How to Live Longer and Stronger with Dr. Stuart Phillips

Show Notes

Starting around age 30, we all begin to lose muscle mass and strength. For some, this progresses into sarcopenia, a condition that can reduce independence, increase disability, and heighten risks of falls, hospitalizations, and other health complications.

Joining us to discuss how to prevent muscle loss with age is Dr. Stuart Phillips, muscle health expert and professor at McMaster University.

Episode Transcript

Lindsay Clarke:

Hello, and welcome to This Is Growing Old, the podcast all about the common human experience of aging. My name is Lindsay Clarke and I’m the COO and Senior Vice President of Health Education at the Alliance, and I’ll be your host today. I’m thrilled to be joined by Dr. Stuart Phillips, a leading expert in muscle health and aging. Dr. Phillips is a professor in the Department of Kinesiology and a member of the School of Medicine at McMaster University. He’s also the director of the Physical Activity Center of Excellence and the McMaster Center for Nutrition, Exercise, and Health Research, and the lab lead for the Exercise Metabolism Research Group. As you might have guessed from his many roles and titles, Dr. Phillips focuses on how exercise and nutrition impact skeletal, muscle, and body composition, especially as we age. 

Today we’re going to dive into some of that research, and we’re going to look at what we all can be doing to prevent the loss of muscle strength and function as we age. Dr. Phillips, welcome. 

Dr. Stuart Phillips:

Thanks very much for having me, Lindsay. Pleasure to be here. 

Lindsay Clarke:

It’s great to see you. Let’s start, as you know, the Alliance has done a lot of education over the years on a condition called sarcopenia. Could we start by having you tell our listeners what exactly is sarcopenia and what impact does it have as we age? 

…we’re going to add life to your years, as opposed to years to your life.

Dr. Stuart Phillips:

Yeah. It’s an old definition, and I think the original definition still fits, is the core component of which is the age-related loss of skeletal muscle. That’s all going to happen, so none of us is going to escape that. But the loss of muscle to the extent that it creates problems. The main problems being with mobility or other aspects of health as well. There were a lot of definitions out there, but I think it crystallizes around loss of muscle as we age that becomes problematic. 

Lindsay Clarke:

Obviously, anyone who has a diagnosis of sarcopenia is thinking about and probably worrying about their muscle health as they age. But what I’m also hearing from you, and I want to underscore, is that muscle loss is inevitable as we age. Is that right? 

Dr. Stuart Phillips:

Nobody’s figured out how to dial back aging yet. I wish they had. Or if I did, I wouldn’t be talking to you from McMaster University, I’d be on a beach somewhere. But no, aging happens and it wins. We haven’t been able to dial the clock back yet. But it’s about the difference between, on a downward trajectory being like this versus being on a much shallower trajectory. Those folks who lose muscle slower as they age, they do a lot better later in life. 

Lindsay Clarke:

Okay. Key takeaway here is everyone listening needs to be thinking about their muscle health as they age. What should we all be doing to stay muscle healthy? 

Dr. Stuart Phillips:

Yeah. It’s not my analogy, but I think it’s a good one. We all know exercise is good for us. Most people would say, “I know 150 minutes on the guidelines, that’s what I’ve got to do aerobic-wise.” I’m like, “Yeah, you’re right.” I have a wife who studies cardiovascular physiology, I’d never disagree. That adds years to your life. That keeps you out of the cardiologist’s office, it keeps you out of the endocrinologist’s, diabetologist, all these people with chronic metabolic diseases. 

What we’re going to talk about now by strength training or resistance training is we’re going to add life to your years, as opposed to years to your life. I’m a firm believer that, at some point in your life, you’re going to be limited in a mobility way. There’s something you’re not going to be able to do and it’s going to be an activity that’s probably not related to your aerobic fitness, in other words, biking, running, swimming, et cetera, but your strength and your power. That’s really only something that you can push back against as you age by engaging in what we call resistance exercise or weightlifting. 

Lindsay Clarke:

Okay, so resistance exercise and weightlifting, the best kinds of exercise for maintaining muscle health. But for those … I don’t think it’s uncommon, I’m going to raise my hand here, that it can be intimidating when we’re thinking about huge changes in our exercise routines. 

