Sarcopenia

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By Matt Stone

I’ve been thinking a lot about aging lately.  My grandfather, age 87 and my last living grandparent, ain’t doin’ so hot.  And yes, he’s old.  He’s falling to pieces.  He’s going to eventually die.  I’m not fighting that, and tend to look at whether it happens now or several months or even years from now as pretty inconsequential in the grand scheme of things.  Sure, he’ll miss a few golf tournaments and football games on tv, but from this point forward it doesn’t really matter when the big day arrives.  The world will go on whether he is alive to watch The O’Reilly Factor or not (Yeah I know that’s kinda mean, but he’s at the bedridden diaper stage – the stage where most people promise themselves and their loved ones they’ll never reach).

So yes, I’m aware there’s nothing that is going to make him jump up and do cartwheels at this point.  But I have to rant over the care that he has been given over the last several weeks.  It’s ridiculous, and violates some of the most basic elements of proper elderly care.

While my tendency to encourage increased calorie consumption, including many naughties like sugar, salt, and saturated fat, as well as making an effort to maximize anabolic factors over the catabolic factors for health could be perceived as controversial for the general public, the older you get the less controversial and more obviously correct this advice becomes.  When it comes to increasing health, immunity, longevity, and functionality for the elderly there’s no question that high calorie consumption and minimizing catabolism is highly effective.

When it comes to elderly care, and maintaining their functionality especially, a loss of which has landed my grandfather in a nursing home as of last Monday, there’s no question that the prevention of sarcopenia, or loss of muscle mass, is where success and failure resides.

When old people do their getting old thing, muscle mass decreases.  This is due primarily to an increase of catabolic hormones like adrenaline and the glucocorticoids and others in proportion to youthful hormones like testosterone, DHEA, and growth hormone.  One set favors muscle loss, the other set favors muscle gain.

While the effects of aging are inevitable and unavoidable in the long run, there are certainly measures, as discussed in the last post on metabolism changes with aging, that can delay and in some cases even temporarily reverse these declines.  Some of the hallmarks of aging such as loss of appetite and a reduction in physical activity are clear contributors to loss of muscle mass. 

But loss of muscle mass aside, what really matters most is that strength is maintained.  Activities vital to doing basic things without requiring assistance, such as standing up and sitting down, rolling over in bed, walking, and moving around without reaching total exhaustion in the process, are mostly attributable to strength in proportion to bodyweight.  For example, if you can leg press 400 pounds, and you weigh, 150, walking up a flight of stairs is effortless.  If you leg press 150 pounds and weigh 250, sitting down on the toilet and getting back up again is damn near impossible.  Walking up a flight of stairs is like a 20-year old walking up a flight of stairs carrying his bodyweight on his shoulders.  It’s exhausting, and will cause you to suck wind like Arnold on Mars.

When it comes to maintaining strength and muscle mass, it is no different from the simple basics known about such things.  Eat at least maintenance calories, preferably more, including plenty of carbohydrates and protein in particular.  Do progressive resistance exercise – meaning continue to increase the weight you are able to lift as long as you can.  Get plenty of sleep.  If you can’t or won’t do resistance exercise, at least staying physically active and moving around will help.

So, ol’ grandpa, who my family has always referred to as “Granddaddy” (and since Puff Daddy made the switch to P-Diddy – G-Diddy), checked into the hospital for a mysterious infection a few weeks ago.  Since then, from a lethal combination of laying around doing absolutely nothing, eating very little (mostly attributable to the hospital food being disgusting, not very calorie dense, and get this – low in salt because he had a couple of temporary high blood pressure readings), and in turn getting very little sleep – G-Diddy has lost 16 pounds in 3 weeks time.

16 POUNDS!

And now lacks the strength to do anything and everything that he was capable of doing just a month ago.  Because of this, he is no longer at home with his wife (who is NOT Starla, unfortunately) to help take care of him.  He can’t help her enough, because of his lack of strength, to get in and out of his chair, in and out of bed, on and off the toilet, and so forth.

How in the world do they let this happen?  Tube feed the guy if he’s losing weight like that.  Or at least start by giving him ice cream instead of unsalted turkey and carrots for dinner, steamed broccoli, low fat scrambled eggs that an astronaut wouldn’t eat, and watery porridge with margarine… and feeding him a hell of a lot more often than three times per day.  Get him out of bed and do some exercises to keep his strength up.  Anything.

16 POUNDS!

You never let an old-timer lose 16 pounds in less than 3 weeks.  That should be rule #1 of elderly care.

It’s so dumb.  The people down in “dietary” are giving him unsalted food.  Meanwhile, the doctors are trying to perk him up by pumping saline into him.  Know how much salt is in a liter of saline solution?  9 GRAMS!  About the same as 3 double cheeseburgers and a half bag of sea salt potato chips.  Where is the disconnect?  These people work right down the frickin’ hall from one another.  Why is one using salt to save lives while the other is mistakenly thinking they are saving lives by restricting salt?  To borrow a phrase from the movie character Patches O’Houlihan, “it’s like a bunch of retards trying to hump a doorknob.”

Even more ironic is that G-Diddy’s problems turn out to be from a pill that went down the wrong hatch and ended up in his lung, triggering pneumonia-like symptoms, that the doctor went in to remove and accidently broke into several pieces making the problem worse.  So basically he is almost killed by the “care” he was given while trying to fix a problem caused by a medication or vitamin pill that was supposed to keep him healthy.

Anyway, there’s no question that sarcopenia is one of the most, if not THE most, important issue with the elderly.  Maintenance of muscle mass has repeatedly been found to be the physical attribute most tightly correlated with above-average longevity.  Sleep, calorie dense and highly-palatable food with plenty of carbs and protein consumed frequently, and strength training in a few basic planes of motion, especially the legs, is the triad of strategies that prevent and reverse it.  This triad also performs the same feat on osteoporosis and osteopenia, other primary elderly issues.

