11. Dr. Jack Guralnik: What You Should Know About Sarcopenia
Published October 28, 2020
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Show Notes
On this episode of This is Growing Old, we talk about something that is quite common, but that you might not have ever heard of before: sarcopenia. Joining Alliance for Aging Research President and CEO Sue Peschin on the podcast is Dr. Jack Guralnik, professor of epidemiology and public health at the University of Maryland School of Medicine. Listen as Jack talks about health issues impacting older adults, including sarcopenia.
Watch the Alliance for Aging Research’s new film, Sarcopenia: Taking Charge of Your Muscle Health As You Age: https://www.youtube.com/watch?v=CAC2g03_-2Y
Get to know today’s podcast guest, Dr. Jack Guralnik: https://www.agingresearch.org/blog-get-to-know-the-2020-daniel-perry-founders-award-honoree-jack-guralnik/
Learn more about the Alliance’s Aging in Motion program, a diverse group of patient, caregiver, health and aging groups working together to press for greater levels of research and innovation to develop treatments in the area of sarcopenia and age-related functional decline: https://www.aginginmotion.org/
Get the latest information and resources about age-related conditions, diseases and issues that impact the health of older Americans: https://www.agingresearch.org/health-topic/
Episode Transcript
Sue Peschin:
Hi there. I’m Sue Peschin, President and CEO of the Alliance for Aging Research, and you’re listening to our podcast, This is Growing Old. Today we’re going to be talking about something that is quite common, but that you might not have ever heard of before. It’s called sarcopenia. Joining me is Dr. Jack Guralnik, professor of epidemiology and public health at the University of Maryland School of Medicine. Jack is going to talk about health issues impacting older adults, including sarcopenia. Jack, thanks so much for joining us today.
Jack Guralnik:
It’s my pleasure, Sue.
Sue Peschin:
First, let us know, how have you been coping during the COVID-19 pandemic?
Jack Guralnik:
I’ve been doing pretty well. Fortunately, no one in my family has gotten sick. We’re all trying to stay out of trouble. In relation to aging, I do have parents who are in their late 90s, who are actually still living in independent living, but it’s been a really difficult, frustrating time. For a number of months we couldn’t see them at all. We’re now able to visit them in a very limited basis. During the summer we saw them outside wearing masks. Now we’re allowed into their apartment, but only for one hour. I myself am doing well, but I see how difficult it is for a lot of people, especially the older people in the society.
Sue Peschin:
Very, very true. And I have experienced that with my own parents so I hear you. The Alliance feels very fortunate to have you serve as chair of the Science Advisory Board for Aging in Motion or AIM program, which works to educate and advocate for research in the areas of sarcopenia and age-related functional decline. What exactly is sarcopenia and what are some of the highlights of the latest research in sarcopenia?
Jack Guralnik:
Sarcopenia is age-related loss of muscle and the consequent loss of physical strength and ability to perform normal daily activities. It’s an interesting word. It comes from the Greek roots. sarx, which means flesh and penia, which means loss of, or lack of. So it is simply the loss of muscle in the body. It’s an area that is somewhat new in the aging world, although it’s been a universal component of aging. We start losing muscle when we’re in our 30s, where we reach our peak and then it goes down slowly. But in some people, especially when they hit their late 70s, 80s, and into their 90s, in some people, this loss of muscle accelerates and we’re learning now about the reasons for that acceleration. But as that happens, it can cause really profound problems with loss of strength. So people have trouble climbing stairs, getting out of the chair, doing anything down to opening jars that requires strength.
Jack Guralnik:
Fortunately, there’s been a lot of research and the amount of research in sarcopenia has been growing. One area that’s been a challenge in sarcopenia is coming up with ways of clearly identifying who has the problem. One way that’s been used is to do use a machine called a DEXA machine. This is a machine that people may be aware of getting scans] for a loss of bone and osteoporosis. The same machines have been used to assess lean body mass, which is the component of the body that’s not muscle and not fat. It’s also called fat-free mass. The problem is that this is not really a terribly good measurement of actual muscle mass because the fat-free mass includes not only muscle, but it includes things like water and the organ weight and a number of other non-bone, non-fat soft tissues in the body.
Jack Guralnik:
So when we measure fat-free mass, we’re only measuring only about 50% of it, of this lean or fat-free mass is actually muscle. So the research has been hampered by this measurement issue for a long time. And some of the associations we expect to see between the amount of muscle we have and how we function have not really looked as clear as we had hypothesized them to be. Well, there’s a whole new way of measuring muscle that had recent work that I’m very excited about. It’s called D3-creatine dilution. And what this method does is it has a labeled isotope with a substance called creatine, which is a protein that’s in all the skeletal muscle in our body. People are given a capsule that has this labeled creatine in it. It distributes itself throughout all the muscles in the body.
