肌肉减少症的病因、治疗及康复锻炼：最新研究进展 什么是肌肉减少症？

肌肉减少症的病因、治疗及康复锻炼：最新研究进展

陶可（北京大学人民医院骨关节科）

什么是肌肉减少症？

肌肉减少症这个词的意思是“缺乏肌肉”，一旦你了解了这种情况，它就明白了。肌肉减少症是一种与年龄相关的肌肉退化有关的疾病。它在50岁以上的人群中更相关也更常见。30岁以后，人开始失去肌肉力量。根据2004年发表在Current Opinion in Clinical Nutrition and Metabolic Care上的一篇评论，人们往往每十年失去3%到8%的肌肉力量(1)。

失去肌肉力量会降低您进行日常活动和日常任务的能力。它可能会增加患残疾、失去独立性和需要护理的风险。它可能会增加跌倒、事故、受伤、骨折、住院、手术和术后并发症的风险。考虑到住院和家庭护理的费用，肌肉减少症也会变得非常昂贵。根据Worldviews on Evidence-Based Nursing发表的2016年评论，肌肉减少症还可能缩短您的寿命(2)。

根据2015年发表在《营养学会会刊》上的一篇评论，肌肉减少症的发生可能是由于肌肉细胞生长（合成代谢）信号和分解信号（分解代谢）信号之间的不平衡 (3)。在一个健康的身体里，你的生长激素与蛋白质破坏酶一起工作，在肌肉生长、压力、损伤、分解、破坏、修复和恢复的持续循环中保持你的肌肉健康和肌肉质量稳定。在衰老的身体中，信号之间的不平衡和对生长信号的抵抗可能会发展，这会导致比合成代谢和肌肉生长更多的分解代谢和肌肉损失。

图1 aging muscle: 衰老的肌肉

肌肉减少症的症状

肌肉减少症的症状可能包括：

• 肌肉无力，

• （容易）摔倒，

• 步行速度减缓慢

• 自我报告的肌肉萎缩

• 难以执行或参与正常的日常任务和活动

• 运动时容易感到疲劳

肌肉减少症的根本原因

如果您有任何健康问题，请务必查看问题的根本原因。如果我们着眼于问题的根本原因，我们就可以制定治疗策略来解决这些问题，而不是仅仅在症状上贴上创可贴（即大家经常说的：治标不治本）。肌肉减少症的根本原因可能包括：

图2 肌肉减少症的影响与危害：25%的65岁及以上人群受到影响，60%的80岁以上人群受到影响，以肌肉萎缩和活动减少为主要特征。

（1） 炎症反应：可导致的肌肉减少症

术语炎症，也称为炎症老化，是指随着年龄的增长而出现的炎症反应上调和全身低度炎症。炎症会加速衰老过程，并可能使一些与年龄相关的症状和疾病恶化。

根据2013年发表在Longevity ＆ Healthspan上的一项研究，炎症可能是先天和后天免疫系统的结果，它可以增加体内炎性细胞因子的产生(4)。这会促进炎症并导致与年龄相关的健康问题，包括肌肉衰退。

2013年发表在Thorax上的一项研究发现，患有慢性阻塞性肺病(COPD)和相关慢性炎症的患者的肌肉质量也有所下降(5)。还有许多其他以长期慢性炎症为特征的疾病，包括慢性感染、炎症性肠病和自身免疫性疾病，可能会增加肌肉减少和肌肉减少症的风险。根据2016年发表在Maturitas上的系统回顾和荟萃分析，较高水平的C反应蛋白可能与慢性炎症和肌肉减少症有关(6)。

图3 炎症可通过一系列复杂的机制和病理过程，影响我们身体的各个重要器官：脑心肝肾肺、肌骨皮肤、肠道和甲状腺等。

（2） 蛋白质摄入不足：可导致的肌肉减少症

遵循低营养素和高精制糖、精制油、人工成分和过度加工食品的不健康饮食会增加慢性炎症。注意您的常量营养素也很重要。热量和蛋白质含量过低的饮食不仅会导致体重减轻，还会导致肌肉质量下降。

蛋白质对肌肉健康、肌肉质量和肌肉力量至关重要。蛋白质摄入不足可能导致肌肉减少症。随着年龄的增长，许多人的牙齿和牙龈出现问题，吞咽困难，口味和食欲发生变化，购物和烹饪的挑战也越来越大。

这会增加他们无法满足蛋白质和热量需求的风险。根据2015年发表在《临床医学研究杂志》上的一篇评论，每餐摄入25至30克蛋白质可能有助于降低肌肉减少症的风险(7)。

图4 蛋白质摄入对人体的8点益处：①维持稳定的血糖；②改善脂肪利用效率；③促进肌肉重建；④提高记忆与学习能力；⑤保持积极的心态；⑥心脏正常的功能所必须；⑦减缓衰老进程并有可能长寿；⑧改善骨密度

（3） 胃酸水平低：所致的肌肉减少症

胃酸是一种水状无色液体，由胃壁形成，可促进消化。顾名思义，胃酸是非常酸性的，它支持食物的分解以进行适当的消化。胃酸还有助于营养物质的适当吸收。

胃酸水平低下显然会导致消化问题。如果您的胃酸水平较低，您的身体可能无法分解和吸收食物中的蛋白质和其他营养物质。这不仅会导致消化问题，还会导致慢性炎症和健康并发症。

根据2022年发表在《营养学》杂志上的一项研究，胃动力差可能与老年人的肌肉减少症有关(8)。2019年发表在《科学报告》(Science Reports)上的一项研究将与低胃酸水平相关的胃食管反流病与骨骼肌衰减不良和肌肉减少症联系起来(9)。

图5 胃酸的7大主要功能：①杀灭食物中的病菌，达到无菌化处理；②蛋白质分解；③激活胃蛋白酶（胃内最重要的消化酶）；④活化内源性因子；⑤促进胆汁和胆酶转运（至十二指肠）；⑥关闭食管括约肌（胃的入口，以便胃酸不易反流至食管，造成胃食管反流病，避免食管胃酸液的化学性腐蚀、损伤）；⑦打开幽门括约肌（胃的排出口，以便经胃酸消化的食物，进入小肠内，便于吸收）

（4） 肠道菌群失调：可致肌肉减少症

您的肠道是数万亿细菌和微生物的家园。其中一些微生物对您的健康有益，而另一些则对您的健康有害。关键是肠道微生物失衡，有益细菌多于有害细菌。不幸的是，炎症性饮食、不良的生活方式选择、营养失衡、压力、环境毒素和其他因素都会破坏平衡。

