Age Related Muscle Loss and Sarcopenia An Interview with Dr Chris Adams

by Nina

Muscle Man Standing by Hans Baldung

Although we haven't heard from Dr. Brad Gibson lately, he is still consulting with me behind the scenes and also gives me a heads up when he comes across some information he thinks we might want to share with you. And recently when his colleague Dr. Chris Adams, who is a medical researcher studying muscle aging and sarcopenia, was in town, Brad arranged for me to meet Chris because he knew I'd be very interested in the work that Chris is doing. And I was! But I was very good and didn't pester Chris too much over our dinner, but instead approached him afterward to see if he would let me officially interview him. The result is this post today! Thank you so much, Chris, for taking the time out of your busy schedule to educate us all on this important topic. (By the way, Chris says that although he doesn't do yoga, his wife does. And he's becoming aware that he himself needs to start.)

Nina: Let’s start by having you address what sarcopenia is. We here at YFHA understand that muscles change as we age, losing mass and density in everyone to some extent. Is sarcopenia the name of this natural process? Or is sarcopenia the disease stage of this process, the way osteopenia is the disease stage of natural bone loss associated with aging?

Chris: In general, sarcopenia is a condition of being of advanced age and having an amount of skeletal muscle mass that is significantly lower than the average muscle mass of the general population. However, there are several competing definitions of sarcopenia, and, at this point, there is no general agreement on how to specifically define lower than average muscle mass in older people. In addition, comparing an older individual's muscle mass to the general population can be misleading. Because people come in many shapes and sizes, the amount of muscle mass varies widely from individual to individual. Also, as you noted, we all lose muscle mass to some degree as we age. An older person who was very muscular as a younger adult may have experienced quite significant muscle loss with age, even though their muscle mass as an older adult appears normal relative to the general population.

In addition to underestimating the number of people who have lost muscle mass with age, sarcopenia does not consider the most important aspect of muscle aging, the loss of strength. Between the ages of 30 and 40, nearly all people, even elite athletes, begin to experience a loss of muscle strength. Over the following decades, strength continues to erode while muscle mass typically declines to a lesser degree. As a result, reduced muscle quality (i.e., strength per unit muscle mass) is a hallmark of the aging process. By the age of 70, almost everyone will report that they are not as strong and probably not as muscular as when they were 25 years old. 

The most important question for older people is not whether their muscle mass is lower than the general population, but whether they remain strong enough to accomplish the physical tasks that they wish to accomplish. Fortunately, the field of muscle aging seems to be moving away from strict considerations of muscle mass and moving towards a greater focus on muscle quality and functional outcomes. I think this transformation will be necessary before muscle aging is able to take its place in the mainstream of medical practice. Right now, muscle aging is scarcely addressed by the medical community. 

Compared to the field of muscle aging, the field of bone aging is much more advanced in every way, and in contrast to the term sarcopenia, the term osteopenia is very useful. Osteopenia and its more severe form, osteoporosis, describe well-defined stages in a disease process, can be easily diagnosed, and have real prognostic value, or, in other words, they are clearly associated with clinically meaningful outcome, fracture. It is also worth noting that the definitions osteopenia and osteoporosis are based on the strength of bone (bone density) rather than the amount of bone, which, like the amount of muscle, can vary widely from person to person and is rather beside the point.

Nina: Is there a theory of why this happens?

Chris: Yes. The fundamental underlying process in muscle aging is called skeletal muscle atrophy. In skeletal muscle atrophy, skeletal muscle cells, or muscle fibers, become smaller and weaker, leading to a loss of muscle mass, quality, and strength. Skeletal muscle atrophy can be generalized (affecting most or all of the muscles in the body) or it can be localized (affecting only one or a few muscles in the body). Aging typically promotes generalized skeletal muscle atrophy.

It is important to know that skeletal muscle atrophy can be caused by many things in addition to aging. Other common causes of skeletal muscle atrophy include malnutrition, muscle disuse (e.g., sedentary lifestyle, bed rest, orthopedic injuries, osteoarthritis, stroke, spinal cord injury, and other neurologic disorders), certain illnesses (e.g., cancer, diabetes and several other endocrine disorders, heart failure, COPD, kidney failure, cirrhosis, rheumatoid arthritis, critical illness, and chronic infections such as HIV/AIDS) and certain medications (e.g., prednisone, cancer chemotherapy, and hormonal prostate cancer treatments). If a person develops a condition that causes skeletal muscle atrophy, then that condition will accentuate the loss of muscle mass, quality, and strength during aging.

