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Sarcopenia

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12/07/2015

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Declining health and increased vulnerability to disease are characteristics of aging. In many ways this seems almost paradoxical - with advances in medical science comes the promise of longevity and indeed people are enjoying longer lives, but over time the body gradually loses vigor. It's not uncommon for elderly people to be afflicted with at least of one the following ailments:

obesity
diabetes
arthritis
stroke
cardiovascular disease

Although medical science has yet to understand precisely how the human body enters a state of physical decline, we do know that part of the reason is a gradual loss of cellular energy and with it, increased susceptibility to internal and external stressors.

In this article, I'm going to talk about some of the stressors and how supplementing your diet with bergamot may help your body to remain healthy for a longer period of time.

Aging and Metabolism

God has given us a set amount of time to live; at present He does not want these bodies to continue indefinitely. Therefore He incorporated an almost incalculable number of mechanisms into the functioning of the human body, their interaction can keep the internal machinery running smoothly i.e. prolonged health or fall into a state of illness and eventual death.

To get a better appreciation of this, I'm going to tell you some interesting facts about the physiology and biochemistry that we rely on every second of our lives.

The human body is amazingly designed, it's composed of trillions of living cells and each of them is equipped with internal machinery and the ability to regulate itself and to regulate and be regulated by other cells.

We should think of cells as living machines and as with any machine, they require a battery, a steady supply of fuel and a means to remove excess waste.

Food is the fuel of the body; in the stomach and small intestine, food is digested i.e. broken into chemicals which are eventually transported to each cell. From there the fuel is used by the cells for energy.

Mitochondia are the cellular batteries that I mentioned above. You maybe surprised to know that our cells "breathe". Mitochondria use oxygen from cellular respiration to produce adenosine triphosphate (ATP). ATP is a high energy molecule; when it is used up, ATP is broken down to adenosine diphosphate (ADP) and eventually adenosine monophosphate (AMP). AMP is the "end of the line" so to speak, the cell would be out of energy if it were left with only AMP.

Fortunately, the body produces 5'adenosine monophosphate-activated protein kinase (AMPK) which is a special chemical that makes good use of AMP.

One of the functions of AMPK is to recognize when cells are running low on ATP.

When ATP is low, AMPK helps stimulate production of more ATP through a variety of mechanisms including:

fatty acid oxidation - breaking down fat for energy
glycolysis - converting stored glucose for energy
increased synthesis of a protein that transports glucose across cell membranes
increased production of mitochondrial enzymes involved in the production of oxygen carrier molecule

Unfortunately, we gradually lose energy as we age. Although aging is a natural part of living, some of its consequences can be very problematic, because they can lead to metabolic syndrome and with it a host of potentially deadly illnesses.

Metabolic Syndrome - the Killer Within

Metabolic syndrome is a name given to a condition that encompasses a variety of inter-related illnesses. I've written several articles discussing its potential danger to the human body. In short, people diagnosed with metabolic syndrome often have the following ailments:

obesity
type 2 diabetes
high cholesterol
high blood pressure
inflammation

Each of the above illnesses are serious in and of themselves, but imagine how much more deadly they are when a person is afflicted with all of them. Even worse, fatty liver disease - a condition wherein the liver accumulates excess fat - often accompanies metabolic syndrome.

Does this mean that we are destined to be destroyed by this affliction? Not necessarily.

AMPK and Bergamot May Hinder Metabolic Syndrome

Medical scientists have been devoting a great deal of study to finding ways to combat age-related illnesses. Recently research teams have discovered that bergomot polypehlic fraction (BPF) can work with AMPK to combat the effects of metabolic syndrome.

AMPK and bergomot polypehlic fraction (BPF) can improve metabolic syndrome in a variety of ways:

in terms of the pancreas, liver, heart, healthy weight management, and free radicals from Reactive Oxygen Species-

The pancreas is an organ that produces insulin in response to glucose that is produced by the liver. One of insulin's jobs is to tell cells to open up so the glucose can enter. When the level of serum glucose increases, so does insulin output from the pancreas. Eventually this can lead to insulin resistance, a condition whereby cells start to ignore the signals from insulin which causes more glucose to accumulate in the bloodstream which triggers more insulin from the pancreas. This feedback loop then creates a situation that we in science refer to as a "snowball effect."