肠道菌群失调意味着肠道微生物群失衡，有害细菌过多而有益细菌过少。肠道菌群失调会导致慢性炎症和慢性严重健康问题的风险。它还可能增加患肌肉减少症的风险。

2018年发表在Mediators of Inflammation上的一项研究发现，肠道菌群失调可能在与年龄相关的炎症、炎症、肌肉老化和肌肉减少症中发挥作用(10)。研究人员发现，在解决肌肉减少症时，针对肠道菌群失调可能很重要。发表在恶病质、肌肉减少症和肌肉杂志（Cachexia, Sarcopenia, and Muscle）上的2021年系统综述支持了这些发现，并发现肠道生态失调可能在肌肉减少症的发展中发挥关键作用(11)。

图6 肠道菌群失调是肠道内菌群的失平衡，即有益菌（益生菌，good bacteria）减少的同时，机会致病菌（有害菌，opportunistic bacteria）大量繁殖

（5） 慢性压力和睡眠质量差：可致肌肉减少症

慢性压力和睡眠不佳是慢性炎症、炎症和与年龄相关的健康问题（包括肌肉减少症）背后的主要潜在因素。根据2018年发表在激素杂志上的一项研究，慢性压力可能在身体成分失调中发挥作用，包括肌肉减少症(12)。

与健康问题相关的慢性和严重压力也可能导致肌肉减少症。根据2015年发表在《营养学会会刊》上的评论、2016年发表在《当前胃肠病学报告》上的评论、2016年发表在《肾泌尿学月刊》上的评论和2016年发表在《营养学会会刊》上的评论，与慢性压力相关的压力肝病、慢性心力衰竭、慢性肾病和癌症治疗可能会导致肌肉减少和肌肉减少症(13, 14, 15, 16)。

慢性压力会导致睡眠不佳。然而，睡眠不足也会导致慢性压力。睡眠不佳和慢性压力都会增加慢性炎症。而慢性炎症会导致睡眠不佳和慢性压力。慢性压力、睡眠不佳和慢性压力的循环会增加肌肉流失的风险。

2017年发表在《医学》（巴尔的摩）杂志上的一项横断面研究发现睡眠持续时间与肌肉减少症之间存在联系(17)。根据发表在《临床医学杂志》上的2019年系统评价和荟萃分析，睡眠质量差会对肌肉减少症产生负面影响(18)。

图7 慢性压力的主要症状（磨牙、冷漠、注意力不能集中、易愤怒、焦虑、头痛、肌肉紧张、胃肠道病、皮肤刺激、性欲下降、易疲劳）及其对身体的影响巨大

teeth grinding, apathy, trouble concentrating, anger, anxiety, headaches, muscle tension, stomach problems, skin irritations, decreased sex drive, fatigue

肌肉减少症的自然支持防治策略

幸运的是，在一些简单的饮食、生活方式和营养补充策略的帮助下，您可以自然地改善健康。我推荐以下针对肌肉减少症的自然支持策略：

（1） 抗炎营养计划

慢性炎症反应是肌肉减少症的一些主要原因(4, 5, 6)。炎症性饮食是慢性炎症和炎症的主要驱动因素之一。食用精制糖和精制油会加剧炎症并加速炎症，这可能会导致肌肉减少症。根据2020年发表在《营养杂志》上的一项研究，饮食的炎症潜力与患肌肉减少症的风险之间存在联系(19)。

我建议去除所有精制糖和碳水化合物、精制油、人造成分、油炸食品、垃圾食品和过度加工食品。食用富含营养和抗炎天然食物的饮食。

多吃绿色蔬菜、香草、香料、豆芽、发酵食品、低升糖指数水果（如苹果、香蕉、番茄、橙子等）、草饲牛肉、内脏肉、牧场饲养的家禽和鸡蛋、草饲动物的黄油和酥油、野生鱼和野生动物（禁止吃国家野生动物保护法明文保护的动物）。尽可能吃有机食品。

图8 抑制炎症反应的食物（anti-inflammatory foods）与促进炎症反应的食物（pro-inflammatory foods）

图8-1 精炼油Refined oil只不过是普通油的“精炼”版本。精炼过程涉及化学物质，这些化学物质在一定数量上对我们的健康有害。油的“净化”是通过用酸、碱或漂白处理来完成的。精制油也经过中和、过滤或除臭。所有这些过程都涉及己烷等化学品

Refined oil is nothing but the ‘refined‘ version of the normal oil. The process of refining involves chemicals, which in certain quantities, are harmful to our health. The ‘purification‘ of the oil is done by treating it with acid, alkali or by bleaching. Refined oil is also neutralized, filtered or deodorized. All of these processes involve chemicals such as hexane

（2） 优质蛋白质的摄入

蛋白质摄入不足会导致肌肉流失并增加患肌肉减少症的风险(7)。确保在营养丰富、抗炎的饮食中摄入足够的蛋白质。目标是每磅体重摄入0.5至1克蛋白质。我建议您主要关注健康的动物性蛋白质，包括草饲牛肉、内脏肉、牧场饲养的家禽和鸡蛋、野生鱼类和海鲜（痛风患者需注意选择不易影响血尿酸的食物）。

如果您难以通过食物满足蛋白质需求，可以使用蛋白粉来帮助获取足够的蛋白质。坚果和种子可以添加额外的植物性蛋白质。我不推荐豆类和小扁豆，尤其是不要大量食用，因为它们的碳水化合物含量很高，可能会导致消化不适。我建议避免食用谷物，因为它们含有麸质和碳水化合物。

图9 决定蛋白质摄入的目标：

①体重控制减少，每日摄入蛋白量1-1.5g/kg体重，如果您的体重是70kg，那么每天蛋白质需要70-105g即可；

②重塑肌肉，每日摄入蛋白量1.5-2.0g/kg体重，如果您的体重是70kg，那么每天蛋白质需要105-140g即可；

③运动员，每日摄入蛋白量1.8-2.5g/kg体重，如果您的体重是70kg，那么每天蛋白质需要126-175g即可；

④久坐不动的朋友，每日摄入蛋白量1.0-1.2g/kg体重，如果您的体重是70kg，那么每天蛋白质需要70-84g即可sedentary individuals

（3） 抗阻力训练

缺乏运动和久坐不动的生活方式会增加肌肉无力、肌肉流失和肌肉减少症的风险。根据2015年发表在《临床密度测定杂志》上的一篇评论，没有充分使用肌肉是肌肉减少症的主要驱动因素之一(20)。根据2016年发表在《脆弱与衰老杂志》上的一篇评论，生病或受伤后卧床休息和不活动会导致老年人肌肉快速流失(21)。

由于不活动和久坐不动的生活方式导致的肌肉力量下降会导致疲劳、虚弱和力量不佳，这可能会使锻炼变得更加困难，运动的动力也会降低。这会导致不活动、肌肉损失和疲劳的恶性循环。定期移动身体，更重要的是，进行阻力和力量训练对于提高肌肉力量、质量和健康以及降低肌肉减少症的风险至关重要。