At the molecular level, muscle aging is still poorly understood. The molecular mechanisms are no doubt complex, and they are difficult to study because they occur so slowly. In all likelihood, muscle aging reflects an accumulation of small molecular changes in skeletal muscle that persist over many years. We and others are working to understand how aging affects skeletal muscle at the molecular level, and our laboratory recently discovered the first example of a protein that is required for the loss of muscle mass, quality and strength during aging. The protein is called ATF4, and it is a transcription factor that alters skeletal muscle gene expression in a manner that causes muscle atrophy. This finding of ATF4 provides an important clue that should help us uncover other molecular aspects of muscle aging over the next few years.

Nina: You told me earlier that there is a great variation in the way individuals lose muscle mass, depending on their body types, and so on. Could you briefly explain that?

Chris: Variability in muscle mass and strength in older individuals is at least partially explained by genetic, environmental, and behavioral factors that determine: 1) the amount of peak, or young adult, muscle mass and strength, and 2) the absence or presence of other causes of skeletal muscle atrophy. There may also be genetic variability in the rate at which proteins such as ATF4 reduce muscle mass and strength during aging, but that is speculative at this point. 

Nina: Are there effective interventions for halting or slowing the progression of muscle loss?

Chris: Unfortunately, at this point, there are no available interventions for halting or slowing muscle aging, and a medicine for skeletal muscle atrophy does not yet exist. However, a healthy lifestyle can significantly reduce a person's risk for developing additional causes of skeletal muscle atrophy. For example, exercises such as yoga prevent muscle disuse, a very potent cause of skeletal muscle atrophy.

Nina: How effective is target muscle building in the presence of muscle loss?

Chris: It can be very effective, especially when we are younger. It becomes more difficult to rebuild muscle as we grow older.

Nina: For people who are aging, what would you recommend as the best ways to maintain muscle strength as we age?

Chris: At this point, the recommendations are pretty general and would consist of: 1) maintaining a healthy diet, 2) resistance exercise, such as yoga or weight lifting, assuming there is no medical contraindication to exercise, and 3) avoiding preventable or treatable risk factors for other conditions that cause skeletal muscle atrophy, such as smoking, alcoholism, hypertension, obesity, high LDL cholesterol, etc. 

There is a large unmet need for more specific recommendations, and scientists such as Blake Rasmussen at University of Texas-Galveston are doing some very nice and important work to develop specific exercise recommendations for older people, as well specific dietary recommendations, particularly for protein intake, which is especially important for muscle health. In addition to that work, we and others are working to develop nutritional products that are enriched in dietary compounds that help maintain muscle mass and strength during aging. For example, our laboratory recently discovered two natural compounds that reduce ATF4 activity in skeletal muscle of elderly mice, leading to increased muscle mass, quality and strength. One of those compounds, called ursolic acid, is naturally found in apples and several other edible fruits and herbs. The other natural compound, called tomatidine, is a metabolite of a compound that is found in tomatoes, especially unripe, green tomatoes. We are optimistic that compounds such as ursolic acid and tomatidine will someday form the basis for specially designed foods that help promote healthy aging. In addition, we are hopeful that compounds such as these will lead us to medicines that can halt or reverse the effects of muscle aging.

Nina: Besides our muscles getting weaker as we age, they also get stiffer. Is this increasing stiffness due to the same changes that make our muscles weaker?

Chris: That's a very interesting question. To my knowledge, the answer is unknown. I am also not aware of any ongoing research in this area, but it is certainly an important issue, and it would be a great area for research.

Nina: In our previous conversation, you said to me about bones something that I didn’t know, which is that bones age in a similar way to muscles in everyone (not just in people who are prone to develop the “disease” osteoporosis). Can you say a bit more about that? And what is the relationship between the changes in the muscles and the changes in bones that result from aging?

Chris: In most circumstances, muscle and bone go hand-in-hand. Muscle strength and bone strength require similar nutrition and exercise, and both are weakened by poor nutrition, disuse, serious illness, and aging.

