You know you’re not in the best of health. After all, you’ve had your share of heart-related issues. However, you’re still getting around and able to do most of the activities you did in the past. You’re just moving a little slower.
But, you have noticed your shoulders are starting to look a little smaller and your legs a bit skinny. You shrug it off, telling yourself that it must be just due to your age.
Then, your balance and stability start to falter. You dismiss it. “It’s just one of those things,” you think.
The muscle loss continues. Your scale weight drops. On one hand, you feel good because your doctor’s been telling you to drop some weight for a while, but you don’t really look leaner in the mirror. You just look skinnier.
In jeans and a long-sleeved shirt, you look normal. In fact, some of your friends remark about how much weight you’ve lost, so you fool yourself into thinking it’s actually a good thing.
You get a blood test and your blood sugar is at pre-diabetic or diabetic levels. You wonder how that’s possible since you don’t have much of an appetite anymore, and barely eat anything. “It must be genetic,” you think. Your doctor wants you to get on a diabetes drug just to be safe.
You rarely feel energetic or enthusiastic. You don’t like the feeling. It’s not like you have a reason to feel depressed, but you do. Life is actually pretty good, so you don’t want to burden anyone by sharing how you feel. Maybe the feeling will pass.
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If this sounds at all familiar, stop!
As bad as the above scenario sounds, it can get a lot worse.
This is what sarcopenia and cachexia sound and feel like. Sarcopenia is age-related muscle loss. Cachexia is accelerated, disease-related tissue loss. Neither is a good situation, but cachexia causes much more dramatic deterioration in your health.
In this article, I hope to open your eyes to the effects of age and disease-related tissue loss, and implore you to take action and extend your quality of life.
Unfortunately, most doctors give little direction to their older adult patients, seeing their physical decline (and cognitive decline) as just a part of getting old.
In my opinion, this mindset would be like a football team giving up when they’re behind by two touchdowns after the first half of the game.
Although there are many different diseases connected to cachexia, and the strategies to slow it have similarities, I’m writing this article with the focus on cardiac cachexia because I believe a close family with heart disease is dealing with cardiac cachexia right now. Perhaps you, or one of your family members is as well.
Muscle And Quality Of Life
To think of muscle as something useful only for vanity or athletics is like thinking your brain is only good for math problems and trivia.
Here’s a handful ways muscle impacts your health, none of which relate to vanity or being the fittest man or woman in your age range.
Muscle provides strength, stamina, and balance for everyday movement. Muscle and its connection to your nervous system (the neuromuscular system) creates smooth, fluid movement so you can continue knocking golf balls down the fairway, write your name with the same handwriting you’ve used your whole adult life, or lift a soup spoon to your mouth without spilling on your chin.
Muscle protects and stabilizes your joints.Would you knowingly drive down the road with loose lug nuts on each of your tires? Of course that would be stupid. Yet, that’s what happens when you ignore the loss of muscle supporting your joints, and hope that you make it through the day without hurting something.
Like the giant cables that support a bridge, your muscles add support to your joints.
Muscle is the main storage area for glucose. Your liver and muscle tissue are the only places you can store glucose. When the tanks shrivel up, you either have to avoid carbs completely, which isn’t fun or realistic, or your fasting blood sugar rises.
Elevated blood sugar is bad news for your brain and body, and the most effective way to keep it under control is to maintain bigger storage tanks — muscle tissue.
Muscle provides an emergency fund for amino acids.Muscle is your quality of life savings account. The more of it you have, the more you can draw on as you age, without it leading to major health problems.
Degenerative diseases increase amino acid needs, and if you don’t get enough amino acids from a high-protein diet, your body breaks down muscle to get the amino acids.
Muscle mass is a marker of bone density. Though one does not always lead to another, in most cases your lean body mass indicates your bone density. The more muscle you lose, the more fragile your skeleton becomes as well.
What Is The Difference Between Sarcopenia and Cachexia?
Sarcopenia is age-related muscle loss.
For the average, sedentary person, it’s considered a “normal” part of aging. In sarcopenia, the loss of muscle is often offset by an increase in body fat. So, most people’s body weights remain the same, but their body fat percentage climbs over time. They don’t realize how much muscle they lose because the scale remains the same.
Cachexia is rapid, disease-related loss of body mass.
After age 55, the risk of developing chronic heart failure doubles every seven years in women, and every ten years in men.
Cachexia is most often discussed in the context of cancer, but it’s really a condition that’s part of many degenerative diseases. It occurs in 16-42% of heart failure, 30% of COPD, 60% of kidney disease, and the majority of late-stage cancer patients.
The word “cachexia” comes from the Greek words kakos and hexis, which translate to “bad condition.” And that’s exactly what it is.
Cachexia is unintended anorexia.
The effects of cachexia are more obvious than sarcopenia because you lose muscle and body fat.
