Muscle tissue health and good tone, natural ways to maintaining good mass as we age
November 15 2019 by Ray Sahelian, M.D.

Muscle is a contractile tissue of the body whose function is to produce force and cause motion, either locomotion or movement within internal organs. Much of muscle contraction occurs without conscious thought and is necessary for survival, like the contraction of the heart or peristalsis, which pushes food through the digestive system. Voluntary muscle contraction is used to move the body and can be finely controlled, such as movements of the finger or gross movements like the quadriceps muscle of the thigh.

Muscle strength and volume decline with age
The ability to maintain balance deteriorates with increasing age. Anticipatory and compensatory postural adjustments, both, are known to be affected in the elderly.
Diet and exercise can reduce muscle loss as people age. People lose 30 percent to 50 percent of their muscle mass between the ages of 40 and 80. Muscle loss can lead to reduced strength, more difficulty doing everyday tasks, and increased health care needs and costs. Perhaps creatine can help.

One key to keeping muscles young is as close as the nearest gym. High-level exercise appears to help keep older people's muscles young at the cellular level. Exercise is definitely an important contributor to functional performance, and even non-athletes can benefit from workout. Staying active, even later in life, can help reduce muscle loss.

Recently published studies find that older individuals who include protein in breakfast and lunch, rather than mostly during the evening meal, maintain their muscle strength better.

Beet juice for muscle strength
Beet juice, with its high concentration of nitrates, may help boost muscle strength among heart patients. Nitrates are processed into nitric oxide by the body, which helps relax blood vessels and improve metabolism. Dietary nitrate, found in beets and leafy greens like spinach, has been shown to boost muscle performance in elite athletes.

Creatine for muscular development
Creatine is an essential player in the primary energy source used for muscle contraction. It exists in two different forms within the muscle fiber: as free (chemically-unbound) creatine and as creatine phosphate. This later form of creatine makes up two-thirds of the total creatine supply. When your muscles contract, the initial fuel for this movement is a compound called ATP. ATP provides its energy by releasing one of its phosphate molecules. It then becomes a different compound called ADP. Unfortunately, there is only enough ATP to provide energy for about 10 seconds, so for muscle contraction to continue, more ATP must be produced. Creatine phosphate comes to the rescue by giving up its phosphate molecule to ADP, recreating ATP. This ATP can then be burned again as fuel for more muscle contraction.

In your opinion, what is the best supplement for muscle growth?
   Creatine supplement and protein powders are the best supplements to increase muscle growth.

Other supplements
Diabetes. 2015. Evidence for a direct effect of the NAD+ precursor acipimox on muscle mitochondrial function in humans. Recent preclinical studies showed the potential of nicotinamide adenine dinucleotide (NAD(+)) precursors to increase oxidative phosphorylation and improve metabolic health, but human data are lacking. We hypothesize that the nicotinic acid derivative acipimox, an NAD(+) precursor, would directly affect mitochondrial function independent of reductions in nonesterified fatty acid (NEFA) concentrations.

J Int Soc Sports Nutr. 2016. In a single-blind, matched group design: BCAA branched-chain amino acid supplementation and resistance training maintains lean body mass during a caloric restricted diet.

Protein Metabolism
Muscle plays a central role in protein metabolism by serving as the principal reservoir for amino acids to maintain protein synthesis in vital tissues and organs in the absence of amino acid absorption from the gut and by providing hepatic gluconeogenic precursors. Furthermore, altered muscle metabolism plays a key role in the genesis, and therefore the prevention, of many common pathologic conditions and chronic diseases. Nonetheless, the maintenance of adequate muscle mass, strength, and metabolic function has rarely, if ever, been targeted as a relevant endpoint of recommendations for dietary intake.

Skim milk better than soy milk for muscle growth
Weightlifters who drink skim milk after a workout build more muscle than those who drink a soy beverage. Consuming protein after "pumping iron" is known to help build muscle mass, Quickly digested or "fast" proteins, including whey and soy, cause a temporary flood of amino acids into the blood, they explain, making more of these protein "building blocks" available for uptake by muscle. Proteins that take longer to digest, such as casein that is found in milk, produce a more gradual and long-lasting increase in blood levels of amino acids. While these "slow" proteins don't promote muscle formation, they do prevent muscle breakdown. Researchers hypothesized that a combination of "slow" and "fast" proteins like casein and whey, both found in cow's milk, would be most effective for building muscle. Eight men who regularly lifted weights were given a soy beverage or skim milk after performing a series of exercises with one leg. For three hours after the workout muscle uptake of amino acids was significantly greater when the men drank milk than when they consumed soy. The current study was funded by the National Dairy Council, along with the Canadian Institutes for Health Research. American Journal of Clinical Nutrition, April 2007.