Dr. Stuart Phillips:

Yeah. 

Lindsay Clarke:

Especially with age. Do you have any tips for people who are listening, they hear you, they’re saying, “Okay, I want to be muscle healthy here,” they’re getting started today? What are some small steps that can have meaningful impact? 

Dr. Stuart Phillips:

Yeah. Let’s start out with two I think riders before we begin. The first of which is that when, just like it is with any type of physical activity, when you go from doing nothing to something, that’s when the really big changes start, and that’s when the really big benefit happens as well. More of something, things begin to slow down. But your risk goes down as soon as you start to do this. 

And, and I know you’ve heard it before but I’ll say it again, it is literally never too late to start. There are programs and pieces in the literature of training people in their 90s. So nonagenarians that are able to improve their strength, improve their physical function, and improve their mobility. Now, they’re not going in the gym and smashing heavy weights, but the point is it has an effect at any stage of life.

But to your point, it is intimidating. A lot of people, “I don’t like to go to the gym, I don’t want to go to the gym. I don’t have the means to have a personal trainer.” All I’ll say is gyms are great. We have one two floors down from here where 500 community members show up, you mentioned it, PACE. Awesome. But if you don’t have access to that, even doing something resistive in nature. Everybody knows what a pushup is. Most people hate them, I think because they were used as punishment when we were younger. “Drop and give me 20,” of course. 

Lindsay Clarke:

Yeah. 

Everything helps.

Dr. Stuart Phillips:

Something where you can improve your leg strength is even something as little as coming up and down out of a chair and doing it five or 10 times. People go, “Oh, how strong can that make you?” But that’s supporting your own body weight, which is really the last form of weight that you need to be able to lift as we get older. It doesn’t take much. Resistance bands, for example, which are elastic bands, for lack of a better word, that you can buy on Amazon relatively cheap, you can use them at home. Small weights. Things that a lot of people, “Oh, you need big, heavy weights,” and it’s not true. Everything helps. 

Lindsay Clarke:

It’s not too late, just get started, you can do it at home. 

Dr. Stuart Phillips:

There you go. 

Lindsay Clarke:

Okay. All right, we’re all in, everyone listening. 

Dr. Stuart Phillips:

Yeah, awesome. 

Lindsay Clarke:

What if we talk about nutrition to keeping our muscles healthy? What does it mean to eat healthy for muscle health? And are there key nutrients we need to make sure we’re getting enough of? 

Dr. Stuart Phillips:

Yeah. If you study muscle as I have been now for almost 30 years, you obligatorily have to talk about protein, it’s the substrate that muscles are made up of, and just about every other body tissue we have as well. Good sources of protein are the stereotypical ones. We talk about dairy, we talk about eggs, we talk about meat obviously. A lot of people go, “Oh, well, I thought all those things were maybe bad for you,” saturated fat and this sort of thing. There are lots of lean options of meats, there are low fat dairy. Eggs, I think have been probably falsely vilified for way too long. High quality protein, source of lots of different nutrients you don’t get in other foods. 

In March, which is nutrition month, we have in our center It’s Okay to Have an Egg Week. Everybody goes, “I thought these cholesterol …” I was like, “You know what, your relationship with cholesterol, pretty much your genetics rather than your diet, so it’s okay to have an egg.” I’m not talking about a dozen eggs, I’m talking about one or two eggs, one or two times a week, you’ll be okay. 

But these are the sources of not only protein, they’re sources of lots of other nutrients. We can talk about calcium, we can talk about vitamin D, which are bone supportive of course, but they’re really good for muscle as well. Muscle has vitamin D receptors on it and I think it probably responds pretty well to that vitamin as well. There’s lots of other nutrients in there that lots of other tissues need. 

But we’ve begun to uncover evidence now that even plant sources of protein, which are beginning to become more available, a bigger part of a lot of dietary guidance in a lot of places. That if you’d asked me 20 years ago I’d be like, “Not quite as good.” But now, legumes, peas, beans, these sorts of things, they get the job done, too. I don’t want to mean that it’s exclusively animal source proteins, plant protein can do it, too. Much, much closer than I ever thought to the animal protein, even though they’re supposed to be lesser quality. 