我建议每周至少进行3到4天的阻力训练。尝试复合运动，例如深蹲、硬拉、推举、划船等。与物理治疗师或教练一起工作可以帮助您学习正确的形式，安全地尝试新的练习，并有效地提高您的力量。如果您正从一段时间的受伤、疾病或不活动中恢复过来，这可能尤为重要。如果您对阻力训练和锻炼完全陌生，这也是一个不错的选择。

图10 高强度间歇和阻力训练的对于肌肉减少症明显有益（选择适合自己的日常锻炼方式，量力而行）

high intensity interval and resistance training benefits

（4） 限时饮食或间歇性禁食

限时进食或间歇性禁食也可能有助于降低肌肉减少症的风险。根据2014年发表在《国际健康科学杂志》(Qassim)上的一项研究，间歇性禁食可以减少炎症和相关疾病的风险(22)。

1988年发表在《临床研究杂志》上的一项研究发现，间歇性禁食还可以改善人类生长激素(HGH)的分泌和水平，从而有助于改善肌肉质量(23)。根据2019年发表在《营养学》杂志上的一项研究，间歇性禁食还可以提高支持关节和皮肤健康的胶原蛋白水平 24)。

我建议实行限时进食。理想情况下，我建议在6到10小时的进食窗口和14-18小时的禁食窗口期间进食。如果您不熟悉限时喂食，请从12小时的隔夜禁食开始。

晚餐后停止进食，直到12小时后的第二天早餐才进食。逐渐延长禁食时间，直到找到适合自己的方法。记住不要在进食窗口期间限制自己。食用含有大量健康脂肪、足够蛋白质和大量微量营养素的抗炎全食，以满足您的热量和营养需求。

图11 7步法轻松搞定间歇性禁食（每位朋友，可以根据自己情况量力而行，而非推荐必须执行上述禁食）：

① simple fast:12 hours，简单常规的禁食12小时；

② brunch fast:14 hours，早午餐一起吃，禁食14小时，

③ crescendo fast:16 hours，渐进式禁食16小时，每周2天，

④ cycle fast: 16 hours，循环禁食16小时，每周3次，

⑤ strong fast: 18 hours，增强禁食18小时，每天一次，

⑥ warrior fast: 19-21 hours，激进禁食19-21小时，每天一次，

⑦ 1 day fast: 18 hours fast each week，彻底禁食24小时，每周一天

（5） 减轻压力和改善睡眠质量

慢性压力和睡眠不足可能会增加肌肉减少症的风险(12, 13, 14, 15, 16, 17, 18)。减轻压力水平和改善睡眠质量可能会有所帮助。我建议练习冥想、呼吸、引导式放松技巧、祈祷和感恩，以降低压力水平并更好地应对压力。

写日记可能有助于释放情绪压力并发现消极的心理漏洞。练习心态转变和积极肯定。花时间在大自然中。花时间与支持你的朋友、家人和社区成员在一起。

目标是每晚睡7到9个小时。大约在同一时间睡觉和起床，以支持您的昼夜节律。睡前至少两小时避免：①糖、②咖啡因、③过量饮食（最好是所有食物）、④酒精、⑤电子产品和⑥压力过大。

参加放松的活动，例如拼图、写日记、阅读、冥想、治疗浴、喝凉茶，以及在晚上平静地交谈。买一张有支撑力的床、有支撑力且舒适的床垫、枕头和床上用品、遮光窗帘和眼罩，以获得更好的睡眠。

图12 良好夜间睡眠的方法：①床要舒适、②卧室尽量黑、③可以戴眼罩、④睡前8小时避免咖啡、⑤3小时前避免吃东西、⑥白天多晒太阳、⑦规律锻炼，而非睡前锻炼、⑧夜晚避免强亮灯环境、⑨ 九点入睡

（6） 改善胃酸水平

胃酸水平低下也会导致肌肉减少症(8, 9)。改善胃酸水平至关重要。

•① 全天使用液体营养：尽量确保至少一半的膳食是液体形式，例如蛋白质奶昔或绿色奶昔（广东人讲究的喝汤是很有道理的）。蛋白质奶昔是预代谢的，非常容易消化，不依赖于胃酸HCL的产生。如果您的胃酸HCL含量较低，每天喝一到两杯蛋白质奶昔可能会有所帮助，以支持氨基酸的吸收，减少对消化的额外压力，并支持健康的胃酸水平。

•② 使用生姜：生姜是改善消化液的最佳物质之一。我建议每天喝2至3杯姜茶，您可以将姜精油放入水中（2至3滴放入8盎司水中）(1盎司=31g=31ml)，每天将1/2英寸的新鲜姜根放入绿汁中(1英寸=2.54厘米)，然后使用在你的食物上磨碎生姜。您还可以在饮食中加入发酵生姜，这在泡菜等亚洲菜肴中很常见。由于辛辣食物可能会引发反流问题，因此请确保它不会为您引发。如果是，请专注于其他步骤。

•③ 进餐时间以外的超级水合物：良好的水合作用可以帮助激活肠蠕动并推动内容物通过消化系统，从而减少体内的微生物发酵和毒性。这有助于维持胃酸水平。

•④ 吃肉时少喝水：当您吃肉或任何较重的食物时，您应该至少在餐前30分钟停止饮用水或其他液体，除非您需要补充2盎司的水，在这些进餐期间不喝水将减少胃液的任何潜在稀释并允许更好的消化（饭前不建议大量饮水、吃水果、冷饮或果汁等稀释胃液的物品）。

•⑤ 饭后不要喝水：为了实现最佳消化，我还建议至少在饭后30分钟后再喝水或其他液体。这允许适当的胃酸活动、杀菌和蛋白质代谢。

•⑥ 使用柠檬和苹果醋：挤压新鲜柠檬或在肉类和蔬菜上使用柠檬汁或苹果醋有助于预先代谢食物并支持更好的消化和营养吸收（这可能是为何西方餐食，开胃配水，都会加上柠檬的原因）。您可以用柠檬或苹果醋腌制食物，也可以在食用前将它们作为调料添加。再次确保苹果醋不会引发任何反流症状，关注我的其他建议。

•⑦ 开餐时吃蛋白质食物：当您开始进食时，特别是当您摄入蛋白质时，胃会开始搅动胃酸。虽然在他们的蛋白质菜肴之前吃沙拉在文化上很常见，但这对您的胃酸HCL生产来说并不好。将蛋白质与沙拉或蔬菜一起吃而不是之后吃是一个更好的主意。