Nina: Should that information about the connection between aging of muscles and bones affect our thinking about how to maintain both muscle and bone strength as we age?

Chris: Yes, a healthy lifestyle that includes exercises such as yoga can be beneficial for the strength of both muscle and bone.

Christopher M. Adams, MD, PhD is a physician-scientist, a Professor of Internal Medicine and Molecular Physiology and Biophysics at the University of Iowa, and Founder and President of Emmyon, Inc., a biotechnology company focused on discovery and development of nutritional and pharmaceutical compounds that reduce skeletal muscle atrophy and improve muscle function. His clinical practice is in internal medicine and endocrinology. His research primarily focuses on molecular mechanisms and treatment of skeletal muscle atrophy. He received his MD and PhD degrees from the University of Iowa in 1999, and then completed an internship and residency in Internal Medicine, a fellowship in Endocrinology and Metab.olism, and post-doctoral training at the University of Texas Southwestern Medical Center before joining the faculty at the University of Iowa in 2006. He was elected to the American Society for Clinical Investigation in 2013.

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Interview with Anna Guest Jelley of Curvy Yoga

by Nina

I’m excited to welcome a special guest today here on the blog, yoga teacher, author and activist Anna Guest-Jelley of Curvy Yoga. I’ve been admiring her from afar for some time now because of her work as a champion for women’s empowerment and body acceptance. Recently I finally got up the courage to approach her. And guess what? She was as warm and welcoming as I imagined her to be, and she agreed to let me interview her so you can find out more about her mission and her work.

Nina: Tell us a bit about yourself and how you got started with yoga.

Anna: Hi, everyone! I’m excited to be here because I love this blog!

Chronic migraines brought me to the mat a little over 15 years ago. I was desperate for anything to help, and several people recommended yoga.

At the time, I was also completely disconnected from my body. I hated it and wanted it to change – less pain, less weight. I eventually tried over 65 diets before yoga helped me realize that body acceptance is a much better and happier way to live life (even though body acceptance is the last thing I was expecting, or even wanting, from yoga at first!).

Nina: Why did you start Curvy Yoga?

Anna: I started Curvy Yoga because for about the first 8+ years of my practice, I always thought something was wrong with my body during asana. Since my teachers never talked about how to adapt poses for bigger bodies, and I almost never saw any other bigger-bodied students in class, I assumed (incorrectly, thank goodness!) that the problem was me.

Over time, though, as I began my journey towards body acceptance, I had the thought: “Hey, maybe the problem isn’t my body! Maybe the problem is there’s just not enough information about how to adapt yoga for curvy folks.”

Once I realized that, indeed, the latter was the case, I set out to see what I could do about changing that.

Nina: Which yoga practices and/or yoga poses do you think are especially helpful for body acceptance?

Anna: I believe that the way yoga can move people towards body acceptance is by helping them (re)connect with their bodies. So many of us are disconnected for various reasons, and it’s quite hard to accept, much less love, something that you can’t feel or connect with. 

For me, once I began to be able to feel what was going on in my body physically during asana, I was then able to slowly extrapolate that to noticing my breath, my mental and emotional states, etc. It was only from that place of embodiment that I began to be able to know and meet my body’s needs from a place of love, not misplaced, unhealthy and (in my case) disordered approaches to weight, eating and exercise.


I see the whole path of yoga as one of body acceptance because of how each of the limbs teaches us to connect with our body and self in a holistic way.

Nina: Do you have anything else you’d like to tell our readers?

Anna: I’ll just add that for anyone reading this, student or teacher, that making yoga accessible for people of all shapes and sizes doesn’t have to be complicated. Whether through pose modifications, props, sequencing, body positive theming, or some combination, it’s all very doable.

Yoga has a profound ability to connect us with our bodies and empower us when it comes from a place of acceptance, not shame that a body is not this or that seemingly ideal way. You never have to change your body for yoga! 

Anna Guest-Jelley is the founder of Curvy Yoga, a training and inspiration portal offering classes, workshops, teacher trainings, retreats, a virtual studio and lots of love and support to people of every size, age and ability. She is also the author of Permission to Curve: Inspiring Poses for Curvy Yogis & Their Teachers and the co-editor of Yoga and Body Image: 25 Personal Stories About Beauty, Bravery and Loving Your Body (forthcoming Fall 2014, Llewelleyn). Visit Curvy Yoga online at CurvyYoga.com.