Imagine that you've placed a little snowball at the top of a snow covered hill. Now you roll that snowball down the hill. The snowball gets larger as it rolls downhill because more snow sticks to it. By the time you reach the bottom of the hill, you've got a huge snowball.

This is what can happen if insulin resistance goes unchecked. Gradually it may develop into full blown diabetes.

AMPK helps the cells accept glucose. This will reduce the strain on the liver. Bergomot polyphenols also assist in glucose uptake into cells.

Metabolic syndrome can also cause the liver to accumulate large amounts of fat leading to nonalcoholic fatty liver disease(NAFLD). If something isn't done to reverse the process, it will eventually kill you. In fact the condition is linked to the life-threatening ailment cirrhosis.

AMPK prevents the liver from collecting too much fat (triglycerides) and stimulates fatty acid oxidation. This is an example where oxidation is a good thing, wherein it helps the body use fat for energy.

Although the precise mechanism hasn't been discovered, a study of patients with nonalcoholic fatty liver disease has found that BPF improves lipid profile. The patients experienced improved high density lipoprotein (HDL) and lower low density lipoprotein (LDL) and serum cholesterol. Thus, bergomot polyphenolic fraction also prevents NAFLD.

By helping glucose uptake, the enzyme also eases the work of the pancreas. When the pancreas is overworked it may become scarred, inflammed or develop other problems. In fact, inflammation is one of the hallmarks of metabolic syndrome, pancreatitis and nonalcoholic fatty liver disease.

There are also benefits to heart health; risk for heart attack and stroke increase when the body has too much LDL, and unhealthy cholesterol. AMPK and bergamot polyphenol effects on fatty acid oxidation (as I discussed above) may improve cardiovascular health thereby reducing the risk of stroke and heart attacks.

AMPK and bergamot polyphenolic fraction may be helpful for healthy weight management, too. Bergamot activates AMPK, and AMPK stimulates cellular metabolism. When your body is using more energy, less of it will be stored as body fat.

AMPK stimulates mitochondia to make cellular energy but one of the drawbacks of this important process is production of leftover oxygen molecules or Reactive Oxygen Species (ROS). Free radicals create oxidative stress which cause cellular aging and eventual death. Polyphenols have been shown to combat oxidative stress thereby inhibiting this by-product of cellular metabolism.

Bergamot Polyphenolic Fraction Activates AMPK Naturally

Medical science has sought many remedies for the treatment of metabolic disorders such as type 2 diabetes. Metformin is one such medication; it is a man-made pharmacological agent that helps lower blood sugar levels. It is also a very powerful AMPK activator.

Interestingly, bergomot polyphenolic fraction is a natural activator of AMPK. It's important to point out that metformin is manufactured by the pharmaceutical industry, and only pharmaceutical companies are authorized to make claims about a medicine's ability to cure disease. But for people who are seeking natural ways to keep healthy and reduce their risk for developing metabolic syndrome, bergamot polyphenolic fraction is an option.

Bergamonte vegetarian capsules which are distributed by Nutri Lifescience are made from bergamot citrus fruit and contain the bergamot polyphenolic fraction that I talked about in this article.

Read my sponsored article Got Bad Cholesterol? Try Bergamonte from Nutri Lifescience to learn more about this remarkable gluten-free health supplement. Buy your very own bottle of 60 Bergamonte vegetarian capsules today!

Summary

Aging populations are susceptible to metabolic syndrome which can have a detrimental effect on quality and quantity of life. Fortunately, God has created the human body to be able to make use of food for fuel and provided numerous mechanisms to help the body function efficiently.

AMPK is an enzyme that is manufactured by every cell of the body and is involved in energy production for cellular metabolism. Therefore, AMPK is a chemical that can have a positive effect on metabolic syndrome because it is necessary for health and longevity i.e. it slows down the aging process.

Bergamot polyphenolic fraction are chemicals that come directly from bergamot citrus fruit. Bergamot polyphenolic fraction is a natural activator of AMPK, thus bergamot polyphenolic fraction may also help slow down the effects of aging.

Health supplements should not be mistaken for medicinal drugs that would be prescribed by physicians for treatment of any given disease.

***Disclaimer: This article is not endorsed by the US Food and Drug Administration (FDA). People should consult their physician before making changes to their diet. The content in this sponsored article and elsewhere on Living Fit, Healthy and Happy_(SM) is for informational purposes only, and is not intended to substitute for medical advice, treatment or diagnosis. People should consult their physician before making changes to their diet.