Muscles strengthen bones, not fat tissue
Dr. Vicente Gilsanz and colleagues from Children's Hospital Los Angeles and colleagues used a technique called dual X-ray absorptiometry and CT scanning to precisely measure body fat, lean body mass, bone density and mineral content in 300 people between 13 and 21 years of age. Half were female and half were male. The researchers found strong associations between lean body mass and bone size and density. But the amount of fat mass either had no relationship to measures of bone strength or a negative one, meaning the more fat mass, the less dense the bone. The findings back up the idea that "bone strength is primarily determined by dynamic loads from muscle force, not static loads, such as fat mass. The Journal of Clinical Endocrinology & Metabolism, January 2007.
   Comments: Perhaps those who have more muscle mass may be more physically active and thus the physical activity itself may strengthen bones?

Muscle training reverses muscle aging, so does adequate protein intake
Strength training may not only make older adults' muscles stronger, but younger as well. It's well known that resistance exercises improve muscle strength and function in young and old alike, but strength training also affects older muscles on the level of gene expression -- essentially turning back the clock on muscle aging.
   Older men and women have to lift weights more often than younger adults to maintain mass and size.

Reduction of lean mass is a primary body composition change associated with aging. Because many factors contribute to lean mass reduction, the problem has been given various names depending on the proposed cause, such as “age-related sarcopenia,” “dynapenia,” “myopenia,” or simply “sarcopenia.” There is currently no consensus on how to best diagnose the reduction of lean mass and its consequences on health.

Sarcopenia is an age-related condition associated with a progressive loss of muscle mass and strength. Insufficient protein intake is a risk factor for sarcopenia. Protein supplementation is suggested to improve muscle anabolism and function in younger and older adults.

Although there is mounting evidence that muscle-strength training provides key health benefits, most middle-aged and older adults in the United States don't engage in this type of exercise.

Adv Nutr. 2014. Keeping older muscle “young” through dietary protein and physical activity. Sarcopenia is characterized by decreases in both muscle mass and muscle function. The loss of muscle mass, which can precede decrements in muscle function, is ultimately rooted in an imbalance between the rates of muscle protein synthesis and breakdown that favors a net negative balance (i.e., synthesis < breakdown). A preponderance of evidence highlights a blunted muscle protein synthetic response to dietary protein, commonly referred to as “anabolic resistance,” as a major underlying cause of the insipid loss of muscle with age. Dietary strategies to overcome this decreased dietary amino acid sensitivity include the ingestion of leucine-enriched, rapidly digested proteins and/or greater protein ingestion in each main meal to maximally stimulate muscle anabolism. Anabolic resistance is also a hallmark of a sedentary lifestyle at any age.

Muscle recovery after exercise
After a long bout of physical activity, eating a bowl of healthy cereal with skim milk may help muscle tissue recover at least as well as, if not better, than drinking a specialized sports drink. Heavy exercise damages muscle tissue, and milk and a 100-percent whole-wheat cereal, which contain protein and carbohydrate, help rebuild damaged tissue. Twelve athletes (8 men and 4 women) fasted for 12 hours, then cycled for 2 hours at least 5 days apart on a stationary bicycle. The subject did not ride to exhaustion. Immediately after each ride, the athletes ate either a 100-percent whole-wheat flake cereal with nonfat milk or drank a typical carbohydrate-packed sports drink. During recovery, cereal blunted the rise in blood lactate compared with the sports drink. The cereal and milk, and the sports, drink helped the body replenish depleted glycogen -- a fuel the body uses during exercise -- but the cereal and milk displayed greater glycogen storage potential. Tests showed the tired muscles were ready to store additional glycogen after the cereal-and-milk regimen, even after glycogen had already been synthesized.

PLoS One. December 2013. Effects of resveratrol on the recovery of muscle mass following disuse in the plantaris muscle of aged rats. The resveratrol-associated improvement in type II fiber size and muscle mass recovery after disuse may have been due to decreases in the abundance of pro-apoptotic proteins Bax, cleaved caspase 3 and cleaved caspase 9 in reloaded muscles. Resveratrol appears to have modest therapeutic benefits for improving muscle mass after disuse in aging.

Flexible muscles lead to stronger muscles
Most physically active people probably do a little stretching or know that they should. There is a correlation between muscle flexibility and muscle performance. Flexible muscles are stronger muscles. Flexibility training may help prevent knee injuries. It's important to regularly stretch not only the hamstrings, but other muscle groups as well. Clinical Journal of Sports Medicine, 2007.

Muscle tissue and acid base balance, the role of diet
An alkaline diet favors lean tissue mass in older adults. Metabolic acidosis promotes muscle wasting, and the acid load from diets that are rich in net acid–producing protein and cereal grains relative to their content of net alkali–producing fruit and vegetables contribute to a reductions in lean tissue mass in older adults. Higher intake of foods rich in potassium, such as fruit and vegetables, may favor the preservation of muscle mass in older men and women. American Journal of Clinical Nutrition, March 2008.

Whole body vibration training is good for muscle fibers
Standing on a vibrating platform helps muscles and bones, particularly in older or sedentary adults. Whole body vibration training involves standing on a platform that sends mild vibratory impulses through the feet and into the rest of the body. These vibrations activate muscle fibers more efficiently, it is claimed, than conscious contraction of muscles during regular exercise. Whole body vibration training is often promoted as a way to improve muscle power, jump higher or sprint faster.