Lindsay Clarke:

That’s great. I know also though that our needs, our dietary needs change as we age. 

Dr. Stuart Phillips:

They do. 

Lindsay Clarke:

Can you talk a bit about that? 

Dr. Stuart Phillips:

Yeah. There’s a number in North America, Canada and the United States have harmonized guidelines around what we call the Dietary Reference Intakes. The recommended dietary allowance, or RDA, for protein is .8 grams of protein per kilogram of body weight. Now, I’ll translate that. That’s about .35 grams of protein per pound of body weight. I think it should be higher. I think it should be at least .5 and maybe up as high as about .7 grams per pound, which really means that the focus on protein has to be a central part of how you plan your diet. 

The one meal where people tend to fall down, and I say fall down, they follow guidance and it’s a very carbohydrate-centric meal, is breakfast. I say that’s a meal where you can stand to put some protein in. My go-to food, it’s a breakfast food, people like it, it’s easily available is Greek-style yogurt. Very nutrient dense, lots of great stuff in it, but it’s also protein-rich as well. A cup of Greek-style yogurt and you’ve already got about 20 grams of protein. It’s about focusing a little bit more on protein than you usually would, but not having it all where most people have it, which is at dinner at the end of the day. 

Lindsay Clarke:

Okay. No, that’s great. I also know that sometimes it can be harder to prepare meals with age.

Dr. Stuart Phillips:

Yeah. 

Lindsay Clarke:

And also, a lot of people experience reduced appetites.

Dr. Stuart Phillips:

Yes. 

Lindsay Clarke:

They’re tending to eat smaller portions. 

Dr. Stuart Phillips:

Yeah.

Lindsay Clarke:

Then, what do we do? We’ve got this increased need to maintain our muscle health, and maybe a decreased desire and ability to prepare. What are some tips there? 

Dr. Stuart Phillips:

Yeah. I think the big thing is is to focus on, if it’s smaller meals, that’s fine. What older people generally do find is that fluid fills them up a lot less than solid does. I like to remind people that milk, dairy is a good source of protein. That glass of milk that you were drinking before you went to bed which your mom told you was so good is still pretty good and good advice. 

At the same time, yeah, maybe the snack that you have mid-morning, or mid-afternoon, or pre-sleep is something more protein-focused as opposed to what most people reach for, which tends to be carbohydrate-focused, heavily sugared sometimes. I teach a lot of varsity athletes around here how to shop, believe it or not. I say, “If you shop around the outside of the grocery store, you usually find fruits and produce up one side, dairy and meat down the other side, and then usually the bread and cereal down this side.” If you go into the middle aisles, I said, “Be careful what you’re picking up there, usually processed foods.” That’s usually what most people choose for a snack instead of something that is from the outside aisle. I think if everybody spent more time on the outside and ate foods from the outside, we’d probably be okay. 

Lindsay Clarke:

I love it. I don’t think it’s uncommon though for people to find that they’re not getting everything they need from their diet and they’re turning to supplements. 

Dr. Stuart Phillips:

Yeah. 

Lindsay Clarke:

Any recommendations or tips when choosing supplements for muscle health? 

Dr. Stuart Phillips:

Yeah. There’s probably two things. A lot of people go to, say protein-based supplements. They use bars or powders. I’m okay with those. Athletes that I coach obviously and give the nutritional advice to, that’s mainstream stuff for them. They’re not always cheap, they don’t always taste great, and they may not give you everything that you need. Now, the protein powders are fine. You could add a protein powder to other foods and improve the amount, the quantity of protein that you’re eating. 

I do think, however, that your better off trying to get it from food sources. It’s tough, I’ll admit. I do think some of the meal replacement drinks have gotten a little bit better, so these ready-to-drink sources that are blends of not only fats, but carbohydrates and proteins, and a lot of vitamins and minerals. If you sip or drink those, that’s a good way of getting things as well. Always a food-first approach if you can, but I appreciate that there are barriers and tough points. “Can I eat this? How much should I eat?” It’s just a little bit about making the protein-focused part of things a push. 