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Article References

Shirwany, N., & Zou, M. (2010). AMPK in cardiovascular health and disease Acta Pharmacologica Sinica, 31 (9), 1075-1084 DOI: 10.1038/aps.2010.139

Peng W, Zhang Y, Zhu W, Cao CM, & Xiao RP (2009). AMPK and TNF-alpha at the crossroad of cell survival and death in ischaemic heart. Cardiovascular research, 84 (1), 1-3 PMID: 19671584

Gliozzi, M., Carresi, C., Musolino, V., Palma, E., Muscoli, C., Vitale, C., Gratteri, S., Muscianisi, G., Janda, E., Muscoli, S., Romeo, F., Ragusa, S., Mollace, R., Walker, R., Ehrlich, J., & Mollace, V. (2014). The Effect of Bergamot-Derived Polyphenolic Fraction on LDL Small Dense Particles and Non Alcoholic Fatty Liver Disease in Patients with Metabolic Syndrome Advances in Biological Chemistry, 04 (02), 129-137 DOI: 10.4236/abc.2014.42017

Gliozzi M, Walker R, Muscoli S, Vitale C, Gratteri S, Carresi C, Musolino V, Russo V, Janda E, Ragusa S, Aloe A, Palma E, Muscoli C, Romeo F, & Mollace V (2013). Bergamot polyphenolic fraction enhances rosuvastatin-induced effect on LDL-cholesterol, LOX-1 expression and protein kinase B phosphorylation in patients with hyperlipidemia. International journal of cardiology, 170 (2), 140-5 PMID: 24239156

Shirai A, Onitsuka M, Maseda H, & Omasa T (2015). Effect of polyphenols on reactive oxygen species production and cell growth of human dermal fibroblasts after irradiation with ultraviolet-A light. Biocontrol science, 20 (1), 27-33 PMID: 25817810

Hardie, D. (2008). Role of AMP-activated protein kinase in the metabolic syndrome and in heart disease FEBS Letters, 582 (1), 81-89 DOI: 10.1016/j.febslet.2007.11.018

Grahame Hardie D (2014). AMP-activated protein kinase: a key regulator of energy balance with many roles in human disease. Journal of internal medicine, 276 (6), 543-59 PMID: 24824502

Musi N, Hirshman MF, Nygren J, Svanfeldt M, Bavenholm P, Rooyackers O, Zhou G, Williamson JM, Ljunqvist O, Efendic S, Moller DE, Thorell A, & Goodyear LJ (2002). Metformin increases AMP-activated protein kinase activity in skeletal muscle of subjects with type 2 diabetes. Diabetes, 51 (7), 2074-81 PMID: 12086935

Rajesh G, Kumar H, Menon S, & Balakrishnan V (2012). Pancreatitis in the setting of the metabolic syndrome. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 31 (2), 79-82 PMID: 22422323

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Sarcopenia: Causes, Prevention, And Treatement. Part 2

01/06/2010

Sarcopenia: Causes, Prevention, And Treatement. Part 2
By Will Brink

Nutrient considerations

There are several supplemental nutrients that should be
especially helpful for combating sarcopenia, both directly and
indirectly. Supplements that have shown promise for combating
sarcopenia are creatine, vitamin D, whey protein,
acetyl-L-carnitine, glutamine, and buffering agents such as
potassium bicarbonate.

Creatine

The muscle atrophy found in older adults comes predominantly
from a loss of fast twitch (FT) type II fibers which are
recruited during high-intensity, anaerobic movements (e.g.,
weight lifting, sprinting, etc.). Interestingly, these are
exactly the fibers creatine has the most profound effects on.
Various studies find creatine given to older adults increases
strength and lean body mass (Chrusch et al., 2001; Gotshalk et
al., 2002; Brose et al., 2003). One group concluded:

"Creatine supplementation may be a useful therapeutic strategy
for older adults to attenuate loss in muscle strength and
performance of functional living tasks."