I suspect that in the distant future we’ll see resistance exercise machines like the CZT in every nursing home and assisted living facility, and perhaps even hospitals too.  And hopefully better food.  From what I can tell the food is still very much governed by the steamed broccoli paradigm of nutrition, when calorie-dense rocket fuel is needed by the elderly even more than the rest of us.  I hope to write about this in much greater detail in the future, putting out an actual guide of some sort on this important and very basic and straightforward subject.  All I really want to say right now is…

16 POUNDS!

Friends don’t let their friends’ grandparents lose weight.

77 Comments

  1. This reminds me of when my grandma was put in a nursing home after a fall. Almost immediately her condition got really bad and they said she was going to die pretty soon. Then my uncle took her back in his house and took care of her. Feeding her these extremely calorie dense astronaut desserts or something. And when she was able again he started doing basic exercises with her.

    She lived for years with him after that while she was predicted to stay in bed and die within the week.

    Reply
    • Yeah, if I had the time and will to live with G-Diddy, make food for him, and change his diapers every few hours and all that I’m sure I could rehabilitate him somewhat. It’s complicated by the fact that he has a neurodegenerative disorder that messes up his balance. He can’t just get stronger and stand up and stuff without falling over even when he did have the strength.

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      • I hear ya Mattie. My mom got to this point, I just could no longer care for her properly. It was a short time in a nursing home, where I visited three times a day before she finally passed away. I wish it was easier and I really feel for how hard this is for you. Much Love my friend and I hope he gets home soon so you can at least get some nice satisfying food in him. :-) xooxoxoxoxoxoxoxo

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      • Thank you for the excellent post describing the real challenges of taking care of the elderly in our “modern” healthcare system. As an orthopedic trauma surgeon who treats elderly patients with hip and other fractures on a daily basis, i agree with your assessment. Getting folks home, decreasing narcotic exposure and getting them eating a high calorie diet (with some enjoyment), makes a big difference. Having a supportive family though, is the biggest factor. Kudos for caring.

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  2. Dunno how much he weighed before the weight loss, but some definitions of AIDS target the loss of 10% of bodyweight within 30 days, in addition to either diarrhea or weakness or fever, as an indication of ‘wasting syndrome.’ No good. Even 5% in that same time can be problematic.
    http://www.aidsinfonet.org/fact_sheets/view/519

    In any event, sorry to hear about this brother. Sending good thoughts G-Diddy’s way.

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  3. Sorry, Matt. Are you raising hell with the hospital? Because you should. I have taken nutrition coursework, and it actually is well-known and taught that you should feed energy-dense foods, etc.(Don’t think salt was mentioned, but it’s plain stupid to try to lower the blood pressure of an old person who is at risk of dying. BP is a long-term risk if anything.) In fact, we were taught that elderly people losing weight should eat whatever they want, because just plain EATING is most important. What this hospital is doing is malpractice, and you should call it that to scare them. Can you bring in salt and other food to help him?

    My grandmother is in an assisted-living facility and I cannot stand what they feed her. She mostly drinks (whole) milk because it’s what’s most palatable. A lot of old people say that to stay healthy you should stay out of hospitals. I couldn’t agree more.

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    • He’s not in the hospital anymore, but in a nursing home and doing much better. EATING is definitely most important, which is what this post is meant to be a reminder of. Sometimes people have their priorities all mixed up, and in a calorie and salt-phobic society often forget about these big essentials.

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  4. I’ve seen a similar thing happen with my grandmother recently who has severe osteoporosis. She was hospitalized a few weeks ago and lost twenty pounds in the hospital. Luckily she’s out now and back to her normal diet of fish sandwiches from Long John Silvers and Breyers vanilla ice cream against her doctor’s orders. She was once a health nut who survived on a low fat, low salt diet, but since her health has deteriorated she’s given herself permissions to eat whatever she wants. Maybe her health would be better now if she’d started doing that earlier in life.

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  5. “A few basic planes of motion”?

    I contest that.

    I am in Asia right now and very impressed with locals and how they squat in different ways. Sometimes they squat (to do dishes, work on a motor bike engine, prepare food) in different ways, with the knees together, out to the sides, sometimes one knee down kneeling. They transfer easily from squatting to lotus position.

    That’s not even to mention the different types of squats they must use to poop. In China, the vast majority of toilets are at ground level, basically drains in the floor. Old people still squat, obviously.

    Multiple planes of motion I believe is absolutely imperative to combat aging. I squatted and dead lifted for years but did not work on yoga type mobility and I am paying for it with joint pain.

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    • Hi Gabriel, I’ve been to Japan and Taiwan a number of times, and I’ve never seen anyone perform a lotus position except for monks in pictures and people practicing yoga.

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    • No doubt that as many planes and ranges of motion a person does work in the better. But I’m talking specifically about building enough leg strength to get on and off the toilet, walk, and stuff like that – prioritizing the simple instead of trying to do it all.

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  6. Sorry to hear this, Mattie-San. Sending goods thoughts your (and the Did’s) way.
    I have an elderly client currently who came in with a diagnosis of metastases to the liver a year after removal of a cancerous stomach. She had lost upwards of 50# during the year after her surgery, and received NO ADVICE re:proper eating. We got her on bone broths, increasing calories/nutrient density of her small, frequent meals, herbs and acupuncture, etc., and she has GAINED 10# in about 6 weeks. Feels good, blood work looks good, bowels and digestion are good, and we will have a scan in another month. Can’t wait. Would like to poke the oncologist in the eye. Told her there was nothing more to do. My Chinese herbal teacher, Dr. Huang, who treats cancer in China had three big recommendations for working with cancer patients – help them keep a positive, happy attitude and a good appetite, and DON”T let them lose weight. His favorite food recommendation is red cooked pork belly, the Chinese equivalent of BBQ pork. Yum. When he tells his patients to go home and eat this popular comfort food (which most assume would be forbidden,what with the gelatinous sugar and fat, and unctuous deliciousness) they often break down in tears. Of gratitude. :D

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  7. My father just happened to go into the hospital last week too. His legs got swollen to the point where he couldn’t walk, he fell over and didn’t have a cell phone on him. A few hours later his office assistant found him…fast forward to the hospital.

