Where ageing is concerned, there is one huge factor we need to understand and that’s inflammation.
If we want to slow down the ageing process and remain fit, healthy, functional into our 40s, 50s, 60s and beyond, managing inflammation is critical.
In this final instalment of our series on ageing, we will explore how managing inflammation, dietary habits and hormone optimisation can play a huge role in healthy ageing.
Sarcopenia – the loss of muscle mass – and the related anabolic resistance, are not an inevitability for anyone over the age of 40.
In fact, losing muscle, strength and suffering anabolic resistance is actually a result of increases physical disuse of the muscles along with higher levels of inflammation.
So, understanding inflammation and how it impacts the ageing process gives us the tools to properly manage it and enable us to age optimally.
What is the role of inflammation in ageing?
One of the key theses in explaining why anabolic resistance occurs in an ageing muscle is the effect inflammation has on muscle mass and protein metabolism, which will subsequently impact anabolic sensitivity of older muscles.
In this area of limited human research, there have been strong relationships shown to exist between higher circulating levels of inflammatory markers (e.g. TNF-a) and reduced muscle protein synthesis. 22
Specifically, one of the key molecules involved in the hypertrophy signalling pathway, mTOR, is blunted with higher levels of immune activation generated from inflammation. 14
As we have previously discussed, lower levels of muscle protein synthesis, whether it be from a meal or exercise, will ultimately result in no increase, or even in decreases in muscle mass, especially when there is an inability to match muscle protein breakdown.
What causes this inflammation with ageing?
Unsurprisingly, the greatest cause of growing chronic inflammation in ageing populations is related to physical inactivity and lifestyle factors.
This alone highlights the vital importance of increased and continuing exercise as we age. However, there a few things have been highlighted in ageing populations that may contribute to the development of chronic inflammation.
One of the most popular theories is the free-radical theory, which explains that age-related inflammation is as a result of cumulative free radical and oxidative damage. Combined with a gradual lack of antioxidant capacity, this causes the body to be unable to deal with oxidative stress, leading to damage in protein structures, as well as important energy production sites in the body, like our mitochondria. 24
Combined with a gradual lack of antioxidant capacity, this causes the body to be unable to deal with oxidative stress, leading to damage in protein structures, as well as important energy production sites in the body, like our mitochondria.
Essentially, the many different theories (most go beyond the scope of this article) relate to the cumulative damage collected over the years to many molecular, cellular and systemic processes in the body. This highlights the importance to live a healthy lifestyle throughout your life, not just when you hit your 40s.
How can we reduce this inflammation?
As with just about everything related to this topic, resistance exercise is one of the most powerful tools in reducing chronic inflammation.
In fact, a study on the frail elderly (Griewe 2001) found that three months of resistance exercise reduced muscle TNF-a, which as discussed above, is inversely related to the rate of muscle protein synthesis.
The gain in muscle and loss in body fat from hard resistance exercise will undoubtedly lower both muscular and systemic inflammation, and help counteract the rise in inflammatory markers present in older populations with ‘anabolic resistance’ symptoms.8
The gain in muscle and loss in body fat from hard resistance exercise will undoubtedly lower both muscular and systemic inflammation, and help counteract the rise in inflammatory markers present in older populations with ‘anabolic resistance’ symptoms.
Figure 7- Managing inflammation with the correct diet and training protocols can give you a six-pack well into your middle ages.
What about diet?
So far, we haven’t discussed the role of nutrition in middle aged and older populations.
This isn’t to understate its importance, but rather, highlight the significance of implementing resistance exercise in allowing any changes in inflammation and nutrition to take place.
When considering dietary manipulations for these populations, we must consider three things: managing inflammation, creating a positive hormonal environment and optimising protein synthesis.
1. Managing inflammation and creating a positive hormonal environment.
Integrating dietary habits to manage and reduce inflammation in the body is of paramount importance as we age, as this will not only lead to a better hormonal status, but also allow protein to function as the driver for muscle building.
Writing about lowering inflammation through diet is nothing new. Eat a wide variety of fruits and vegetables, stay hydrated and steer clear of ‘junk’ foods.
As discussed, the effect of inflammation is cumulative over your lifespan, rendering the applicability of the IIFYM model of eating for older populations (or any, for that matter).
When we encounter older clients at UP, they have spent their lives eating junk and accumulating a very poor inflammatory status.