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Living with Me and My OCD An Interview for Claires Documentary

ClaireJaneOCD on twitter is creating a documentary about the experience of having OCD, and invited me to contribute a video.  Claire and Jane are twins in the UK, who just completed running a marathon in order to bring awareness about OCD.  This is my first time recording myself!  And definitely an exposure to make it, but hopefully will be helpful to other people who struggle with OCD.

Brain Health An Interview with Ram Rao

by Nina and Ram

New Growth by Melina Meza

I’m trying to learn more about brain health so I can write a brief overview about how you can use yoga to foster brain health. And since we just happen to have a handy expert on the topic—Dr. Ram Rao—I thought I’d interview him as a way of doing my research. You lucky people get to see my interview in its complete form today. —Nina

Nina: What are the types of dementia? And what is the probability for developing one of these forms of dementia as you age?

Ram: Memory loss can be a simple age-associated phenomenon or due to a pathological condition. Age is one of the known risks for memory loss or forgetfulness. Age-associated memory loss is not the same as dementia. If a person experiences forgetfulness without having any underlying pathological condition, then the memory loss is solely due to age. Age-associated memory loss is not disabling and does not impact or interfere with daily performance.

Dementia is a pathological term to indicate loss of memory and other mental abilities including thinking and reasoning. The condition can be severe so as to interfere with daily life. Any damage to the memory centers can trigger the onset of dementia. Although many diseases trigger dementia, some forms of dementia may improve greatly when the underlying cause is treated. Dementia can arise due to:

• NeuroDegenerative diseases, including Alzheimer's disease, Parkinson's disease, Huntington's disease (a rare inherited disorder), and multiple sclerosis
• Vascular disorders that results from multiple strokes in the brain
• Traumatic brain injury due to accidents, severe injuries to the brain, hits to the brain
• Infections, including meningitis, HIV
• Chronic alcohol or drug use
• Depression
• Developmental abnormalities

Nina: Can yoga help us reduce our probabilities of developing memory loss? If so, how?

Ram: According to the Mayo Clinic, memory loss can be prevented by: 1) physical activity/exercise, 2) staying mentally active, 3) being socially active, 4) eating a healthy diet, 5) leading a stress-free life and 6) sleeping well.

There are so many scientific studies that indicate benefits of yoga (asanas, meditation and pranayama) in combating stress, keeping the individual physically and mentally stable and active, improving the digestive capacity and also helping in the sleeping process, all of which will result in combating age-associated memory loss. Yoga does this through multiple cellular mechanisms.

Nina: How can yoga help prevent strokes?

Ram: Yoga (asanas, meditation and pranayama) has been shown to improve the health of the heart and blood vessels, reduce blood pressure, reduce arrhythmia, reduce anxiety and depression, and improve metabolic parameters including blood lipid profiles all of which help in keeping stroke at bay

Nina: How can yoga help reduce chances of getting Alzheimer’s Disease?

Ram: In a recent study involving patients with early signs of Alzheimer’s disease (AD), it was shown that Yoga and Meditation increased functional connectivity in the areas involved in memory and also decreased the early degenerative changes that are typically seen in these regions, suggesting that Yoga and meditation have a positive impact on the regions of the brain related to AD. According to one Harvard researcher, yoga and meditation need to be included as part of the treatment regiment for dementia and Alzheimer’s patients. All the above-mentioned risk factors for stroke including hypertension, atherosclerosis, abnormal lipid profile, and stroke can trigger (AD).  Since Yoga has been proven to improve all these conditions, in turn it can also reduce the onset and/or severity of AD.

Nina: How about general mental acuity? Can yoga help us stay mentally sharp as we age?

Ram: Yes, there are numerous studies that show that practice of yoga (asanas, meditation and pranayama) has beneficial effects on the emotional well-being and general mental acuity without any of the side effects. It’s no wonder that a recent article in Yoga Journal on yoga’s effects on mental acuity was aptly entitled Yoga-Better than Prozac. That in itself sums up the power of yoga. Yoga increases brain chemicals such as endorphins and enkephalins that contribute to a feel-good response and ward off mental stress. It is akin to stimulating the brain in a positive way, which results in optimal brain function all of which can keep an individual alert and sharp.

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