    Two days of testing later it was determined to be a bacterial infection. They put him on 2 antibiotics, which turned out to be very effective. By day 4 he’s back home and by day 5 he’s back to work. Mom says he’s doing better now than he has in years.

    Did the anti-biotics, which obviously killed off the infection, make that much of an improvement? (I’d say yes if it had been a chronic infection but it wasn’t.) If not, then why the major improvement?

    This is what they fed him for 4 days:

    http://en.wikipedia.org/wiki/Parenteral_nutrition#Solutions

    Maybe, just maybe, he ate ‘better’ intravenously those 4 days than he has by his normal diet in a long time. Dunno…just wondering out loud.

    Reply
    • Taking a course of antibiotics can lift a lot of chronic bacterial burdens temporarily. Many notice dramatic improvements from antibiotics, like Russ Farris whose experience with taking a round of antibiotics prompted him to research and write a book about chronic infections.

      But I suspect the intravenous boost was a big help too. That stuff is magic.

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  8. After my own experience on death’s door, I didn’t have the strength to eat or drink. I was offered jello and applesauce and literally could not swallow. The only thing that motivated me was strawberry fribbles. It was amazing to suddenly be able to use my throat muscles. It was a lot harder to swallow the vanilla milkshake with less artificial flavor. The real difficulty in getting nutrition was that no one understood that I needed to be indulged, that my self-preservation instincts were no longer functioning.

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    • Yeah, he can’t swallow properly and likes ice cream and cheesy soups the best of course. But they still insist on serving him pasta and broccoli and dumb shit like that. And what’s with that weird no-melt ice cream they have now? Anyone know what’s in that stuff?

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      • The approach to nutrition for the seriously ill/ injured makes my blood boil. Losing weight is seen as either inconsequential or inevitable. The weaker you are, the harder it is to communicate what your body needs and the more important it is to have family around that will speak for you and act on your behalf.

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      • It’s the quantity of stabilizers that cause it to not melt (i.e. guar gum, carageenan, other gums or starches, cellulose). There was a recent taste test on America’s Test Kitchen, I just watched it again on their website. I’d link it here, but you have to register to view their free content.

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        • Why would anyone even want this? The melty part is the best part about ice cream!

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          • In Austin we have an Ice Cream place called, actually, Amy’s Ice Cream, and it is made like this to not melt in the Texas heat. It is the best known local ice cream but it is so disgusting! Like eating some sort of gummy gel.

      • anti freeze. No lie. it’s in ice cream now. yum.

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      • in France, we officially recommend the (whole) milk&egg desserts for elderly people suffering from “denutrition” which is, I think, the sarcopenia you describe. Let’s go for crème pâtissière, crème brûlée etc. I have explained it to many visitors in the hospital I have worked in for 6 weeks.
        I have also worked on the presentation of food in small quantities on separate plates with lots of color-touches on it (including tomato-sauce).
        Sorry i don’t know more about this weird ice-cream you describe.
        I hope your G-diddy will feel better soon.

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  9. So sorry to hear about this, Matt. Best wishes for the speediest and least-painful possible resolution for all involved. :-(

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  10. Well, iatrogenic illness is the third leading cause of death in the US after all.

    :(

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  11. This post is brought to you by CZT.

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  12. My grandma was pretty healthy and with it for a long time. She came down with congestive heart failure 7 years ago and was admitted to the hospital. Since then she was in and out of the nursing home with various ailments and had to move into an assisted living facility. Although her acuity was declining, she still seemed more with it than some of the guests. The food at the assisted living apartments was definitely of the steamed broccoli, margarine, low calorie variety. And here’s my grandma talking about when she used to eat head cheese. I don’t know what’s going on in our culture, but I dread the day I get sucked into that system. Still, my grandma managed to squeak into her nineties. Sorry to hear about your grandpa. Please give them hell.

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  13. I hope you’re able to intervene and be of some help to the situation. After all, you’re the man for the job. My whole family is F**ked but I don’t want to delve into that. I feel I should share with you all my doctors visit today. I have health insurance through my employer, just for emergency purposes. Otherwise, I wouldn’t have it. I had to set up an appointment for a annual routine check up, otherwise I’d be charged an extra 25 dollars a month next year for medical. Bullshit part of that is, I still get a half of a point for being late. LAWL. Anyhow, they didn’t make me take off my shoes for my weight, and it was monday, so I indulged on the weekend (some times I do, sometimes I dont, I felt I definitely needed it this time around) I was 275. They just asked my height (guess that’s normal for adults?) and I said Six five and a half. So my BMI ended up being 32 or some shit. So here are the results. Just the basics. It was 10:30, I didn’t eat yet, and I indulged in some liquid nicotine (e-cig) prior to my visit. Blood pressure 128/90. Said the second number was kinda high, and I should definitely reduce my salt intake. (thats the only piece of advice he had…) and I never told him about my diet. My pulse was 84. My oral temperature with their digital doo-dads was 98.8. I was definitely feeling flushy from not eating, idk exactly what that means, but used to happen much more when I was hypoglycemic a lot in prior years. Sweating balls for no reason for example. He said you know some insurance companies actually pay you to have a lower BMI and you should probably lower yours its kinda high. Tried to get me to get a anti-inflammatory prescription for my sprained wrists, asked me if I was depressed. This guy was a joke to me. I said I’m not going to lower my “BMI” right now, I’m gaining weight on purpose, I said it’s some nerdy metabolism stuff. He gave me a strange look and shut up about it. First off all, fuck BMI, couldn’t he see I wasnt a blob, and actually had some good form going on, I told him multiple times I worked in a metal recycling yard, and he asked me a couple times if I got any exercise LOL ya like I have to consume thousand upon thousands of calories just to maintain my weight exercise. And I’m probably still not eating enough. Anyhow, that visit sucked, took too long, basically an hour had passed after my actual appointment time before I was seen. Fuck his knowledge. what do you guys think about my stats? I had a number twelve for lungs too, don’t know what that means. But I got big lungs, I used to be able to take the biggest a-hem hits. I’m trying to incorporate more salts into my diet actually. Considering how much I sweat, I think this will be a good thing. The gatorade powder probably is too much sugar not enough salt perhaps. Good luck to all of you and your families health problems, that’s the yin and yang of things though…

