Sarcopenia, the age-related loss of muscle mass and strength, is a major concern for health and mobility in older adults. But muscle decline can begin much earlier, often as soon as our 30s and 40s. Here's why building and maintaining muscle strength is crucial at every stage.

Muscle Strength Over the Life Course 📊
Research shows muscle strength peaks in our 20s and early 30s, remains steady in midlife, and declines at about 1-2% per year post-50.

Have you read “Metabolic Basis of Creatine in Health and Disease: A Bioinformatics-Assisted Review”

You should!

Follow along as we discuss this paper. @dabonillao @RBKreider @ExphysPhD @daforerog @chadkerksick @DrMikeRoberts @EricRawsonPhD @Creatine4Health @darrencandow @DrCreatine Creatine’s role goes beyond athletic performance—it’s central to cellular energy in various tissues. This review shows how creatine supports high-energy systems like muscles, heart, and brain, helping cells meet energy demands when they need it most.

Iron deficiency without anemia (IDNA) is more common than most people realize. Many think anemia is the first sign of low iron, but often, deficiency starts well before that. You can be iron deficient without having low hemoglobin. This means your oxygen-carrying capacity might be affected before you have "anemia."

Hey!

What can we do to avoid lean mass loss with weight loss?

Check out this recent paper with me:

Strategies for minimizing muscle loss during use of incretin-mimetic drugs for treatment of obesity @DrCarlaPrado @imwmhealth @DrZhaopingLi @heymsfield @DrNadolsky Background: Incretin-mimetic drugs (IMDs) like semaglutide and tirzepatide have shown remarkable efficacy in treating obesity. However, rapid weight loss can lead to skeletal muscle loss, impacting long-term health and metabolic outcomes.

Have you read:

"Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?" from the JISSN?

You should. Here's a 🧵, a conversation about it, and the article link. Pick your favorite mode of learning and share it. Creatine Supplementation: Debunking Myths and Highlighting Facts

~ 9 minute listen unless 2x speed then it's 4.5 mins!

rss.com/podcasts/talki…

Have you read:

“Exercise-Specific Adaptations in Human Skeletal Muscle: Molecular Mechanisms of Making Muscles Fit and Mighty”

If you have then awesome b/c it’s a lot to discuss. Too much for one thread. I’d like to share some concepts that I found interesting. I’ll stick to one at a time.

Let’s look at the molecular mechanisms behind getting "fit" vs. getting "mighty".

work by: Aaron Thomas @_ConnorStead, @ExercProteomics @mackinprof

In 1982, Dr. Brenner published "Dietary Protein Intake and the Progressive Nature of Kidney Disease:..." aka the "Brenner Hypothesis."

This pervasive hypothesis of protein on, specifically kidney health, that is like a zombie...it just won't die.

Let's look at recent evidence Title: Protein Intake and Mortality in Older Adults With Chronic Kidney Disease

Background:

Aging is associated with changes that can increase protein requirements while impairing the body's ability to utilize protein.

Have you read "Does one dose of creatine supplementation fit all?" by

@darrencandow , Sergej M. Ostojic b, @DrCreatine , and @JoseAntonioPhD

If not, you should.

Here's an overview 🧵 Research on creatine supplements shows benefits for muscle, bone, and brain health. However, the optimal dose across these tissues is unclear.

Have you read:

"Sarcopenia in the setting of nonalcoholic fatty liver disease"

You should.
A 🧵 1/
A recent review highlights the intricate relationship between sarcopenia and nonalcoholic fatty liver disease (NAFLD). Both conditions are interconnected, with each exacerbating the severity of the other. This thread dives into the findings and implications.

Impact of Aerobic Exercise on Arterial Aging and Cerebrovascular Function
Advanced age is a primary risk factor for dementia, including Alzheimer's disease. Understanding the mechanisms of brain aging is crucial for developing interventions to maintain cognitive health. Link Between Arterial Aging and Brain Health: Recent evidence underscores the relationship between arterial aging, manifested as increased central arterial stiffness, and cerebrovascular dysfunction, significantly impacting brain health in older adults.

