Sarcopenia: The Silent Muscle Crisis | Why Muscle Loss Accelerates Aging | Vitality Unfiltered

Vitality Unfiltered Podcast

Host: David J. Bauder, PA-C
 Founder – Weight Loss & Vitality

Guests: Stephanie Lattimore, NP Weight Loss & Vitality Washington DC & Shah Ahmed Weight Loss & Vitality – Riverhead, NY

In this episode of Vitality Unfiltered, we explore one of the most important—and often overlooked—drivers of aging-related health decline: sarcopenia. 

Sarcopenia refers to the progressive loss of skeletal muscle mass, strength, and function that occurs with aging. While many people think of muscle only in terms of appearance or physical strength, muscle is actually one of the body’s most important metabolic organs. 

David J. Bauder, PA-C, founder of Weight Loss & Vitality, along with Stephanie Lattimore, NP, and Shah Ahmed from Weight Loss & Vitality – Riverhead, NY, discuss how muscle loss contributes to insulin resistance, metabolic dysfunction, frailty, falls, loss of independence, and reduced quality of life. The episode also explains why muscle health is increasingly recognized as one of the strongest predictors of healthy aging and long-term survival. 

The discussion further explores the biology behind sarcopenia, including anabolic resistance, hormonal decline, mitochondrial dysfunction, inflammation, and neurologic changes that occur with aging. Additional topics include the importance of resistance training, adequate protein intake, hormonal balance, and recovery in preserving muscle throughout life. 

A central message of this episode is that muscle loss is not inevitable. Through proper nutrition, strength training, metabolic health optimization, and individualized care, sarcopenia can often be slowed—or significantly improved.

In This Episode We Discuss

• What sarcopenia is and why it matters clinically
 • Why muscle functions as a metabolic organ
 • The connection between muscle loss and insulin resistance
 • The biologic drivers of age-related muscle decline
 • Hormonal influences on muscle mass and repair
 • How sarcopenia contributes to frailty and falls
 • Why resistance training remains effective later in life
 • The importance of adequate protein intake and nutrition
 • How muscle health influences independence and longevity
 • Strategies that may help preserve muscle as we age 

Key Takeaway

One of the most powerful predictors of healthy aging is not simply body weight—it is muscle mass and function. Preserving muscle helps protect metabolic health, physical independence, and long-term quality of life.

Learn More About Sarcopenia & Muscle Health

🌐 https://www.weightlossandvitality.com/contents/conditions/sarcopenia

📞 Weight Loss & Vitality: 571-550-9000

About Vitality Unfiltered

Vitality Unfiltered is a medical podcast exploring the science of hormones, longevity, metabolism, weight loss, aesthetics, and precision medicine.

Each episode provides clinical insight from healthcare professionals who treat these conditions every day.

Our goal is simple: to help people better understand the biology of their health so they can make informed decisions about wellness, prevention, and long-term vitality.

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_03 0:00

Vitality.

SPEAKER_01 0:02

Vitality Unfiltered.

SPEAKER_03 0:04

Unfiltered.

SPEAKER_01 0:05

With David Bowder. And we're back for another episode of Vitality Unfiltered. I'm David Bowder, your host today. With me from Weight Loss Vitality is Dr. Shaw from Riverhead, New York, and nurse practitioner Stephanie Lattimore from Washington, D.C. One of my favorite conversations today is sarcopenia, the loss of muscle mass. And we're gonna really, we're gonna really dive into this and explain this to the listeners about how important it is in the long term. When we think about aging, we think about chronic disease, we always think about these things that eventually get us at the end heart disease, diabetes, cancers. But one of the most important things that's relevant, relevant to longevity and decreasing your risk of later on in life diseases, and to help maintain a healthy metabolism and healthy body weight is muscle. And there is a lot of work that has to go into keeping your muscle mass, but it's possible. And there's not nearly enough energy placed on discussing maintaining healthy muscle mass with our patients. So to get this going, let's first define what is sarcopenia.