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    • Hi Matt I am sorry to hear this and I hope you’re able to help him. It may not be too late. My own 80 year old mother nearly died in January due to an infection in her pinned femur and only got better when she got out of that place and slowly started to eat and move again. And it took months, and yes, she could not be cajoled into eating anything she didn’t feel like. And we held our breath. But your advice is spot on: food and gentle exercise have done the trick. And she was on the edge. Get him home if you can, it all starts there.

      Where do you start with the stupidity of the diet advice that 1. got her bones so frail they broke – she’s always ‘watched her weight’ and never doubted that she was doing the right thing :( , still would not believe me if I told her; and then 2. led to the loss of at least 10 -12 pounds in hospital (off a 5 foot nine, 120pound frame) (uncommented on by doctors or nurses) and that in itself nearly killed her … it’s actually criminal.
      My sister in law, thanks to her doctor’s fearmongering, is in terror of a tumour because she has ‘unexplained’ anaemia and a swollen spleen – get this, ‘not dietary’ says her doctor, even though she’s been vegetarian 3 years,on a nutrient poor diet! Scans, specialists and fear – but please, don’t mention that maybe a bit of red meat might fix all this! I badgered her into eating meat again but I can tell she is not convinced. She’d almost rather have surgery than doubt her useless doctor or try – just try – something harmless and easy like a steak!
      This is such a big ugly can of worms – doctors, hospitals, diets. Not just the elderly – there’s also the damaged babies and the half-lived lives for those of us in between. A dirty secret that just stays a secret.
      Good luck with your granddad.

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      • “This is such a big ugly can of worms – doctors, hospitals, diets. Not just the elderly – there’s also the damaged babies and the half-lived lives for those of us in between. A dirty secret that just stays a secret.”

        ^^THIS^^ : +1,000,000

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      • I have this link I got from a rant by a former Republican. One of the things he complains about is the educated stupid: i.e. intelligent people with college degrees that still deny things like global warming. As I was reading this it did not escape me that to the mainstream, we are the educated stupid when it comes to nutrition. The problem is that most people don’t have the time or capability to be experts on everything and so have to rely on external authority. If you look at how the human animal works, we rely on logic for very little of our decision making. Relying exclusively on logic is simply too expensive. It is therefore rational, from an evolutionary perspective, to take things into account like group consensus and the advice of experts.

        Unfortunately there’s very little the rest of us can do. But here’s a good way to handle those situations. Stand by your beliefs. Don’t back down, act like they’re stupid, or act uncertain about them. State that you’re open to debate on the issues, but don’t get into a typical argument. At this point you’re kind of stuck comparing evidence against each other and a long drawn out debate. Most likely you’ll waste a lot of time without either of you changing beliefs, which is exactly why other people aren’t open to listening to alternative theories in the first place.

        The “experts” hold a lot of power. It’s sad but true. I’ve felt we possibly need a few malpractice lawsuits to really push the issue.

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        • It’s the experts telling you to believe in global warming, drrr.

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        • Does anyone *not* believe in global warming these days??? According to said Republican, the educated stupid make up but a tiny percentage of the educated mass, and they’re stupid because they’ve determined that the evidence is faulty? People believe in global warming, not because they’ve studied it, but cause they’ve watched An Inconvenient Truth.:)

          Just like with good nutrition, anthropogenic global warming is not an issue you can establish with any amount of certainty. Science remains a vast field of hypotheses based on scatterings of ‘hard’ facts.

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    • That’s all quite solid. A dude that is solid and muscular should have at least a BMI of 30, like any NFL power position athlete. The temps and pulse rate seem excellent, and blood pressure damn near perfect. I wish my blood pressure was that normal, lol.

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      • Thank you for your input dude that makes me feel awesome! I’m sure your blood pressure is awesome too man don’t worry! It’s not how high your blood pressure is, it’s how often it flows through your dick. LOL idk why I said that…

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      • My health has improved SO much since my blood pressure increased (bottom number used to be as low as 49 sometimes, now it’s 80), thanks to RRARFing and eating lots and lots of salt.

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      • Matt, interesting comment about BMI.

        According to the BMI chart you are considered overweight at 25. I always thought that was a bit severe and the chart should be adjusted up about 10 lbs or so.

        You said 30 was a good number for a guy who is solid and muscular. I’m around 6’2″ so that would put me at 235.

        That seems high to me. What bodyfat percentage would you consider healthy and roughly how many calories should a man this size be taking in?

        Thanks

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    • Hey Bob? ….you’ve mentioned in another thread that you take Vit.E, I was wondering what your Vit.E is filled with? As I here can only find the ones with either sunflower-,saffloer-,soy- or wheatgermoil, which I all kinda don’t want to have but I need Vit.E. (There’s actually one brand that sells it with olive oil,but it’s very expensive and not much pills in it….so I kinda have to wager,but don’t know which one to chose as the lesser evil.)