Vitamin D

It's well established that vitamin D plays an essential role in
bone health. However, recent studies suggest it's also essential
for maintaining muscle mass in aging populations. In muscle,
vitamin D is essential for preserving type II muscle fibers,
which, as mentioned above, are the very muscle fibers that
atrophy most in aging people. Adequate vitamin D intakes could
help reduce the rates of both osteoporosis and sarcopenia found
in aging people (Montero-Odasso et al., 2005) leading the author
of one recent review on the topic of vitamin D's effects on bone
and muscle to conclude:

"In both cases (muscle and bone tissue) vitamin D plays an
important role since the low levels of this vitamin seen in
senior people may be associated to a deficit in bone formation
and muscle function"

and

"We expect that these new considerations about the importance
of vitamin D in the elderly will stimulate an innovative
approach to the problem of falls and fractures which constitutes
a significant burden to public health budgets worldwide."

Whey protein

As previously mentioned, many older adults fail to get enough
high quality protein in their diets. Whey has an exceptionally
high biological value (BV), with anti-cancer and immune
enhancing properties among its many uses. As a rule, higher
biological value proteins are superior for maintaining muscle
mass compared to lower quality proteins, which may be of
particular importance to older individuals. Finally, data
suggests "fast" digesting proteins such as whey may be superior
to other proteins for preserving lean body mass in older
individuals (Dangin et al., 2002).

Additional Nutrients of interest

There are several additional nutrients worth considering when
developing a comprehensive supplement regimen designed to
prevent and or treat sarcopenia. In no particular order, they
are: fish oils (EPA/DHA), acetyl-l-carnitine, glutamine, and
buffering agents such as potassium bicarbonate. There is good
scientific reason to believe they would be beneficial for
combating sarcopenia, but data specific to sarcopenia is
lacking. For example, EPA/DHA has been found to preserve muscle
mass (e.g. is anti-catabolic) under a wide range of
physiological conditions. The anti-inflammatory effects of fish
oils would also lead one to believe they should be of value in
the prevention or treatment of sarcopenia. In general, fish oils
have so many health benefits, it makes sense to recommend them
here.

Acetyl-l-carnitine also offers many health benefits to aging
people, and data suggests it should be useful in combating this
condition. More research specific to sarcopenia is needed
however.

Glutamine is another nutrient that should be useful in an
overall plan to combat sarcopenia. Finally, data does suggest
strongly that bicarbonate and citrate buffering agents
containing minerals such as potassium, magnesium, and calcium
can reverse the metabolic acidosis caused by unbalanced western
diets. However, I hesitate to recommend this particular strategy
as it does not address the root cause, which is the diet itself.
Much greater health benefits will result from improving the diet
over simply adding in this supplement. In addition, there are
potential problems that could result from excessive intake of
buffer salts, such as hyperkalemia and formation of kidney
stones.

Exercise Considerations

Exercise is the lynchpin to the previous sections. Without it,
none of the above will be an effective method of
preventing/treating sarcopenia. Exercise is the essential
stimulus for systemwide release of various hormones such as GH,
as well as local growth factors in tissue, such as MGF. Exercise
is the stimulus that increases protein and bone synthesis, and
exerts other effects that combat the loss of essential muscle
and bone as we age. Exercise optimizes the effects of HRT, diet
and supplements, so if you think you can sit on the couch and
follow the above recommendations...think again.

Although any exercise is generally better then no exercise, all
forms of exercise are not created equal. You will note, for
example, many of the studies listed at the end of this article
have titles like: "GH and resistance exercise" or "creatine
effects combined with resistance exercise" and so on. Aerobic
exercise is great for the cardiovascular system and helps keep
body fat low, but when scientists or athletes want to increase
lean mass, resistance training is always the method. Aerobics
does not build muscle and is only mildly effective at preserving
the lean body mass you already have. Thus, some form of
resistance training (via weights, machines, bands, etc.) is
essential for preserving or increasing muscle mass. The CDC
report on resistance exercise for older adults summarizes it as:

"In addition to building muscles, strength training can promote
mobility, improve health-related fitness, and strengthen bones."

Combined with HRT (if indicated), dietary modifications, and
the supplements listed above, dramatic improvements in lean body
mass can be achieved at virtually any age, with improvements in
strength, functionality into advanced age, and improvements in
overall health and general well being.

