a beginner’s guide to successful aging: get moving and eat ...€™s-guide-t… · a...

08/06/2013

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A Beginner’s Guide to Successful Aging: Get Moving and Eat Well

Stuart M. Phillips, Ph.D., FACSM, FACNStuart M. Phillips, Ph.D., FACSM, FACNProfessor, McMaster UniversityProfessor, McMaster University

McMaster University Stuart M Phillips – 2012

What I’m going to tell you1.1. Skeletal muscle is an important tissueSkeletal muscle is an important tissue2.2. Sarcopenia in aging is problematic and predisposes Sarcopenia in aging is problematic and predisposes

older people to disability, but it’s not a slow and older people to disability, but it’s not a slow and insipid process as we’re lead to believeinsipid process as we’re lead to believeinsipid process as we re lead to believeinsipid process as we re lead to believe

3.3. Changes in muscle protein synthesis are determined Changes in muscle protein synthesis are determined by protein ingestion and loading and changes in by protein ingestion and loading and changes in skeletal muscle mass are predicted by these skeletal muscle mass are predicted by these changeschanges

4.4. MilkMilk--based proteins are a special case: whey is the based proteins are a special case: whey is the p p yp p y‘active’ component‘active’ component

5.5. In aging it doesn’t take much to make you In aging it doesn’t take much to make you ‘anabolically resistant’ to protein ingestion‘anabolically resistant’ to protein ingestion

Stuart M Phillips – 2012 McMaster University

08/06/2013

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Wh t d it t What does it mean to age ‘successfully’

Is it merely freedom from Is it merely freedom from ill ?ill ?illness?illness?

Mobility

Muscle, Bone, and ActivityMuscle, Bone, and Activity

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60,000

80,000

nnua

lly

CVD – cardiovascular diseaseCRVD – cerebrovascular diseaseCOPD – chronic obstructive pulmonary diseaseCNS – central nervous system degenerative diseases

(i.e., Alzheimer’s disease)PAD – peripheral arterial disease1 includes influenza deaths also

0

20,000

40,000

Dea

ths

An

CVD+C

RVD

Canc

erCO

PDIn

jury 1

Pneum

onia

Diabet

esCN

SPA

D

Psyc

hose

s

Suicide

Source: Statistics Canada, Health Statistics Division.http://www40.statcan.ca/l01/cst01/health36.htm

EPIDEMIOLOGY OF AGING: DISEASES

The leading Causes of Morbidity: The leading Causes of Morbidity: OsteoprosisOsteoprosis OsteoprosisOsteoprosis Osteoarthritis Osteoarthritis Vision/Hearing ProblemsVision/Hearing Problems Falls and FracturesFalls and Fractures

Disease in older population is the Disease in older population is the norm… and norm… and many many have multiple have multiple morbiditiesmorbiditiesUse of multiple medicationsUse of multiple medications Use of multiple medicationsUse of multiple medications

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Control What We Can and Accept What We Can’t… CanCan

DiDi DietDiet Physical activityPhysical activity SmokingSmoking AlcoholAlcohol

Can’tCan’t Genetic riskGenetic risk EnvironmentEnvironment

Sarcopenia“A progressive neuromuscular syndrome that will

l th lit f lif i th ld l b lower the quality of life in the elderly by:

decreasing the ability to lift loads, progressing to

difficulty arising from a chair; and decreasing

endurance, leading to an inability to perform the

activities of daily living, which increases health

care costs.” Tseng and Booth, 1995

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Quantity

Quantity…Quantity… SarcopeniaSarcopenia Insipid Insipid –– ageage--relatedrelated

Stuart M Phillips – 2012

The roles of skeletal muscle

Contributor to Contributor to RMR RMR –– thermogenicthermogenictititissuetissue

Site of glucose Site of glucose disposal… largestdisposal… largest

f l d df l d d Site of lipid oxidationSite of lipid oxidation

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“Normal” Sarcopenia

5 60kg)

3

4

5

20

40

60

eg le

an m

ass

(k

Dis

abili

ty R

isk

50 55 60 65 70 75 80 85 90 95Age (yr)

L

What can offset muscle loss in aging?

P R O T E I Nand

E X E R C I S E E X E R C I S E

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Adjusted lean mass (LM) loss by quintile of energy-adjusted total protein intake. n = 2066.

Houston D K et al. Am J Clin Nutr 2008;87:150-155

©2008 by American Society for Nutrition

Men, leg strength, and mortality

Newman A B et al. J Gerontol A Biol Sci Med Sci 2006;61:72-77

The Gerontological Society of America

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Women, leg strength, and mortality

Newman A B et al. J Gerontol A Biol Sci Med Sci 2006;61:72-77

The Gerontological Society of America

Stuart M Phillips 2012 McMaster University

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How is muscle mass How is muscle mass regulated?