Lindsay Clarke:

Okay. Switching gears a little bit, there are a lot of people who are really benefiting from the GLP-1 weight loss drugs.

Dr. Stuart Phillips:

Oh, yeah. 

Lindsay Clarke:

But we also know that that weight loss is going hand-in-hand with muscle loss. What should people be doing if they’re taking those medications? 

You’re losing a little bit more muscle because you lose weight so rapidly on these drugs.

Dr. Stuart Phillips:

Yeah. There’s a general rule when people lose weight, we call it Forbes rule. If you’re just restricting energy, this is old school weight loss so not drug induced, is that for every pound that you lose, about a quarter of it is what we call lean tissue. Most people translate into that’s muscle and it’s not quite, but it’s a reasonable proxy of muscle. Let’s just say is that that’s usually three-to-one. Three-quarters of it is fat, which is what you want to lose, and then a quarter of it is this lean tissue and some of that is muscle. 

Enter the GLP-1 drugs. Ridiculously effective. I think the term gets thrown around a lot, but a real game-changer for people who are overweight and obese and have struggled with that for a long, long time. What they do, two things, is they reduce the rate of gastric emptying, so they make you feel full for longer and they reduce your appetite centrally. You don’t eat as much, you feel you can’t eat as much. Very effective. They’re so effective however, that the ratio that we usually see of fat to lean loss is skewed a little bit towards the lean side. You’re losing a little bit more muscle because you lose weight so rapidly on these drugs. 

There’s a debate, I’ll be honest, about whether that’s an issue or not. Because if you lose weight, maybe your mobility improves anyway. We think it’s an issue for older people particularly, to want to not lose as much muscle as you can. Because, again, if you’re on that steep part of the curve already, to lose some muscle in a rapid period of time bends the curve downwards quite sharply. 

There’s two things, exactly what you would expect. First, focus on protein as a nutrient that you’re eating because that might help prop up muscle. But probably the far more effective and the better of the two is to engage in resistance exercise, weightlifting because that’s a very powerful stimulus to hang onto muscle. The better would be to do both together obviously, and that’s the athlete strategy around if you’re gaining muscle when you’re younger, we’re trying to prevent this scenario. You’re trying to lift weights, and then you eat a bit of protein, then next day you lift some weights. Doing that will definitely slow the amount of muscle loss. 

But the truth is, we don’t have a lot of good data whether that’s true or not. We don’t have any data actually whether it is a problem for older people mobility-wise. My guess is we’re going to have to wait a few years to see whether it’s a problem, but there will be some people who it will be a problem for. 

Lindsay Clarke:

Okay. But at the very least, we know that you lose weight, you lose probably muscle mass.

Dr. Stuart Phillips:

Yeah. 

Lindsay Clarke:

At the very least, people who are on these medications need to make sure they’re really focusing on their protein and their exercise, their muscle resistance and strength training. Okay. 

Dr. Stuart Phillips:

Absolutely. Any clinician who puts somebody on those drugs should be giving that sort of advice to people. It’s maybe not something they can control, but they should say, “You know what, these drugs are going to be very effective, you’re going to lose weight. You’re going to lose it probably pretty quickly. You’d be advised to eat more protein. Hopefully, if you’re not exercising, start, and do something to preserve your muscle.” 

Lindsay Clarke:

Okay. Anything else you want to tell our listeners? Especially, is there anywhere that people should go to learn more about this topic? 

Dr. Stuart Phillips:

Yeah. I think there’s an increasing recognition that sarcopenia is an issue. It’s doesn’t have to be a normal part of aging. 

Lindsay Clarke:

Right. 

Dr. Stuart Phillips:

A lot of clinicians out there look at it and say, “Well, that’s just aging, that’s just what happens.” There are a lot of, I think, things like that where the age that people are beginning to push back on, and sarcopenia or muscle loss is definitely one of them. 

Lots of great resources and places where you could go to check out what you can do. The hard part is we don’t have a drug to stop it right now, so it’s all lifestyle-based. It’s all about trying to eat a little bit better, trying to stay physically active, and definitely trying to lift some weights to make yourself stronger. I think the big part, and you’ve already seen my curves already, but the point we like to make to people is that a small difference at a certain point in your life, and it could be just a one to two-degree shift in that decline or incline, you can begin to see is that it has a tremendous difference later in life. It’s that the lines diverge. The point to make there is that that divergence could be the difference between five or six years of independent living later in life. 

