The Twin Terrors of Aging

I think the effects of aging really hit me as I watched my grandparents bodies decline toward the end of their lives. They looked, and were, fragile. My recollection is that the first time I heard of Osteoporosis was in the context of my grandmother having it. It also occurs to me that these two were some of the hardest working people I ever knew; they had far from a sedentary job. They owned a small business, a bait and tackle shop in New Milford, CT. In the summers they would open at 5:00am and close at or often 7:00pm, and they were open every single day. Some of my fondest memories of my childhood were spending a week or two in the summer with them, as my grandfather had a route delivering bait and tackle, checking his chub traps, the shiner tanks sloshing around in his red International truck. There was a lot of manual labor involved. But even that wasn't enough to keep them from "The Twin Terrors of Aging" - Sarcopenia and Osteopenia.

twin terrors

Simply defined, Sarcopenia is the loss of muscle mass, and Osteopenia is the loss of bone density. These twin terrors have a cause and effect relationship on the aging process.

Losing muscle tissue (Sarcopenia) has been shown to cause a decline in your bodies ability to use glucose and a corresponding decline in insulin signaling and sensitivity. This becomes a vicious cycle, as a decrease in insulin sensitivity makes it more difficult for the body to grow and repair itself, which can lead to further muscle atrophy, which can lead to further decreased insulin signaling, and around and around we go. And don't miss the important distinction here. Muscle Atrophy is losing mass because the cell is getting smaller - this is largely reversible. But a muscle cell that dies is difficult if not impossible to replace. 

Bone mass has been shown to peak at about age 35 and decline with age. Our bones are living active tissue, and just like muscle if you don't give them much to do they will start to decline and you lose bone density more rapidly, which leads to Osteopenia, and can progress to Osteoporosis. 

And this leads to the frailty I saw in my grandparents - because of muscle and bone loss they became easier to break - they became fragile.

But let's back up a little. Why and how did this muscle and bone loss get started? While it might seem like it, nobody wakes up one morning after the "fragile fairy" visited, weaker and fatter. More than likely they have been experiencing a very gradual decline, which like a snowball racing downhill, becomes bigger and bigger as momentum gathers.

Have you ever been diagnosed with one or more of the following?

Hypertension - elevated blood pressure.

Dyslipidemia - abnormal amounts of blood lipids (triglyceride/cholesterol). In North America, this is usually hyperlipidemia - elevated cholesterol and/or triglyceride.

Systemic Inflammation - these can be measured with a Hemoglobin A1C and C Reactive Protein blood test, among others.

Insulin Resistance and/or Hyperglycemia (high blood sugar) - these were briefly discussed above.

Visceral Obesity - accumulation of fat around the internal organs. The InBody scanner at Cr8 Fitness is one way to get a measure of this.

Usually these disorders build on each other, and often lead to Metabolic Syndromewhich affects 1 out of 3 Americans.

Including, at one time, me. 

Yes. Yours truly had hyperglycemia, high blood pressure, elevated cholesterol, high visceral obesity, and if I remember correctly my A1C tilted toward the high side too.

Key word: HAD

So what can we do about it? 

That is the million dollar question, right?

Now I don't want you to get me wrong here. I am not a doctor, and I have a tremendous amount of respect for the hard work it takes to become one. There are realities of the system and constraints that medical professionals have to navigate and work within. But the cold hard truth is that much of western medicine is very broken.

If you look up the word "Medicine" in the Cambridge Dictionary, you will find the following definitions in the following order: 

  1. the science dealing with the preserving of health and with preventing and treating disease or injury:
  2.  a substance taken into the body in treating an illness:

I LOVE the words "preserving (health)" and "preventing (disease).

Yet I bet you if you asked, 9 out of 10 people would equate the word "medicine" with "drugs". And while there are certainly appropriate drugs to be taken in acute circumstances -  where would we be without penicillin? - I am talking about other kinds of drugs that function far differently.

In "The Barbell Prescription" Dr. Sullivan introduces a word, Polypharmacy, which he simply defines as "lots of drugs". 

It got me thinking. How many people do I know that take prescription medications regularly take only one?

Rarely do we see clients that are only on one med, usually there are three or four or more. Often we will see a diabetes drug (or two) paired with blood pressure medicine, maybe thyroid or statin thrown in, with a side of something to help indigestion, or just as likely constipation, caused by the other drugs. Prescription anti-inflammatory and SSRI's are also very common. 

Again, don't get me wrong. I am NOT "anti-drug", and recognize the necessity for these in certain situations. And I am not making a value judgement here, because I have no room to talk given my history.

But in my mind there is a crucial question and subsequent conversation we should be having. "What is this plethora of prescriptions doing to solve the underlying cause, rather than just covering the symptoms?"

Drugs are not like vitamins. You can have a Vitamin D deficiency. You do not have a Lisinopril, or Celebrax, or Zantac, or Cardizem deficiency. There is an underlying cause that is rarely being addressed simultaneously to the prescription being filled. 

And even worse is that some of these drugs can actually increase the rate of muscle and bone loss we discussed before.

Is that really healing? Preserving health and preventing disease? I think not.

Years ago I remember talking to a co-worker who had just been to the doctor. He said the doctor told him he was clinically obese, and if he got on a regular exercise program and good eating plan he could lose the weight, without drugs. But then he said (according to my co-worker), "Since I know you aren't going to do it, I am going to put you on X, Y, Z." I couldn't settle on if that was a bigger indictment of my (still unhealthy) co-worker or the doc. You decide.

Dr. Sullivan also pointed out an interesting thing about modern medicine. We don't generally don't die of syphilis and smallpox anymore. Instead we die of heart failure, stroke, myocardial infarction (told you he was a doctor) and dementia. And not when we are in our eighties and nineties. It's very common for any and all of those things to happen in our 50's and 60's.

I am not afraid of dying. But I have no desire to live longer if in reality it is just extending the length of time I hurt, don't want to move, and have no energy. And I am guessing neither do you.

So we've discussed one option to the "Twin Terrors" - drugs. Is there an alternative?

As an Athlete of Aging, I'll be you already know at least part of the answer.

We'll explore next time. Until then, take stock. If you take prescription drugs; Do you know what they are for? Do you know how they interact with each other? Have you discussed with your doctor a path to get off of any or all of them? If not, consider investigating these your homework.

Until next time,

Coach Dean

This post is second in a series called "Athletes of Aging".

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