•⑧ 使用发酵蔬菜：酸菜、泡菜、泡菜、腌姜和其他发酵蔬菜等发酵食品都含有有机酸、酶和益生菌，有助于改善消化液分泌（韩国泡菜？但腌制的蔬菜可能会含有较多的细菌，且烟硝酸盐含量往往过高，不建议多吃或经常吃）。我建议您在所有较重的膳食中使用其中一种尤其是任何含蛋白质的食物。

•⑨ 使用发酵饮料：发酵饮料，如苹果醋、椰子开菲尔和康普茶，具有抗菌功效，有助于减少细菌负荷，尤其是胃中的细菌，如幽门螺杆菌。保持幽门螺杆菌水平下降对于身体能够产生足够的胃酸至关重要。

•⑩ 在最放松的时候吃最大的一餐：您的身体需要激活副交感神经系统以产生足够的胃酸。如果您很忙并且在旅途中，您将处于战斗或逃跑的同情模式。如果您与低胃酸作斗争，这种战斗或逃跑状态不会让您的身体产生足够的能量。饭前放松对改善胃酸分泌很重要。（心情愉快、精神压力小时，是享用美味的大餐绝佳时机）

图13 10种改善胃酸的好方法（如上面①-⑩所述）

（7） 支持整体肠道健康和消化

肠道菌群失调和肠道健康状况不佳也可能增加患肌肉减少症的风险(10, 11)。我建议支持您的整体肠道健康和消化。2021年发表在《营养前沿》(Frontiers in Nutrition)上的一项研究发现，用益生菌和消化酶靶向肠道微生物群可能有助于肌肉减少症(25)。2022年发表在恶病质、肌肉减少症和肌肉杂志上的一项研究发现，补充益生菌可能支持肠道肌肉轴，并可能减少与年龄相关的肌肉减少症(26)。根据2018年发表在《临床营养和代谢护理当前观点》上的一篇评论，支持蛋白质消化可能有助于减少与年龄相关的肌肉减少症(27)。

多吃富含益生菌的食物

富含益生菌的食物包括酸菜、发酵香草、泡菜、开菲尔、康普茶和酸奶。然而，吃富含益生菌的食物不足以支持您的肠道菌群，尤其是当您正在应对肠道微生物失衡和各种慢性肠道健康问题时。益生菌可能有助于改善肠道微生物失衡和消化。我推荐使用 Probiocharge 1000亿（药店有一点商品化的非处方益生菌可以选择：双歧杆菌，培菲康等。在使用前请咨询你的药师或医生。温馨提示：益生菌不可以与抗生素等药物同时服用，且最好用温水送服）。

为了进一步支持您的消化，我还建议使用消化酶（乳酶生片等）。消化酶可能有助于减轻腹泻和肠易激综合征IBS的症状，这些症状通常与胆汁酸吸收不良有关。我推荐Proteo Enzymes来支持蛋白质和整体消化。Proteo Enzymes™影响细胞因子和类花生酸的平衡，促进关节舒适度并支持身体维持组织完整性的能力。它还有助于平衡免疫系统，降低自身免疫活性并分解体内的致病性生物膜。Proteo Enzymes中的蛋白水解酶可以分解因受伤和组织损伤而产生的蛋白质和复合物。据信，这项活动有助于营养和氧气的输送，并可能有助于加快身体恢复和愈合的能力。耐酸胶囊促进酶的全身递送。每餐服用或根据需要服用。

图14 建议使用益生菌（必要时添加消化酶）

（8） 补充必需氨基酸

获得足够的蛋白质并满足您的氨基酸需求对于减少肌肉减少症至关重要(7)（推荐每天1-2个鸡蛋）。补充必需氨基酸可能会有帮助。我推荐Amino Strong Essential Amino Acids。Amino Strong™代表了使用氨基酸合成肌肉蛋白质的突破。已经进行了20多项人体试验，以得出这种特定的、正在申请专利的氨基酸组合，具有最有效的合成代谢比例。无论您是想增强肌肉力量和功能，还是想防止因缺乏运动或衰老而导致的肌肉流失，Amino Strong都能以正确的比例提供正确的氨基酸，帮助您实现目标并保持健康。包含Amino Strong的氨基酸(AA)配方由国际公认的肌肉代谢和衰老以及长寿领域的研究人员精心开发和研究。Amino Strong专为寻求刺激肌肉蛋白质合成、加速肌肉恢复以及促进肌肉力量和功能的年轻人和老年人而设计。

图15 建议摄入优质必须氨基酸（多推荐：鸡蛋、各种鱼肉、牛肉）

（9） 考虑使用乳清蛋白

获得足够的蛋白质对于减少肌肉减少症至关重要(7)。使用乳清蛋白可能会有所帮助（主要来源于鸡蛋清）。我推荐乳清浓香草。强乳清粉是一种美味、高蛋白、低碳水化合物的功能性食品粉。它采用品质卓越的乳清蛋白制成，这些乳清蛋白来自新西兰无农药、非转基因草场上放牧的奶牛，这里被认为是世界上污染最少的环境之一。奶牛从不喂谷物，也没有接受激素或抗生素治疗。与其他速溶乳清配方不同，Whey Strong不含大豆。乳清蛋白由称为氨基酸的单个“构件”组成，用于制造酶、激素和抗体。乳清蛋白被认为是一种完整的蛋白质，因为它含有足够比例的所有必需氨基酸，这些氨基酸是人体无法制造的，必须通过饮食获得。它还富含半胱氨酸，有助于在体内产生一种重要的抗氧化剂，即谷胱甘肽。乳清蛋白还含有大量支链氨基酸(BCAA)，尤其是亮氨酸。亮氨酸的重要作用是锻炼肌肉。已发现乳清蛋白支持健康的身体成分。每天将30克（约一勺）混合在8盎司水或任何其他饮料中，或遵照保健医生的指示。

图16 建议摄入乳清蛋白（主要来源于鸡蛋清）

小结

肌肉减少症是指与年龄相关的肌肉退化。肌肉质量下降和肌肉减少症可能会降低您参与日常任务和活动的能力。它可能导致跌倒、受伤、住院、残疾、丧失独立性、护理和寿命缩短。幸运的是，借助一些简单的自然策略，您可以自然地改善肌肉健康。建议您遵循我针对肌肉减少症的自然支持策略，以随着年龄的增长保持肌肉质量。

（文中所涉及优质蛋白、氨基酸、乳清蛋白等，都可以在日常生活中食材中获得，不推荐选择进口商品替代）

What is Sarcopenia

The word sarcopenia means “lack of flesh”, which makes sense once you understand the condition. Sarcopenia is a condition related to age-associated muscle degeneration. It is more relevant and more common in those over 50 years of age. After the age of 30, people start losing their muscle strength. According to a 2004 review published in Current Opinion in Clinical Nutrition and Metabolic Care, people tend to lose between 3 to 8 percent of their muscle strength each decade (1).