Jack Guralnik:
And then from two to four days later, we simply take a urine sample and measure the proportion of the labeled creatine to the normal unlabeled creatine. And since we know how much creatine we gave them, we can then calculate how much actual muscle mass they have. The early work with this has just been very impressive, showing very clear relationships between the amount of muscle that people have and their ability to function a number of different ways. This method is so sensitive that’s now being used in babies and young children in third world countries to follow the effects of malnourishment and how they regain muscle when their nutritional intake is improved. And this is work that’s been funded by the Gates’ Foundation. So you have a very sensitive measure of how much muscle is in the body. And this is a really good method that’s going to support a lot of work in trying to build muscle in older people who have lost it.
Jack Guralnik:
There are a number of other assessments that may improve our ability to identify muscle and the change in muscle quantity. And the area of interventions, some of the pharmaceutical interventions that had looked promising have not panned out all that well, but there still continues to be a lot of work in nutritional interventions and specific amino acids, which are the building blocks of protein that support the increase in muscle mass. Also in exercise interventions that can be very effective in preventing loss of muscle or even building muscle in older people.
Jack Guralnik:
The other thing I’ve seen in terms of recent research is a resurge in the approach to research on sarcopenia in specific diseases. We’re starting to see a lot of research come out now that addresses the issues of sarcopenia in cancer, liver disease, heart disease, heart failure, diabetes. All of these conditions can be linked to sarcopenia, which can have a very profound effect on quality of life and ability to function independently. It’s been very, very nice to see this field really grow and the Aging in Motion coalition has played an important role in bringing the importance of sarcopenia to the attention of both clinicians and researchers.
Sue Peschin:
That’s really great to hear and a terrific overview. I think in particular, it sounds also like some of this research, as it relates to other types of chronic conditions, might help improve treatment and recovery related to those chronic conditions, which could also be pretty groundbreaking.
Sue Peschin:
The Alliance for Aging Research recently released a new video to raise awareness about sarcopenia that I know you helped us review. Why do you think awareness of sarcopenia is low? And what steps can we take to help raise awareness?
Jack Guralnik:
That’s a good question that those of us in the field often ask ourselves in terms of awareness being low. And I kind of think back to 30, 40 years ago when people were first starting to really become aware of Alzheimer’s disease and dementia. For a long time, dementia was thought of as just a normal part of aging. If you got old enough, you lost your mental capacity. And then it took some work to educate people to the fact that no, it’s a normal part of aging, that it’s a disease or a condition that we need to address and that that people need to be aware of and we need to do research on. In sarcopenia, we’re really in the early stages of that. People have assumed that getting weaker and losing physical abilities are kind of a normal part of aging, but they’re not. And we see examples of people who do well into their 80s and 90s and stay highly functional. So understanding what goes wrong when there’s an accelerated loss of muscle.
Jack Guralnik:
We’re not going to stop all muscle loss. There are a number of physiologic parameters that do affect muscle loss over time. And we see everyone losing some strength over time, but what we need to do is address this accelerated loss of muscle. Part of increasing awareness is to educate clinicians. Most physicians are not really aware of the work that’s going on in sarcopenia. And again, that’s something that the Aging in Motion coalition has really been addressing. And then the general public needs to address sarcopenia. I’ve given lectures to groups of older people living in independent living and in the community. And when they hear about this, it really makes a lot of sense to them.
Jack Guralnik:
In some ways, I was told that at one facility that after hearing about this in my lecture, that the attendance at exercise class just shot up, that people really realized that this loss of strength was something that was affecting them and that they could do something about. So I think when people become more aware of it, they’re going to become more engaged and asking their physicians about it, and also becoming more active physically to prevent some of the effects of sarcopenia.
Sue Peschin:
I love that bit about signing up for the exercise class. That’s fantastic. To me, that’s like a complete testimony to why education, health education, can be so empowering for people because when they know about something, they feel like there’s something they can do about it. It really allows them to take charge of their own health. That’s great.
Sue Peschin:
Congratulations on receiving the Alliance for Aging Research’s 2020 Daniel Perry Founder’s Award. As you know, this award is presented to an individual who is helping to change the paradigm of how we view aging and well-being as we age. What do you think needs to be done to change how we view aging?
Jack Guralnik:
Well, the most obvious answer to that is that we need to make the case that you can stay highly functional and engaged as you age. That we need to view aging, not as the dark part of life, as the part of life that no one wants to live through, but a time of life that can be high quality and very satisfying.
Jack Guralnik:
Now, not everyone can be in perfect physical condition as they reach old age. And we need to avoid saying that successful aging only includes those who are still able to say, run around the track or continue to perform at a very high level. Many of us, despite having good health habits and taking care of ourselves, we’ll develop some chronic conditions as we age. And so I think that another way of viewing successful aging is the ability to have a good quality of life and life satisfaction, even in the face of having a chronic disease, or in the case of many older people, having multiple chronic diseases. I think the medical care system, the rehabilitation interventions that can be done can help people maintain good quality of life, even in the face of some chronic conditions.