Women like men with muscles
Muscles in men are akin to elaborate tail feathers in male peacocks: They attract females looking for a virile mate. Prior studies indicated a man's desirability was influenced more by his earning potential and commitment. Women were more physically attracted to brawny men, especially for a fling. But when it comes to finding a long-term partner, they tend to pick a regular man over a mate with huge biceps.

Diseases involving muscles
Duchenne Muscular dystrophy disease

Muscle damage from prescription drugs
Statin drugs used for cholesterol can damage muscle tissue.
Muscle injury, rhabdomyolysis, occurs when the cholesterol drug simvastatin is combined with the anti-arrhythmia medicine amiodarone. Simvastatin is an ingredient in Merck & Co's Zocor and Abbott Laboratories Inc's Simcor, and is sold generically. It also is one of two components in Merck and Schering-Plough Corp's Vytorin. Amiodarone is an ingredient in Wyeth's Cordarone and is also sold generically.
Viagra, Cialis, and Levitra can cause muscle aches and low back pain.

A whole range of heart medications can interact with statins:
Other cholesterol drugs called fibrates, particularly gemfibrozil (Lopid).
Blood pressure medications called calcium channel blockers, which include amlodipine (Norvasc), verapamil (Calan, Covera-HS) and diltiazem (Cardizem, Dilacor).
Clot-preventing drugs such as warfarin (Coumadin) and ticagrelor (Brilinta).
Drugs used to treat heart-rhythm problems, such as amiodarone (Cordarone, Pacerone), dronedarone (Multaq) and digoxin (Digox, Lanoxin).
Heart failure medications like ivabradine (Corlanor) and sacubitril/valsartan (Entresto).
The most common concern is that the other drugs boost statin levels in the blood. That, in turn, raises the risk of muscle-related side effects.

Questions and correspondence
Q. Does tongkat ali lead to muscle tissue increase? What about LJ100 or tribulus terrestris?
   A. I doubt if it, or the other sexual herbs have a significant effect on muscle tissue growth.

Could you recommend some herbs that can muscle spasms in my back. I have myofascial trigger point pain.
    Kava may occasionally be used for muscle spasms but not more than 3 days a week. Have approval by your doctor.

Could you please advise as to what is best to help with muscle tone. I am 52 years old and have had many years of an unfortunate situation that has caused my family and I to be subjected to severe/chronic stress. Things are better for us now and i am trying to get healthier. Starting last year i began to notice how much muscle tone i was losing. My arms sag like i am 70 y/o. I am starting a weight training program but would like to take a supplement that could enhance my tone. Any suggestions?
    Creatine monohydrate and protein supplements are good options.

As a boxing coach, my husband has run into several young men (less than 25 years old) who were not able to gain muscle mass. When he referred them to doctors for testosterone levels, they all had very low levels. This was in Mexico and in the US as well. More than one had levels equal to what was expected at 70--80 years of age! Granted, with one, a confounding factor may be that he has chronic Lyme and went through several years of treatment as a teen. It seems many males who have had problems with Lyme have had low testosterone levels for some reason. But, all of the others were healthy otherwise. In 50 years of training, he's never seen this until the past several years. What supplement would you recommend in those who are young with low testosterone levels in order to increase the levels?
  I prefer evaluating the whole person as opposed to relying treatment simply on blood levels of one hormone. Some may have low levels of testosterone but yet no need any additional hormone, and in some providing it may cause future health problems.

I have a condition called benign fasciculation syndrome. My symptoms are muscles twitching all the time in my calves and electrical type sensations in my feet. Been to plenty of neurologists. I am going to a neuromuscular specialist soon. I have tried magnesium with no change.

In 2014, research, which I have been informed was largely funded by the Dept. of Veterans Affairs, was conducted at the University of Iowa under Dr Christopher Adams in which mice were fed either ursolic acid or tomatidine. After 8-9 weeks, there was an average increase of 10 percent in muscle size, an average of 30 percent increase in grip strength, but no significant weight change, indicating fat loss concomitant with muscle increase. Although the research is apparently considered promising as far as being possibly useful in the treatment of sarcopenia and cachexia in general in humans, after email correspondence with the National Institutes of Health (one of the funders of the research done at the University of Iowa under Dr Christopher Adams ), l have been informed that no human clinical trials are scheduled in the foreseeable future. My questions are as follows : If the research on these compounds is truly promising with respect to human application, and since these compounds are both natural in origin, not drugs, why doesn't there seem to be much more interest in pursuing further research involving humans to try and determine efficacy, dosage, safety profile, etc.? Why is it that there seems to to be so little interest from health insurance providers, the government (MEDICARE, MEDICAID ), the medical community in general, other researchers/universities, supplement companies specializing in sports supplements, etc.? Any pertinent information that you may be able to provide would be much appreciated.
   A. There are thousands of potentially beneficial substances that are available, and science does not have the funds to evaluate all of them. It is very expensive to do human studies.