Losing muscle strength can reduce your ability to perform regular daily activities and routine tasks. It may increase the risk of developing a disability, losing independence, and needing care. It may increase the risk of falls, accidents, injuries, fractures, hospitalization, surgeries, and post-surgery complications. Considering the cost of hospitalization and homecare, sarcopenia can also become very costly. According to a 2016 review published in Worldviews on Evidence-Based Nursing, sarcopenia may also shorten your lifespan (2).

According to a 2015 review published in The Proceedings of the Nutritional Society, sarcopenia may develop because of the imbalance between the signals for muscle cell growth (anabolism) and signals for breakdown (catabolism) (3). In a healthy body, your growth hormones work together with protein-destroying enzymes to keep your muscles healthy and muscle mass steady throughout the ongoing cycle of muscle growth, stress, injury, breakdown, destruction, repair, and recovery. In an aging body, an imbalance between signals and a resistance to growth signals may develop, which can cause more catabolism and muscle loss over anabolism and muscle growth.

Symptoms of Sarcopenia

Symptoms of sarcopenia may include:

• Muscle weakness
• Falling
• Slow walking speed
• Self-reported muscle wasting
• Difficulty performing or partaking in normal daily tasks and activities
• Fatigue easily during exertion

Root Causes of Sarcopenia

If you have any health issues, it’s important to look at the root causes of the problem. If we look at the root cause of the problem, we can develop treatment strategies to address them instead of only putting a band aid on the symptoms. The root causes of sarcopenia may include:

Inflammaging

The term inflammaging, also known as inflamm-aging or inflamm-ageing, refers to an upregulated inflammatory response and a low-grade inflammation throughout the body that develops with advanced age. Inflammaging can accelerate the aging process and may worsen some age-related symptoms and diseases.

According to a 2013 study published in Longevity ＆ Healthspan, inflammaging may be a consequence of the innate and acquired immune system that can increase inflammatory cytokine production in the body (4). This can promote inflammation and contribute to age-related health issues, including muscle decline.

A 2013 study published in Thorax has found that patients with chronic obstructive pulmonary disease (COPD) and related chronic inflammation also had a decline in muscle mass (5). There are many other diseases that are characterized by long-term chronic inflammation, including chronic infections, inflammatory bowel diseases, and autoimmune conditions, that may increase the risk of muscle loss and sarcopenia. According to a 2016 systematic review and meta-analysis published in Maturitas, higher levels of C-reactive protein may be associated with chronic inflammation and sarcopenia (6).

Inadequate Protein Intake

Following an unhealthy diet low in nutrients and high in refined sugar, refined oil, artificial ingredients, and overly processed foods can increase chronic inflammation. Paying attention to your macronutrients is critical as well. A diet too low in calories and too low in protein can not only result in weight loss, but also in a loss of muscle mass.

Protein is critical for muscle health, muscle mass, and muscle strength. An inadequate protein intake may lead to sarcopenia. With aging, many people develop problems with their teeth and gums, have issues swallowing, experience changes in their taste and appetite, and have increased challenges shopping and cooking.

This can increase their risk of not meeting their protein and caloric needs. According to a 2015 review published in the Journal of Clinical Medicine Research, consuming 25 to 30 grams of protein at each meal may help to lower the risk of sarcopenia (7).

Poor Stomach Acid Levels

Stomach acid is also known as gastric acid. It is a watery, colorless fluid made by your stomach lining to support digestion. As its name suggests, stomach acid is very acidic, which supports the breakdown of food for proper digestion. Stomach acid also helps the proper absorption of nutrients.

Poor stomach acid levels can clearly cause problems when it comes to digestion. If you have poor stomach acid levels, your body may not be able to break down and absorb protein and other nutrients from food. This can not only lead to digestive issues but chronic inflammation and health complications.

According to a 2022 study published in Nutrients, poor gastric motility may be associated with sarcopenia in older adults (8). A 2019 study published in Science Reports has linked gastroesophageal reflux disease, associated with low stomach acid levels, to poor skeletal muscle attenuation and sarcopenia (9).

Gut Dysbiosis

Your gut is home to trillions of bacteria and microbes. Some of these microbes are beneficial, others are harmful to your health. The key is to have a gut microbiome imbalance, where you have more beneficial bacteria than harmful ones. Unfortunately, an inflammatory diet, poor lifestyle choices, nutrient imbalances, stress, environmental toxins, and other factors can disrupt the balance.

Gut dysbiosis means that there is an imbalance in your gut microbiome, and there are too many harmful bacteria and too few beneficial ones. Gut dysbiosis can create chronic inflammation and the risk of chronic and serious health issues. It may also increase your risk of sarcopenia.

A 2018 study published in Mediators of Inflammation has found that gut dysbiosis may play a role in age-related inflammation, inflammaging, muscle aging, and sarcopenia (10). Researchers found that targeting gut dysbiosis may be important when addressing sarcopenia. A 2021 systematic review published in the Journal of Cachexia, Sarcopenia, and Muscle has supported these findings and has found that gut dysbiosis may play a critical role in the development of sarcopenia (11).

Chronic Stress ＆ Poor Sleep Quality

Chronic stress and poor sleep are major underlying factors behind chronic inflammation, inflammaging, and age-related health issues, including sarcopenia. According to a 2018 study published in the Hormones, chronic stress may play a role in body composition disorders, including sarcopenia (12).

Chronic and serious stress related to health issues may also contribute to sarcopenia. According to a 2015 review published in the Proceedings of the Nutritional Society, a 2016 review published in Current Gastroenterology Reports, a 2016 review published in Nephro-Urology Monthly, and a 2016 review published in the Proceedings of the Nutritional Society, stress related to chronic liver disease, chronic heart failure, chronic kidney disease, and cancer treatment may cause muscle loss and sarcopenia (13, 14, 15, 16).

Chronic stress can contribute to poor sleep. However, poor sleep can also contribute to chronic stress. Both poor sleep and chronic stress can increase chronic inflammation. And chronic inflammation can cause poor sleep and chronic stress The cycle of chronic stress, poor sleep, and chronic stress can increase the risk of muscle loss.

A 2017 cross-sectional study published in Medicine (Baltimore) has found a link between sleep duration and sarcopenia (17). According to a 2019 systematic review and meta-analysis published in the Journal of Clinical Medicine, poor sleep quality can negatively affect sarcopenia (18).

