Get Older, Stay Strong: Exciting New Research

Sarcopenia, a medical term based on Greek words meaning “poverty of flesh,” is applied to the loss of lean muscle mass often observed in old people.  Traditionally, this deterioration has been seen as a natural part of the aging process:  old people were thought to be incapable of maintaining their strength and building new muscle as well as young people.  Recent research is calling this view into question.  

In a video clip Douglas Paddon-Jones, PhD, describes one study in which young and old people were each given 4-ounce portions of lean beef.  Researchers were able to use a stable isotope form of one amino acid to track the process by which the food was transformed into muscle in the human body.  In both young and old subjects eating the beef stimulated the ability to build muscle by about 50% for about three hours.  The conclusion:  “Aging per se doesn’t really impair our ability to take food and turn it into muscle.”  Dr. Paddon-Jones, an Associate Professor at the University of Texas Medical Branch in Galveston, studies “mechanisms contributing to skeletal muscle protein synthesis and breakdown and identification of interventions to counteract muscle loss in healthy and clinical populations.” 

So what do we need to do in order to maintain muscle mass as we get older?  Recent research suggests that instead of consuming the bulk of the day’s protein at dinner, as most Americans do, we should spread it out over three meals, consuming 20 to 30 grams of protein per meal for a daily maximum of 90 grams.  Eating larger amounts of protein, 12 ounces of beef rather than 4 ounces, does not produce additional gains in muscle mass, according to Paddon-Jones.  Meals of less than 20 grams actually reduce protein synthesis in older adults.   The research also emphasizes the importance of exercise, including resistance work, in preventing sarcopenia.

Based on these recommendations I am going to start adding roasted soybeans to some of my meals.  A third of a cup has 13 grams of protein and 163 calories, better than many protein bars.

Good Food Made Easier: Oatmeal

Recently my husband and I spent a few days in New York.  We ate breakfast at 3 Guys Restaurant on Madison near 76^th.  A big bowl of oatmeal with lots of strawberries and blueberries was $9 and kept me from being hungry through a long morning of museuming.  I thought this was a great deal, especially for New York, and it reminded me of how much I like oatmeal.

At home I have oatmeal for breakfast several days a week.  I especially like oatmeal made from steel-cut oats because it has a more substantial, chewy texture than rolled or instant.  When you buy it in bulk at the health food store, it is also cheap.  Unfortunately, it takes 30 minutes to cook, much too long in the morning.  So I’ve devised a system for speeding up the process.  About once a month, while I am fixing breakfast, I put a large pot on the stove and put in an even number of cups of water, filling it about 2/3 of the way.  I bring it to a boil, turn off the heat, and stir in half the number of cups of steel-cut oats.  Then I cover the pot and let it sit while I eat breakfast.

After an hour or so, the oatmeal has absorbed all the water.  I get out a bunch of square, plastic, storage containers, a roll of waxed or parchment paper, and a pair of scissors.  Using a measuring cup, I scoop out equal portions of cereal and put them in the containers, separated by squares of parchment paper so they look a bit like hamburgers.  I then store them in the refrigerator or freeze them for later use.  To use the oatmeal “patties” I put one in a sauce pan with a little water – usually I add some of the water I have just boiled to make my tea.  I heat up patty, breaking it apart with a wooden spoon and in a few minutes it turns back into oatmeal again.

Making Oatmeal

Imponderables

• When I’m looking around at the Y I usually see lithe, ballerina-like young ladies doing stretching, never strength training; big, paunchy guys are always working shoulders, pecs, and arms, never abs.
•  According to the National Heart, Lung, and Blood Institute (part of NIH), large waist size (more than 35” for women, 40” for men) is a predictor of heart disease and type 2 diabetes but the only doctor I’ve ever heard of who measures people’s waists is Dr. Oz. 
• In a small Japanese study, older women treated with menatetrenone (a form of vitamin K2), vitamin D2, and calcium were 87% less likely to sustain a fracture. The Japanese Ministry of Health has approved menatetrenone for the prevention and treatment of osteoporosis since 1995 (source Wikipedia).  This form of vitamin K2 is readily available, inexpensive, and safe but patients in the US are usually given bisphosphonates, which are costly and associated with a slight increase in the risk of atypical femur fracture. In rare cases, usually in cancer patients, these medications have also been implicated in osteonecrosis of the jaw (death of the jaw bone).

Biotin - for Better Hair?

Yesterday I went to the hairdresser. I only go once every ten weeks so when there are changes he really notices them. He said that my hair is growing faster and getting thicker. My eyebrows seem to be bulking up too, a good thing because I pretty much plucked them to death in my teens. We were trying to figure out what could be causing these differences and I finally decided it was the biotin I had been taking for a month or two for my fingernails. 

 As a child I had terrible-looking nails; they would constantly break or peel off in layers. For a while I took Knox gelatin, which helped some, but I got bored and gave it up. A few years back, when I increased my protein intake, my nails got a lot better but more recently they'd been getting worse again, snagging on sweaters and breaking off for no reason. I read in a couple of places that biotin might help so I bought some from Target. The pills were 1000mg each, which seemed like a lot since I’m already taking a B-complex supplement, so I’ve been taking half a pill each day. It’s too early to tell about the nails--they take about three months to grow out--but the hair seems to be benefitting from this regimen. 

Biotin is a B-complex vitamin (vitamin B7) that is involved in various metabolic processes and may help to stabilize blood sugar. Deficiency is rare but there are a number of conditions (including being elderly and being an athlete) that can increase a person’s need for biotin. This nutrient is water soluble so the body just excretes what it doesn’t need. I haven’t had hair loss, dermatitis, or any of the other unpleasant symptoms of a serious biotin deficiency. On the other hand, it looks as though my body is making good use of the extra I’ve been giving it recently so maybe my level was a little bit low.