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      • I’m cheap at the moment, just some wal-mart bewshit. I’m suure there are much better alternatives with more complete tocopheryls hehe i’m smart look what I said. I’m just ridin the placebo train probably. Nature valley Vitamin E. Not the kind that says natural though, no no, that kind has soybean oil in it haha. I just have glycerin, polysorbate whatever that is, don’t wanna know unless I’ll be like Michael Fox or somethin =( and it says mono and di glycerides. Which could be synthetic fats or some shit I guess who knows. If something were to have soybean oil in it, I guess at least theres vitamin E with it haha. It really doesn’t make sense why they’d use that but..whatever. And why does soybean oil appear in cheap spices and stuff too. Anyone ever seen that? WTF soybean oil is in fucking everything GTFO. Can’t even eat a piece of bread without that shit. Guess I rack a diss-a-prin and need to learn how to bake a loaf SON.

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  14. Matt, I agree that you should get him back home if at all possible, but thought of one other thing. A lot of times the dietary plans are automatic, knee-jerk stuff. They’re not considering individual situations. Try an insist that he be seen by a dietician asap, and explain to him/her about the weightloss, etc. They have to do something because it’s a huge concern.

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    • The nursing home discovered the weight loss, so they’re on the right track I suppose. Not sure they know how to help people gain weight though, with all the cognitive dissonance about salt, sugar, saturated fat, calories, yada yada.

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  15. Hi Matt, I’m sorry to hear about this!

    Were there Allied Health staff at the hospital? At the acute care hospital I work at (i’m a Speech Pathologist) patients like your dad are seen by physios to get then moving around (to prevent de-conditioning and assist with mobility) and occupational therapists who look after their ability to function in activities of daily life. I would have expected your grandaddy to be seen by a dietician who likely would have prescribed calorie dense foods and protein supplements or a feeding tube if his appetite was poor and he wasn’t meeting 100% of his nutritional requirements orally. A Speech Pathologist should have seen him as it sounds like he had aspiration pneumonia and therefore required a swallowing assessment of some kind to rule out if he was aspirating and provide appropriate intervention. Physio, occupational therapy and social work should have been involved to assist mobility/function/additional supports and discharge planning from the hospital.

    If he did not have access to this within the hospital – well that really scares me as it’s standard here in Australia.

    Unfortunately hospital food is bland and usually the standard ‘meat and two veg’. There are several barriers to it being delicious food that everyone enjoys – I know my hospital strives to overcome this with the limited budget they have. I always encourage my patients families to bring in food their loved one likes if the patient is not eating the food because they don’t like it. It’s particularly difficult when you get patients from cultures that never eat meat and two veg – the food is just so foreign to them.

    I agree that Western Medicine can exacerbate some problems, and when elderly people start getting sick and come into hospital they may become sicker and sicker with each visit and that can be due to picking up bugs that thrive in hospital environment or due to polypharmacy and its host of side effects – but at the same time I have seen so many elderly people come in who already have multiple co-morbidities – their acute illness prevents them from being able to mobilise even with assistance from Allied Health – they become more and more de-conditioned and these people just don’t have much reserve to fight back and the drugs just don’t always work. In older people one little infection can really knock them around (with or without a hospital stay) and reduce their ability to function independently. Also, I think it’s inappropriate and narrow minded to disregard Western Medicine – doctors do some amazing things, and deal with medical issues that most of us could not understand without medical training. I believe in having a holistic view of health – and that includes the option of medical assistance, as well as less invasive measures.

    I’m really sorry to hear about your grandaddy’s experience Matt.

    Cally

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    • I saw no such special attention. All of those would have been great and very helpful assessments and interventions. I wouldn’t mind Western Medicine, if they knew what they were doing or weren’t still dragging their knuckles in the dietary department.

      As far as making food tasty for cheap, it’s easy. It’s called butter, salt, and sugar – some of the cheapest commodoties on a calorie for calorie basis on earth. Or what I jokingly refer to as the 3 French food groups: cream, butter, and cheese.

      Butter is so cheap in the states you can get 1000 calories worth for less than $1 US.

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      • Yes, but dietary guidelines absolutely prohibit going that path, sadly. I don’t think it’s politically feasible for a dietician to suggest it, even if they think it’s the right thing to do. They’d probably lose their job.

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      • Wow. That makes me really sad/worried. Nursing homes should also be able to refer to speech pathologists and dieticians to review their patients. Particularly if they are at risk of malnutrition/re-feeding and/or are having swallowing difficulties. If your grandaddy does have swallowing difficulties he needs an assessment to at least rule out aspiration, as he could end up with recurrent chest infections from the things he eats/drinks, poor control of saliva/poor mouth care.

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  16. Matt, Wishing your G-Diddy a quick recovery in strength and self-care. The neurodegenerative aspect is also so complicated but hopefully recovering his strength will at least reduce the issues to deal with.

    My G-Mommy used to be in amazing shape in her eighties – never went to a hospital. i dont even remember her ever falling sick! She was short and quite chubby. But she could walk a couple of miles carrying shopping bags filled with vegetables and then do housework , pray, cook etc. during the day and then relax in the evenings. All this with a jovial attitude. However, she did not really eat much. I guess living in a village where you know everyone and are in a low stress atmosphere also helps.

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    • Pretty impressive. But then every single diet has its success stories and so it is hard figure out whether that was a n=1 success or can be made as the general rule for everyone. For every such success there are a whole bunch of failures as well. Another pretty successful vegan athlete is Brendan Brazier. I was pretty surprised when I heard that the Wolverine uses his products:
      http://vegnews.com/articles/page.do?pageId=2518&catId=1

      So all in all, good job by mr Roll – it might help a few people but like most other diets will not work for everyone..

