Protein, muscle mass, falls and recovery.

[Chuckanut]

In the podcast below Peter Attia interviews a researcher in the field of protein consumption and how it affects muscle mas. Like many of his interviews he goes deep into the medical weeds using lots of terms and jargon we non-medical people don't understand. I recommend skipping to about 1:05 and listening to the next 35 minutes.

As I understand this interview, older people who get surgery for replacement hips and knees, whether elective or due to a fall can lose about 3 pounds of muscle mass after being bedridden for four days to a week. I found the loss of strength to be true after my knee surgery and it took me well over a year to get strength back in my legs and hips. But, until now I did not realize that the loss does not happen over time but in discrete chunks when we stop moving and become sedentary, even for only a few days.

#299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D. - Peter Attia

"It's the exercise that makes you respond way more to the same or less amount of protein that you ingest.” —Luc van Loon

peterattiamd.com

• Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
• Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
• Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
• Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
• Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];

 

[euro]

Yes, its truly amazing how fast one can lose muscle mass. Of course, this comes as no surprise to anyone who has had their entire leg in a cast for any length of time.

 

[donheff]

Attia's stuff is very good but it is a bit dense.

 

[MarieIG]

Thanks. I will listen to it while I ride my stationary bike. I have recently tried to increase protein (in part due to Dr. Gabrielle Lyon's podcasts endorsing protein consumption and exercise, and warning of frailty and sarcopenia in the elderly).

Same podcast on Youtube #299.

 

[harley]

Since I started dialysis, plus the couple of years of failing health before the diagnosis, I've lost about 30 lbs, and lost of it seems to be muscle mass. Especially since I'm supposed to be limited to lifting only 20 lbs due to having a fistula. I semi-disregard that, but do keep it below 40-50 lbs. The lack of ability to do heavier work has stopped me from building any muscle back up, and having to limit protein and fluid intake makes it even harder. I'd always heard/read about old people losing muscle, but seeing it first hand sucks. As does getting old in general.

 

[euro]

Since I started dialysis, plus the couple of years of failing health before the diagnosis, I've lost about 30 lbs, and lost of it seems to be muscle mass. Especially since I'm supposed to be limited to lifting only 20 lbs due to having a fistula. I semi-disregard that, but do keep it below 40-50 lbs. The lack of ability to do heavier work has stopped me from building any muscle back up, and having to limit protein and fluid intake makes it even harder. I'd always heard/read about old people losing muscle, but seeing it first hand sucks. As does getting old in general.

Sorry to hear - that is tough! Does the dialysis demand you limit protein? Wonder why. The only way I can think of to get around your muscle building problem is to focus on less weight but more repetitions (basically, muscle builds when you work it out to near exhaustion. You can do that with higher weights/resistance and fewer reps, or with lower weights/resistance and more reps. Also, you can make the exercise even more effective if you prolong the individual work. In other words, when you do say a bench press, go very slowly up and then very slowly back. Like "slo-mo". That is very demanding onthe muscle and stimulates growth.

 

[Slater]

I touched on this in the fitness membership / cost thread...
Yes I understand as im not old compared to some as im only 51....
But ive had a very hard work career as a heavy engine line mechanic for ford. 30+ years of non stop sonic speed work ethic, going-in eraly, leaving late, work through lunch, non stop, etc...
Both shoulders have torn rotator cuffs, lower back l5/s1 discectomy / laminectomy surgery, c5/c6 neck fusion, degenerative disc disease, degenerative joint disease, most of my joints have moderate+ arthritis, my right knee talks to me every day from a snow ski spill in my 20's, etc...
For me, ive seen change in a good way to the pain & joints by putting-in the work....

Like I said, im still only 51, lets see my attitude at 65+....

Im not trying to preach here...
Diet & life style is huge here, we need to keep moving....
high protein is building block to building / retaining muscle....
As we get older, we lose muscle mass, bone density, hormones go to xhit, etc...
We need to do whatever it takes to retain as much as we can for easier golden years...
I know its not always easy as the joints sometimes have a different plan than our mindset.
Consistency is key!

 

[audreyh1]

Wow seriously tough break Harley! Best wishes for your health going forward.

