Frailty and its answer: Protein!

What is frailty?

Frailty is living with more vulnerability due to decline in reserve and function from aging. Frailty is associated with a compromise multiple dimensions like coping with everyday stressors. Frailty is hard to be defined, but it in medical circles, it has been defined by as meeting three out of five criteria below:

  • unintentional weight loss,
  • exhaustion,
  • muscle weakness,
  • slow walking speed, and
  • low levels of activity

A “pre-frail stage”: when you have two criteria. This can serve as a predictor of frailty that you might notice in your parents. Those not matching any of the criteria are defined as “robust”.]

Other criteria can include:

What’s the problem with being frail? It is a strong predictor of several negative outcomes including disabilities, institutionalization, acute illness, falls, and mortality.

So being able to catch frailty in its early stages is important because there are things you and your elder parents can do to prevent or even reverse it. These include:

1) aerobic, balance and resistance exercising: this intervention carries over into ameliorating fatigue, appetite, strength, and functional difficulties to say the least

2) optimal nutrition (see below)

3) optimal oral health (which also assists in nutrition)—getting to the dentist is maybe one of our least favorite fun things to do, but vital in avoiding frailty in your elder parents.

4) environmental modifications (especially designed to reduce the chances of falls in particular),

5) family and professional caregiver education: If your loved one is already being cared for, let them know you are concerned about the signs of increased frailty that you want them to inform you about too.

Nutrition is a major factor as it relates to frailty. And it can influence several of the “frailty criteria” including unintentional weight loss, low muscle strength, fatigue, reduced physical activity levels, and slow walking speed).

Studies have revealed that several factors might be responsible for this fact, including oral health, dietary habits, antioxidants in the diet, micronutrients, and macronutrients intake. But what they feel is that protein intake might be the main factor behind this relationship! And this explains why older people lose a lot of muscle, as seen in the graph below:

(FFM = fat free mass)
Taken from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555150/

You’d be surprised to learn our muscles actually break down, but also build up on a daily basis. That is, there’s an overall balance, and most people’s overall muscle mass doesn’t change much. But too much breakdown leads to less muscle and overall weakness. Eventually this translates into physical disability, obesity and becoming sedentary. Avoiding this is simple: getting enough protein intake. Aging results in two processes: more net muscle breakdown and less protein intake (due to reduced hunger, worsening dental health, loss of taste, smell and sight to name a few). The answer to this is that your elder parents need to consume more protein.

Other links between low protein intake and frailty have been demonstrated including: decreased cognition, visuo-spatial skill, nonverbal and logical memory in older adults, and basically all aspects linked with frailty.

How do old people miss out on protein? Several reasons:

And the evidence for the link between frailty and protein? One study concluded that low protein intake was associated with frailty status in older adults https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165078/

Put another way, increasing protein in the diet (from 0.8 g/kg (from the RDA) to about 1.2 to as 1.8 g/kilo in one study) may even reverse this effect as seen in a study involving about 25 thousand women:

https://www.ncbi.nlm.nih.gov/pubmed/?term=Protein+Intake+and+Incident+Frailty+in+the+Women%E2%80%99s+HealthInitiative+Observational+Study

According to the National Policy and Resource Center on Nutrition and Aging, older men need approximately 2,200 calories per day, while older females need 1,980 calories per day.

So for an average 2,000 calorie-a-day diet, a good protein intake could mean 125 grams of protein daily –your elder parents could easily get this from a two-egg omelet for breakfast (20 g.), chicken for lunch (30 g.), yogurt for a snack(17 g.) and salmon for dinner (40 g.).

The opposite can happen. In one study, those who got only 5 percent of their calories from protein ended up storing 95 percent of the excess calories as fat. Obesity in itself has a negative impact in your elder parents’ overall wellbeing, adding the risk of arthritis and falls, for example.

The take home message here is that your elder parents can probably benefit from increasing the amount of protein in their diet. Now the trick is to know where the protein is coming from. There may be evidence that red meat is more of an issue for the development of cancer before the age of 65. Still, a good balance of protein sources should be obtained, including plant, dairy and an emphasis on white meat. In fact, one study involving women over 60 years in age increased red meat at lunch and dinner. Combined with exercise, these women gained lean muscle mass with a moderate increase in their protein intake. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555150/

And to satisfy your curiosity on protein more, you should know there are complete proteins and incomplete proteins in our diet.

Complete protein food sources give us all nine essential amino acids that our bodies can’t make by itself. Some top sources of complete protein include like meat, poultry and seafood (e.g. steak, chicken and salmon). Other animal sources include eggs and low-fat dairy, which are also good sources of complete protein.

Unfortunately, some high-protein foods may have a lot of saturated fat. Take steak for example, which has a lot of good quality protein (40 grams) but 12 grams of saturated fat. So the USDA recommends low-fat meat and poultry instead. Getting seafood twice a week is a good idea, and avoid frying.

Incomplete proteins don’t have one or more essential amino acids needed to make a complete protein. Unfortunately, most plant proteins are incomplete (e.g. beans, peas, seeds, nuts, soy beans). It would be hard to remember which foods combine to make an optimal complete protein combination (such as rice and beans), so mixing different types of plant proteins may be the trick to get enough essential amino acids, especially if you are vegetarian.

Given your parents already may have decreased appetites, making good habits to incorporate complete proteins in their diet is essential. Because this can be a challenge, supplements such as whey powder to make smoothies may be a palatable way to get around this, especially if they have bad teeth to consume meat, for example.

Is whey protein cancerous? No! In fact, There is evidence that whey protein may increase your body’s glutathione (GSH) levels. Glutathione is the most important antioxidant produced by your body, and serves to help get rid of toxins.

https://www.ncbi.nlm.nih.gov/pubmed/2025891

In fact, a recent study showed that whey protein supplementation actually can improve the nutritional status, glutathione levels and immune function in cancer patients.

https://www.ncbi.nlm.nih.gov/pubmed/29565716

In the “Aquavore” Diet (www.theaquavorediet.com) we emphasize the importance of water content and overall hydration in health. One thing to note is that while one increases the amount of protein in the diet, adequate hydration is of utmost importance. This can come from foods and drinks alike.

Finally, keep in mind that aging muscle does respond to exercise, especially resistance exercise.

A meta-analysis of studies on resistance training in older adults showed a clear benefit for improved physical function. Other study results show that resistance exercise is as effective in older adults as in young adults to reverse muscle loss and improve muscle protein synthesis.

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