Natural Support Strategies

Fortunately, with the help of some simple dietary, lifestyle, and supplement strategies, you can improve your health naturally. I recommend the following natural support strategies for sarcopenia:

Anti-Inflammatory Nutrition Plan

Chronic inflammation and inflammaging are some of the main root causes of sarcopenia (4, 5, 6). An inflammatory diet is one of the main driving factors of chronic inflammation and inflammaging. Consuming refined sugar and refined oils drive up inflammation and accelerate inflammaging, which may contribute to sarcopenia. According to a 2020 study published in Nutrition Journal, there is a link between the inflammatory potential of your diet and the risk of developing sarcopenia (19).

I recommend removing all refined sugar and carbs, refined oils, artificial ingredients, deep-fried foods, junk foods, and overly processed foods. Consume a diet high in nutrients and anti-inflammatory whole foods.

Eat plenty of greens, vegetables, herbs, spices, sprouts, fermented food, low glycemic index fruits, grass-fed beef, organ meat, pasture-raised poultry and eggs, grass-fed butter and ghee, wild-caught fish, and wild game. Eat organic whenever possible and available.

Optimize Protein Intake

Inadequate protein intake can cause muscle loss and increase your risk of sarcopenia (7). Make sure that within your nutrient-dense, anti-inflammatory diet, you get enough protein in. Aim for 0.5 to 1 gram of protein per pound of body weight. I recommend that you mainly focus on healthy animal-based proteins, including grass-fed beef, organ meat, pasture-raised poultry and eggs, wild-caught fish and seafood, and wild game.

If you have difficulty meeting your protein needs through food, you can use protein powders to help get enough protein. Nuts and seeds can add additional plant-based protein to the mix. I don’t recommend beans and lentils, especially not in higher amounts, as they can be high in carbohydrates and may cause digestive discomfort. I recommend avoiding grains due to their gluten and carbohydrate content.

Do Resistance Training

Inactivity and a sedentary lifestyle can increase your risk of muscle weakness, muscle loss, and sarcopenia. According to a 2015 review published in the Journal of Clinical Densitometry, not using your muscles enough is one of the main driving factors of sarcopenia (20). According to a 2016 review published in the Journal of Frailty and Aging, bed rest and inactivity after an illness or injury can cause rapid muscle loss in older adults (21).

Decreased muscle strength due to inactivity and a sedentary lifestyle can lead to fatigue, weakness, and poor strength, which may make exercise more difficult and motivation to move low. This can lead to a vicious cycle of inactivity, muscle loss, and fatigue. Moving your body regularly and, more importantly, doing resistance and strength training workouts is critical for improving your muscle strength, mass, and health and reducing the risk of sarcopenia.

I recommend resistance training at least 3 to 4 days a week. Try compound movements such as squats, deadlifts, push presses, rows, and so on. Working with a physical therapist or trainer can help you learn the proper form, try new exercises safely, and improve your strength effectively. This may be particularly important if you are coming back from a period of injury, illness, or inactivity. It’s also a great option if you are completely new to resistance training and exercise.

Time-Restricted Feeding

Time-restricted feeding or intermittent fasting may also help reduce the risk of sarcopenia. According to a 2014 study published in the International Journal of Health Sciences (Qassim), intermittent fasting may reduce inflammation and the risk of associated diseases (22).

A 1988 study published in the Journal of Clinical Investigation has found that intermittent fasting may also improve human growth hormone (HGH) secretion and levels contributing to improved muscle mass (23). According to a 2019 study published in Nutrients, intermittent fasting may also improve collagen levels supporting joint and skin health (24).

I recommend practicing time-restricted feeding. Ideally, I recommend eating during a 6 to 10-hour eating window with a 14-18 hour fasting window. If you are new to time-restricted feeding, begin with a 12-hour overnight fast.

Stop eating after dinner and don’t eat until breakfast the next day, 12 hours later. Extend your fasting window gradually until you find what works for you. Remember not to restrict yourself during your eating window. Consume anti-inflammatory whole foods with plenty of healthy fats, enough protein, and lots of micronutrients to meet your caloric and nutritional needs.

Reduce Stress ＆ Improve Sleep Quality

Chronic stress and poor sleep may increase the risk of sarcopenia (12, 13, 14, 15, 16, 17, 18). Reducing your stress levels and improving your sleep quality may help. I recommend practicing meditation, breathwork, guided relaxation techniques, prayer, and gratitude to reduce your stress levels and respond to stress better.

Journaling may help to release emotional stress and spot negative mental loopholes. Practice mindset shifts and positive affirmation. Spend time in nature. Spend time with supportive friends, family, and community members.

Aim to get 7 to 9 hours of sleep a night. Go to bed and wake up around the same time to support your circadian rhythm. Avoid sugar, caffeine, heavy food, ideally all food, alcohol, electronics, and stress at least two hours before going to bed.

Engage in relaxing activities, such as puzzles, journaling, reading, meditation, healing baths, sipping on herbal tea, and calm conversations in the evening. Invest in a supportive bed, supportive and comfortable mattress, pillows, and bedding, blackout curtains, and an eye mask for better sleep.

Improve Stomach Acid Levels

Poor stomach acid levels can also contribute to sarcopenia (8, 9). Improving your stomach acid levels is critical.

• Use Liquid Nutrition Throughout the Day: Try to make sure that at least half of your meals are in a liquid form, such as a protein shake or green smoothie. Protein shakes are pre-metabolized and very easy to digest and do not depend upon HCL production. If you have low HCL, it may be helpful to drink one to two protein shakes daily to support amino acid absorption, reduce extra stress on your digestion, and support healthy stomach acid levels.
• Use Ginger: Ginger is one of the best things for improving digestive juices. I recommend drinking 2 to 3 cups of ginger tea each day, you can put ginger essential oil in water (2 to 3 drops in 8 oz of water), juice a ½ inch of fresh ginger root in a green juice each day, and use ground ginger on your foods. You can also add fermented ginger to your diet, which is common in Asian dishes such as kimchi. Since spicy foods can be triggering for reflux issues, make sure that it is not triggering for you. If it is, focus on the other steps.
• Super Hydrate Outside of Meal Times: Good hydration can help activate bowel motility and push contents through the digestive system which will reduce microbial fermentation and toxicity in the body. This can help to support your stomach acid levels.
• Drink Very Little With Meat Containing Meals: When you are eating meat or any sort of heavier food, you should stop drinking water or other liquids at least 30 minutes before the meal, except if you need to take a supplement with 2 ounces of water. Holding off water during these meals will reduce any potential dilution of the gastric juices and allow for better digestion.
• Hold Off On Water After a Meal: To allow for optimal digestion, I also recommend not drinking water or other liquids until at least 30 minutes after a meal. This allows for proper stomach acid activity, sterilization, and protein metabolism.
• Use Lemon and Apple Cider Vinegar: Squeezing fresh lemon or using lemon juice or apple cider vinegar on your meat and vegetables helps to pre-metabolize the food and support better digestion and nutrient absorption. You can either marinate foods in a lemon or ACV base or just add them as a dressing right before you consume them. Again, make sure that apple cider vinegar is not triggering any reflux symptoms, focus on my other recommendations.
• Eat Protein Foods at the Beginning of the Meal: The stomach will begin churning out its stomach acid when you begin eating, especially when you are consuming protein. While it’s culturally common to a salad before their protein dish, this is not great for your HCL production. It is a much better idea to eat your protein with the salad or vegetables instead of after.
• Use Fermented Veggies: Fermented foods such as sauerkraut, kimchi, pickles, pickled ginger, and other fermented vegetables all contain organic acids, enzymes, and probiotics which help to improve digestive juice secretions I recommend using one of these with all of your heavier meals and especially any meal with protein.
• Use Fermented Drinks: Fermented drinks such as apple cider vinegar, coconut kefir, and kombucha offer antimicrobial benefits and help to reduce the bacterial load, especially the bacteria in the stomach such as H Pylori. Keeping H Pylori levels down is critical for the body to be able to produce enough stomach acid.
• Eat Your Largest Meal When You Are Most Relaxed: Your body needs to activate the parasympathetic nervous system to produce enough stomach acids. If you are busy and on the go, you will be in fight or flight sympathetic mode. If you struggle with low stomach acid, this fight or flight state is not going to allow your body to produce anywhere near enough. Relaxing before the meal is important to improve stomach acid production.