 

[audreyh1]

I see a lot of old people at the senior center who eat a “healthy” diet high in veggies and whole grains and not much meat, eggs, and dairy. They are frail, sometimes bordering on being feeble. I blame this on the bogus low fat, low cholesterol food recommendations from the 1970s and 1980s. It was drilled into our heads, and today it’s still hard to just eat healthy because of this nonsense. Eggs were bad, cheese was bad, butter was bad, Etc.

I even avoided olive oil for a while.

So totally agree. It’s terrible.

Cereal, skim milk, orange juice, and sweetened non-fat yogurt for breakfast. What a way to start the day! But this is served everywhere, all the time, and common at home.

 

[Sunset]

I've added half of a protein drink from Costco (Premier Protein) to get an extra 15g of protein in the morning each.
It was a easy tasty way to boost our protein intake in the morning.

I'm pretty new to all this worry about losing muscle mass, so that was a pretty good video to learn some stuff.

 

[Trooper]

So totally agree. It’s terrible.

Cereal, skim milk, orange juice, and sweetened non-fat yogurt for breakfast. What a way to start the day! But this is served everywhere, all the time, and common at home.

Not sure why Chuckanut's post is no longer in this thread, but I just finished reading "The Big Fat Surprise" by Nina Teicholz. Fascinating look at why we eat what we do. Made me irate.

 

[old medic]

can lose about 3 pounds of muscle mass after being bedridden for four days to a week.

And I spent 2 months in the hospital, then 2 more in a wheelchair. Its amazing I didn't start out mobility as rolling along like the BLOB!

 

[MarieIG]

It seems that older persons need a higher bolus of good quality protein, along with resistance exercise, to stimulate muscle synthesis. For example while 20 grams may be enough in a younger person, 30 grams may be needed in an older person.

 

[aja8888]

It seems that older persons need a higher bolus of good quality protein, along with resistance exercise, to stimulate muscle synthesis. For example while 20 grams may be enough in a younger person, 30 grams may be needed in an older person.

Yes, but just a large intake of protein is not enough as it has to be taken right after exercise to be absorbed to aid muscle recovery/growth, otherwise, it just goes out as a waste product.

 

[Rianne]

Dialysis cannot be easy, sorry to read that Harley. My eGFR is low as well. With kidney issues you have to be careful overusing your muscles. That causes higher rates of creatinine secreted in the urine. I have to limit my protein intake. I get most of my protein from beans, tofu, nuts, and dairy. I find simple exercises at home, dancing in front of Youtube videos, walking around with milk cartons filled with water, lots of stretching and walking. Balancing on one leg throughout the day helps. Falls are scary. All it takes is one misstep.

 

[Accidental Retiree]

Yes, but just a large intake of protein is not enough as it has to be taken right after exercise to be absorbed to aid muscle recovery/growth, otherwise, it just goes out as a waste

Thanks for posting. I was unaware.

 

[audreyh1]

Yes, but just a large intake of protein is not enough as it has to be taken right after exercise to be absorbed to aid muscle recovery/growth, otherwise, it just goes out as a waste product.

I don’t think it must only be consumed right after exercise, but that’s a good time to consume it.

 

[bloom2708]

I don't know any older people (or younger for that matter) who only eat whole grains and veggies/fruit. That generation and all the others has meat and dairy with every meal. My 82 year old father in law doesn't have any meals without meat and multiple dairy forms (milk, yogurt, cheeses, sour cream). I guess it is hard to view what others are eating. Breakfast is sausage and bacon and eggs. Lunch is lunch meat and cheese. Supper is burger, chicken, steak.

Go out to eat and try to find a single meal without meat and dairy. Nearly impossible unless a specialty restaurant. So I don't think a lack of meat/dairy is much of a problem.

Many get 2-3x recommended protein daily. It seems like activity (stretching, strength, yoga, pilates, walking, biking) is much more important. Use it or lose it.

 

[harley]

Sorry to hear - that is tough! Does the dialysis demand you limit protein? Wonder why. The only way I can think of to get around your muscle building problem is to focus on less weight but more repetitions (basically, muscle builds when you work it out to near exhaustion. You can do that with higher weights/resistance and fewer reps, or with lower weights/resistance and more reps. Also, you can make the exercise even more effective if you prolong the individual work. In other words, when you do say a bench press, go very slowly up and then very slowly back. Like "slo-mo". That is very demanding onthe muscle and stimulates growth.