Conclusion

Hopefully, the reader will appreciate that I have attempted to
cover a huge amount of territory with this topic. Each
sub-section (nutrition, hormones, etc.) could easily be its own
article if not its own book. This means each section is a
general overview vs. anything close to an exhaustive discussion.
Below is guide to web sites that offer additional information
regarding the topics covered in this article and should
(hopefully!) help fill in any gaps. To summarize, to prevent or
treat sarcopenia:

• Get adequate high quality proteins from a variety of sources
as well as adequate calories. Avoid excessive animal protein and
cereal grain intakes while increasing the intake of fruits and
vegetables.

• Get regular blood work on all major hormones after the age of
40 and discuss with a medical professional if HRT is indicated.

• Add supplements such as: creatine, vitamin D, whey protein,
acetyl-l-carnitine, glutamine, and buffering agents such as
potassium bicarbonate.

• Exercise regularly, with an emphasis on resistance training,
a minimum of 3 times per week.

I'm going to conclude this article the way most people would
start it, with the good news and the bad news. The bad news is,
millions of people will suffer from a mostly avoidable loss of
functionality and will become weak and frail as they age from a
severe loss of muscle mass. The good news is that you don't have
to be one of those people. One thing is very clear: it's far
easier, cheaper, and more effective to prevent sarcopenia - or
at least greatly slow its progression - than it is to treat it
later in life. Studies have found, however, that it's never too
late to start - so don't be discouraged if you are starting your
sarcopenia fighting program later in life.

About the Author: Want to gain muscle, strength, and save time
and money while doing it? Find out more at
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Sarcopenia: Causes, Prevention, And Treatement. Part 1

01/06/2010

Sarcopenia: Causes, Prevention, And Treatement. Part 1
By Will Brink

Is a loss of strength, mobility, and functionality an
inevitable part of aging? No, it's not. It's a consequence of
disuse, suboptimal hormone levels, dietary and nutrient
considerations and other variables, all of which are compounded
by aging. One of the greatest threats to an aging adult's
ability to stay healthy and functional is the steady loss of
lean body mass - muscle and bone in particular.

The medical term for the loss of muscle is sarcopenia, and it's
starting to get the recognition it deserves by the medical and
scientific community. For decades, that community has focused on
the loss of bone mass (osteoporosis), but paid little attention
to the loss of muscle mass commonly seen in aging populations.
Sarcopenia is a serious healthcare and social problem that
affects millions of aging adults. This is no exaggeration. As
one researcher recently stated:

"Even before significant muscle wasting becomes apparent,
ageing is associated with a slowing of movement and a gradual
decline in muscle strength, factors that increase the risk of
injury from sudden falls and the reliance of the frail elderly
on assistance in accomplishing even basic tasks of independent
living. Sarcopenia is recognized as one of the major public
health problems now facing industrialized nations, and its
effects are expected to place increasing demands on public
healthcare systems worldwide" (Lynch, 2004)

Sarcopenia and osteoporosis are directly related conditions,
one often following the other. Muscles generate the mechanical
stress required to keep our bones healthy; when muscle activity
is reduced it exacerbates the osteoporosis problem and a vicious
circle is established, which accelerates the decline in health
and functionality.

What defines sarcopenia from a clinical perspective? Sarcopenia
is defined as the age-related loss of muscle mass, strength and
functionality. Sarcopenia generally appears after age 40 and
accelerates after the age of approximately 75. Although
sarcopenia is mostly seen in physically inactive individuals, it
is also commonly found in individuals who remain physically
active throughout their lives. Thus, it's clear that although
physical activity is essential, physical inactivity is not the
only contributing factor. Just as with osteoporosis, sarcopenia
is a multifactorial process that may involve decreased hormone
levels (in particular, GH, IGF-1, MGF, and testosterone), a lack
of adequate protein and calories in the diet, oxidative stress,
inflammatory processes, chronic, low level, diet-induced
metabolic acidosis, as well as a loss of motor nerve cells

A loss of muscle mass also has far ranging effects beyond the
obvious loss of strength and functionality. Muscle is a
metabolic reservoir. In times of emergency it produces the
proteins and metabolites required for survival after a traumatic
event. In practical terms, frail elderly people with decreased
muscle mass often do not survive major surgeries or traumatic
accidents, as they lack the metabolic reserves to supply their
immune systems and other systems critical for recovery.
There is no single cause of sarcopenia, as there is no single
cause for many human afflictions. To prevent and/or treat it, a
multi-faceted approach must be taken, which involve hormonal
factors, dietary factors, supplemental nutrients, and exercise.