Jack Guralnik:
I think we can also view aging, not as a situation where you get sick and then life is awful, but one in which you can respond in a vigorous way to illness, can be resilient to the point where you’re still living a full and satisfying life as you age with chronic disease.
Sue Peschin:
Great. Yes, and we very much subscribed to that framing. In your opinion, what are the most pressing issues older adults face today that must be resolved?
Jack Guralnik:
That’s a big question. And if you brought together a big group of older people, you’d hear a lot of different issues that people… And thinking about this kind of stepping back and the big picture, I think health care and integrated good healthcare is probably a really important issue to most older people. We have a terrific healthcare system in many ways in this country. You can get some of the best care anywhere in the world, but we have a system that just doesn’t run very well. And the thing where I see the biggest problems is how it’s not integrated. People don’t have a primary care provider who can oversee all of the details that people are concerned about. We end up getting sent to multiple specialists who often don’t talk to each other.
Jack Guralnik:
So the splintering of healthcare can make it very difficult. And as a consequence, we see people who are on just an amazing number of drugs, 15, 20 drugs, and the physicians who are prescribing them are specialists in different areas and not talking to each other. So it’s just one example of where healthcare really needs to improve.
Jack Guralnik:
Getting off of the health issue, the area of financial security I think is a really pressing issue facing a large proportion of our older people. When you look at how little Social Security pays, I just don’t myself understand how people who are only receiving Social Security can survive these days. It just doesn’t seem like enough money to really be able to make it.
Jack Guralnik:
I think another pressing issue is the whole area of social change that we’ve seen, not just during this past year where it’s been incredibly powerful and difficult, but really over the past couple decades. Families often are not living in the same geographic area. You have people who just don’t get to see their children and grandchildren very much. Loneliness is an issue that many, many older people are dealing with and it’s a very pressing issue for them. And so psychological factors, anxiety and depression are areas that really impact people’s lives in a big way.
Jack Guralnik:
Those are three general areas. We could go on and on, but there are lots of challenges for older adults and the COVID pandemic has not helped those at all. It has made them even more difficult.
Sue Peschin:
Yeah. I think you raised some of the key issues of our time right now, and I think it’s comforting when people hear them said out loud. So I appreciate you going through those.
Sue Peschin:
I’m changing course here a little bit. When you were a kid, what did you imagine growing older would be like?
Jack Guralnik:
That’s an interesting question. I don’t think I thought a whole lot about growing older. When you’re a kid, being 30 seems to be so far away that old age just is not part of your reality. I had two grandparents who were immigrants from Europe and they seemed to be pretty sturdy people. My grandma cooked meals for many, many people, even in her 70s, early 80s. I don’t remember them talking about aging, complaining about getting old. Now, I was still a little kid when they died so probably just didn’t hear that. That didn’t really affect my image of growing older. I suppose that in a general sense, I just thought I would get smarter and smarter as I got older. I’m not sure if that’s exactly the case, but I think we do get somewhat wiser and have a better sense of the world around us as we age.
Sue Peschin:
Yeah, I think that’s definitely true. What do you enjoy most about growing older now?
Jack Guralnik:
I think life seems like less of a struggle now. As you reach older age, you’re not pushing quite as hard. You can enjoy what you’ve accomplished and not feel like you have to keep competing at the highest level anymore. And that’s a bit of a relief. I think that when you are older, you have relationships that you’ve had for many, many years. Sometimes I’m astounded when I think about how long I’ve known some people, and it’s very comforting to have those relationships and be able to interact with those people and go… Even people that you haven’t seen for a long time, it’s like you go back and interact with them, and it’s like you’ve only been apart for a week. You’re just so familiar with them. So that’s a nice thing in older age that you have these long, long established relationships.
Jack Guralnik:
And then I certainly have enjoyed watching my children become adults. It’s satisfying to see that either I did something right, or I’m just lucky that I have kids who have done well. Still waiting for grandchildren and my wife and I are very anxious to have them, but we’re trying not to put too much pressure on… Both our children are married, so they’re candidates for children and that will happen someday we hope.
Sue Peschin:
I think it’s good to put out a little subtle message on a podcast here. So make sure they tune in.
Jack Guralnik:
I will, for sure.
Sue Peschin:
Jack, thank you so much for being on our show today. It’s really been wonderful talking to you.
Jack Guralnik:
Okay. It’s my pleasure. I’m glad we got to talk.
Sue Peschin:
Me too.
Jack Guralnik:
Thank you, Sue.
Sue Peschin:
Thank you so much for listening to This is Growing Old. Check out the show notes for this episode for a link to our new film about sarcopenia, as well as Jack’s interview with Alliance founder, Daniel Perry. We encourage you to follow the Alliance on Facebook, Twitter, and Instagram. Visit agingresearch.org to learn more about age-related conditions, diseases and issues that impact the health of older Americans. If you enjoy our show, please subscribe now and rate us on Apple Podcast, Google Podcast, Spotify, or anywhere else you listen to podcasts. Thank you and have a wonderful day.