      Reply
      • Narain, read Brandon brazier book thrive diet, it might put some things into perspective. I suspect Rich roll suffers from the same low body temp ( while not running). In the book brandon talks about how after you transition to his thrive diet ( all plant based ) you will notice you feel noticeably colder and he attributes this to “the body working more efficiently” and not wasting energy on digesting meats and fats. ( this should be a dead give away to anyone following matts blog or mine, being cold is actually a really bad sign ) I would attribute this to the body adapting to a lack of calorie abundance and gets less energy from all the low calorie density raw food “turning the heat down” to save fuel not digestive efficiency.

        I would venture to predict that both rich roll and brandon will feel the effects of the body eating itself later in life most likely after fight or flight response wears off when they stop trying to outrun the imaginary bear all day long. I know people that are nearly bed ridden from following very similar sort of diet 15 years and they worked a desk job with weekly exercise that didn’t tap the body nearly as hard on a consistent basis.

        Reply
        • Just to clarify, what I was saying was impressive was the man’s transition from being a former alcoholic to an endurance athlete after age 40. Totally agree with Uncephalized’s comment on the way he looks..

          Reply
      • He looks like he’s halfway to dying in Auschwitz. That is not my picture of “good health”.

        He actually looks much healthier and IMO more attractive (I’m a straight dude so take THAT for what it’s worth LOL) in his “before” pics. He went from solid, strongish and vital in appearance to emaciated and starved. He definitely lost a little lean mass too.

        Reply
    • I guess that’s the body type for a triathlete, but he looks a little frail to me in the after pictures, especially his sunken-in looking cheeks. That’s not my ideal for a healthy looking physique.

      That said, I’m sure he trains hard and I guess he enjoys himself, so good on ya, man.

      But as Narain says, who knows how effective or healthy this is for the average person?

      What do you think Bob?

      Reply
      • I’m not Bob but I think he looks old and scary! He has a nice physique to start with and I can see him with more muscle but without the pinched old man look, some other route.

        Reply
        • “old and scary” lol :) I guess in terms of scariness, the very lean and the older Schwarzenegger body are both less than optimal. doc Mercola looks pretty fit even though he is pretty lean.

          Reply
          • Sorry, I disagree. Dr. Mercola looks like sh*t…gaunt and emaciated.

          • My feelings are hurt. Just kidding lol :) what about Sisson and Unconquerable Dave that the metal dude is talking about ? Sisson looks a bit too good for his age ….

          • Sisson does look very good for his age.

            I followed his diet, best I could, and that’s why I’m here (went hypothyroid for a bit, better now).

            So, how does he do it?

            Well I think he supplements VERY smartly. That’s what he sells after all. I believe his supplements ares keeping him safe from his own VERY stupid diet.

            I never bought his supplements, I thought the ‘all-natural’ diet alone would do better…I thought wrong.

      • I think if I did what he did I would go bald in two seconds. He isn’t really muscular to me, he just has a really low body fat percentage, so low, that as you’ve pointed out, his cheeks look kinda fucked up. When the body is pushed we see that it can adapt very well sometimes. Who knows the variables..Will he be able to sustain his lifestyle that way forever? Will he start having health problems sooner or is he actually healthier now?

        http://www.builtlean.com/2011/12/05/inspirational-fitness-photos-of-men-over-40-50-and-60/

        I found that on google when I was searching for Sisson Sucess Stories. It seems like if you stay muscular you definitely will have more vitality as you age. But also, you hear of tiny little ladies and their old ages, and it’s all confusing. I’m not trying to live forever though, I’m just saying. But if there is a post of what I’m about to ask, please, share it with me. How does Sisson maintain his “health”, is he going to have a drop off? Matt said, uhh, what was it after 6 months of low carbing he started feeling terrible or somethin. What about Kurt Harris, or any of these dudes. And when I did low carb shit for a while, the success story that stuck in my mind, and I still remember it of course, is the Unconquerable Dave. I’m sure some of you have seen him. Is it real? If he’s following Sissons advice how are his feet not freezing in the snow. I got questions motha bleepa. Maybe his feet are cold, and he stood outside for a second and then ran in and started chuggin moonshine cuz he’s carb fiendin.

        http://www.marksdailyapple.com/the-unconquerable-dave/#axzz26xfOwtfT

        Reply
        • Bob, I should post pics of my dad, that might be helpful. For the long term proof of the pudding. Because while my mom at 80 is an old lady thanks to a lifetime of dieting (hence bone loss), my dad at 84 is young. Truly, young. He has muscle mass, he smokes, he has a whisky at night, he has four sugars in his tea and has a hearty appetite. His appetite is a family joke. He loves sweet things and eats as much as he wants, which is plenty. He also is a firm believer in exercise (recommended it for my migraine, that’s going a bit far!) walks daily, he rides a horse 5 days a week, falls off sometimes and still bounces (rather than breaks bones), is active all day long, he works, and he started up (at 78) and still runs a food garden in a poor community. He is an optimist and he has plans. He runs around like he has no aches and pains (he doesn’t). The only thing not recommended would be the smoking as he has had a bad bronchitis from that. Even the whisky works for him when it’s one a day. He makes me feel old … well, next to him I am :( . He also overworks then goes to bed for 2 days and sleeps. Till he feels better. We could never convince him to eat ‘politically correctly’ (drop the ‘naughty’ sugar, as a start!) He has always been a constant weight, about 130 on a smallish frame, about 5 foot 8 or 9. Can you believe I have this inspiration before my eyes and I am such a wreck? I do think my mother’s ‘watching what she ate’ did me some harm before birth and then, after too (“why don’t you do what I do,look it works for me” well maybe not so much as it turns out). Anyway, sense prevails when you look at him vs examples like these. I’d bet on my dad rather than them. I know who I’d rather feel like when I’m 84.

          Reply
        • Bob,

          See my post above for my thoughts on how Sisson does it.