Dietary considerations

The major dietary considerations that increase the risk of
sarcopenia are: a lack of adequate protein, inadequate calorie
intake, and low level, chronic, metabolic acidosis.

Although it's generally believed the "average" American gets
more protein then they require, the diets of older adults are
often deficient. Compounding that are possible reductions in
digestion and absorption of protein, with several studies
concluding protein requirements for older adults are higher than
for their younger counterparts (Young, 1990; Campbell et al.,
1994; Campbell et al., 1996). These studies indicate that most
older adults don't get enough high quality protein to support
and preserve their lean body mass.

There is an important caveat on increasing protein, which
brings us to the topic of low level, diet-induced, metabolic
acidosis. Typical Western diets are high in animal proteins and
cereal grains, and low in fruits and vegetables. It's been shown
that such diets cause a low grade metabolic acidosis, which
contributes to the decline in muscle and bone mass found in
aging adults (Frassetto et al., 2001). One study found that by
adding a buffering agent (potassium bicarbonate) to the diet of
post-menopausal women the muscle wasting effects of a "normal"
diet were prevented (Frassetto et al., 1997). The researchers
concluded the use of the buffering agent was "... potentially
sufficient to both prevent continuing age-related loss of muscle
mass and restore previously accrued deficits."

The take home lesson from this study is that - although older
adults require adequate intakes of high quality proteins to
maintain their muscle mass (as well as bone mass), it should
come from a variety of sources and be accompanied by an increase
in fruits and vegetables as well as a reduction of cereal
grain-based foods. The use of supplemental buffering agents such
as potassium bicarbonate, although effective, does not replace
fruits and vegetables for obvious reasons, but may be
incorporated into a supplement regimen.

Hormonal considerations

As most are aware, with aging comes a general decline in many
hormones, in particular, anabolic hormones such as Growth
Hormone (GH), DHEA, and testosterone. In addition, researchers
are looking at Insulin-like Growth factor one (IGF-1) and
Mechano Growth factor (MGF) which are essential players in the
hormonal milieu responsible for maintaining muscle mass as well
as bone mass. Without adequate levels of these hormones, it's
essentially impossible to maintain lean body mass, regardless of
diet or exercise.

It's been shown, for example, that circulating GH declines
dramatically with age. In old age, GH levels are only one-third
of that in our teenage years. In addition, aging adults have a
blunted GH response to exercise as well as reduced output of MGF
(Hameed et al., 2003), which explains why older adults have a
much more difficult time building muscle compared to their
younger counterparts. However, when older adults are given GH,
and then exposed to resistance exercise, their MGF response is
markedly improved, as is their muscle mass (Hameed et al.,
2004).

Another hormone essential for maintaining lean body mass is
testosterone. Testosterone, especially when given to men low in
this essential hormone, has a wide range of positive effects.
One review looking at the use of testosterone in older men
(Gruenewald et al., 2003) concluded:

"In healthy older men with low-normal to mildly decreased
testosterone levels, testosterone supplementation increased lean
body mass and decreased fat mass. Upper and lower body strength,
functional performance, sexual functioning, and mood were
improved or unchanged with testosterone replacement"

Contrary to popular belief, women also need testosterone!
Although women produce less testosterone, it's as essential to
the health and well being of women as it is for men.

The above is a highly generalized summary and only the tip of
the proverbial iceberg regarding various hormonal influences on
sarcopenia. A full discussion on the role of hormones in
sarcopenia is well beyond the scope of this article. Needless to
state, yearly blood work after the age of 40 is essential to
track your hormone levels, and if needed, to treat deficiencies
via Hormone Replacement Therapy (HRT). Private organizations
like the Life Extension Foundation offer comprehensive hormone
testing packages, or your doctor can order the tests. However,
HRT is not for everyone and may be contraindicated in some
cases. Regular monitoring is required, so it's essential to
consult with a medical professional versed in the use of HRT,
such as an endocrinologist.

End Part 1

About the Author: Want to gain muscle, strength, and save time
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Tags: causes of sarcopenia, sarcopenia, sarcopenia and aging, sarcopenia and diet, sarcopenia and fruit, sarcopenia and hormones, sarcopenia and muscle loss, sarcopenia and protein, sarcopenia and vegetable, sarcopenia treatment