Supplements 2: The Dr. Weil Vitamin Advisor

Does a pregnant, white, 20-year old woman living in Miami have the same nutritional needs as a 35-year-old, Asiatic, male athlete living in Seattle? Does either of them have the same requirements as a black, 70-year-old doctor living in rural Ohio? Probably not, and yet the RDA’s and DV’s on the labels of vitamin bottles suggest that the same vitamin will work just as well for any of us. In fact, the vitamin story is a complicated one and getting more so all the time. Age, gender, health, ethnic background, type of work, and living environment are just a few of the factors that can come into play. According to the web site of the Harvard School of Public Health, people who spend most of their time indoors, use sunscreen, live in a northern latitude, have darker skin tones, are older, or have excess body fat have a greater likelihood of being deficient in vitamin D. Recent research has linked low vitamin D levels with cancer, heart disease, depression, and other illnesses.  The new field of nutritional genomics is likely to introduce additional variables that affect each individual’s response to various foods.

What we really need is an analytical tool, like a decision tree, to help us to sort out all these factors. The Dr. Weil Vitamin Advisor, which I discovered today, is a major step in the right direction. You enter your personal information, complete a survey that includes lifestyle questions, gender concerns, family history, and medical history. The web site then lists “areas of concern based on your answers” and provides a list of supplements corresponding to those concerns. You can then purchase vitamin packets from the web site; most of the ones recommended for me I am already taking so I did not place an order.  I am assuming that the Vitamin Advisor is a work in progress; there was no place for me to indicate that I was hypothyroid. Two of the supplements recommended by the site, acetyl l-carnitine and alpha lipoic acid, are said by some to affect thyroid function so I have avoided them in the past and will continue to do so. But this is a minor point.  The Vitamin Advisor is a valuable resource for people seeking individualized guidance about what vitamins to take.

My Problem with “Issue”

Issues are all around us these days.  Anything from a minor disagreement to a major health concern, such as substance abuse, may be called an “issue.”  The current avoidance of the word “problem” suggests an unwillingness to take responsibility for bad situations in our lives or even to discuss them in clear language.  Plumbers know that leaking faucets and burst pipes don’t heal themselves; someone has to wade in and do the actual work of repairing them.  By mischaracterizing problems that require human intervention as “issues” we turn serious matters into vaporous entities, like unpleasant aromas, which may go away on their own.  If it’s an issue then nobody needs to do anything about it; instead, we can sit around discussing the situation at length (think 3-hour meetings).  If it’s a problem, then a person or several people are required to analyze and deal with it, to be problem-solvers.  

At the far end of the problem-solving spectrum are people like surgeons and architects, who want everything to be perfect.  For family doctors and home remodelers, compromise is the order of the day: how much of this problem can I solve without precipitating an even worse one?  Problem-solving has its limits.  When I was young I used to believe that persistence and hard work could overcome any obstacle.  One of the reasons why I like going to the gym is that effort tends to produce visible results, which doesn’t necessarily happen in the rest of the world.  When I was in my forties, partly under the influence of yoga, I came to accept the fact that some imperfections must simply be accepted – the food allergies, the one leg shorter than the other.  No body’s perfect.

"Humana, I Want My Premarin!" Sequel

Last Thursday, after learning from my doctor’s office that my appeal had been denied, I called Humana to ask why.  After going through the usual menu tree, followed by the usual layer of people who don’t deal with this sort of thing, I finally got through to Humana Clinical Pharmacy Review, where a helpful young woman clarified the situation for me.  She said there were now three different transactions relating to my Premarin, each with its own number.  The first two had been denied but the third was still open.  I told her about the blog post I had written and she recommended faxing that, together with my doctor’s latest request, a cover letter referencing all three numbers, and any previous faxes or documents relating to the situation.  Later that day the doctor’s office sent all of this off.

On Thursday at 6pm I got a call from a young man at Humana.  He said that there had been a number of cases like mine and that most had been resolved in the patient’s favor.  The directive about not giving Premarin to women in their 60’s, he said, had actually originated with Medicare.  He hoped that my case would be settled within the next day or so.
 

Around noon on Friday I got a call from the same young man saying that Humana had accepted my appeal.  I now have a new number which I can use when the same situation comes up next year, which it will if I stay with Humana.  RightSource, the mail order drug branch of Humana, didn’t seem to have gotten the word about the recent decision so it took several long waits on “hold” before I actually got the pills ordered - but it’s done now.  From the time I first ordered the refill, the whole process had taken about a month.

On Saturday the mail included a largish wad of papers from Humana telling me that my appeal (the second one, evidently), had been denied and detailing the further appeal procedures that were open to me.  Why hadn’t they e-mailed all this to me when the decision was first made?

From Humana’s side of things, my doctor’s office could probably have laid a more solid foundation for the appeal, based on my current health and medical history.  It seems reasonable for the insurer to expect the doctor and/or patient to make a case for requesting a drug not in their formulary.  On the other hand, this doctor’s office has only known me for a couple of years and no one there would have time to dig through decades of my medical records.

What happens to patients who are not able to appeal a decision? Is someone with a painful or life-threatening condition nevertheless required to wait 72 hours for an “expedited appeal”? How many of them just give up and do without their medication?

Note to Medicare: Since you do not know me personally, nor have you read my medical history, I wish you would leave decisions relating to my health care to my doctor and me.  Please also read my blog post entitled "Statistics and the Twenty Year Rule."