So we really want to focus on quality food and nutrition here, as the ability to ‘get away’ with poor choices is vastly diminished, especially if they are inflamed and insulin-resistant.
The latter point brings us to the next vital step in achieving body composition for older clients: maximising insulin sensitivity, or perhaps, restoring insulin sensitivity.
How can we do this through nutrition?
Lower inflammation through quality choices, and opt for lower carb approaches.
Many of the insulin pathways will be severely dysfunctional, and for those people encountering andropause or menopause, this needs to be fixed to help with their hormonal symptoms (we will discuss this in further detail later).
In fact, some strong research is developing linking lower IGF (insulin growth factors) from dietary stimulation to successful ageing and longer life expectancy, highlighting the benefits of lowering carbohydrate intake as you age, and keeping insulin sensitivity high.15
What about supplementation?
For older populations, arguably the best supplement for counteracting ‘anabolic resistance’ is fish oil, and specifically, the omega 3s.
Research has shown the administration of approximately 4g over the course of eight weeks was sufficient to increase the activation of proteins associated with anabolic signalling pathways in the elderly. 21
Although the exact mechanisms are not understood, it is speculated (and probably correctly so) that their anti-inflammatory properties are responsible for this, of which their effect will be vastly superior in older populations.
Another great supplement worth taking for anyone over 40 is curcumin, a natural spice proven to work wonders for improving someone’s overall health status.
When combating anabolic resistance, you are fighting against oxidation and inflammation of the cells, of which curcumin has been repeatedly shown to be a powerful antagonist towards.
In particular, curcumin has been highlighted to have a strong effect on the NF-kB inflammation pathway19, which has been considered the ‘holy grail’ as the target for new anti-inflammatory drugs.
Although other essential supplements applicable to all populations exist, such as probiotics, magnesium and creatine, the two listed above will arguably have the most profound impact on a client looking to counteract symptoms of ageing.
2. Optimising protein synthesis
If we refer back to the diagram used in Part 1 (see figure eight below (Breen & Phillips, 2011)), we know that the muscle protein synthesis response to an anabolic stimulus in a typical aged muscle is lower than in younger populations.
Two of the reasons for this are physical inactivity and inflammation, so before looking to optimising protein synthesis we must first manage those two issues, so that the signalling pathways through which protein synthesis occur can work efficiently.
Figure 8: The response of muscle protein metabolism in response to anabolic stimuli in young and elderly. As you can see, the elderly have a reduced ability to generate a maximal protein synthetic response.
Despite the improvements that can occur in the graph above from training and inflammation control, it seems that older populations will benefit more from higher and more frequent levels of protein intake, as opposed to younger populations.
When looking at the research surrounding protein synthesis, it seems a ‘leucine threshold’ is required in order to maximally activate an increase in protein synthesis from basal rates.2,4
When comparing a dose response curve of protein synthesis between older and younger muscle, it seems the dose threshold in the young is a lot lower.4
This highlights the possible need for more protein in each feeding, or perhaps, staying consistent with protein intake feedings through the day, as a low protein meal would fail to generate a substantial anabolic stimulus.
Therefore, a typical intermittent fasting strategy often employed by older adults would fail to work here (skipping breakfast, for example), as research suggests keeping protein higher throughout the day and evenly spread is important for these populations. This may possibly be due to the often delayed, and less transient effect of anabolic stimuli required for protein turnover.
Further positives drawn from the research suggest that once the pathways ‘resistant’ in older populations are functioning more effectively, the maximal level of muscle protein synthesis that can be achieved can equal younger populations.4
In order to reach these thresholds, there’s no specific need to supplement with additional leucine powder.
Instead, focusing on high-quality protein sources from whole foods, aiming for approximately 30 to 50 grams (higher end of the scale for men) will do the job effectively.
Figure 9: The graph above shows the muscle protein synthetic response to protein intake at rest (solid curves) and with prior completion of resistance exercise (dashed curves) in young (green) and elderly (blue) individuals.
It illustrates the need for more protein intake to sufficiently increase MPS above baseline levels, whilst showing that the same maximum can be achieved.
The graph also highlights the benefits of resistance exercise for these populations, as prior completion allows for much greater spikes in anabolic stimulus.