McMaster University

Variations in protein synthesis determine net protein balance

te o

f PS

and

PB

PS PB

Time (h)

protein proteinRat

protein


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h lWhat is an optimal amount of protein in a single dose?

Whey dose-response in older men

0 12 Non-exercised†

0.03

0.06

0.09

0.12Exercised

*

†

#*

FS

R (

%.h

-1)

0 10 20 400.00

Ingested whey protein (g)


Yang et al. Br. J. Nutr. In press, 2012

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40g of protein (16.8g of EAA) maximally ) ystimulates muscle protein synthesis after resistance exercise in elderly men


The protein source is important?


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*

12 weeks of resistance training with milk consumption promotes greater lean mass gains in young men

2

3

4

**

bo

dy

mas

s (k

g)

CON SOY MLK0

1

L

ean

b

© SM Phillips, 2012

Hartman et al. Am. J. Clin. Nutr. 86(2):373-81, 2007

Wh t i it i ilk th t k What is it in milk that makes it so effective?


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Whey promotes a greater rise in MPS than casein at rest and with resistance exercise in older men

Casein Whey

0 02

0.04

0.06

y

*

*

†

†

PS (

%

h-1)

FED EX-FED0.00

0.02M

Burd et al. Br.J. Nutr., 2012, In press

Whey protein is superior to soy in promoting gains in muscle protein at rest or after exercise

R e st

E x

R e st - S o y

E x - S o y

R e s t - W h e y

E x - W h e y

0 .0 4

0 .0 8

0 .1 2

* *††

* ‡

E x E x S o y E x W h e y

MP

S (

%

h-1

)

McMaster University

0 .0 0 0 20 40

Ingested pro tein (g)

M

Yang et al. Nutr Metab 14;9(1):57, 2012

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All of these data suggest that whey containing high whey, containing high leucine, would be much more beneficial to stimulate anabolism in aging skeletal musclemuscle…

McMaster University

PS PB

‘Anabolic resistance’ of muscle protein in aging

Rate

of

PS a

nd P

B

Time (h)

protein protein protein

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Muscle Strength & Power

C Press S Press L Ext L Press0

40

80

120 PrePost

1RM

(lb

)

C Press S Press L Ext L Press0

40

80

Peak

pow

er (

W)

C Press S Press L Ext L Press

Lift

C Press S Press L Ext L Press

Lift

Walking distance & speed

400

800

1200 PostPre

Dis

tanc

e (m

)

1

2

3 PrePost

eloc

ity

(m/s

)

0

00

D

0

Ve

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Power… beyond the lab

40

80

Peak

pow

er (

W)

L Press0

Walking speed… beyond the lab

3 PrePost

1

2

Post

Vel

ocit

y (m

/s)

0

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Stronger men (and likely women too) have reduced risk for cancer and cardiovascular disease

Ruiz, J. R et al. BMJ 2008;337:a439

‘Another’ picture of aging

McMaster University Stuart M Phillips, 2012

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Acute disuse events punctuate the normal sarcopenic decline in muscle mass

NormalDis se e ent)

3

4

5Disuse-event

g le

an m

ass

(kg)

50 55 60 65 70 75 80 85 90 95

3

Age (yr)

Leg

14d of step reduction in elderly men and women results in leg lean mass loss

9000

12000

ep-c

ount

Pre-intervention Post-intervention0

3000

6000

Mea

n da

ily s

te

-0 2

0.0

ass

(kg

)


-1.0

-0.8

-0.6

-0.4

-0.2

L

eg s

kele

tal m

usc

le m

a

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14d of step reduction in elderly men and women results in reduced insulin sensitivity

500

600

*

AU

C

10

12

14

Pre-intervention

Post-intervention

mo

l·m

L-1

)

Pre Post0

300

400

500

Pla

sma

glu

cose

A

0 10 20 30 60 90 1200

2

4

6

8

10

Time (min)

Pla

sma

glu

cose

(m

m

80

100

Pre-intervention

Post-intervention

L-1

)

2750

3000

*

C

Stuart M Phillips –2012 McMaster University

0 10 20 30 60 90 1200

20

40

60

80

Time (min)

Pla

sma

insu

lin ( l

U·m

Pre Post0

2000

2250

2500

2750

Pla

sma

insu

lin A

UC

14d of step reduction in elderly men and women results in reduced ability to make new muscle protein