          Reply
          • A probably possibility Tony. Those coconut oil protein powder doo-dads must be tastey =) What do you think about the unconquerable Dave? Maybe he’s eatin a good amount of snarbosnydrates.

          • His story raises an interesting point.

            Dave was obese before going paleo. He lost a lot of weight quickly on paleo, and yes a year or so later he looks a lot better/healthier. GOOD for Dave! But does this mean good for paleo??

            For at least the first 6 months, his body was catabolizing (breaking itself down). In other words, Dave’s diet was really ‘self-cannibalistic’. All of his extra tissue (not the food he was eating) that was being catabolized was more than adequate to supply the ‘essential nutrients’ for the rest of his ever shrinking mass.

            What happens on paleo when that ’tissue buffer’ is depleted and all ‘essential nutrients’ have to come from the diet alone? Dave is about to find out. Hopefully he’s supplementing, in which case he may continue to appear to be a paleo success story.

            I was not obese when I went paleo, I lost 10-15lbs over about 4 months. Somewhere around month 6 is when I crashed…

  17. My brother actually came down with necrotizing fasciitis a couple months ago. He started with a BMI of 40 and wound up losing about 20% of his body weight over the course of a month. Of course, my brother is happy to have lost so much weight and is talking about losing the rest of it. Mind you, he’s basically still bed bound and may need another operation. I get the impression, that the hospital thought they were doing him a favor by getting him to lose weight. My family seems to think the weight loss is a good thing and everyone comments on how great it is that he lost some weight. Comments about him keeping the weight off and getting healthy abound. I just keep thinking to myself, what morbidly obese person gets horribly ill, loses an absurd amount of weight and is healthier for it?

    Reply
  18. Hi Matt,
    Sorry to hear about your grandpop; I’m dealing with a somewhat similar situation- my mother, age 91, who has been living by herself for the last year and a half and is still functioning fully- like driving, taking care of all her needs, even playing the violin in an orchestra, has had a rough last 5-6 weeks. First a bad fall (nothing broken but bad bruises), then another fall when a chair she was sitting on collapsed, leaving her with extreme back pain & essentially laid her up for a while. After that she got pneumonia which of course led to hospitalization and a rehab place. She seems to have made it past everything but of course she lost weight (not good on a 110 lb person). Anyone who knows even the smallest amount of nutrition will feel completely frustrated at what the elderly are fed. Of course there is no silver bullets (except astaxanthin!) but I think whey protein might be an excellent addition to prevent muscle loss (some pubmed articles agree with this). Jello is probably a good addition also. Oh yeah, my mother got a raised toilet seat which she says made all the difference in the world. Good luck with your grandpop.

    Reply
  19. Matt,

    Same type thing with my grandma. She’s also 87, and had a mild heart attack. While in the hospital, she lost weight, barely slept, and eventually ended up in assisted living home. She was miserable. We got her out and back home. She’s back to eating toast with butter, bacon, coffee, ice cream, cookies, real white bread, and creamy soups. She now swims every day and is back to her old self.

    I have lost 10 pounds this year by only eating what sounds good to me at the time — which just happens to be a lot of processed foods and sugar. I went the whole “only organic” route a few years ago and my hair started falling out. Tried a million things, but the only thing that makes me feel good is a ton of sugar and carbs through the day and a light dinner. I also do circuit interval training for an hour a day.

    I’ll be hoping for the best for you and your grandpa, Matt.

    Reply
    • That’s been my experience too in terms of the eating. What made sense didn’t work. What didn’t make sense made me feel the best, and I continue to feel better and better.

      Reply
  20. Amazing timing on this article, Matt. I’m visiting my 83 yo dad in Hong Kong where he has round the clock care by domestic help for alzheimer’s. He eats a lot at a restaurant owned by his brother who has a chain of some 20+ high end Chinese eateries. My uncle is very supportive of my dad. I asked him last night while we were eating Alaskan king crab battered and deep-fried what oils do they cook with. “Vegetable oil, of course. It’s the healthiest. Saturated fat is very bad for you.”. OMG. Tried to explain to him that the science does not support that idea and he was very skeptical. I’ve been sending him links about the diet-lipid heart hypothesis that’s easy – and credible for a busy restauranteur to read. Love Chris Masterjohn’s stuff but frankly it’s a bit of a grind. Too many ifs ands or buts for people who have been deeply mind controlled about sat fat dangers for decades. Anyway, the elderly need sat fats to keep their minds and bodies going but most will have access only to “heart healthy” pufa’s. I don’t think you can even buy lard in stores in Hong Kong, anymore, it’s been so demonized.

    Reply
  21. “calorie dense and highly-palatable food with plenty of carbs and protein”

    Here’s an interesting quote from an ancient roman recommending figs which are 82% sugar.

    Pliny of Rome (62-113) said
    “Figs are restorative. The best food that can be eaten by those who are brought low by long sickness and are on the way to recovery. They increase the strength of young people, preserve the elderly in better health and make them look younger with fewer wrinkles”.

    Reply
  22. Oh Matt, feel for ya, and for anyone else who has to watch a loved one deteriorate in front of their very eyes. I work in the care “biz” and I am maddened by the ignorant views on nutrition that also can be a cause of abuse…such as dictating to an “individual” (they like that buzz word in the biz) that they cannot eat this or that because it is bad for their condition yadda yadda. WhereTF do these little hitlers get off? Firstly, at an elderly age, THEY (should) get to choose what they want to eat, even if that pisses off those with letters after their names. If they get enjoyment out of a roast din with all the trimmings but put themselves at greater risk of an acute myocardial infarction…then thats their choice and least they’d go feeling satiated.