Support Overall Gut Health and Digestion

Gut dysbiosis and poor gut health may also increase your risk of sarcopenia (10, 11). I recommend supporting your overall gut health and digestion. A 2021 study published in the Frontiers in Nutrition has found that targeting a gut microbiome with probiotics and digestive enzymes may be helpful for sarcopenia (25). A 2022 study published in the Journal of Cachexia, Sarcopenia, and Muscle has found that probiotic supplementation may support the gut-muscle axis and may reduce age-related sarcopenia (26). According to a 2018 review published in Current Opinions in Clinical Nutrition and Metabolic Care, supporting protein digestion may help to reduce age-related sarcopenia (27).

Eat plenty of probiotic-rich foods

probiotic-rich foods including sauerkrauts, fermented herbs, kimchi, kefir, kombucha, and yogurt. However, eating probiotic-rich foods is not enough to support your gut flora, especially if you are dealing with gut microbiome imbalance and all kinds of chronic gut health issues. Probiotics may help to improve gut microbiome imbalance and digestion. I recommend using Probiocharge 100 Billion.

To further support your digestion, I also recommend the use of digestive enzymes. Digestive enzymes may help to reduce symptoms of diarrhea and IBS, which are often connected to bile acid malabsorption. I recommend Proteo Enzymes to support protein and overall digestion. Proteo Enzymes™ affect cytokine and eicosanoid balance, promote joint comfort and support the body’s ability to maintain tissue integrity. It also helps balance the immune system, reduce autoimmune activity and break down pathogenic biofilms in the body.

Proteolytic enzymes in Proteo Enzymes may break down proteins and complexes that can be produced as a result of injury and tissue damage. This activity is believed to aid nutrient and oxygen delivery and may help speed the body’s ability to recover and heal. Acid-resistant capsules facilitate the systemic delivery of enzymes. Take it with each meal or as needed.

Supplement with Essential Amino Acids

Getting adequate protein and meeting your amino acid needs is critical for reducing sarcopenia (7). Supplementing with essential amino acids may help. I recommend Amino Strong Essential Amino Acids. Amino Strong™ represents a breakthrough in the use of amino acids for muscle protein synthesis. Over 20 human trials have been conducted to arrive at this specific, patent-pending combination of amino acids in the most effective anabolic ratios.

Whether you want to support muscle strength and function or prevent muscle loss associated with inactivity or aging, Amino Strong provides the right amino acids in the right ratios to help you meet your goals and stay healthy.

The amino acid (AA) formula that comprises Amino Strong was meticulously developed and studied by internationally recognized researchers in the fields of muscle metabolism and aging, and longevity. Amino Strong is designed for both young and elderly individuals who are seeking to stimulate muscle protein synthesis, hasten muscle recovery, and promote muscle strength and function.

Consider Using Whey Protein

Getting adequate protein is critical for reducing sarcopenia (7). Using whey protein may help. I recommend Whey Strong Vanilla. Whey Strong is a great-tasting, high protein, low carbohydrate, functional food powder.

It is made with an exceptional quality whey protein made from the milk of cows that graze on pesticide-free, non-GMO grass pastures in New Zealand, which are known to be one of the least polluted environments in the world. The milking cows are never fed grain and are not subjected to hormone or antibiotic treatments. Unlike other instantized whey formulations, Whey Strong is soy-free.

Whey protein is made up of individual “building blocks” called amino acids, which are used to manufacture enzymes, hormones, and antibodies. Whey protein is considered a complete protein, as it contains an adequate proportion of all the essential amino acids, which are those that cannot be made by the body and must be obtained through the diet. It is also rich in cysteine, and it helps create an important antioxidant in the body, which is glutathione.

Whey protein also contains a high amount of branched-chain amino acids (BCAAs), especially leucine. The important role of leucine is to build muscles. Whey protein has been found to support healthy body composition. Mix 30 grams (approximately one scoop) in 8 ounces of water or any other beverage per day or as directed by your healthcare practitioner.

Final Thoughts

Sarcopenia refers to age-associated muscle degeneration. Losing muscle mass and developing sarcopenia may decrease your ability to participate in daily tasks and activities. It may lead to falls, injuries, hospitalization, disability, loss of independence, care, and a shorter lifespan. Fortunately, you can improve your muscle health naturally with the help of some simple natural strategies. I recommend that you follow my natural support strategies for sarcopenia to keep your muscle mass as you age.

If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. Our website team offers long-distance functional health coaching programs. For further support with your brain health and other health goals, just reach out and our fantastic coaches are here to support your journey.