Signs And Symptoms Of Cardiac Cachexia
The following are symptoms, signs, and metabolic markers common among those with cardiac cachexia:
- Decreased appetite or food aversion
- Reduced stamina, strength, and tolerance to exercise
- 7.5% loss of body weight in six-month period without any other logical causes
- Surprising loss of body fat along with muscle loss
- Elevated blood sugar caused by muscle loss
- Elevated creatinine, a sign of muscle breakdown, and/or C-Reactive Protein and Homocysteine, signs of inflammation
- Foggy-headedness, social isolation, and difficulty following along in conversations (signs of starvation)
- Visible change in body – significant muscle and body fat loss
The Complexity of Cachexia
Cachexia is easy to diagnose, but it isn’t easy to treat. In fact, there’s no way to treat cachexia. The problem is that multiple systems have gone awry, so it’s impossible to treat with a single medication. As a result, cachexia drug trials have led to disappointing results.
You can, however, do much to slow the progression, which we will get to in a moment.
Cachexia creates a domino effect of metabolic dysfunction.
Increased inflammation is one of the key contributors to the development of diseases like heart disease. Inflammation causes numerous immune system effects, including elevations in tumor necrosis factor (TNF), and based on the latest theories around cardiac cachexia, it seems TNF might be the first of the dominos.
TNF causes apoptosis, or cell death. In healthy people, apoptosis helps rid the body of unhealthy cells. But in the case of degenerative diseases, TNF can cause the death of healthy cells too. In the case of cardiac cachexia, it can alter bone structure, reduce capacity for exercise, induce anorexia, and reduce blood flow to the arms and legs.
Metabolic rate rises, increasing your need for nutrients. Unfortunately, dysfunction in appetite-related hormones decreases the desire to eat, even though patients need the nutrition.
The digestive system produces fewer of the enzymes and acid necessary for digestion and absorption of food, so when food is consumed, many of the nutrients don’t get absorbed properly. Older adults also have “anabolic resistance.” They get less of a muscle-building effect from dietary protein, so they need to eat more than younger adults would, in order to have the same tissue-supporting effects.
Not only does cardiac cachexia cause accelerated muscle loss, but it also changes the type of muscle fibers in the muscle tissue that’s left. Type I, fast-twitch (think reflexes and strength) muscle fiber transitions to Type II, slow-twitch (think slow, endurance) muscle fibers. While the transition to Type II fibers might make you think you’d have better endurance, the problem is that the cachexia also reduces mitochondria, which are the powerhouses of the cell. Though you have a higher concentration of type II muscle fibers, you have fewer mitochondria to give you the energy to do anything.
The malnutrition causes physical decline, and also leads to cognitive decline, like you’d expect from someone who is starving.
Thinking slows, emotions change. People with cachexia may feel like they don’t have the energy to eat a meal, much less have a conversation with someone else who’s eating it with them.
One other fascinating change is this. White adipose tissue, or fat tissue, turns to brown adipose tissue. Brown adipose tissue is more thermogenic, and speeds up the fat loss that’s already taking place from being in starvation.
How To Slow Progression of Cardiac Cachexia
At this time, there is nothing available to stop cachexia. However, you can certainly slow its effects on the body. Improving your quality of life won’t come from doing any one of the following, but from the combination of most or all of them.
Nutrition And Cardiac Cachexia
Cachexia is the result of malnutrition, so it’s little wonder that you have to be extra intentional with your nutrition when dealing with it.
Those with cachexia have less of an effect from eating protein, which means they need to eat more of it. Unless someone also has kidney disease, the evidence indicates 1 gram of protein per pound body weight would be a good place to start.
Take that protein amount and divide it over four to five feedings per day.
Healthy people can get by with intermittent fasting, but in the case of cachexia, it’s imperative to eat protein-rich meals and snacks every few hours.
If you don’t get your amino acids through your diet, your body will get its amino acid by destroying your body’s own tissue.
Muscle builds muscle, bone builds bone.
You need to frequently eat protein-rich meals, mostly made up of meat, poultry, and fish (muscle). Marrow, bone broth, and organ meats are rich in nutrients and proteins you don’t find in other meats, so they ought to be part of the diet as well.
If you tolerate diary, use whey and casein protein powders to make shakes a couple of times per day, or have cottage cheese and berries as a snack.
Like instructing a young child, sometimes you need to eat even when you don’t feel like it. As a matter of fact, in the case of cachexia, you’ll probably need to eat more often when you don’t feel like it then when you do.
Give your body a reason to maintain muscle. Get in the gym and lift weights.
You won’t feel like it. It’ll probably feel exhausting when you start. But start anyway.
Like frequent, moderate-sized meals, you need to frequently and consistently give your body the stimulus of strength training.
As a young adult, you might away with weight training just a few times per week. This isn’t one of those times. You’re better off weight training five to six days per week, focusing on just a few muscle groups or movements with each session. You’re not only working that muscle group, but you also triggering a hormonal response that affects your whole body, and may help slow the loss of muscle tissue all over.
Your anabolic hormones peak during deep sleep.
Go to bed at a consistent time. Keep your bedroom cool if you have trouble falling asleep or staying asleep. And consider some of the sleep supporting supplements such as melatonin, magnesium threonate, and valerian.*
Your body does its best job of recovering when you’re resting, so you have to make sleep a priority.