Interestingly, as discussed previously, the red curve shows the almost non-existent anabolic response to protein intake in a disused muscle, further emphasizing physical inactivity as a key driver in sarcopenia and age related frailty.4
What about caloric restriction?
One of the popular topics related to successful ageing is the concept of purposeful caloric restriction, utilising extended periods of fasting within the day.
The scientific reasoning is based upon the idea of increasing the process of autophagy, which can be described as a ‘highly conserved mechanism of quality control inside cells’, or more simply, the remove of ‘cellular junk’. 3
The concept is very well researched and antagonises many of the processes associated with ageing, such as the accumulation of inflammatory markers, free radicals and damaged cells, proteins and mitochondrion.
However, the problem with anabolic resistance is that autophagy does not work efficiently, as these populations are often so inflamed and in a state of oxidative stress, as well as being deficient in amino acids, that they cannot produce many of the compounds necessary for successful autophagy to occur.
So how do we counter this supposed vicious cycle?
In order to combat much of this anabolic resistance, it seems to we need to remove all the accumulated ‘junk’ in our body (autophagy), whilst at the same time maximising anabolism to build muscle. To do this is very simple. A simple way to increase autophagy is through fasting, but as we also have a strong need to build muscle in this population (intermittent fasting, if muscle building is the aim, rarely works), we have a paradox.
Many older people will do this already, but an easy way to implement this is to have a 12-hour fast between dinner and breakfast, where hydration and quality sleep is the aim. In terms of calorie restriction, this is a viable option for these populations as the majority by now will be overweight, with all the consequences of it: insulin resistance and leptin resistance to name two.
It does not mean fasting, but maintaining a healthy calorie deficit (periodically through your life, especially when older) will work wonders in fixing many issues discussed.
The key to anabolism, as we know, is through lifting weights and eating sufficient protein and nutrients. Specific to this topic, an argument could be made for including specific types of protein in your diet.
Protein sources rich in cysteine, such as whey protein, are an excellent choice, as cysteine is often the rate-limiting factor in glutathione production, the body’s most powerful antioxidant.
This is particularly important for older populations due to its role in reducing inflammation and oxidative stress, as well as maintaining healthy functioning of detoxification pathways.
With faster-acting proteins, such as whey, also being documented as superior for older populations in preserving lean body mass, a strong argument could be made for including whey protein in your diet, especially post training.2
Does our metabolic rate decline naturally?
Arguably the greatest myth in anti-ageing discussions, our metabolic does not just naturally decline. The most metabolic tissue in the body is muscle mass.
Due to inactivity and the plethora of reasons we have discussed in this series, it’s fair to say that we know the body does not just shut down after 40.
The cumulative stress over the years from poor habits and inactivity drive this loss of metabolic rate. In order to counter it, focusing your dietary and lifestyle habits on staying fit and building muscle mass should be the number one goal.
Fig 10 – Panos showing the benefits of consistent resistance exercise, as well as focused dietary and lifestyle habits whilst working as a high level accountant.
Are there any gender differences?
So far, we have discussed dietary advice and ageing as a whole, with information applicable for both men and women.
Whilst the training aspect of andropause vs. menopause is similar, the nutrition advice does have some slight differences, primarily relating to menopausal women.
With the declining gonadal (gonads: sex glands part of the reproductive system) production of hormones during menopause, your body aims to protect itself by looking to other sources to keep its regular systems running.
As discussed, body fat becomes the primary source of sex hormones, and so naturally the body will want to put on body fat.
However, the paradox presents itself in the fact that increased levels of body fat, in particular, visceral fat, will manifest into the majority of the issues we have tackled over this series.
For women, lowering levels of gonadal estrogen and progesterone means reduced sensitivity to insulin and increased sensitivity to stress triggers. This means during and after menopause, even if you were considered ‘fit and healthy’, your ability to process carbohydrates will be hampered, making insulin sensitivity a top priority.
Further, any consumption of inflammatory foods will trigger greater cortisol responses and consequently more insulin surges, so these need to be kept under control.
A familiar theme is emerging here, and it’s clear that the types of foods you may have got away with when younger will haunt your waistline now.
Focusing on the hormonal impact and quality of food now is far, far more important for healthy ageing.
Specifically to menopausal symptoms, many women experience hot flushes during this time, which can be attributed to many factors such as dietary intake (omega 3 intake particularly, can help with many menopausal symptoms, due to its ability to upregulate estrogen metabolism down a healthier detoxification pathway in the body) and genetics.