参考文献Sources in This Article Include:

1. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care. 2004 Jul;7(4):405-10. doi: 10.1097/01.mco.0000134362.76653.b2. PMID: 15192443

2. Chang SF, Lin PL. Systematic Literature Review and Meta-Analysis of the Association of Sarcopenia With Mortality. Worldviews Evid Based Nurs. 2016 Apr;13(2):153-62. doi: 10.1111/wvn.12147. Epub 2016 Feb 4. PMID: 26844538

3. Murton AJ. Muscle protein turnover in the elderly and its potential contribution to the development of sarcopenia. Proc Nutr Soc. 2015 Nov;74(4):387-96. doi: 10.1017/S0029665115000130. Epub 2015 Mar 31. PMID: 25826683

4. Baylis D, Bartlett DB, Patel HP, Roberts HC. Understanding how we age: insights into inflammaging. Longev Healthspan. 2013 May 2;2(1):8. doi: 10.1186/2046-2395-2-8. PMID: 24472098

5. Constantin D, Menon MK, Houchen-Wolloff L, et alSkeletal muscle molecular responses to resistance training and dietary supplementation in COPDThorax 2013;68:625-633. Link Here

6. Bano G, Trevisan C, Carraro S, Solmi M, Luchini C, Stubbs B, Manzato E, Sergi G, Veronese N. Inflammation and sarcopenia: A systematic review and meta-analysis. Maturitas. 2017 Feb;96:10-15. doi: 10.1016/j.maturitas.2016.11.006. Epub 2016 Nov 13. PMID: 28041587

7. Yanai H. Nutrition for Sarcopenia. J Clin Med Res. 2015 Dec;7(12):926-31. doi: 10.14740/jocmr2361w. Epub 2015 Oct 23. PMID: 26566405

8. Huang HH, Wang TY, Yao SF, Lin PY, Chang JC, Peng LN, Chen LK, Yen DH. Gastric Mobility and Gastrointestinal Hormones in Older Patients with Sarcopenia. Nutrients. 2022 Apr 30;14(9):1897. doi: 10.3390/nu14091897. PMID: 35565864

9. Kim, Y.M., Kim, JH., Baik, S.J. et al. Association between skeletal muscle attenuation and gastroesophageal reflux disease: A health check-up cohort study. Sci Rep 9, 20102 (2019). Link Here

10. Picca A, Fanelli F, Calvani R, Mulè G, Pesce V, Sisto A, Pantanelli C, Bernabei R, Landi F, Marzetti E. Gut Dysbiosis and Muscle Aging: Searching for Novel Targets against Sarcopenia. Mediators Inflamm. 2018 Jan 30;2018:7026198. doi: 10.1155/2018/7026198. PMID: 29686533

11. Liu C, Cheung WH, Li J, Chow SK, Yu J, Wong SH, Ip M, Sung JJY, Wong RMY. Understanding the gut microbiota and sarcopenia: a systematic review. J Cachexia Sarcopenia Muscle. 2021 Dec;12(6):1393-1407. doi: 10.1002/jcsm.12784. Epub 2021 Sep 14. PMID: 34523250

12. Stefanaki, C., Pervanidou, P., Boschiero, D. et al. Chronic stress and body composition disorders: implications for health and disease. Hormones 17, 33–43 (2018). Link Here

13. von Haehling S. The wasting continuum in heart failure: from sarcopenia to cachexia. Proc Nutr Soc. 2015 Nov;74(4):367-77. doi: 10.1017/S0029665115002438. Epub 2015 Aug 12. PMID: 26264581

14. Kappus MR, Mendoza MS, Nguyen D, Medici V, McClave SA. Sarcopenia in Patients with Chronic Liver Disease: Can It Be Altered by Diet and Exercise? Curr Gastroenterol Rep. 2016 Aug;18(8):43. doi: 10.1007/s11894-016-0516-y. Erratum in: Curr Gastroenterol Rep. 2016 Nov;18(11):57. PMID: 27372291

15. Hirai K, Ookawara S, Morishita Y. Sarcopenia and Physical Inactivity in Patients With Chronic Kidney Disease. Nephrourol Mon. 2016 Apr 26;8(3):e37443. doi: 10.5812/numonthly.37443. PMID: 27570755

16. Prado CM, Cushen SJ, Orsso CE, Ryan AM. Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact. Proc Nutr Soc. 2016 May;75(2):188-98. doi: 10.1017/S0029665115004279. Epub 2016 Jan 8. PMID: 26743210

17. Hu X, Jiang J, Wang H, Zhang L, Dong B, Yang M. Association between sleep duration and sarcopenia among community-dwelling older adults: A cross-sectional study. Medicine (Baltimore). 2017 Mar;96(10):e6268. doi: 10.1097/MD.0000000000006268. PMID: 28272238

18. Rubio-Arias JÁ, Rodríguez-Fernández R, Andreu L, Martínez-Aranda LM, Martínez-Rodriguez A, Ramos-Campo DJ. Effect of Sleep Quality on the Prevalence of Sarcopenia in Older Adults: A Systematic Review with Meta-Analysis. J Clin Med. 2019 Dec 6;8(12):2156. doi: 10.3390/jcm8122156. PMID: 31817603

19. Bagheri, A., Soltani, S., Hashemi, R. et al. Inflammatory potential of the diet and risk of sarcopenia and its components. Nutr J 19, 129 (2020). Link Here

20. Dodds RM, Roberts HC, Cooper C, Sayer AA. The Epidemiology of Sarcopenia. J Clin Densitom. 2015 Oct-Dec;18(4):461-6. doi: 10.1016/j.jocd.2015.04.012. Epub 2015 Jun 12. PMID: 26073423

21. Bell KE, von Allmen MT, Devries MC, Phillips SM. Muscle Disuse as a Pivotal Problem in Sarcopenia-related Muscle Loss and Dysfunction. J Frailty Aging. 2016;5(1):33-41. doi: 10.14283/jfa.2016.78. PMID: 26980367

22. Aly SM. Role of intermittent fasting on improving health and reducing diseases. Int J Health Sci (Qassim). 2014 Jul;8(3):V-VI. doi: 10.12816/0023985. PMID: 25505868

23. Ho KY, Veldhuis JD, Johnson ML, Furlanetto R, Evans WS, Alberti KG, Thorner MO. Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man. J Clin Invest. 1988 Apr;81(4):968-75. doi: 10.1172/JCI113450. PMID: 3127426

24. Bragazzi NL, Sellami M, Salem I, Conic R, Kimak M, Pigatto PDM, Damiani G. Fasting and Its Impact on Skin Anatomy, Physiology, and Physiopathology: A Comprehensive Review of the Literature. Nutrients. 2019 Jan 23;11(2):249. doi: 10.3390/nu11020249. PMID: 30678053

25. Frontiers in nutrition 2021. Link Here

26. Chen LH, Chang SS, Chang HY, Wu CH, Pan CH, Chang CC, Chan CH, Huang HY. Probiotic supplementation attenuates age-related sarcopenia via the gut-muscle axis in SAMP8 mice. J Cachexia Sarcopenia Muscle. 2022 Feb;13(1):515-531. doi: 10.1002/jcsm.12849. Epub 2021 Nov 11. PMID: 34766473

27. Boirie Y, Guillet C. Fast digestive proteins and sarcopenia of aging. Curr Opin Clin Nutr Metab Care. 2018 Jan;21(1):37-41. doi: 10.1097/MCO.0000000000000427. PMID: 29028650

https://drjockers.com/sarcopenia/

感谢原文作者。