Read also: Sleep Now Or Pay Later.
I’m a big fan of supplementation in general, but if there was ever a time to supplement the diet, it would be in the case of malnutrition.
The following are some of the most important supplements to consider, many of which help deal with the deficiencies caused by cachexia.
High-Quality Multivitamin: As you might expect, when dealing with malnutrition, a high-quality multivitamin is more important than ever. It will not cover all the micronutrients you’ll need, but will get most of them. Low levels of folate, vitamin D, B12, C and E are common with cachexia.
Vitamin D: Vitamin D is actually a hormone precursor, and plays an important role in immune function as well as in supporting normal inflammation levels. It takes 5000-10,000 IU per day of vitamin D to reach optimal levels, which is more than you’ll find in a multivitamin.
Magnesium: Magnesium is essential for bone formation and muscle function. Mineral absorption decreases when stomach acid falls as well, so if your digestive system isn’t healthy, you won’t absorb minerals as well as you should. Since high-quality magnesium, like magnesium glycinate, is so large, you won’t find optimal doses in a high-quality multivitamin. You’ll need to take extra.
Amino Acids: With a reduced appetite, it’s a challenge to get in enough protein to support your amino acid needs. That’s not an excuse not to eat, though.
One way to get in additional amino acids, which can stimulate protein synthesis and decrease protein breakdown, is to supplement directly with amino acids. The branched-chain amino acids are probably the most important.
However, Thorne offers a patented amino acid supplement originally designed to support the maintenance of lean mass for patients with sarcopenia and cachexia.* It is the amino acid formula I’d recommend in this case. If you’d like to order it, set up a Wellevate Account.
Digestive Enzymes And Hydrochloric Acid: Consuming protein is an important step toward minimizing muscle loss. But once you consume it, you have to break it down and absorb it. Healthy people produce sufficient digestive enzymes and stomach acid to break down protein to amino acids, and absorb it.
In older adults and those with degenerative diseases, enzyme production is often compromised. So, supplementing with digestive enzymes and hydrochloric acid can support optimal protein breakdown and absorption.*
beta-Hydroxy beta-Methylbutryrate (HMB): HMB is one of my top four most-recommended muscle-building supplements. What’s interesting about HMB though, is that it’s most effective use seems to be in those with accelerated muscle loss.* Interestingly, it’s the key ingredient in Ensure®. Fortunately, HMB can be supplemented on its own so you don’t have to drink the extra sugar.
While I can’t recommend strongly enough to do what you can through natural means, this isn’t a time where you should try all the natural options and wait for six months. You need to combat cachexia with anything available.
Two medications often recommended by doctors for patients with cachexia are corticosteroids and ACE Inhibitors.
Cardiovascular Drugs: ACE-inhibitors are knowns for their cardioprotective effects. But research also shows that with extended use, they reduce muscle and strength loss in those with heart disease. They seem to improve mitochondrial function, oxidative stress, insulin sensitivity, and nitric oxide signaling, which are all important for muscle function.
Beta-blockers are often used with cardiac patients, and although they also seem to lessen weight loss, it seems that patients still lose muscle, but gain body fat with their use. Though the scale doesn’t change, their body composition does.
Appetite Stimulants: The aversion to food is a real issue. It’s not that those with cachexia refuse to eat, it’s that the idea of eating can seem repulsive. For those of us with insatiable appetites, that’s might seem like it would be a good thing. It isn’t.
Cachexia patients can literally starve with food readily accessible.
Corticosteroids, cannabinoids, and melatonin supplementation may help stimulate appetite enough to make it easier to eat on a regular schedule. In the states where weed is legal, it might provide a double advantage in that it may lower inflammatory levels while also increasing appetite.
In those states where it isn’t legal, hemp oil may provide some of the benefits. Of course, melatonin is an easy and affordable supplement to use as well.
Hormone Therapy: Testosterone levels are often low in people with heart failure. For that matter, testosterone is often low in men and women in general. Unfortunately, few doctors check their patients’ testosterone levels. And when they do, they use normative ranges that lead to them telling patients their testosterone is “normal” when it’s well below optimal.
Not surprisingly, testosterone therapy in heart failure patients improves cardiovascular performance, strength, stamina, and muscle mass. As I’ve often told my wife, if there ever comes a day when my testosterone levels fall below optimal while doing everything I can to naturally maintain them, I’ll gladly work with a good hormone doctor to help me maintain optimal levels with testosterone therapy.
Do Not Wait If You’re Quickly Losing Weight
We are quick to help someone else who’s having health problems, but when it comes to our own health, we drag our feet about doing anything. Cachexia isn’t something to shrug off.
Half of those with cachexia die within 18 months. They literally waste away until they’ve lost so much tissue they can no longer survive. It doesn’t have to be that way. There’s much you can do to significantly slow the progression of cardiac cachexia. Hopefully if you do everything right, you’ll live as long as you would have if you’d never have had the issue in the first place.
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After 20 years of working with clients, I’ve realized your health and fitness depends more on these three habits than any others.