SPEAKER_00 1:11

David, sarcopenia is the progressive loss of skeletal muscle that occurs with aging. This natural process actually can start as early as someone's 30s, more significant into their 50s, but it's that progressive loss of muscle that comes with time that we work to combat in this space with preventative medicine. Sarcopenia means decreased protein synthesis in the muscle tissue, decreased activation of those motor neurons, and actual decreased mitochondrial efficiency of the muscle tissue. My millennial brain is buzzing with the mitochondria is the powerhouse of the cell. We've learned that in seventh grade biology. Think of your muscles as an organ for protein synthesis.

SPEAKER_01 2:01

So as we age, obviously there's a lot of biological processes to kick this thing off, right? And 30, 30 is, you're right. Your 30 is about the age where you got to work at it to maintain it. Otherwise, it kind of starts to get increased. What are what are those biological systems and factors that kind of address this?

SPEAKER_02 2:15

Yeah, it it is related to biological age. And we all know about, you know, as a young man, like you go to the gym early on in your teens and college years, and the gains just kind of like accrue, like the newbie gains. And it's just easy because as you're when you're young, your constitution, your hormonal milieu, your ability to output work, your recovery is all conducive to muscle development. There is an age-related decline in being able to develop more muscle, secondary to hormones, chronic inflammation, you know, lifestyle factors as well. You know, unfortunately for us, midlife is around the time when things get complicated. You know, you get married, you have kids, you focus less on yourself, you're like really focused on other things. Um, so there's like biological factors, lifestyle factors. I think the biggest factor, unfortunately, and the one that people don't talk about a lot, is like the age-related decline in hormone function, mainly testosterone, both in men and women, and the opportunity there for hormone supplementation to either build muscle had you not done it earlier on in your age, and if you have done it early on in your age, to keep it, to maintain it.

SPEAKER_01 3:24

Do you think uh I guess we can go go walk through kind of the different hormones that are associated with healthy muscle mass. Do you think if there's one thing, if there's one thing that's related to the most most stark biological change that occurs in a body as it aged, is it the green, do you think it's the decrease of hormones, or do you think it's the the lifestyle as we age?

SPEAKER_02 3:45

Oh man, it's hard to pick what. I mean, there's no study to show like what's what or what has more impact. I mean, there's you hit it.

SPEAKER_01 3:51

You hit on it. It's like your life becomes more complicated.

SPEAKER_02 3:54

It all kind of happens at the same time, yeah.

SPEAKER_01 3:56

Less you're you have less time to focus on your, you know, when you're 18, 23 years old, most of those people, you know, you're going to college or you got a part-time job or you're doing something like you can spend time on yourself. But when you're uh you know, 30 years old, 35 years old, you have some, you have your family, time is limited, your full mode work, paying the bills, stress, yeah. You're just you're competing with sleep and all of this.

SPEAKER_02 4:21

Yeah, looking at the chronology, actually, this is what I'll say. Like if you are inadequately layering muscle in your 30s, it's most likely secondary to lifestyle. And you're not putting in the work, probably at that point. Because like most people are not going through andropause at 30. Correct. You know? Whereas, like, if you're you've been putting in the work, you've been doing good through your 30s and 40s, but then like your 40s, late 40s, early 50s, you're hitting a wall. That's when I would say, hey, like you might be going through an age-related decline of testosterone and other hormones, like growth hormone access goes down as well. Like all of these functions, everyone declines inevitably, but different systems decline at different rates. And that's where data-driven medicine is very helpful to check levels.

SPEAKER_01 5:02

So when you think about hormones, let's start going through the hormones. Insulin, what's the effect of insulin on the muscle or muscle on insulin?

SPEAKER_00 5:09

So the way I think about insulin and how the body uses insulin and glucose for energy, I think about having a pasta party before a big soccer game in high school. You're feeding your muscles with that glucose, right? The muscles use glucose for energy. And in the case of sarcopenia or muscle loss, you're gonna have reduced glucose synthesis because you don't have the muscles to process the energy, the uh the intake that you're giving your body. This results to increased insulin resistance. So you're not having that good use of, you're not giving your body the good use of the insulin that you have. And then the other piece of this is with the decreased glucose regulation, you're having um decreased, you're increasing your risk of metabolic disease through muscle loss.