    I also cared for an 88yo lady who never used oils, but used lards, fat, butter, and everything else that would make most peeps 20years her junior reel back in horror. But, she made every darn thing from scratch. Everything. We would go walking on the moors, taking about an hour or so to walk a short distance, but she broke her hip few years before. But we did it. Remarkable lady. Against my advice, she got a piggy flu shot and had a spell of respite in a nursing home over the winter. 3 weeks after arriving at the home, and letting everyone know she hated the place, she “wouldnt touch their muck” , caught an infection in there, deteriorated rapidly and died.

    Thankfully I have worked on wards where nurses dont adhere to the fanactical brigade, but we are still a long way off implementing a 180 on the NHS’s idea of nutrition, and health for that matter…

    Reply
  23. My grandpa died after two years of what was some kind of severe dementia. The kind of thing where my dad was giving him a shower and my grandpa crapped all over the floor, he would forget who we all were and yell and try to hit people and he was always talking about nonsensical stuff with people with made up names. In a lot of ways it was horrible but in some ways he still kept the same sense of humor he always had.

    Anyway, my dad knows nothing at all about nutrition. He noticed my grandpa was losing weight and so he started getting him McDonald’s and getting some snack foods like potato chips and letting him eat as much as he wanted, and encouraging him to. We managed to get him to stay at home with my grandma and a long series of caregivers, and that went back and forth with hospital stays.

    My grandpa was pretty much mentally gone right from the start of that 2 year period. But my dad trying to get my grandpa to eat as much as he could really helped a lot. And he did eat a lot. He’d sit there eating chips like they were going out of style, he’d ask for more ice cream, and so on and so on.

    Before and after the dementia set in, I didn’t really think he declined physically at all. I think a lot of that had to do with keeping him eating a lot and fighting really hard to get him out of the hospital and to stay back at home with my grandma — if we didn’t do that he would’ve been on hospital diet fare (which I’ve had my fair share of in my mental hospital days…ugh).

    The people in hospitals are trying their best to do their job. They’re just ignorant about various things like diet. To people like my dad it’s just common sense to feed high-calorie food to elderly people that look like they’re wasting away. Other people are still stuck in ‘health land’ where anything that tastes too good is junk. They’re well-meaning, but misinformed.

    Hopefully the message you keep spreading will get through eventually and people will start to wake up and repair the damage that years and years of health dogma have done to them and our society as a whole.

    Reply
  24. My father is 93, with advanced vascular dementia. As a retired pharmacist, he always used to say ‘doctors bury their mistakes.’ Your post reminds me of this saying. You really have to be your own doctor to a large degree, in addition to accepting aid from what is a hopefully a competent medical practitioner. Wishing your grandfather a complete and speedy recovery.

    Reply
  25. Guys, this is getting a bit of hand..
    Saying that the guy Dave was better being fat is .. a very personal position.
    We all agree that low carb in long terms without a proper supervision for deficiencies is dangerous as could be vegetarian, vegan and rest, but if the whole noise is about eating no grain.. Let’s not exaggerate. There are good sources of carbs as tubers, rice, fruits.. I check once in a while MDA forums, there are many who seem to get it right, lose the weight they feel they should, upping their carbs to stay in mentioning state and they don’t appear in the successful stories.
    Hey, as a woman I would like to tell you one thing.. After 35 is a hell of a nightmare to lose weight, it creeps on your butt, legs and one day you wake with a body that has nothing to do with the one of your 20s.
    It hit back real bad.. Then you start trying different things , nothing really works. Diets, plans, nothing, bloody nothing.
    Low fat first, cuz it is the conventional way.. It sucks, hungry,
    angry and gaining. Then others.. Then you arrive at the Paleo stuff. I truly think that the whole concept of Paleo is painfuly ridiculous, Grok, playing&company,but the thing is that when you can’t lose weight otherwise, low carbing for a while does the job.
    And then you can start eating carbs again.
    And also,, healing your self with easy digestible and high caloric density food , there is logic in that, but ice cream’s been with humanity for awhile and hamburgers were not invented by MCDonalds,
    no need to classify then as a junk food, they just got caught in the
    nets of fast food giants.. A recipe for the best home made ice cream, all handmade:
    500 gr mascarpone
    5 eggs
    150 sugar
    1 tablespoon rum
    Bourbon vanilla, a lot.
    Beat the white of the eggs with the sugar till is very firm, mix the yellow with the vanilla, mascarpone and rum till smooth.
    Put the beaten white in the yolks and mascarpone, mix with Woden spoon till all homogene. Put it in the freezer, take it out 3 or four times to turn it with the spoon.. It is the best I have ever tasted.. I have tasted ice cream in 5 continents.

    Reply
  26. All said, I think that low carb is a useful short term tool.
    Like the Twinkles.

    Reply
  27. i do fine on a home cooked veg diet with a bit of ghee (only animal product). 6’2 and 78 kgs. taste your pee after a junk food spree, you’ll spit it out! try it after a home cooked meal – huge difference. so why overburden the eliminatory organs?

    don’t do salt or sugar either – doesn’t tempt me either.

    Reply
  28. How’s Granddaddy now? Good lord did I laugh when I read the part about the doctor smashing apart the misplaced pill in his lung. No disrespect, but after reading the contrasting stories about saline solution and the steamed broccoli plate, I was brimming with gallows giggles. Get the man some Ensure! They have it in butter pecan!

    Reply
  29. Some weight loss, is sadly considered normal in the hospital. I would encourage you to go talk to the kitchen/staff dietician. They don’t want their patients to lose weight. In our building, they encourage families to bring in food, and take into account the food people want to eat. If they want a milkshake all three meals in order to get calories in, they give them that. Ice Creams, cookies, and snacks are all encouraged and the residents are encouraged to eat whatever they wish, so that people don’t lose dangerous amounts of weight. The therapists should also be working with the person so that they can maintain muscle mass. Even if the low salt diet is what they said, you can fight it. They just write non-compliant on the card and that allows the person to eat whatever they want, against what the “recommended” diet is.

    Reply

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