I call it an investment in the future you to do this stuff now. Everybody wants to know when aging starts, when sarcopenia starts. I’m about to have a significant milestone birthday. My friends call it a paying birthday, let’s put it that way. I’m more and more interested in this because people say, “What am I training for?” It’s I am training to age well, that’s exactly what it’s all about. 

Lindsay Clarke:

But I love the investment analogy, but also you can invest in small amounts and still make a huge difference. 

Dr. Stuart Phillips:

It’s compound interest. 

Lindsay Clarke:

Right, right. 

Dr. Stuart Phillips:

These small investments along the way and it has a big dividend, and that’s the point. The difference in matching of … Everybody wants lifespan. I say, “I have no interest in living to be 120 and feeling like I’m 120.” 

Lindsay Clarke:

Yeah. 

Dr. Stuart Phillips:

But the matching of health span, for me, a core component of which is being physically mobile, with our lifespan, I think that’s the future of aging well. Trying to be as healthy for as long as you can that would match your lifespan. I think being strong, and fit, and physically active, good diet, et cetera, et cetera, are key components of that. 

Lindsay Clarke:

Well, this is all great. But before I let you go, I want to ask you two questions that we ask all of our podcast guests. 

Dr. Stuart Phillips:

Okay. Yeah, go for it. 

Lindsay Clarke:

First of all, when you were younger, what did you imagine that growing older would be like? 

Dr. Stuart Phillips:

Oh, yeah. I had a great childhood. I had both sets of grandparents on my mother and my father’s side around. Growing older meant sitting in a, I’m going to say a rocking chair, and just sitting around. Smoking in my grandfather on my mother’s side case, so he didn’t stick around too long. His wife did, and the same on my father’s side. But there was a lot of, yeah, just gracefully aging, but letting age wash over you and maybe not being as active a participant in pushing back against it. My parents, another level up. They were much more physically active. 

I plan of … 70 is the new 50. I forget the analogy.

Lindsay Clarke:

We’ll take that. 

Dr. Stuart Phillips:

Yeah. My plan is to try and push the envelope again, and probably my kids are going to do more than I ever did. I think that it’s about realizing that aging happens to everybody and everything slows down, et cetera, et cetera. But it can happen at different rates, and I think that that’s the really big message. Trying to do all you can to slow that decline as much as possible, mentally, physically, I think they go hand-in-hand. 

Lindsay Clarke:

What do you enjoy most about growing older, about aging? 

Dr. Stuart Phillips:

Yeah. I’ve gained a different appreciation for … I have a fantastic job, I’m really lucky to do what I do at the university. Because in a sense, every September, I’m reborn. There’s 5000 new undergraduate students. All the faculty look and they go, “They look so young.” The truth is they’re the same age every year, we just keep getting older. I’m surrounded by young people with energy and vitality. They amaze me and they constantly just challenge me to be better, and to try and keep up with them in a large part. It must be just age and experience is to take a tremendous amount of pride in interacting with them because now they’re younger than my kids’ ages. It’s like having a second set of kids. Yeah, a nurturing of a younger generation has been part of my aging process. I never thought that would happen, it’s just grown. All of a sudden I find myself thinking, “What would you be most proud of?” I’m most proud of those folks. Yeah, it’s the funnest part of what I do for sure. 

Lindsay Clarke:

They’re clearly lucky to have you, so thank you for sharing that. 

Dr. Stuart Phillips:

I appreciate that. Thank you. 

Lindsay Clarke:

Dr. Phillips, thank you so much for joining us and teaching us so much about how we can maintain our muscle health as we age. 

Dr. Stuart Phillips:

You’re most welcome. Thanks for having me on the show. 

Lindsay Clarke:

Thank you, everyone whose listening, for tuning in. Be sure to go to our website, agingresearch.org, for more resources on sarcopenia. You can download other episodes of This Is Growing Old wherever you get your podcasts. 

This episode is brought to you, in part, by Nestle Health Science.