SPEAKER_01 5:59

Yeah, you just can't process the calories, correct. You're not burning, your burning potential is gone. I mean, I don't know how accurate it is, but I've read stuff that said that every pound of muscle burns 35 to 50 calories a day. Yeah. I don't know if that's gonna, you know.

SPEAKER_02 6:12

Your muscle is your tank in your depot for your BMR, your basal metabolic rate. If you don't have the capacity for glucose disposal, as Stephanie said, you will develop metabolic dysfunction. Like people develop pre-diabetes, diabetes at a very familiar trajectory, and it can happen at any time. Like just because you're in your 40s and you're not pre-diabetic yet, doesn't mean it can't happen. It can still happen. So that's why you have to be vigilant about it and really keep that pressure on to maintain your lean muscle mass. The answer with muscle mass is always more. Do you need it?

SPEAKER_01 6:44

Yes, we need more. You need more. You need more. I think we're we'll we'll hit on how you how you fix that at the end. But I I always in my mind it's just like you have to lift heavy items.

SPEAKER_02 6:53

That's it.

SPEAKER_01 6:53

Strength training. Lift heavy items. When um, you know, I I'm gonna t uh hit on this just a little bit and uh I'm gonna try to keep it real simple, but uh the reason I want to address this is because I can't tell you the number of patients I see that don't eat breakfast. And I'm gonna bring this up because when we think about muscle, it is there's probably opinions out there on this, but I'm giving you mine. We know in our body we have something called the mTOR system. And I would encourage the listeners to go online and type it in. M-T-O-R. And you should read about it, okay? Because this is really important. The mTOR system is like visualize the circuit board in your house for your breakers. Okay? If you go to your house and the power goes out, you go downstairs, you find the circuit board, and you you turn the breaker back on. Think of the m-TOR system in our body as that breaker box. Every switch on your breaker box represents a hormone, a branching amino acid, and the electricity coming in is protein. Okay? So if all of your switches aren't on on the breaker box, you're not going to deliver electricity to the house. This is the same principle with your mTOR system. Your mTOR system is this giant circuit board in your box. It relies on testosterone, estrogen, growth hormone, IgF-1, IgF, BP3, branch chain amino acids, specifically Leucine, all of these things feed this. There are some nutritional components there, not entirely as a switch, but they have a supporting role like B vitamins, magnesium, all of these things. You can even make an argument that HMB, a common supplement that you can get online to help develop muscle mass, it's it helps your switchboard. Breakfast is the mechanism to kind of activate your switchboard. Okay? If you don't load your your if you don't load your body with protein amino acids in the morning, it's kind of like your system never starts. I cannot overemphasize the importance of eating breakfast to help activate your ametore system. And where I was leading with this is where we're going to get with hormones. Hormones have a profound effect in muscle mass. Everyone thinks it's just testosterone. It's not. It's not testosterone. Testosterone has a role when it comes to muscle. Obviously, testosterone facilitates, this is why bodybuilders use it and a lot of athletes. It builds muscle. It helps with protein synthesis. It converts more protein proteins into lean muscle mass, essentially through a long process. But there's also estrogen. People don't think about estrogen when it comes to muscle. Estrogen has a role. Estrogen is estrogen, think of it it protects the wiring in your house. It's absolutely true. So what when you contract, which we're going to do in a little bit, we're going to check grip strength. But when we when you think about estrogen, estrogen helps specifically on this thing called the neuromuscular junction inside your nerves to allow for good contraction. So as an individual ages, specifically postmenopausal women, when they have low estrogen levels, they will lose the ability to actually conduct the contraction of a muscle. So it's profoundly important. And on top of this, you have the growth hormones, as I mentioned before. As we age, our growth hormone levels drop. And so there's a lot involved with this. But to think that you can build muscle effectively without hormones very difficult. Very, very difficult. Trevor Burrus, Jr. If not impossible, actually. It's not impossible. But I said if not impossible. If not impossible. It's yeah, it's like it it takes um there is an argument to be made too. If you don't have muscle mass, muscle is directly related to the amount or levels of hormones that you carry in your body. There's kind of like a feedback process that occurs in the body. The more lean muscle mass you have, the more hormones, specifically growth that is tied back to having healthy levels uh of body. And when you think about aging population, it's not impossible, but is it possible for a 70-year-old to build muscle?