Pre-intervention

Post-intervention

0 025

0.050

0.075Post intervention

* †

*

illar

FS

R (

%·h

-1)

Stuart M Phillips –2012 McMaster University

Postabsorptive Postprandial0.000

0.025

Myo

fibri

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What if… There were a treatment that would lower risk There were a treatment that would lower risk

for all known chronic diseases for all known chronic diseases It would work regardless of age, sex, race, and It would work regardless of age, sex, race, and

riskrisk It already has a large evidence base on which to It already has a large evidence base on which to

base recommendationsbase recommendations It could save the healthcare system billions of It could save the healthcare system billions of

dollars and cost comparatively little in return dollars and cost comparatively little in return dollars and cost comparatively little in return dollars and cost comparatively little in return The sideThe side--effect profile of this treatment effect profile of this treatment

includes better prognoses for a variety of includes better prognoses for a variety of unrelated ailments including depression and unrelated ailments including depression and suicide incidencesuicide incidence

What is the single best thing we can do for our health?

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Annual Reviews

What I’ve told you1.1. Skeletal muscle is an Skeletal muscle is an importantimportant tissuetissue2.2. Sarcopenia in aging is problematic and Sarcopenia in aging is problematic and predisposes predisposes

older people to disabilityolder people to disability, but it’s not a slow and , but it’s not a slow and insipid process as we’re lead to believeinsipid process as we’re lead to believeinsipid process as we re lead to believeinsipid process as we re lead to believe

3.3. Changes in muscle protein synthesis are determined Changes in muscle protein synthesis are determined by protein ingestion and loading and changes in by protein ingestion and loading and changes in skeletal muscle mass are predicted by these skeletal muscle mass are predicted by these changeschanges

4.4. MilkMilk--based proteins are a special case: whey is based proteins are a special case: whey is p p yp p yparticularly ‘active’ protein in stimulating muscleparticularly ‘active’ protein in stimulating muscle

5.5. In aging it doesn’t take much to make you In aging it doesn’t take much to make you ‘anabolically resistant’ to protein and to promote a ‘anabolically resistant’ to protein and to promote a move toward disabilitymove toward disability


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Do not go gentle into that good night,Do not go gentle into that good night,Old age should burn and rave at close of day;Old age should burn and rave at close of day;Rage, rage against the dying of the light.Rage, rage against the dying of the light.

Though wise men at their end know dark is right,Though wise men at their end know dark is right,Because their words had forked no lightning theyBecause their words had forked no lightning theyDo not go gentle into that good night.Do not go gentle into that good night.

Good men the last wave by crying how brightGood men the last wave by crying how brightGood men, the last wave by, crying how brightGood men, the last wave by, crying how brightTheir frail deeds might have danced in a green bay,Their frail deeds might have danced in a green bay,Rage, rage against the dying of the light.Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,Wild men who caught and sang the sun in flight,And learn, too late, they grieved it on its way,And learn, too late, they grieved it on its way,Do not go gentle into that good night.Do not go gentle into that good night.

Grave men, near death, who see with blinding sightGrave men, near death, who see with blinding sightBlind eyes could blaze like meteors and be gay, Blind eyes could blaze like meteors and be gay, Rage rage against the dying of the lightRage rage against the dying of the lightRage, rage against the dying of the light.Rage, rage against the dying of the light.

And you, my father, there on the sad height,And you, my father, there on the sad height,Curse, bless, me now with your fierce tears, I pray.Curse, bless, me now with your fierce tears, I pray.Do not go gentle into that good night.Do not go gentle into that good night.Rage, rage against the dying of the light.Rage, rage against the dying of the light.

Dylan Dylan MarlaisMarlais Thomas 1914Thomas 1914--19531953

The TEAM(s)McMasterMcMasterTodd PriorTodd PriorTracy RerecichTracy RerecichDr. Nick Dr. Nick BurdBurd UK – GEMH Derby (Nottingham)

Mik R i

Health Science - McMasterMark TarnopolskySteven BakerAdeel Safdar

Dr. Dan WestDr. Dan WestDr. Yifan YangDr. Yifan YangDr. Andrea Dr. Andrea JosseJosseDr. Leigh BreenDr. Leigh BreenTyler ChurchwardTyler Churchward--VenneVenneCameron MitchellCameron MitchellDanielle DiDonatoDanielle DiDonato

Mike RenniePhil AthertonKen Smith

RMITJohn HawleyVernon CoffeyDonny Camera

Danielle DiDonatoDanielle DiDonatoAISLouise Burke

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