Recent research has increasingly looked at the effect of soy isoflavones and whether it can exert a control on menopause-related vasomotor symptoms, such as hot flushes.
This theory was based on the observation that only 10 to 20% of Asian women report hot flushes whereas 70 to 80% of North American women reported experiencing them.
A review of 19 studies published in Menopause: The Journal of the North American Menopause Association, examined the effects of soy isoflavones on 1,200 women, concluding that there is a positive long-term effect (at least two months) on hot flushes and other symptoms.21
Soy is a controversial topic in the world of healthy body composition, but some good quality, organic fermented soy products such as natto, edamame and tempeh a couple times a week can be useful and healthy for this population.
Poor quality soy and supplementation will often do more harm than good, and can often result in hypersensitivity reactions and interference of nutrient uptake, so it’s best to steer clear from those options.
The most commonly discussed topic amongst menopausal health is the increased risk of osteoporosis, due to the declining rates of calcium absorption.
With the declining gonadal estrogen production, the ability of the body to slow bone breakdown diminishes (estrogen is bone protective), as well as its ability to turn on vitamin D receptors in the gut (to increase absorption of calcium).
Of course, one of the big factors involved in the onset of osteoporosis in this population is the growing level of systemic inflammation, due to the cumulatively poor quality lifestyle factors over the years (as previously discussed).
However, poor vitamin D status combined with declining gonadal estrogen levels means calcium absorption is sub-par.
In order to correct this, getting your vitamin D levels to normal range and increasing consumption of green leafy, cruciferous vegetables are the key steps in aiding this.
For the issues discussed above, and many of the overall symptoms associated with menopause, whether it be emotional changes, skin health or cardiovascular risk, the number one nutrition tip is to make sure you consume enough variety of essential fatty acids.
Omega-3s and -6s in the right ratios are critical for the proper metabolism and balance of prostaglandins, which essentially regulate pain, inflammation, blood pressure, hormone synthesis, gut function, amongst others.
We already know the benefits of omega 3s, but one lesser-known essential fatty acid vital in these processes is gamma-linoleic acid (GLA), an omega-6 that can be found in evening primrose oil and borage oil, both commonly associated with aiding menopausal symptoms.
Saving the best two tips till last, one of the most effective strategies for helping menopausal women is consuming some dark chocolate with a glass of red wine at night.
Why? The secret is in the flavonoids they are both packed full of. What do they do?
These flavonoids have antioxidants called resveratrol (in particular abundance in red wine), catechins and phenols that eat away at free radicals and help combat oxidative stress.
If you read back to earlier in this article, cumulative free radical damage can have a great impact on the onset of ‘anabolic resistance’. The bad news is, both have to be consumed in small portions (a glass for wine, and 20-40g of 70%-plus cocoa content for the chocolate) and in moderation, or you will gain weight!
Is there anything different for men?
In terms of andropause specific advice, all of the key principles discussed thus far apply.
The key issue with these men is the high inflammatory markers (homocysteine and C reactive protein in particular), lack of useful testosterone production in the body, and the growing abundance of estrogen.
When considering the lifestyles of most men during this period of their life, alcohol consumption is perhaps the greatest issue they deal with. Specifically, their beer drinking habits.
Everyone loves a cold beer, but for men struggling through andropause, you are only escalating the debilitating emasculation process that is occurring.
Beer is loaded with hops (a powerful preservative that’s used in beer), and is highly estrogenic, explaining the growing epidemic of ‘man boobs’ and ‘beer bellies.’
Instead, limiting intake to a few drinks a week is best, again opting for ‘cleaner’ drinks such as red wine and vodka limes over beers and ciders. Better yet, green tea consumption can be very potent in increasing the detoxification of estrogen in men.
If you’ve been following us the whole way, above 40 and stuck in a rut about your health, physique and happiness, you should be ready to make the change that is necessary.
Resistance training offers a myriad of benefits to the human body, and this extends all the way to even the oldest populations.
In fact, we would argue that as each decade passes, the need to train with weights increases exponentially.
When you train, all the dysfunctional pathways in the body will be given the opportunity to change, given the correct dietary protocols in combination.
The myth that sarcopenia is inevitable has well and truly been debunked here.
Instead, you now have the tools to make a complete transformation, from both the inside and out.
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