SPEAKER_02 10:46

It's not impossible. Correct. And that's why, yeah, that's why I want to emphasize this. Like, depending on when you come in through our doors, like we have options. You know, like if you haven't lifted a single weight your whole life and you come in at 70 years old and you have zero hormonal function, there are options. Like man, man or woman. Okay. Men, very simple. Like if you have your testosterone's in the toilet, there's exogenous testosterone replacement therapy. If you want to do a cycle of uh a growth hormone boost, you can use a growth hormone secretogog, like sermoralin or tesomeralin, which are both FDA-approved medications, albeit at this point for uh off-label use for the building of muscle. But that with a very, very specific and titrated nutritional plan and exercise regimen, plus a data-driven approach to monitor your progress. Like that's how I would typically take on that 70-year-old. I would get a set of labs, see where they're at, see what hormones I can optimize and increase. I would get their grip strength, I would get their body composition analysis to see how much lean muscle mass we have. I would design a nutritional protocol that's protein first. I would execute that for 30 days or 60 days, and then test again. And then if we are making progress, I would permutate that further, maybe tweak up or down something. Again, test again in 30 to 60 days. And that way you give them a win. Every 30 to 60 days, they're like making progress, moving up. And you're not just leaving them. You're not like, oh, I'll see you in a year. No, we need to make progress.

SPEAKER_01 12:14

Yeah, you're actually you're the it's a plan. It's a plan. It's moving forward. And it's a, and there's and there's a goal in mind and an objective. The objective is building muscle mass. That's it. That's the objective. Yeah. Okay. You mentioned grip strength. Yeah. Talk about it.

SPEAKER_02 12:25

Grip strength is key because it is a there's abundant literature to show that grip stay grip strength is associated with longevity. Now, people have conflated this literature to say that the grip strength is what is like that's that's not where the juice is, though. It's like it's a proxy for overall strength. Okay. So, but it's an important marker because you can just do it in the office. So this is like a dynometer that you can just buy at on Amazon. You know, PCPs and clinics have weight scales, blood pressure cuffs. This is not a hard thing to add. Nope. You know, it's a nice thing to follow. And again, when it comes to data-driven medicine, I love to trend grip strength. My answer is I never want to go down. I would like it to go up. Going down is bad, even is okay, up is better.

SPEAKER_01 13:09

It's a signal. If it's going down, it's if it's going down. If you're on like this, would be a great example. Like if you're on a weight loss program and you're you're starving yourself to weight loss. Yeah. And you um and you're losing muscle mass in the process. If you did a grip strength test at the very beginning and then three months into your weight loss program, you would be weaker. You're you're weak. If you're weaker, that's a problem. That is not good. All right. That is a direct correlation that you are losing lean muscle mass and and if you're losing it in your forearm, you're losing it in your entire body. Um we're gonna check grip strength. Sure. All right? We're gonna start with Miss Stephanie. All right.

SPEAKER_00 13:45

I'm ready.

SPEAKER_01 13:46

All right? All right.

SPEAKER_00 13:47

They've only done this once, so we'll see. All right, let's see where you're at. All right. Okay. Dominant hand. Did you put in my statement? I didn't. We did just do the raw number. Okay, five seconds, right?

SPEAKER_02 13:57

It's hard to do that.

SPEAKER_01 13:57

Just grip as hard as you can, let go. It'll read. What you got?

SPEAKER_00 14:02

Just say it. Oh, there you go. I did better than last time. That's strong. So I I'm in the I hit the strong. Anything for a woman, a 32-year-old female over 77.

SPEAKER_02 14:13

For the uh users. She got a 77. That's huge. No, she got a 90.

SPEAKER_00 14:16

I'm up to a 90. Oh, 90, that's awesome.

SPEAKER_02 14:18

It's all about um strength to weight ratio. That's because I had breakfast. Yeah, that's because I had breakfast. I like to yell when I do it, so I apologize to the readers.

SPEAKER_01 14:29

Listeners. Listeners.

SPEAKER_02 14:30

Or listeners.

SPEAKER_01 14:31

142. I don't know if I can beat that.

SPEAKER_02 14:32

Yeah, you can. That's good, Dr. Shaw. That's good. That's why that's why I tell, especially my postmenopausal when they get stressed out with the raw number. Think about your strength to weight ratio. I tied you. 142.