Thanks to everyone for the sympathy and good wishes.

It's not so much dialysis that requires controlling protein intake as it is eating a renal diet. We have to manage/minimize protein, sodium, potassium, and phosphorus, as well as fluids. That's actually the hardest part, being limited to 32 oz. of fluids/day. That includes anything that is liquid at room temperature. I dream of large jugs of ice-cold water. I never realized, before mine failed, how much of the body's functions and cheminal balance were controlled by the kidneys.

I'm on the transplant list, and hopefully will eventually get back a semi-normal life. For now, I just keep on keeping on. Y'all watch your blood pressure (and diabetes, if you're so inclined). This is manageable, but very limiting, and not fun.

 

[MarieIG]

Yes, but just a large intake of protein is not enough as it has to be taken right after exercise to be absorbed to aid muscle recovery/growth, otherwise, it just goes out as a waste product.

The expert interviewed by Attia discusses time frames for protein usage. The youtube video is time stamped and expounds on the nuances at: 1:44:10-Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality.

 

[Rianne]

I hope for more research on time-restricted eating and kidney health. I've been eating in a 6-8 hour window for the most part. There are exceptions for social functions, vacation, etc. I still don't know if this way of eating is good for kidney function

 

[audreyh1]

I hope for more research on time-restricted eating and kidney health. I've been eating in a 6-8 hour window for the most part. There are exceptions for social functions, vacation, etc. I still don't know if this way of eating is good for kidney function

Considering that Dr. Jason Fung is a nephrologist (kidney specialist) and got into promoting time restricted eating to help his overwhelmingly type 2 diabetes patients with their resulting kidney problems I don’t think you need to worry. He also supports lower carb in this context.

If you haven’t watched some of his videos that’s a good place to do some research. He doesn’t discuss kidney function specifically. He’s trying to get his patients out of situations that endanger kidney health.

Other doctors have gotten ver vocal about promoting low carb or time restriction (plus lower carb) too. An orthopedic surgeon who got tired of removing toes and feet and other amputations. An ophthalmologist who got tired of having patients go blind. These are long term risks of type 2 diabetes and injecting with more and more insulin doesn’t avoid these problems. Dr. Fung really rails against the aggressive use of insulin approach.

 

[Rianne]

Considering that Dr. Jason Fung is a nephrologist (kidney specialist) and got into promoting time restricted eating to help his overwhelmingly type 2 diabetes patients with their resulting kidney problems I don’t think you need to worry. He also supports lower carb in this context.

If you haven’t watched some of his videos that’s a good place to do some research. He doesn’t discuss kidney function specifically. He’s trying to get his patients out of situations that endanger kidney health.

Other doctors have gotten ver vocal about promoting low carb or time restriction (plus lower carb) too. An orthopedic surgeon who got tired of removing toes and feet and other amputations. An ophthalmologist who got tired of having patients go blind. These are long term risks of type 2 diabetes and injecting with more and more insulin doesn’t avoid these problems. Dr. Fung really rails against the aggressive use of insulin approach.

Yes, I followed some of Dr Fung and Attia’s discussions a couple of years ago. I don’t have type 2 diabetes. They discussed so many benefits to time restricted eating I have to believe it’s healthier than not. If I search for NIH research, there is none specifically to this question. Glucose, BP, cholesterol, sodium, potassium, etc. all normal, actually sodium is low. I’m going to search for more recent Fung discussions. I find it interesting I have no symptoms. I feel as good now as when my eGFR was normal. The only alarming thing about this was in the blood work, specifically creatinine.

 

[Chuckanut]

I think Attia has backed off some of his previous zeal for fasting and timed eating. That’s been my impression for the past year or so. I think it has to do with the body not being able to adequately absorb all the nutrients in food in such a short time. Amazing as they are our bodies make a lot of trade offs when it comes to nutrition and health habits. I could be wrong.

 

[Dreamer]

Sorry to hear about your dialysis, Harley. I think that the hardest part for me would be limiting myself to 32 oz of fluids a day. Hate to hear this for you.