now, asking a question for someone I know, does this also impact being able to get up off the floor? This person says, if they get on the floor with their kids or their dog, you need a forklift to get back up.

DR. EDWIN DAVILA
100%. One of the areas that we notice that begins to have loss of muscle soonest, and it's a very unfortunate thing because we need it sometimes the most, is the legs. There’s our quads and our hamstrings, which we use to do everything, including get up off the floor. They have a huge burden when it comes to sarcopenia. We do MRIs and we look at the quality of muscle with people with sarcopenia. A vast majority of it is gone and it's replaced by fat and fat is not contractile tissue. It can't move you.

DESAREA MURRAY, NP
Right.

DR. EDWIN DAVILA
So, this is where people get kind of surprised. Like, my legs don't look any smaller. No, but the ratio from muscle to fat has now changed. Loss of muscle, greater risk of fat. So, that's actually something we call sarcopenic obesity now. We talked a lot about all this stuff. What can we do to either decrease the risk or even turn back time? We actually can improve this. There's three things that govern how much we can build muscle or how to do it. We call it Mechan transduction, which, fancy way, nerd way of saying it, is resistance training. When a muscle is under a load, the tug and the pull, lifting yourself up, the body responds to that by sending out a signal to the body that's saying, hey, we're doing something that is a difficult thing to do. This is not good. We need to find a way to make it easier to build muscle. It's a stimulator. Two, hormonal. Like we talked about testosterone, anabolic hormones, but as we age, we slowly but surely produce less testosterone and we become resistant to the testosterone we make. Some individuals have looked into testosterone replacement therapy. That's a whole other conversation. I won't get into that one right now. That's a whole other thing. Then third, nutritional. That is a huge, huge, huge component. Protein is what muscle is made of. And if you look at the nutritional guidelines, you'll see that for the average individual, they say 0.8 grams of protein per kilogram is what we recommend for the daily person. This is not enough. It is not enough because we've seen that as we age, the demand for protein rises, but our appetite goes down. So, you'll notice people when you talk to them and you go through their nutrition and you ask them, tell me the day in the life of you. Sometimes people are eating 30 grams of protein or 40 grams of protein when their body's needing four times that. We do not have a way to store protein, but we need it for not just muscle, we need it for so many things. Hormone production, mechanical balancing, all of these things. So, the body is going to get it where it can get it. So, when we do not eat enough protein, the body starts to strip away muscle, break it down to its pieces and use the amino acids to do other things, which thereby worsens the problem.

RON AARON
Let me ask you, because somebody told me if you, at a sitting, eat 30 or 40 grams of protein, the answer is your body can't absorb all that, you pee most of it out, and you don't retain it.

DR. EDWIN DAVILA
I've heard that too. The reality is that's not exactly accurate. What we mean by that is because a lot of things go into that one. What is the bioavailability of that protein? Fancy term again. What that means is that not everything can be absorbed at the same rate. What is the ratio or the quality of that protein? Meaning how much essential amino acids are in that protein? What does that mean? So, if you were to eat chicken. Chicken has all the essential amino acids, all nine of them. What do we mean by essential amino acids? It is the amino acids you and I cannot make in our body. We just can't do it. If you ever go to the zoo and you see a silverback gorilla, they have giant muscles. They are muscle on top of muscle, but they eat only plants. So, someone's like, well, that can work because those animals produce every essential amino acid in their body. They can do it endogenously. They just need the components. They can produce them. We can't. Nine of them we cannot. We have to get them in our bodies. We have to eat them. So, we need things that have them. Anything that was a living tissue, chicken, beef, salmon, whatever have you, are bioavailable, good. We need those to build muscle.

DESAREA MURRAY, NP
This isn't fried chicken, right?

DR. EDWIN DAVILA
So important. Correct.

RON AARON
That's grandma's deep fried chicken Desarea.

DR. EDWIN DAVILA
That's the truth. How they prepare this can have other high-end effects. So yes, thank you. Grilled, broiled, steamed, air fried. I like that now. That's a new thing.

DESAREA MURRAY, NP
Yes.

RON AARON
We have an air fryer.

DR. EDWIN DAVILA
All of them are great idea. When I said bioavailability, how quickly can that be broken down and absorbed? Some things like a Whey protein shake, the body doesn't have to work very hard to convert that shake into the components that's able to be absorbed. So, if I drink 40-gram protein shake, I'm absorbing 40 grams of protein. If I'm eating 40 grams of protein in combination of beans and rice, because you have to combine them to make a full essential protein, the body takes a long time to break that down, process it, get it in its components, and the length of time it takes to do all that, the food's moving its way down the GI tract. So, you may not actually absorb as much in the time it took for it to go from stomach to out versus something like an essential amino acid supplement. These are supplements that I recommend to my patients when they are really struggling to be able to get it all in. It's about a liquid, about eight ounces. You mix it, you put it in water, you drink it, you have all nine essential amino acids, and that actually can really help in the building of muscle. That's a long way of answering your question. But yes, we can absorb more protein.

RON AARON
We're flat out of time. Let me ask you quickly, what is that drink you mentioned?

DR. EDWIN DAVILA
These are just essential amino acids. They come in many different brands. They come in many different things. Go to your physician. Any time you are taking a supplement, take it to your physician. There's a lot of things they've got to confirm to make sure it's a quality one, but yes.

RON AARON
Bingo. Got to stop you. Sorry. We've got to do this again. I mean, we could spend three hours just talking with you, and we really, really appreciate your time, Dr. Edwin Davila, and to Desarea Murray, our co-host. Thank you all for joining us today on the award winning Docs in a Pod.

OURO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. Be sure and listen next week to Docs in a Pod, presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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