SPEAKER_00 14:43

All right, guys. So we're all strong. We're strong.

SPEAKER_02 14:46

That's the key. And I and I want to emphasize this with people. Don't get hung up on the raw number. It's like any other biomarker or number or body composition analysis. It's like, what are we doing with your number? Your number is your number. Don't worry about other people's. Okay. Like I want your number to go up, I want it to stay even, don't want it to go down. And the strength to weight ratio is more important than the raw number. Like for me, a woman who say 120 pounds pulling a 70 is better than a man who's 200 pounds pulling a hundred. That's right. You know, and that's that's we have to really understand that.

SPEAKER_00 15:20

The trends are so important. So everyone who comes into my clinic on a weight loss program, I want to evaluate grip strength. I want to establish a baseline just to create that relationship with that patient that exercise has to be a part of this process. And I want you to improve your number, yourself. I want you to get stronger. I want you to eat right. I want you to treat your muscles as an organ that you need to feed with protein in order to get stronger and lose fat, not muscle.

SPEAKER_02 15:47

Yeah. Can I also just sorry, my interrupt quickly? It's really also important to understand where everyone is on their journey. So a lot of our patients who come in do come in for weight loss. I mean, that's like the big ticket item here for the most part, right? I always think about different like when someone comes in and they're like, I just want to lose weight in the next three months, I'm already thinking about three years for them. Okay. And the way I build out, I the way I build it out is I look at their body composition analysis, I see how much body fat percentage they have, and I see how much lean muscle mass they have. I usually have a goal of getting a man down to at least sub-20% total body fat, a woman at least sub-25% total body fat. And then thereafter, I try to build up their lean muscle mass. It's very difficult to body recomposition and lose body fat and build muscle. It's possible in a really optimal system, but the focus should be in the very beginning. If you have a lot of weight loss to do fat loss first, fat loss, lean muscle mass preservation. And then subsequently, when the fat loss is adequate and everyone's satisfied, then lean muscle acquisition. That's an easier approach typically. And the nutritional plan is different in different phases. So in the fat loss phase, you're going to be in a calorie deficit, high protein to retain that lean muscle mass. In the build phase, you might be in maintenance or surplus calories, depending on where you're at with your body fat composition, right? Really, really lean women, for example, are very reluctant to eat more. That's right. But when the time comes to build, build, build, you will need that energy. You will need that protein intake to train hard. And that's what you're gonna have to do. You're gonna have to train very hard to incentivize the body. Irrespective of your of your hormonal milieu, you can have everything optimized. But then if you don't go out and put it all out there on the gym, nothing's gonna happen.

SPEAKER_01 17:36

Trevor Burrus, Jr. That's right. You have to fuel. You have to provide the fuel for to get the results in the end when you're trying to build. Absolutely. Yeah. Obviously, when you're going down, you caloric reduction. Yeah, like you said, it's just so hard to build lean muscle mass at the same time you're cutting fat. It's very difficult. Speaking of protein, why don't you talk about the importance of protein? Like walk through the boots.

SPEAKER_02 17:54

It's huge. In general, people are not eating enough protein. Lean muscle mass acquisition is fully reliant on protein, protein synthesis. Um, you need to give your body the building blocks to build muscle. And people don't realize that protein is required not just for muscle, but for like everything, all your enzymatic function, your hair, your nails, integrity of your organs, your gut, your protein requirement is a lot higher than you realize. You know, people walking around eating just 30 to 40 grams of protein, you don't realize it, but you are just barely, your body is starving for protein. Starving, starving for protein. You're you're barely functioning. Um, just and also from a weight loss perspective, when you increase your protein intake, your satiety throughout the day, you have that breakfast, you have that high protein, 30 gram protein breakfast, you're satiated. You don't reach for the bagels, the chips, the nashes that are in the office and things like that. So, from a weight loss perspective, a high protein nutritional plan is very beneficial. And then at the build phase, a high protein plan is very beneficial because you'll have the building blocks to recover and build that muscle when you sleep. So, for me, you know, you'll you'll hear different metrics in athletic literature, but from a functional and longevity perspective, like really low baseline is you look at your lean mass. So you look at any body composition analysis that you take, you look at your body fat mass, your lean mass. If your lean mass is like 100 pounds, 120 pounds, eat that much protein. You know, very simple math. Like don't make it super complicated. Aaron Powell That's an easy way to do it.