The Sarcopenia Prevention Project

Have you read

“Hand grip strength as a proposed new vital sign of health: a narrative review of evidences”

You should. Here’s a thread from the review article and a few personal notes on how I’ve used it.

#SarcopeniaPrevention Hand grip strength (HGS) emerges as a critical health metric, essential for diagnosing sarcopenia and gauging physical capacity, marking its importance alongside traditional vital signs.

Have you read

“Exercise rescues mitochondrial coupling in aged skeletal muscle: a comparison of different modalities in preventing sarcopenia”

You should.

A 🧵 Mitochondrial coupling efficiency is key, especially in aging tissues, where it denotes ATP production with less oxygen—vital for muscle function and cellular health. It’s a critical target for metabolic health and combating muscle aging.

Another great discussion on body composition vs intensity of exercise.

Slow and Steady, or Hard and Fast? A Systematic Review and Meta-Analysis of Studies Comparing Body Composition Changes between Interval Training and Moderate Intensity Continuous Training

A 🧵

https://twitter.com/JamesSteeleII/status/1733841237432525060

Both IT and MICT similarly affect fat loss. No superiority of IT for fat reduction. EPOC during IT is modest, not significantly aiding fat loss.

By now, almost everyone has seen this new @American_Heart scientific a statement. But as you know, I love to make a thread so here we go!

Effective for primary and secondary prevention, RET reduces all-cause mortality by 15% and CVD risk by 17%.

Have you read:

“The impact and utility of very low-calorie diets: the role of exercise and protein in preserving skeletal muscle mass”

It is of particular interest to me as I work at a clinic prescribing VLCD

A 🧵 VLCDs can lead to significant short-term weight loss which can improve obesity-related conditions like type 2 diabetes and hypertension.
- Short-term use of VLCD under medical supervision can rapidly improve glycemic control and reduce cardiovascular risk factors.

I’m excited to share this new preprint on MedRxiv…It’s mine!

"Clinical sarcopenia identification: Justification for increased sensitivity in SARC-F scores for probable sarcopenia"

Let’s talk about the study. A 🧵 Introduction

Sarcopenia is a progressive loss of muscle mass and strength that adversely affects mobility, function, fall risk, and mortality in older adults.

Muscle and strength loss can begin as early as 30 and accelerate after ages 50 and 60

Have you seen this review?

“Handgrip strength and health outcomes: Umbrella review of systematic reviews with meta-analyses of observational studies”

If you haven’t then you should.

Here are the Cliff Notes in a 🧵 The purpose of this review was:

“The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.”

My take on muscle hypertrophy.

A Halloween Cookie 🧵 All sugar cookies have similar ingredients:
Flour
Baking powder
Egg
Butter
Sugar
Salt

Some may argue that you should use organic vs regular, free-range vs not, more salt, less salt…
Eventually you have to put it in the oven and bake at 375

Anyone else ever go to Pubmed and search for one of their favorite researchers to look for something you haven’t read? I’m the only nerd?

I searched “Candow+creatine” and found this editorial from 2021.
@darrencandow

A short 🧵 Creatine “should” improve bone health. It adds to strength and function gains with resistance exercise. RET improves bone health so that should translate to bone improvement (in my 🧠).

Not every study shows that.

The authors detail 10 RCTs that include CM+RET. Mixed results.

Check this out 👇

“Long-term time-course of strength adaptation to minimal dose resistance training: Retrospective longitudinal growth modelling of a large cohort through training records”
By James and James et al.
@JamesSteeleII @DrJpfisher

A 🧵 14,690 participants
60% female
Average age 48
One 20 minute resistance training workout per week
Up to 352 weeks of workouts
~30-50% strength gain in 1 year
~50-60% gain maintained at 6 years

I posted this figure from “Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function” with little background information and had a few questions so here’s a short 🧵

https://twitter.com/primarycarepac/status/1383559698322845704

“The aim of this study was to examine the independent and synergic associations of muscle mass and muscle function with increased risk for losing physical independence in later life.”