SPEAKER_01 19:18

I usually use like for a weight for weight loss, for the weight loss phase, I usually try to go like 0.5 grams per kilogram of body weight, not to go less than 60 grams a day. Yeah. So depending, you know, like that 60 grams is the bottom number. Trevor Burrus, we're always using like numbers like that. It's never 20, it's never 30. No, we're it's never. And you know, another thing you brought that up about, you know, skipping breakfast and the protein and the control of appetite is when I have patients that come in and they're like, oh, I always have breakthrough hunger in the evening. I want to eat the house, you know, at six o'clock at night, seven o'clock at night. The first thing I ask, I go, Are you eating breakfast? And almost always they say no. Of course you're you're just trying to catch up. Your body is just driving. Still underfueled. It's underfueled the whole time. And you're gonna overeat when that happens.

SPEAKER_00 19:58

A lot of my weight loss patients will say I have I don't eat enough. That's a huge thing. And so whether I'm just to just to drive home the gravity of sarcopenia and how important protein is, whether I have a patient seeking weight loss or weight maintenance, you've got to fuel your body and look at protein as a source of fuel. Um they, you know, you might want to eat some potato chips or some French fries once in a while. I'm not, I'm, you know, which is fine in moderation, but those don't have protein to fuel and feed your body. So think of think of food as fuel and think of content and quality and quantity as what you need to keep your body going throughout the day.

SPEAKER_02 20:37

Yeah. One of my one of my tricks for the evening is like protein is never bad. So like if you can have like a Greek yogurt in the evening, that's good. It's better than a sleeve of Oreos. Oh, yeah. You know, so like if you got that, that's what I do. Honestly, I I'm listening I'm like any other guy. I have a really bad sweet tooth, you know? And so for me, when I get the munchies after dinner, as we all do, I don't know why it happens to me. I don't know why it happens to everybody. Sometimes I do skip breakfast. You know, we're all human. I I reach for uh I reach for a Greek yogurt instead, you know? Like even though the the cookies are tempting. But you never skip.

SPEAKER_00 21:08

I know you're Dr. Shah, we never skip breakfast.

SPEAKER_02 21:10

I don't know. Sometimes I run out, you know? He yelled at me the other day. I made the joke that like some evenings I just have like a granola bar for dinner in a hotel room or something, and he got real mad.

SPEAKER_00 21:20

What's the pro what's the added sugar in that? What's the protein and grain?

SPEAKER_02 21:23

It's not good. Again, but listen, we're not all perfect and we're doing all right. I'm doing all right, but like it's a it's about sticking to the plan overall in consistency, you know? I'm inconsistent like once in a while.

SPEAKER_01 21:34

It's not about perfection, it's about consistency. Consistency, yeah. And and and that's any program you do.

SPEAKER_02 21:38

Anything, yeah.

SPEAKER_01 21:39

Well, guys, I think we hit it. Oh, I have one more comment. You know, I also think, and and for clinicians out there, this is a reasonable thing to have in the office, like you were suggesting, because it does put the focus. If you're testing this and you're asking the patient, can we check your grip strength? It resonates. Why are you checking my grip strength? Why? Because it matters, right? This grip strength has more. Correlation to longevity than any blood test I can do on you, quite honestly. I mean, there there is more data that shows how long you're gonna be okay from a quality of life quality of life standpoint and stick around and be active in all of this, just by this one little test. And you can do this at home. So it's completely worthwhile doing and making sure that it's going in the right direction and not the wrong direction. So that's all I have. You guys have anything? No, this is a good episode. I think people need to listen to this one for sure. Absolutely. Eat your protein. Eat your protein. Build some muscle. Lift heavy items. Yeah. Want to thank each and everyone for you to attend attending the show today. If you enjoyed the show, make sure you click the subscribe button below, and we'll see you on the next episode.

SPEAKER_03 22:37

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.